Materiały źródłowe

• #1 Health: Infectious Disease Epidemiology & Prevention Division: Q Fever

  https://www.in.gov/health/idepd/zoonotic-and-vectorborne-epidemiology-entomology/zoonotic-diseases/q-fever/

  Q fever is a disease caused by the bacterium Coxiella burnetii. This bacterium naturally infects some animals, such as goats, sheep and cattle. About half of people who become infected develop symptoms, which can be mild to severe, and some may develop a chronic form of the disease. […] Certain professions are at increased risk for Q fever infection, including veterinarians, meat processing plant workers, dairy workers, livestock farmers and researchers at facilities housing sheep and goats. […] Illness typically develops 2-3 weeks after being exposed to the bacterium. Signs and symptoms of Q fever may include fever, chills or sweats, fatigue, headache, muscle aches, nausea, vomiting, diarrhea, chest pain, stomach pain, weight loss and a non-productive cough. Symptoms can be mild or severe. People who develop severe disease may experience infection of the lungs (pneumonia) or liver (hepatitis).

• #2 What’s New

  https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Q-Fever.aspx

  Q Fever is a disease of humans and ruminants (cattle, sheep, goats) caused by bacteria called Coxiella burnetii. Most infected animals do not show signs of illness but can shed large amounts of bacteria in the placenta, aborted fetuses, or other reproductive tissues expelled while giving birth. […] Most persons infected with the Q fever bacteria experience no illness or flu-like symptoms (fever, chills, headache), but pneumonia and hepatitis can be seen in elderly or debilitated patients. Q fever patients with pre-existing heart conditions may develop chronic infection of the heart valves. Mild Q fever usually does not require treatment, but weeks or months of antibiotics may be prescribed for patients with heart involvement. […] Individuals who have frequent contact with ruminants, including veterinarians, slaughterhouse workers, and sheep and dairy farmers, are at higher risk. The risk of Q fever may be reduced by avoiding direct and indirect contact with the reproductive tissues and fluids of ruminants.

• #3

  http://www.bccdc.ca/health-info/diseases-conditions/q-fever

  Q fever is a zoonosis (disease we get from animals), caused by the bacterium Coxiella burnetii. It is usually not serious, and is self-limiting, but can be treated with antibiotics if necessary. […] Q fever is a disease that spreads from animals to humans (zoonosis). It is caused by a bacterium called Coxiella burnetii. […] Most of the time, Q fever is mistaken for an acute viral illness. If someone is infected, symptoms appear in 2 to 3 weeks (range 3 to 30 days). The symptoms include rapid onset of fever, chills, headache, weakness, malaise (a general sick feeling), and severe sweats. […] People usually get Q fever when they breathe in dust contaminated with coxiellae. It is very infectious, and only a very few microorganisms can cause infection. […] In most cases, the illness lasts less than two weeks, and does not require special medical treatment.

• #4 Q Fever Treatment & Management: Approach Considerations, Management of Acute Q Fever, Management of Chronic Q Fever

  https://emedicine.medscape.com/article/227156-treatment

  As many as 60% of patients with Q fever are asymptomatic. The disease is self-limiting and spontaneously resolves within 2 weeks in 38% of the remaining patients. However, antibiotic treatment has been shown to reduce the duration of disease, especially if initiated within 3 days of illness onset. The optimal duration of treatment has not been adequately studied, but antibiotics are generally given for 14-21 days, usually in an outpatient setting. […] Doxycycline has been the agent most frequently investigated, and it is the treatment of choice. […] Chronic C burnetii infections are very difficult to treat. A prolonged combined antimicrobial regimen is recommended. Hospitalization may be warranted for intractable heart failure. […] No drug used alone has been shown to be bactericidal against C burnetii. Therefore, prolonged combination therapy is recommended because of the high rate of relapse with treatment of shorter duration.

• #5 Acute Q fever in febrile patients in northwestern of Iran | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005535

  Q fever is an endemic disease in different parts of Iran. This study aimed to investigate the prevalence of acute Q fever disease among at-risk individuals in northwestern Iran. […] The prevalence of acute Q fever was 13.8% (95% confidence interval [CI]: 8.0, 21.0%). Headache (87.5%) and fatigue and weakness (81.3%) were the dominant clinical characteristics among patients with acute Q fever. […] This study identified patients with acute Q fever in northwestern Iran. The evidence from this study and previous studies conducted in different regions of Iran support this fact that Q fever is one of the important endemic zoonotic diseases in Iran and needs due attention by clinical physicians and health care system. […] Clinical manifestations of Q fever in humans include asymptomatic, acute, and chronic to fatigue syndromes. Almost 60% of the infected people may not show any clinical symptoms. Acute Q fever is defined as a primary infection with C. burnetii.

• #6 Health: Infectious Disease Epidemiology & Prevention Division: Q Fever

  https://www.in.gov/health/idepd/zoonotic-and-vectorborne-epidemiology-entomology/zoonotic-diseases/q-fever/

  Q fever is a disease caused by the bacterium Coxiella burnetii. This bacterium naturally infects some animals, such as goats, sheep and cattle. About half of people who become infected develop symptoms, which can be mild to severe, and some may develop a chronic form of the disease. […] Certain professions are at increased risk for Q fever infection, including veterinarians, meat processing plant workers, dairy workers, livestock farmers and researchers at facilities housing sheep and goats. […] Illness typically develops 2-3 weeks after being exposed to the bacterium. Signs and symptoms of Q fever may include fever, chills or sweats, fatigue, headache, muscle aches, nausea, vomiting, diarrhea, chest pain, stomach pain, weight loss and a non-productive cough. Symptoms can be mild or severe. People who develop severe disease may experience infection of the lungs (pneumonia) or liver (hepatitis).

• #7 Acute Q fever in nonpregnant patients – UpToDate

  https://www.uptodate.com/contents/acute-q-fever-in-nonpregnant-patients

  Acute Q fever is the clinical syndrome in the early period following acquisition of Coxiella burnetii. It can present as various syndromes, most commonly a flu-like illness, community-acquired pneumonia, or hepatitis. […] The clinical manifestations, diagnosis, and treatment of acute Q fever in nonpregnant patients are discussed in this topic. […] Clinical presentations of acute Q fever can vary markedly among patients. […] Among symptomatic patients, most (over 90 percent) present with acute Q fever, and the remainder present with chronic Q fever.

• #8 Acute Q fever in febrile patients in northwestern of Iran | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005535

  The most frequent clinical manifestation of acute Q fever is a flu-like and self-limited illness, and the major clinical presentations of these patients are high and prolonged fever, severe headache, coughing, atypical pneumonia, hepatitis, myalgia, arthralgia, cardiac involvement, skin rash and neurologic signs. […] The case fatality rate of acute Q fever is reported 12%. […] In Iran, the first clinical cases of acute Q fever were reported in 1952, including two patients with symptoms of severe fever and neurological signs in Abadan city, southwest Iran. […] Studies conducted in Iran emphasize that Q fever is an endemic disease in different parts of Iran. […] The findings showed that most clinical symptoms in patients with acute Q fever were fever, headache, fatigue and weakness, arthralgia, myalgia, chills, chest pain and dyspnea, respectively.

• #9 Acute Q fever in febrile patients in northwestern of Iran | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005535

  The prevalence of acute Q fever was 14.0% among 116 suspected febrile patients. […] The findings showed that headache (87.5%), fatigue and weakness (81.3%), arthralgia (75%), myalgia (68.8%), chills (62%), chest pain (56.3%) and dyspnea (43.8%) were the most prevalent clinical symptoms in patients with acute Q fever.

