Gorączka q – Leczenie

Gorączka q
Leczenie

Ostra gorączka Q, wywołana przez Coxiella burnetii, najczęściej ustępuje samoistnie, jednak wczesne wdrożenie antybiotykoterapii znacząco skraca czas trwania objawów i zmniejsza ryzyko przejścia w postać przewlekłą. Lekiem pierwszego wyboru jest doksycyklina w dawce 100 mg dwa razy dziennie przez 14 dni, co prowadzi do ustąpienia gorączki średnio w ciągu 2-3 dni, w porównaniu do 12,5 dnia u pacjentów nieleczonych. Alternatywnie stosuje się fluorochinolony, kotrimoksazol (zwłaszcza u dzieci <8 r.ż. i kobiet w ciąży) oraz makrolidy i ryfampicynę, choć ich skuteczność jest niższa. U dzieci powyżej 8 lat zalecana dawka doksycykliny to 2,2 mg/kg dwa razy dziennie (max 100 mg/dawka). Kobiety w ciąży leczone są kotrimoksazolem do 32. tygodnia ciąży. Leczenie wspomagające obejmuje odpowiednią podaż płynów, leki przeciwgorączkowe i przeciwkaszlowe oraz unikanie niepasteryzowanych produktów mlecznych.

Leczenie ostrej gorączki Q

Większość przypadków ostrej gorączki Q ustępuje samoistnie bez antybiotykoterapii, jednak wprowadzenie odpowiedniego leczenia może znacząco skrócić czas trwania objawów choroby i zmniejszyć ryzyko rozwoju przewlekłej postaci infekcji. ¹² Wczesne wdrożenie leczenia jest kluczowe – najlepiej w ciągu pierwszych trzech dni od pojawienia się objawów, co znacząco zwiększa skuteczność terapii. ³⁴

Antybiotykoterapia pierwszego rzutu

Doksycyklina stanowi lek pierwszego wyboru w leczeniu ostrej gorączki Q. Najczęściej stosowany schemat terapeutyczny to 100 mg doksycykliny dwa razy dziennie przez 14 dni. ⁵⁶ Leczenie doksycykliną prowadzi do ustąpienia gorączki średnio w ciągu 2-3 dni od rozpoczęcia terapii, podczas gdy u pacjentów nieleczonych gorączka utrzymuje się średnio przez 12,5 dnia. ⁷ Długość leczenia może być wydłużona do około 15-21 dni w cięższych przypadkach lub do czasu, gdy pacjent będzie bez gorączki przez około 5 dni. ⁸⁹

Alternatywne leki przeciwbakteryjne

W przypadku przeciwwskazań do stosowania doksycykliny, dostępne są alternatywne opcje leczenia:

Fluorochinolony (ofloksacyna/” title=”ciprofloksacyna” class=”to-tag” data-termid=”18221″>ciprofloksacyna, ofloksacyna, pefloksacyna) wykazują skuteczność w leczeniu gorączki Q i mogą być stosowane jako leki alternatywne. ¹⁰¹¹
Kotrimoksazol (trimetoprim-sulfametoksazol) – zalecany szczególnie u dzieci poniżej 8. roku życia oraz u kobiet w ciąży, u których nie można stosować tetracyklin. ¹²¹³
Makrolidy (klarytromycyna, azytromycyna) – mogą być rozważone jako alternatywa, choć ich skuteczność jest niższa niż doksycykliny. ¹⁴¹⁵
Ryfampicyna – również wymieniana jako potencjalna opcja terapeutyczna. ¹⁶

Należy jednak podkreślić, że alternatywne antybiotyki nie są tak skuteczne jak doksycyklina w leczeniu gorączki Q. ¹⁷

Leczenie wspomagające

Oprócz antybiotykoterapii, zaleca się również leczenie wspomagające, które może obejmować:

Odpowiednią podaż płynów
Leki przeciwkaszlowe
Leki przeciwgorączkowe
Unikanie spożywania niepasteryzowanych produktów mlecznych ¹⁸