• #10 Q Fever Treatment & Management: Approach Considerations, Management of Acute Q Fever, Management of Chronic Q Fever

  https://emedicine.medscape.com/article/227156-treatment

  As many as 60% of patients with Q fever are asymptomatic. The disease is self-limiting and spontaneously resolves within 2 weeks in 38% of the remaining patients. However, antibiotic treatment has been shown to reduce the duration of disease, especially if initiated within 3 days of illness onset. The optimal duration of treatment has not been adequately studied, but antibiotics are generally given for 14-21 days, usually in an outpatient setting. […] Doxycycline has been the agent most frequently investigated, and it is the treatment of choice. […] Chronic C burnetii infections are very difficult to treat. A prolonged combined antimicrobial regimen is recommended. Hospitalization may be warranted for intractable heart failure. […] No drug used alone has been shown to be bactericidal against C burnetii. Therefore, prolonged combination therapy is recommended because of the high rate of relapse with treatment of shorter duration.

• #11

  http://www.bccdc.ca/health-info/diseases-conditions/q-fever

  Q fever is a zoonosis (disease we get from animals), caused by the bacterium Coxiella burnetii. It is usually not serious, and is self-limiting, but can be treated with antibiotics if necessary. […] Q fever is a disease that spreads from animals to humans (zoonosis). It is caused by a bacterium called Coxiella burnetii. […] Most of the time, Q fever is mistaken for an acute viral illness. If someone is infected, symptoms appear in 2 to 3 weeks (range 3 to 30 days). The symptoms include rapid onset of fever, chills, headache, weakness, malaise (a general sick feeling), and severe sweats. […] People usually get Q fever when they breathe in dust contaminated with coxiellae. It is very infectious, and only a very few microorganisms can cause infection. […] In most cases, the illness lasts less than two weeks, and does not require special medical treatment.

• #12 Health: Infectious Disease Epidemiology & Prevention Division: Q Fever

  https://www.in.gov/health/idepd/zoonotic-and-vectorborne-epidemiology-entomology/zoonotic-diseases/q-fever/

  Less than 5% of people who become infected with Coxiella burnetii develop a more serious infection called chronic Q fever. This can occur months or years after the initial infection and often leads to inflammation of the heart valves (endocarditis). Chronic Q fever is more likely to occur in people with preexisting heart valve disease or blood vessel abnormalities or in people with weakened immune systems. […] Your healthcare provider might order blood tests to look for Q fever or other diseases. Laboratory testing and reporting of results can take several weeks, so your healthcare provider may start antibiotic treatment before results are available. […] Antibiotic treatment with doxycycline is often recommended for people who develop Q fever disease. […] Take measures to minimize contact with body fluids or infectious materials from sheep, cattle and goats, especially birth products (e.g. placenta, amniotic fluid).

• #13 Q Fever: Causes, Symptoms, Diagnosis, Prevention & Treatment

  https://my.clevelandclinic.org/health/diseases/17883-q-fever

  Chronic Q fever is a serious form of Q fever that can affect your heart, your blood vessels, your bones and other parts of your body. It affects 1 to 5% of people whove had a C. burnetii infection. It can start months or years after your initial symptoms go away and can lead to life-threatening complications. Sometimes people with chronic Q fever had no symptoms with their initial infection. The most common form causes inflammation in your heart (endocarditis). […] If youve been diagnosed with Q fever and have a history of heart valve or blood vessel conditions, talk to your provider about being treated proactively to reduce your risk of chronic Q fever. […] Ways to reduce your risk of Q fever include: Wear a mask and gloves while handling animal fluids, especially birthing products. […] Talk to your healthcare provider about avoiding Q fever if you live or work around farm animals and youre at high risk for Q fever complications. This includes anyone with a history of heart valve or blood vessel conditions, pregnant women and those with a weakened immune system. […] If youve been diagnosed with Q fever, be sure to take any medications as prescribed. Ask your provider how to manage your symptoms and if theres any way to reduce your risk of long-term symptoms or chronic Q fever.

• #14 Q Fever: Causes, Symptoms, Diagnosis, Prevention & Treatment

  https://my.clevelandclinic.org/health/diseases/17883-q-fever

  Chronic Q fever is a serious form of Q fever that can affect your heart, your blood vessels, your bones and other parts of your body. It affects 1 to 5% of people whove had a C. burnetii infection. It can start months or years after your initial symptoms go away and can lead to life-threatening complications. Sometimes people with chronic Q fever had no symptoms with their initial infection. The most common form causes inflammation in your heart (endocarditis). […] If youve been diagnosed with Q fever and have a history of heart valve or blood vessel conditions, talk to your provider about being treated proactively to reduce your risk of chronic Q fever. […] Ways to reduce your risk of Q fever include: Wear a mask and gloves while handling animal fluids, especially birthing products. […] Talk to your healthcare provider about avoiding Q fever if you live or work around farm animals and youre at high risk for Q fever complications. This includes anyone with a history of heart valve or blood vessel conditions, pregnant women and those with a weakened immune system. […] If youve been diagnosed with Q fever, be sure to take any medications as prescribed. Ask your provider how to manage your symptoms and if theres any way to reduce your risk of long-term symptoms or chronic Q fever.

• #15 Health: Infectious Disease Epidemiology & Prevention Division: Q Fever

  https://www.in.gov/health/idepd/zoonotic-and-vectorborne-epidemiology-entomology/zoonotic-diseases/q-fever/

  Less than 5% of people who become infected with Coxiella burnetii develop a more serious infection called chronic Q fever. This can occur months or years after the initial infection and often leads to inflammation of the heart valves (endocarditis). Chronic Q fever is more likely to occur in people with preexisting heart valve disease or blood vessel abnormalities or in people with weakened immune systems. […] Your healthcare provider might order blood tests to look for Q fever or other diseases. Laboratory testing and reporting of results can take several weeks, so your healthcare provider may start antibiotic treatment before results are available. […] Antibiotic treatment with doxycycline is often recommended for people who develop Q fever disease. […] Take measures to minimize contact with body fluids or infectious materials from sheep, cattle and goats, especially birth products (e.g. placenta, amniotic fluid).

• #16 Q Fever (Coxiella burnetii) Causes, Symptoms, Diagnosis, Treatment, Prevention

  https://www.medicinenet.com/q_fever/article.htm

  The main complication seen with acute Q fever is pneumonia, which will affect 30%-50% of patients. Another complication can be hepatitis (inflammation of the liver). Rarely, patients can develop myocarditis (heart inflammation), osteomyelitis (bone inflammation), acalculous cholecystitis (inflammation of the gallbladder), and encephalitis (inflammation of the brain). Pregnant women have complications ranging from miscarriage to premature delivery. About 20% of people will have persistent fatigue called post-Q fever fatigue syndrome, which lasts more than a year after the infection. Also, 5% of patients with acute Q fever will go on to develop chronic Q fever. The main complication of chronic Q fever is endocarditis, which will affect 60%-70% of patients. People who already have problems with their heart valves or their immune system are more likely to develop endocarditis. The second most common complication is vasculitis (inflammation of the blood vessels), which is more likely in people who have grafts in their blood vessels. Chronic lung infections and chronic fatigue syndrome can also occur. Endocarditis can cause destruction of the heart valves and result in heart failure. Surgery may be required to repair or replace the valves. Vasculitis, especially in people with grafts or aneurysms in their blood vessels, can also require surgery.

• #17

  http://www.bccdc.ca/health-info/diseases-conditions/q-fever

  Q fever is a zoonosis (disease we get from animals), caused by the bacterium Coxiella burnetii. It is usually not serious, and is self-limiting, but can be treated with antibiotics if necessary. […] Q fever is a disease that spreads from animals to humans (zoonosis). It is caused by a bacterium called Coxiella burnetii. […] Most of the time, Q fever is mistaken for an acute viral illness. If someone is infected, symptoms appear in 2 to 3 weeks (range 3 to 30 days). The symptoms include rapid onset of fever, chills, headache, weakness, malaise (a general sick feeling), and severe sweats. […] People usually get Q fever when they breathe in dust contaminated with coxiellae. It is very infectious, and only a very few microorganisms can cause infection. […] In most cases, the illness lasts less than two weeks, and does not require special medical treatment.

• #18 Acute Q fever in febrile patients in northwestern of Iran | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005535

  The prevalence of acute Q fever was 14.0% among 116 suspected febrile patients. […] The findings showed that headache (87.5%), fatigue and weakness (81.3%), arthralgia (75%), myalgia (68.8%), chills (62%), chest pain (56.3%) and dyspnea (43.8%) were the most prevalent clinical symptoms in patients with acute Q fever.

• #19 Health: Infectious Disease Epidemiology & Prevention Division: Q Fever

  https://www.in.gov/health/idepd/zoonotic-and-vectorborne-epidemiology-entomology/zoonotic-diseases/q-fever/

  Less than 5% of people who become infected with Coxiella burnetii develop a more serious infection called chronic Q fever. This can occur months or years after the initial infection and often leads to inflammation of the heart valves (endocarditis). Chronic Q fever is more likely to occur in people with preexisting heart valve disease or blood vessel abnormalities or in people with weakened immune systems. […] Your healthcare provider might order blood tests to look for Q fever or other diseases. Laboratory testing and reporting of results can take several weeks, so your healthcare provider may start antibiotic treatment before results are available. […] Antibiotic treatment with doxycycline is often recommended for people who develop Q fever disease. […] Take measures to minimize contact with body fluids or infectious materials from sheep, cattle and goats, especially birth products (e.g. placenta, amniotic fluid).

• #20 Q Fever Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/227156-guidelines

  In March 2013, the CDC issued the first national guidelines for Q fever recognition, clinical and laboratory diagnosis, treatment, management, and reporting for health-care and public health workers. The guidelines address treatment of acute and chronic phases of Q fever illness in children, adults, and pregnant women and the management of occupational exposures. […] Because of the delay in seroconversion often necessary to confirm diagnosis, antibiotic treatment of acute Q fever should never be withheld pending laboratory tests or discontinued on the basis of a negative acute specimen. In contrast, treatment of chronic Q fever should be initiated only after diagnostic confirmation. […] Treatment for acute or chronic Q fever should only be given in clinically compatible cases and not based on elevated serologic titers alone (see Pregnancy section below for exception).

• #21 Clinical Guidance for Q fever | Q Fever | CDC

  https://www.cdc.gov/q-fever/hcp/clinical-guidance/index.html

  Doxycycline is the recommended treatment for most patients with Q fever. […] Doxycycline is the recommended first-line treatment for most adults with Q fever. It most effectively prevents severe complications if it is started within the first 3 days of symptoms. […] Treatment is generally not recommended for patients who are asymptomatic or who have already recovered from their illness, but might be considered for those at high risk of developing chronic Q fever. […] The duration of treatment for patients with chronic Q fever is based on serologic response and evidence of clinical improvement. […] Short course therapy, defined as less than 5 days, with doxycycline does not cause staining of permanent teeth, and most experts consider the benefit of doxycycline in treating Q fever greater than the potential risk of dental staining.

• #22 Clinical Guidance for Q fever | Q Fever | CDC

  https://www.cdc.gov/q-fever/hcp/clinical-guidance/index.html

  Doxycycline is the recommended treatment for most patients with Q fever. […] Doxycycline is the recommended first-line treatment for most adults with Q fever. It most effectively prevents severe complications if it is started within the first 3 days of symptoms. […] Treatment is generally not recommended for patients who are asymptomatic or who have already recovered from their illness, but might be considered for those at high risk of developing chronic Q fever. […] The duration of treatment for patients with chronic Q fever is based on serologic response and evidence of clinical improvement. […] Short course therapy, defined as less than 5 days, with doxycycline does not cause staining of permanent teeth, and most experts consider the benefit of doxycycline in treating Q fever greater than the potential risk of dental staining.

• #23 Q Fever Treatment & Management: Approach Considerations, Management of Acute Q Fever, Management of Chronic Q Fever

  https://emedicine.medscape.com/article/227156-treatment

  As many as 60% of patients with Q fever are asymptomatic. The disease is self-limiting and spontaneously resolves within 2 weeks in 38% of the remaining patients. However, antibiotic treatment has been shown to reduce the duration of disease, especially if initiated within 3 days of illness onset. The optimal duration of treatment has not been adequately studied, but antibiotics are generally given for 14-21 days, usually in an outpatient setting. […] Doxycycline has been the agent most frequently investigated, and it is the treatment of choice. […] Chronic C burnetii infections are very difficult to treat. A prolonged combined antimicrobial regimen is recommended. Hospitalization may be warranted for intractable heart failure. […] No drug used alone has been shown to be bactericidal against C burnetii. Therefore, prolonged combination therapy is recommended because of the high rate of relapse with treatment of shorter duration.

• #24 Q Fever – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK556095/

  Q fever is a zoonotic febrile disease affecting workers involved in farming livestock. […] This activity will help understand its causes, epidemiology, evaluation, and management of the condition by an interprofessional team. […] Evaluate the management options available for Q fever. […] Communicate interprofessional team strategies for improving care coordination to improve Q fever diagnosis and outcomes. […] The best treatment for acute Q fever is doxycycline 100 mg orally twice daily for 14 days. […] In pregnancy, acute non-life-threatening Q fever should be treated with trimethoprim-sulfamethoxazole (160 mg TMP and 800 mg SMX, orally twice a day, in patients with normal renal function) from diagnosis till 32 weeks of pregnancy. […] Pregnant patients with persistent, localized infections are managed with TMP-SMX.

• #25

  https://www.health.nsw.gov.au/Infectious/controlguideline/Pages/qfever.aspx

  Case management: Q fever cases can be treated with appropriate antibiotics. All notifications should be followed up to ascertain the most likely source of infection, and to determine if there are any other linked cases. […] Commence empiric treatment if Q fever is clinically suspected. Do not wait for laboratory results. Refer to latest edition of the Therapeutic Guidelines: Antibiotic. […] A two week course of oral doxycycline is generally used to treat acute Q fever. […] Trimethoprim+sulfamethoxazole is recommended for pregnant women until 32 weeks of gestation, even if recovered, to prevent fetal and maternal complications. […] After treatment of C. burnetii primary infection, it is recommended to screen for risk factors of chronic Q fever infection, including pre-existing valvular heart disease/valvular prosthesis, vascular aneurysms/vascular grafts, and immunosuppression.

• #26 Clinical Guidance for Q fever | Q Fever | CDC

  https://www.cdc.gov/q-fever/hcp/clinical-guidance/index.html

  Doxycycline is the recommended treatment for most patients with Q fever. […] Doxycycline is the recommended first-line treatment for most adults with Q fever. It most effectively prevents severe complications if it is started within the first 3 days of symptoms. […] Treatment is generally not recommended for patients who are asymptomatic or who have already recovered from their illness, but might be considered for those at high risk of developing chronic Q fever. […] The duration of treatment for patients with chronic Q fever is based on serologic response and evidence of clinical improvement. […] Short course therapy, defined as less than 5 days, with doxycycline does not cause staining of permanent teeth, and most experts consider the benefit of doxycycline in treating Q fever greater than the potential risk of dental staining.

• #27 Clinical Guidance for Q fever | Q Fever | CDC

  https://www.cdc.gov/q-fever/hcp/clinical-guidance/index.html

  Children with preexisting cardiac valve disease, or who are immunocompromised, or have delayed Q fever diagnosis and have experienced illness for 2 weeks without resolution of symptoms are considered to be at high risk for developing severe disease and should be treated with doxycycline for 2 weeks.

• #28 Q Fever (Coxiella burnetii) Causes, Symptoms, Diagnosis, Treatment, Prevention

  https://www.medicinenet.com/q_fever/article.htm

  Q fever is very dangerous in pregnancy. About 80% of pregnant women with Q fever will develop a complication if untreated. The complications range from miscarriage to premature delivery and result in fetal death almost half the time. Pregnant women are also at higher risk for developing chronic Q fever. Women who are infected in their first trimester of pregnancy are more likely to develop complications. With appropriate treatment, the risk of these complications can be minimized. […] Acute Q fever is treated with antibiotic medications (usually doxycycline) for 14 days. Pregnant women with acute Q fever should take the antibiotic trimethoprim/sulfamethoxazole (Bactrim, Septra) from the time of diagnosis until week 32 of the pregnancy. Chronic Q fever treatment is more complicated and generally requires months to years of antibiotics.