Leczenie gorączki Q w szczególnych populacjach

Leczenie dzieci

Aktualne wytyczne dotyczące leczenia dzieci powyżej 8. roku życia zalecają dwutygodniową terapię doksycykliną w dawce 2,2 mg/kg dwa razy dziennie (nie przekraczając 100 mg na dawkę). ¹⁹

W przypadku dzieci poniżej 8. roku życia, stosowanie doksycykliny budzi obawy ze względu na ryzyko przebarwienia zębów. W tej grupie wiekowej zaleca się stosowanie kotrimoksazolu (trimetoprim-sulfametoksazol) w proporcji 1:5. ²⁰²¹

Leczenie kobiet w ciąży

Ze względu na potencjalne działania niepożądane doksycykliny na płód, u kobiet w ciąży z gorączką Q zaleca się stosowanie kotrimoksazolu do końca 7. miesiąca ciąży lub do 32. tygodnia ciąży. ²²²³ Po porodzie, kobietom, u których rozwinął się profil serologiczny przewlekłej gorączki Q (miano IgG przeciwko antygenowi fazy I ≥1:1024), zaleca się podawanie doksycykliny z hydroksychlorochiną przez 12 miesięcy. ²⁴

Leczenie przewlekłej gorączki Q

Przewlekła gorączka Q stanowi poważne zagrożenie dla życia i wymaga długotrwałego leczenia antybiotykami. W przeciwieństwie do ostrej postaci, przewlekła gorączka Q jest trudniejsza do wyleczenia i wymaga bardziej złożonego podejścia terapeutycznego. ²⁵²⁶

Standardowe postępowanie w przewlekłej gorączce Q

Obecne zalecenia dotyczące leczenia przewlekłej gorączki Q obejmują kombinację:

Doksycykliny (100 mg dwa razy dziennie) wraz z
Hydroksychlorochiną (200 mg trzy razy dziennie) ²⁷²⁸

Czas trwania leczenia jest znacznie dłuższy niż w przypadku ostrej gorączki Q i wynosi co najmniej 18 miesięcy dla pacjentów z natywnymi zastawkami serca oraz 24 miesiące dla pacjentów z protezami zastawek. ²⁹³⁰ W niektórych przypadkach terapia może być kontynuowana przez 3-4 lata lub nawet do końca życia, w zależności od odpowiedzi na leczenie. ³¹³²

Hydroksychlorochina jest dodawana do terapii, ponieważ zwiększa pH fagolizosomu, w którym znajduje się Coxiella burnetii, co zwiększa skuteczność doksycykliny, która jest mniej aktywna w kwaśnym pH. ³³ To połączenie znacząco skróciło czas leczenia przewlekłej gorączki Q z wcześniejszych około 60 miesięcy do około 26 miesięcy. ³⁴

Alternatywne schematy leczenia

Alternatywny schemat leczenia przewlekłej gorączki Q obejmuje kombinację doksycykliny z fluorochinolonem przez co najmniej 3-4 lata. ³⁵ Fluorochinolony są szczególnie zalecane u pacjentów z objawami neurologicznymi ze względu na ich zdolność do przenikania przez barierę krew-mózg. ³⁶

Leczenie powikłań przewlekłej gorączki Q

Zapalenie wsierdzia

Zapalenie wsierdzia jest jednym z najpoważniejszych powikłań przewlekłej gorączki Q. Leczenie obejmuje długotrwałą antybiotykoterapię, jak opisano powyżej, jednak w wielu przypadkach konieczna jest również interwencja chirurgiczna w celu wymiany uszkodzonych zastawek serca. ³⁷³⁸

Ze względu na kardiotoksyczne działanie hydroksychlorochiny, u pacjentów otrzymujących ten lek należy monitorować odstęp QTc za pomocą powtarzanych badań EKG. ³⁹