• #29 Q Fever – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK556095/

  Q fever is a zoonotic febrile disease affecting workers involved in farming livestock. […] This activity will help understand its causes, epidemiology, evaluation, and management of the condition by an interprofessional team. […] Evaluate the management options available for Q fever. […] Communicate interprofessional team strategies for improving care coordination to improve Q fever diagnosis and outcomes. […] The best treatment for acute Q fever is doxycycline 100 mg orally twice daily for 14 days. […] In pregnancy, acute non-life-threatening Q fever should be treated with trimethoprim-sulfamethoxazole (160 mg TMP and 800 mg SMX, orally twice a day, in patients with normal renal function) from diagnosis till 32 weeks of pregnancy. […] Pregnant patients with persistent, localized infections are managed with TMP-SMX.

• #30

  https://www.health.nsw.gov.au/Infectious/controlguideline/Pages/qfever.aspx

  Case management: Q fever cases can be treated with appropriate antibiotics. All notifications should be followed up to ascertain the most likely source of infection, and to determine if there are any other linked cases. […] Commence empiric treatment if Q fever is clinically suspected. Do not wait for laboratory results. Refer to latest edition of the Therapeutic Guidelines: Antibiotic. […] A two week course of oral doxycycline is generally used to treat acute Q fever. […] Trimethoprim+sulfamethoxazole is recommended for pregnant women until 32 weeks of gestation, even if recovered, to prevent fetal and maternal complications. […] After treatment of C. burnetii primary infection, it is recommended to screen for risk factors of chronic Q fever infection, including pre-existing valvular heart disease/valvular prosthesis, vascular aneurysms/vascular grafts, and immunosuppression.

• #31 Q Fever Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/227156-guidelines

  For acute Q fever, doxycycline is the drug of choice, and 2 weeks of treatment is recommended for adults, children aged 8 years, and for severe infections in patients of any age. […] Women who are pregnant when acute Q fever is diagnosed should be treated with trimethoprim/sulfamethoxazole throughout the duration of pregnancy. […] Serologic monitoring is recommended following acute Q fever infection to assess possible progression to chronic infection. The recommended schedule for monitoring is based on the patient’s risk for chronic infection.

• #32 Q Fever Treatment & Management: Approach Considerations, Management of Acute Q Fever, Management of Chronic Q Fever

  https://emedicine.medscape.com/article/227156-treatment

  As many as 60% of patients with Q fever are asymptomatic. The disease is self-limiting and spontaneously resolves within 2 weeks in 38% of the remaining patients. However, antibiotic treatment has been shown to reduce the duration of disease, especially if initiated within 3 days of illness onset. The optimal duration of treatment has not been adequately studied, but antibiotics are generally given for 14-21 days, usually in an outpatient setting. […] Doxycycline has been the agent most frequently investigated, and it is the treatment of choice. […] Chronic C burnetii infections are very difficult to treat. A prolonged combined antimicrobial regimen is recommended. Hospitalization may be warranted for intractable heart failure. […] No drug used alone has been shown to be bactericidal against C burnetii. Therefore, prolonged combination therapy is recommended because of the high rate of relapse with treatment of shorter duration.

• #33 Q Fever Treatment & Management: Approach Considerations, Management of Acute Q Fever, Management of Chronic Q Fever

  https://emedicine.medscape.com/article/227156-treatment

  As many as 60% of patients with Q fever are asymptomatic. The disease is self-limiting and spontaneously resolves within 2 weeks in 38% of the remaining patients. However, antibiotic treatment has been shown to reduce the duration of disease, especially if initiated within 3 days of illness onset. The optimal duration of treatment has not been adequately studied, but antibiotics are generally given for 14-21 days, usually in an outpatient setting. […] Doxycycline has been the agent most frequently investigated, and it is the treatment of choice. […] Chronic C burnetii infections are very difficult to treat. A prolonged combined antimicrobial regimen is recommended. Hospitalization may be warranted for intractable heart failure. […] No drug used alone has been shown to be bactericidal against C burnetii. Therefore, prolonged combination therapy is recommended because of the high rate of relapse with treatment of shorter duration.

• #34 Q Fever Treatment & Management: Approach Considerations, Management of Acute Q Fever, Management of Chronic Q Fever

  https://emedicine.medscape.com/article/227156-treatment

  The most current recommendation for endocarditis is combination treatment with doxycycline and hydroxychloroquine for at least 18 months to eradicate any remaining C burnetii and prevent relapses. […] Patients should follow up with their primary care provider to confirm complete recovery. Patients with endocarditis or a history of valvular disease may require referral to a cardiologist or cardiothoracic surgeon for possible valve replacement. […] Because of the risk for chronic infection, clinical and serologic follow-up for 2 years is recommended, particularly in individuals at risk.

• #35 About Q fever | Q Fever | CDC

  https://www.cdc.gov/q-fever/about/index.html

  Most people who have Q fever will recover without antibiotics, but for symptomatic patients, doxycycline is the recommended antibiotic for treatment of Q fever. […] For people who develop symptomatic Q fever, treatment with 2 weeks of the antibiotic doxycycline is recommended. […] A life-threatening infection, requiring several months of antibiotic treatment. […] Treated with a combination of antibiotics including doxycycline and hydroxychloroquine for several months.

• #36 Q Fever – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK556095/

  Chronic Q fever that occurs during pregnancy is treated with doxycycline 100 mg twice daily and hydroxychloroquine 200 mg three times daily for a year post-delivery. […] The prevention and management of Q fever are best handled by an interprofessional healthcare team using open communication and collaborative efforts to achieve optimal patient results.

• #37 Clinical Guidance for Q fever | Q Fever | CDC

  https://www.cdc.gov/q-fever/hcp/clinical-guidance/index.html

  Doxycycline is the recommended treatment for most patients with Q fever. […] Doxycycline is the recommended first-line treatment for most adults with Q fever. It most effectively prevents severe complications if it is started within the first 3 days of symptoms. […] Treatment is generally not recommended for patients who are asymptomatic or who have already recovered from their illness, but might be considered for those at high risk of developing chronic Q fever. […] The duration of treatment for patients with chronic Q fever is based on serologic response and evidence of clinical improvement. […] Short course therapy, defined as less than 5 days, with doxycycline does not cause staining of permanent teeth, and most experts consider the benefit of doxycycline in treating Q fever greater than the potential risk of dental staining.

• #38 Q Fever Treatment & Management: Approach Considerations, Management of Acute Q Fever, Management of Chronic Q Fever

  https://emedicine.medscape.com/article/227156-treatment

  As with any patient with a febrile illness, the physician should maintain a sufficient level of suspicion about any patient with fever to exclude other potentially life-threatening diseases, which, in the case of tick-borne disease, involves presumptive antibiotic therapy. […] Although specific antimicrobial therapy is indicated, most patients improve spontaneously. However, when Q fever is diagnosed, the administration of antibiotics is appropriate to prevent progression to chronic disease, which is far more resistant to treatment. In addition, supportive care with fluids, antitussives, and antipyretics may improve patient comfort. Patients should avoid ingestion of unpasteurized dairy products as well. […] Consultation with an infectious diseases specialist is warranted, particularly in cases of suspected chronic Q fever. In addition, consult an internist for admission and management of patients who are immunocompromised, elderly, or who have endocarditis.

• #39 Q Fever Treatment & Management: Approach Considerations, Management of Acute Q Fever, Management of Chronic Q Fever

  https://emedicine.medscape.com/article/227156-treatment

  As many as 60% of patients with Q fever are asymptomatic. The disease is self-limiting and spontaneously resolves within 2 weeks in 38% of the remaining patients. However, antibiotic treatment has been shown to reduce the duration of disease, especially if initiated within 3 days of illness onset. The optimal duration of treatment has not been adequately studied, but antibiotics are generally given for 14-21 days, usually in an outpatient setting. […] Doxycycline has been the agent most frequently investigated, and it is the treatment of choice. […] Chronic C burnetii infections are very difficult to treat. A prolonged combined antimicrobial regimen is recommended. Hospitalization may be warranted for intractable heart failure. […] No drug used alone has been shown to be bactericidal against C burnetii. Therefore, prolonged combination therapy is recommended because of the high rate of relapse with treatment of shorter duration.

• #40 Q Fever (Coxiella burnetii) Causes, Symptoms, Diagnosis, Treatment, Prevention

  https://www.medicinenet.com/q_fever/article.htm

  The main complication seen with acute Q fever is pneumonia, which will affect 30%-50% of patients. Another complication can be hepatitis (inflammation of the liver). Rarely, patients can develop myocarditis (heart inflammation), osteomyelitis (bone inflammation), acalculous cholecystitis (inflammation of the gallbladder), and encephalitis (inflammation of the brain). Pregnant women have complications ranging from miscarriage to premature delivery. About 20% of people will have persistent fatigue called post-Q fever fatigue syndrome, which lasts more than a year after the infection. Also, 5% of patients with acute Q fever will go on to develop chronic Q fever. The main complication of chronic Q fever is endocarditis, which will affect 60%-70% of patients. People who already have problems with their heart valves or their immune system are more likely to develop endocarditis. The second most common complication is vasculitis (inflammation of the blood vessels), which is more likely in people who have grafts in their blood vessels. Chronic lung infections and chronic fatigue syndrome can also occur. Endocarditis can cause destruction of the heart valves and result in heart failure. Surgery may be required to repair or replace the valves. Vasculitis, especially in people with grafts or aneurysms in their blood vessels, can also require surgery.

• #41 Q Fever Treatment & Management: Approach Considerations, Management of Acute Q Fever, Management of Chronic Q Fever

  https://emedicine.medscape.com/article/227156-treatment

  As with any patient with a febrile illness, the physician should maintain a sufficient level of suspicion about any patient with fever to exclude other potentially life-threatening diseases, which, in the case of tick-borne disease, involves presumptive antibiotic therapy. […] Although specific antimicrobial therapy is indicated, most patients improve spontaneously. However, when Q fever is diagnosed, the administration of antibiotics is appropriate to prevent progression to chronic disease, which is far more resistant to treatment. In addition, supportive care with fluids, antitussives, and antipyretics may improve patient comfort. Patients should avoid ingestion of unpasteurized dairy products as well. […] Consultation with an infectious diseases specialist is warranted, particularly in cases of suspected chronic Q fever. In addition, consult an internist for admission and management of patients who are immunocompromised, elderly, or who have endocarditis.

• #42 Q Fever Treatment & Management: Approach Considerations, Management of Acute Q Fever, Management of Chronic Q Fever

  https://emedicine.medscape.com/article/227156-treatment

  As many as 60% of patients with Q fever are asymptomatic. The disease is self-limiting and spontaneously resolves within 2 weeks in 38% of the remaining patients. However, antibiotic treatment has been shown to reduce the duration of disease, especially if initiated within 3 days of illness onset. The optimal duration of treatment has not been adequately studied, but antibiotics are generally given for 14-21 days, usually in an outpatient setting. […] Doxycycline has been the agent most frequently investigated, and it is the treatment of choice. […] Chronic C burnetii infections are very difficult to treat. A prolonged combined antimicrobial regimen is recommended. Hospitalization may be warranted for intractable heart failure. […] No drug used alone has been shown to be bactericidal against C burnetii. Therefore, prolonged combination therapy is recommended because of the high rate of relapse with treatment of shorter duration.

• #43 About Q fever | Q Fever | CDC

  https://www.cdc.gov/q-fever/about/index.html

  Most people who have Q fever will recover without antibiotics, but for symptomatic patients, doxycycline is the recommended antibiotic for treatment of Q fever. […] For people who develop symptomatic Q fever, treatment with 2 weeks of the antibiotic doxycycline is recommended. […] A life-threatening infection, requiring several months of antibiotic treatment. […] Treated with a combination of antibiotics including doxycycline and hydroxychloroquine for several months.

• #44 Q Fever Treatment & Management: Approach Considerations, Management of Acute Q Fever, Management of Chronic Q Fever

  https://emedicine.medscape.com/article/227156-treatment

  The most current recommendation for endocarditis is combination treatment with doxycycline and hydroxychloroquine for at least 18 months to eradicate any remaining C burnetii and prevent relapses. […] Patients should follow up with their primary care provider to confirm complete recovery. Patients with endocarditis or a history of valvular disease may require referral to a cardiologist or cardiothoracic surgeon for possible valve replacement. […] Because of the risk for chronic infection, clinical and serologic follow-up for 2 years is recommended, particularly in individuals at risk.

• #45 Q Fever Treatment & Management: Approach Considerations, Management of Acute Q Fever, Management of Chronic Q Fever

  https://emedicine.medscape.com/article/227156-treatment

  As with any patient with a febrile illness, the physician should maintain a sufficient level of suspicion about any patient with fever to exclude other potentially life-threatening diseases, which, in the case of tick-borne disease, involves presumptive antibiotic therapy. […] Although specific antimicrobial therapy is indicated, most patients improve spontaneously. However, when Q fever is diagnosed, the administration of antibiotics is appropriate to prevent progression to chronic disease, which is far more resistant to treatment. In addition, supportive care with fluids, antitussives, and antipyretics may improve patient comfort. Patients should avoid ingestion of unpasteurized dairy products as well. […] Consultation with an infectious diseases specialist is warranted, particularly in cases of suspected chronic Q fever. In addition, consult an internist for admission and management of patients who are immunocompromised, elderly, or who have endocarditis.

• #46

  https://www.health.nsw.gov.au/Infectious/controlguideline/Pages/qfever.aspx

  Case management: Q fever cases can be treated with appropriate antibiotics. All notifications should be followed up to ascertain the most likely source of infection, and to determine if there are any other linked cases. […] Commence empiric treatment if Q fever is clinically suspected. Do not wait for laboratory results. Refer to latest edition of the Therapeutic Guidelines: Antibiotic. […] A two week course of oral doxycycline is generally used to treat acute Q fever. […] Trimethoprim+sulfamethoxazole is recommended for pregnant women until 32 weeks of gestation, even if recovered, to prevent fetal and maternal complications. […] After treatment of C. burnetii primary infection, it is recommended to screen for risk factors of chronic Q fever infection, including pre-existing valvular heart disease/valvular prosthesis, vascular aneurysms/vascular grafts, and immunosuppression.

• #47

  https://www.health.nsw.gov.au/Infectious/controlguideline/Pages/qfever.aspx

  A cardiac assessment, which may include echocardiography, is recommended to assess whether there are underlying abnormalities of the heart valves. Those who are at higher risk of chronic Q fever should be monitored serologically and clinically at 3, 6, 9, 12, 18, and 24 months after acute infection. […] In chronic disease (e.g. endocarditis), prolonged combination therapy (with addition of hydroxychloroquine) and cardiac surgery may be required. Expert advice from an infectious diseases physician and other specialist physicians should be sought as appropriate.

• #48 Health: Infectious Disease Epidemiology & Prevention Division: Q Fever

  https://www.in.gov/health/idepd/zoonotic-and-vectorborne-epidemiology-entomology/zoonotic-diseases/q-fever/

  Less than 5% of people who become infected with Coxiella burnetii develop a more serious infection called chronic Q fever. This can occur months or years after the initial infection and often leads to inflammation of the heart valves (endocarditis). Chronic Q fever is more likely to occur in people with preexisting heart valve disease or blood vessel abnormalities or in people with weakened immune systems. […] Your healthcare provider might order blood tests to look for Q fever or other diseases. Laboratory testing and reporting of results can take several weeks, so your healthcare provider may start antibiotic treatment before results are available. […] Antibiotic treatment with doxycycline is often recommended for people who develop Q fever disease. […] Take measures to minimize contact with body fluids or infectious materials from sheep, cattle and goats, especially birth products (e.g. placenta, amniotic fluid).

• #49 Q Fever: Causes, Symptoms, Diagnosis, Prevention & Treatment

  https://my.clevelandclinic.org/health/diseases/17883-q-fever

  Chronic Q fever is a serious form of Q fever that can affect your heart, your blood vessels, your bones and other parts of your body. It affects 1 to 5% of people whove had a C. burnetii infection. It can start months or years after your initial symptoms go away and can lead to life-threatening complications. Sometimes people with chronic Q fever had no symptoms with their initial infection. The most common form causes inflammation in your heart (endocarditis). […] If youve been diagnosed with Q fever and have a history of heart valve or blood vessel conditions, talk to your provider about being treated proactively to reduce your risk of chronic Q fever. […] Ways to reduce your risk of Q fever include: Wear a mask and gloves while handling animal fluids, especially birthing products. […] Talk to your healthcare provider about avoiding Q fever if you live or work around farm animals and youre at high risk for Q fever complications. This includes anyone with a history of heart valve or blood vessel conditions, pregnant women and those with a weakened immune system. […] If youve been diagnosed with Q fever, be sure to take any medications as prescribed. Ask your provider how to manage your symptoms and if theres any way to reduce your risk of long-term symptoms or chronic Q fever.

• #50 Q Fever Treatment & Management: Approach Considerations, Management of Acute Q Fever, Management of Chronic Q Fever

  https://emedicine.medscape.com/article/227156-treatment

  The most current recommendation for endocarditis is combination treatment with doxycycline and hydroxychloroquine for at least 18 months to eradicate any remaining C burnetii and prevent relapses. […] Patients should follow up with their primary care provider to confirm complete recovery. Patients with endocarditis or a history of valvular disease may require referral to a cardiologist or cardiothoracic surgeon for possible valve replacement. […] Because of the risk for chronic infection, clinical and serologic follow-up for 2 years is recommended, particularly in individuals at risk.

• #51 Q fever – Health New Zealand | Te Whatu Ora

  https://www.tewhatuora.govt.nz/for-health-professionals/clinical-guidance/communicable-disease-control-manual/q-fever

  This guidance supports public health professionals with the prevention and management of Q fever species disease cases, contacts and outbreaks. […] Q fever causes a variety of clinical syndromes. Asymptomatic infection may occur, but the onset of infection is usually acute and characterised by fever, rigors, sweats, severe headache, weakness and myalgia. […] Consult an infectious diseases physician. Tetracyclines and chloramphenicol are the drugs of choice. […] Advise the case and their caregivers of the nature of the infection and its mode of transmission. […] For anyone exposed to the same potential animal or arthropod source, advise them of the incubation period and typical symptoms of the infection. Encourage them to seek medical attention if symptoms develop. Prophylactic doxycycline may prevent clinical Q fever illness when begun 8–12 days after exposure and continued for 5 days. […] In the event of a New Zealand-acquired Q-fever infection, consider direct communication with local parents, schools and health professionals to encourage prompt reporting of symptoms. In communications with doctors, include recommendations for diagnosis and treatment.

• #52 Health: Infectious Disease Epidemiology & Prevention Division: Q Fever

  https://www.in.gov/health/idepd/zoonotic-and-vectorborne-epidemiology-entomology/zoonotic-diseases/q-fever/

  If you have been diagnosed with Q fever and have a history of heart valve disease, blood vessel abnormalities, a weakened immune system or joint replacement or are pregnant, talk to your healthcare provider about your risk for developing chronic Q fever. […] For Q fever diagnosis, treatment and testing information, click here.

• #53 Q fever – symptoms, treatment and causes | healthdirect

  https://www.healthdirect.gov.au/q-fever

  Q fever is a bacterial infection, usually spread by exposure to animals. […] Most people with Q fever are treated with antibiotics and make a full recovery. […] If you are aged 15 years or older and work with animals, speak with your doctor about Q fever vaccination. […] Q fever is commonly treated with antibiotics. If you get treated early you’re likely to recover quickly. […] Chronic (long-term) Q fever may need treatment with long-term antibiotics. […] Vaccination is the best way to prevent Q fever infection. It’s recommended for all people aged 15 years and over who work in high-risk occupations or may be exposed to Q fever. […] Q fever vaccination is recommended for abattoir workers in cattle, sheep and goat abattoirs, farmers, stockyard workers and livestock transporters, vets and vet nurses, agricultural college staff and students, wildlife park and zoo workers who are exposed to high-risk animals, professional dog and cat breeders, shearers and wool sorters, tanning and hide workers, and laboratory personnel who work with veterinary products or the bacterium that causes Q fever.

• #54 Q fever – symptoms, treatment and causes | healthdirect

  https://www.healthdirect.gov.au/q-fever

  To reduce your risk of infection with Q fever you should wash your hands after touching any animals, wear a properly fitted P2/N95 face mask and gloves when working outdoors in areas with livestock or native animals, wash animal fluids, such as urine, faeces and blood from equipment and other surfaces where possible, cover wounds with waterproof dressings when working with animals, and remove and wash clothing worn during high-risk activities outside.

• #55

  https://www.health.nsw.gov.au/Infectious/factsheets/Pages/q-fever.aspx

  To reduce your risk of infection: wash hands and arms thoroughly in soapy water after any contact with animals, wear a properly fitted P2 mask and gloves, cover wounds with waterproof dressings when handling or disposing of animal products including waste, placentas, and aborted foetuses, wear a properly fitted P2 mask when mowing or gardening in areas where there are livestock or native animals. […] Early treatment with antibiotics can get you better sooner and reduce your risk of long-term complications. It is important to seek early medical attention if you develop symptoms of Q fever and are in one of the groups at risk of infection. Chronic (long-term) Q fever infection may require long-term antibiotics.

• #56 Q fever – symptoms, treatment and causes | healthdirect

  https://www.healthdirect.gov.au/q-fever

  Q fever is a bacterial infection, usually spread by exposure to animals. […] Most people with Q fever are treated with antibiotics and make a full recovery. […] If you are aged 15 years or older and work with animals, speak with your doctor about Q fever vaccination. […] Q fever is commonly treated with antibiotics. If you get treated early you’re likely to recover quickly. […] Chronic (long-term) Q fever may need treatment with long-term antibiotics. […] Vaccination is the best way to prevent Q fever infection. It’s recommended for all people aged 15 years and over who work in high-risk occupations or may be exposed to Q fever. […] Q fever vaccination is recommended for abattoir workers in cattle, sheep and goat abattoirs, farmers, stockyard workers and livestock transporters, vets and vet nurses, agricultural college staff and students, wildlife park and zoo workers who are exposed to high-risk animals, professional dog and cat breeders, shearers and wool sorters, tanning and hide workers, and laboratory personnel who work with veterinary products or the bacterium that causes Q fever.

• #57

  https://www.health.nsw.gov.au/Infectious/factsheets/Pages/q-fever.aspx

  Workers in the following occupations are at high risk of Q fever: abattoir and meat workers, livestock and dairy farmers, farm workers, shearers, wool classers/sorters, pelt and hide processors, stockyard/feedlot workers and transporters of animals, animal products and waste, veterinarians, veterinary nurses/assistants/students and others working with veterinary specimens, wildlife workers working with high-risk animals, agriculture college staff and students, laboratory workers, animal shooters/hunters, dog/cat breeders, and anyone regularly exposed to animals who are due to give birth, pet food manufacturing workers, people whose work involves regular mowing in areas frequented by livestock or wild animals. […] A safe and effective vaccine (Q-VAX) is the best way to prevent Q fever infection. Vaccination is highly recommended for people who work or intend to work in high-risk occupations.

• #58 Q Fever – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK556095/

  Chronic Q fever that occurs during pregnancy is treated with doxycycline 100 mg twice daily and hydroxychloroquine 200 mg three times daily for a year post-delivery. […] The prevention and management of Q fever are best handled by an interprofessional healthcare team using open communication and collaborative efforts to achieve optimal patient results.

• #59 Prerequisites, barriers and opportunities in care for Q-fever patients: a Delphi study among healthcare workers | BMC Health Services Research | Full Text

  https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-023-09269-y

  HCWs reported many prerequisites for high quality care. The most frequently mentioned were: sufficient knowledge of Q-fever among HCWs (36%), financial compensation of care (30%) and recognition of the disease by HCWs (26%). […] According to the panel, a lack of knowledge among HCWs/the disease is not recognized (76%) was the most important barrier for high quality care, followed by unclear/limited scientific evidence for effective treatment (55%) and diagnosis is complex/not always adequate (50%). […] The panel was asked whether reported barriers were easy to solve. The most important barrier, lack of knowledge among HCWs/the disease is not recognized, was considered one of the easier barriers to tackle (65%). […] HCWs mentioned the importance of having one healthcare professional who coordinates the multidisciplinary care. Most of them indicated that a general practitioner (53%) or a medical specialist working in a center of expertise (30%) should have the ultimate responsibility for QFS care.

• #60 Prerequisites, barriers and opportunities in care for Q-fever patients: a Delphi study among healthcare workers | BMC Health Services Research | Full Text

  https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-023-09269-y

  The results of this study showed that, according to HCWs, the care for Q-fever patients leaves much room for improvement. HCWs indicated many prerequisites for high quality care, of which financial compensation of care and sufficient knowledge of Q-fever among HCWs were most frequently mentioned. […] The need for multidisciplinary care also appears to be an important aspect of Q-fever care as HCWs indicate that many healthcare providers from different disciplines should be involved in the care for QFS and chronic Q-fever. […] The results from our study and a previous study among Q-fever patients indicate that the same difficulties with cure versus care may apply to QFS care: HCWs and patients acknowledge the poor quality of care, yet improving the quality of care remains challenging.

• #61 Q Fever Treatment & Management: Approach Considerations, Management of Acute Q Fever, Management of Chronic Q Fever

  https://emedicine.medscape.com/article/227156-treatment

  As with any patient with a febrile illness, the physician should maintain a sufficient level of suspicion about any patient with fever to exclude other potentially life-threatening diseases, which, in the case of tick-borne disease, involves presumptive antibiotic therapy. […] Although specific antimicrobial therapy is indicated, most patients improve spontaneously. However, when Q fever is diagnosed, the administration of antibiotics is appropriate to prevent progression to chronic disease, which is far more resistant to treatment. In addition, supportive care with fluids, antitussives, and antipyretics may improve patient comfort. Patients should avoid ingestion of unpasteurized dairy products as well. […] Consultation with an infectious diseases specialist is warranted, particularly in cases of suspected chronic Q fever. In addition, consult an internist for admission and management of patients who are immunocompromised, elderly, or who have endocarditis.

• #62 Q Fever Treatment & Management: Approach Considerations, Management of Acute Q Fever, Management of Chronic Q Fever

  https://emedicine.medscape.com/article/227156-treatment

  The most current recommendation for endocarditis is combination treatment with doxycycline and hydroxychloroquine for at least 18 months to eradicate any remaining C burnetii and prevent relapses. […] Patients should follow up with their primary care provider to confirm complete recovery. Patients with endocarditis or a history of valvular disease may require referral to a cardiologist or cardiothoracic surgeon for possible valve replacement. […] Because of the risk for chronic infection, clinical and serologic follow-up for 2 years is recommended, particularly in individuals at risk.

• #63

  https://www.health.nsw.gov.au/Infectious/controlguideline/Pages/qfever.aspx

  A cardiac assessment, which may include echocardiography, is recommended to assess whether there are underlying abnormalities of the heart valves. Those who are at higher risk of chronic Q fever should be monitored serologically and clinically at 3, 6, 9, 12, 18, and 24 months after acute infection. […] In chronic disease (e.g. endocarditis), prolonged combination therapy (with addition of hydroxychloroquine) and cardiac surgery may be required. Expert advice from an infectious diseases physician and other specialist physicians should be sought as appropriate.

• #64 Q Fever Treatment & Management: Approach Considerations, Management of Acute Q Fever, Management of Chronic Q Fever

  https://emedicine.medscape.com/article/227156-treatment

  The most current recommendation for endocarditis is combination treatment with doxycycline and hydroxychloroquine for at least 18 months to eradicate any remaining C burnetii and prevent relapses. […] Patients should follow up with their primary care provider to confirm complete recovery. Patients with endocarditis or a history of valvular disease may require referral to a cardiologist or cardiothoracic surgeon for possible valve replacement. […] Because of the risk for chronic infection, clinical and serologic follow-up for 2 years is recommended, particularly in individuals at risk.

• #65 Q Fever Treatment & Management: Approach Considerations, Management of Acute Q Fever, Management of Chronic Q Fever

  https://emedicine.medscape.com/article/227156-treatment

  The most current recommendation for endocarditis is combination treatment with doxycycline and hydroxychloroquine for at least 18 months to eradicate any remaining C burnetii and prevent relapses. […] Patients should follow up with their primary care provider to confirm complete recovery. Patients with endocarditis or a history of valvular disease may require referral to a cardiologist or cardiothoracic surgeon for possible valve replacement. […] Because of the risk for chronic infection, clinical and serologic follow-up for 2 years is recommended, particularly in individuals at risk.

• #66 Q Fever (Coxiella burnetii) Causes, Symptoms, Diagnosis, Treatment, Prevention

  https://www.medicinenet.com/q_fever/article.htm

  The main complication seen with acute Q fever is pneumonia, which will affect 30%-50% of patients. Another complication can be hepatitis (inflammation of the liver). Rarely, patients can develop myocarditis (heart inflammation), osteomyelitis (bone inflammation), acalculous cholecystitis (inflammation of the gallbladder), and encephalitis (inflammation of the brain). Pregnant women have complications ranging from miscarriage to premature delivery. About 20% of people will have persistent fatigue called post-Q fever fatigue syndrome, which lasts more than a year after the infection. Also, 5% of patients with acute Q fever will go on to develop chronic Q fever. The main complication of chronic Q fever is endocarditis, which will affect 60%-70% of patients. People who already have problems with their heart valves or their immune system are more likely to develop endocarditis. The second most common complication is vasculitis (inflammation of the blood vessels), which is more likely in people who have grafts in their blood vessels. Chronic lung infections and chronic fatigue syndrome can also occur. Endocarditis can cause destruction of the heart valves and result in heart failure. Surgery may be required to repair or replace the valves. Vasculitis, especially in people with grafts or aneurysms in their blood vessels, can also require surgery.

• #67 Q Fever (Coxiella burnetii) Causes, Symptoms, Diagnosis, Treatment, Prevention

  https://www.medicinenet.com/q_fever/article.htm

  The main complication seen with acute Q fever is pneumonia, which will affect 30%-50% of patients. Another complication can be hepatitis (inflammation of the liver). Rarely, patients can develop myocarditis (heart inflammation), osteomyelitis (bone inflammation), acalculous cholecystitis (inflammation of the gallbladder), and encephalitis (inflammation of the brain). Pregnant women have complications ranging from miscarriage to premature delivery. About 20% of people will have persistent fatigue called post-Q fever fatigue syndrome, which lasts more than a year after the infection. Also, 5% of patients with acute Q fever will go on to develop chronic Q fever. The main complication of chronic Q fever is endocarditis, which will affect 60%-70% of patients. People who already have problems with their heart valves or their immune system are more likely to develop endocarditis. The second most common complication is vasculitis (inflammation of the blood vessels), which is more likely in people who have grafts in their blood vessels. Chronic lung infections and chronic fatigue syndrome can also occur. Endocarditis can cause destruction of the heart valves and result in heart failure. Surgery may be required to repair or replace the valves. Vasculitis, especially in people with grafts or aneurysms in their blood vessels, can also require surgery.

• #68

  https://www.health.nsw.gov.au/Infectious/factsheets/Pages/q-fever.aspx

  Q fever is a bacterial infection that can cause a severe flu-like illness. […] A safe and effective vaccine is available to protect people who are at risk. Screening tests are required to identify who can be vaccinated. […] Patients may also develop hepatitis (inflammation of the liver) or pneumonia (infection of the lungs). Without treatment, symptoms can last from 2-6 weeks. Illness often results in time off work, lasting from a few days to several weeks. […] Most people make a full recovery and become immune to repeat infections. […] Occasionally, people develop chronic infections up to 2 years later which can cause a range of health issues including heart problems (endocarditis). […] About 10% of patients who are sick with acute Q fever go on to suffer from a chronic-fatigue-like illness which can be very serious for years.

• #69 Q Fever (Coxiella burnetii) Causes, Symptoms, Diagnosis, Treatment, Prevention

  https://www.medicinenet.com/q_fever/article.htm

  The main complication seen with acute Q fever is pneumonia, which will affect 30%-50% of patients. Another complication can be hepatitis (inflammation of the liver). Rarely, patients can develop myocarditis (heart inflammation), osteomyelitis (bone inflammation), acalculous cholecystitis (inflammation of the gallbladder), and encephalitis (inflammation of the brain). Pregnant women have complications ranging from miscarriage to premature delivery. About 20% of people will have persistent fatigue called post-Q fever fatigue syndrome, which lasts more than a year after the infection. Also, 5% of patients with acute Q fever will go on to develop chronic Q fever. The main complication of chronic Q fever is endocarditis, which will affect 60%-70% of patients. People who already have problems with their heart valves or their immune system are more likely to develop endocarditis. The second most common complication is vasculitis (inflammation of the blood vessels), which is more likely in people who have grafts in their blood vessels. Chronic lung infections and chronic fatigue syndrome can also occur. Endocarditis can cause destruction of the heart valves and result in heart failure. Surgery may be required to repair or replace the valves. Vasculitis, especially in people with grafts or aneurysms in their blood vessels, can also require surgery.

• #70 Q Fever (Coxiella burnetii) Causes, Symptoms, Diagnosis, Treatment, Prevention

  https://www.medicinenet.com/q_fever/article.htm

  The main complication seen with acute Q fever is pneumonia, which will affect 30%-50% of patients. Another complication can be hepatitis (inflammation of the liver). Rarely, patients can develop myocarditis (heart inflammation), osteomyelitis (bone inflammation), acalculous cholecystitis (inflammation of the gallbladder), and encephalitis (inflammation of the brain). Pregnant women have complications ranging from miscarriage to premature delivery. About 20% of people will have persistent fatigue called post-Q fever fatigue syndrome, which lasts more than a year after the infection. Also, 5% of patients with acute Q fever will go on to develop chronic Q fever. The main complication of chronic Q fever is endocarditis, which will affect 60%-70% of patients. People who already have problems with their heart valves or their immune system are more likely to develop endocarditis. The second most common complication is vasculitis (inflammation of the blood vessels), which is more likely in people who have grafts in their blood vessels. Chronic lung infections and chronic fatigue syndrome can also occur. Endocarditis can cause destruction of the heart valves and result in heart failure. Surgery may be required to repair or replace the valves. Vasculitis, especially in people with grafts or aneurysms in their blood vessels, can also require surgery.

• #71 Q Fever (Coxiella burnetii) Causes, Symptoms, Diagnosis, Treatment, Prevention

  https://www.medicinenet.com/q_fever/article.htm

  The prognosis for patients with acute Q fever is very good, with most patients recovering fully within a few weeks to months. The prognosis for patients with chronic Q fever is poorer, with up to 10% of patients dying even with appropriate treatment. The acute form of Q fever is rarely fatal (1%-2%), and most people get better without any treatment. About 5% of people with acute Q fever will go on to develop chronic Q fever. The chronic form of Q fever is more dangerous. Without treatment, up to 40% of people with chronic Q fever will die, and 100% of people with endocarditis caused by chronic Q fever will die. With appropriate treatment, chronic Q fever causes death in 10% of people.

• #72 Q Fever (Coxiella burnetii) Causes, Symptoms, Diagnosis, Treatment, Prevention

  https://www.medicinenet.com/q_fever/article.htm

  The prognosis for patients with acute Q fever is very good, with most patients recovering fully within a few weeks to months. The prognosis for patients with chronic Q fever is poorer, with up to 10% of patients dying even with appropriate treatment. The acute form of Q fever is rarely fatal (1%-2%), and most people get better without any treatment. About 5% of people with acute Q fever will go on to develop chronic Q fever. The chronic form of Q fever is more dangerous. Without treatment, up to 40% of people with chronic Q fever will die, and 100% of people with endocarditis caused by chronic Q fever will die. With appropriate treatment, chronic Q fever causes death in 10% of people.

• #73 Prerequisites, barriers and opportunities in care for Q-fever patients: a Delphi study among healthcare workers | BMC Health Services Research | Full Text

  https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-023-09269-y

  HCWs reported many prerequisites for high quality care. The most frequently mentioned were: sufficient knowledge of Q-fever among HCWs (36%), financial compensation of care (30%) and recognition of the disease by HCWs (26%). […] According to the panel, a lack of knowledge among HCWs/the disease is not recognized (76%) was the most important barrier for high quality care, followed by unclear/limited scientific evidence for effective treatment (55%) and diagnosis is complex/not always adequate (50%). […] The panel was asked whether reported barriers were easy to solve. The most important barrier, lack of knowledge among HCWs/the disease is not recognized, was considered one of the easier barriers to tackle (65%). […] HCWs mentioned the importance of having one healthcare professional who coordinates the multidisciplinary care. Most of them indicated that a general practitioner (53%) or a medical specialist working in a center of expertise (30%) should have the ultimate responsibility for QFS care.

• #74 Prerequisites, barriers and opportunities in care for Q-fever patients: a Delphi study among healthcare workers | BMC Health Services Research | Full Text

  https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-023-09269-y

  Q-fever is a zoonotic disease that can lead to illness, disability and death. This study aimed to provide insight into the perspectives of healthcare workers (HCWs) on prerequisites, barriers and opportunities in care for Q-fever patients. […] The panel rated the care for Q-fever patients at a median score of 6/10 (IQR=2). Sufficient knowledge of Q-fever among HCWs (36%), financial compensation of care (30%) and recognition of the disease by HCWs (26%) were considered the most important prerequisites for high quality care. […] A lack of knowledge was identified as the most important barrier (76%) and continuing medical education as the primary method for improving HCWs knowledge (76%). […] Ten years after the Dutch Q-fever epidemic, HCWs indicate that the long-term care for Q-fever patients leaves much room for improvement. Facilitation of reported prerequisites for high quality care, improved knowledge among HCWs, clearly defined roles and responsibilities, and guidance on how to support patients could possibly improve quality of care.

• #75 Prerequisites, barriers and opportunities in care for Q-fever patients: a Delphi study among healthcare workers | BMC Health Services Research | Full Text

  https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-023-09269-y

  The results of this study showed that, according to HCWs, the care for Q-fever patients leaves much room for improvement. HCWs indicated many prerequisites for high quality care, of which financial compensation of care and sufficient knowledge of Q-fever among HCWs were most frequently mentioned. […] The need for multidisciplinary care also appears to be an important aspect of Q-fever care as HCWs indicate that many healthcare providers from different disciplines should be involved in the care for QFS and chronic Q-fever. […] The results from our study and a previous study among Q-fever patients indicate that the same difficulties with cure versus care may apply to QFS care: HCWs and patients acknowledge the poor quality of care, yet improving the quality of care remains challenging.

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