Przewlekłe ziarniniakowe zapalenie wątroby

W przypadku przewlekłego ziarniniakowego zapalenia wątroby optymalny schemat leczenia nie został jednoznacznie określony. ⁴⁰ W przypadkach nieodpowiadających na leczenie przeciwbakteryjne stosowano leczenie wspomagające glikokortykosteroidami. ⁴¹

Powikłania naczyniowe

Powikłania naczyniowe powinny być leczone kombinacją doksycykliny i hydroksychlorochiny, chociaż optymalny schemat leczenia nie jest dobrze zdefiniowany. ⁴² W niektórych przypadkach może być konieczne chirurgiczne usunięcie zakażonej tkanki naczyniowej lub materiału protetycznego. ⁴³

Monitorowanie i obserwacja pacjentów

Pacjenci z gorączką Q wymagają odpowiedniego monitorowania w trakcie i po zakończeniu leczenia. ⁴⁴

Monitoring podczas leczenia

W trakcie leczenia zaleca się monitorowanie:

Objawów klinicznych
OB (wskaźnika opadania erytrocytów)
Morfologii krwi
Miana przeciwciał ⁴⁵

U pacjentów leczonych hydroksychlorochiną konieczne jest regularne monitorowanie stężenia leku w surowicy, aby utrzymać terapeutyczne stężenie poniżej progu toksyczności. ⁴⁶

Badania kontrolne po zakończonej terapii

Po zakończeniu leczenia przewlekłej gorączki Q, zaleca się regularne wizyty kontrolne i badania przez wiele lat ze względu na ryzyko nawrotu infekcji. ⁴⁷

U pacjentów po leczeniu pierwotnej infekcji C. burnetii zaleca się badania przesiewowe w kierunku czynników ryzyka przewlekłej gorączki Q, w tym:

Istniejących wcześniej wad zastawkowych serca lub protez zastawkowych
Tętniaków naczyniowych lub przeszczepów naczyniowych
Immunosupresji ⁴⁸

Zespół przewlekłego zmęczenia po przebytej gorączce Q

U niektórych pacjentów po przebytej gorączce Q może rozwinąć się zespół przewlekłego zmęczenia po gorączce Q (QFS – Q Fever Fatigue Syndrome), charakteryzujący się uporczywym zmęczeniem prowadzącym do znacznej chorobowości i wysokich kosztów społeczno-ekonomicznych. ⁴⁹

Opcje terapeutyczne w QFS

Leczenie QFS stanowi wyzwanie, gdyż brak jest terapii o udowodnionej skuteczności. Prowadzone są badania nad skutecznością długotrwałego leczenia doksycykliną oraz terapii poznawczo-behawioralnej (CBT) u pacjentów z QFS. ⁵⁰⁵¹

Strategie postępowania w zespole przewlekłego zmęczenia po gorączce Q mogą obejmować:

Stopniowe programy ćwiczeń fizycznych w celu odbudowania wytrzymałości
Wsparcie żywieniowe (dieta przeciwzapalna)
Terapię poznawczo-behawioralna (CBT) dla wsparcia zdrowia psychicznego
Suplementację witamin i minerałów ⁵²
Delikatne, nadzorowane ćwiczenia ⁵³

Profilaktyka gorączki Q

Profilaktyka antybiotykowa

U pacjentów z gorączką Q i wywiadem chorób zastawek serca lub naczyń krwionośnych zaleca się profilaktyczne leczenie w celu zmniejszenia ryzyka rozwoju przewlekłej gorączki Q. ⁵⁴ Badania sugerują, że rozpoczęcie antybiotyku w okolicach czasu wystąpienia objawów po ekspozycji na C. burnetii zapewnia optymalne wyniki. ⁵⁵

Szczepienia

Szczepionka przeciwko gorączce Q jest dostępna w Australii i wykazuje skuteczność na poziomie 83-100% w zapobieganiu chorobie. ⁵⁶ Jednakże szczepionka może być podawana tylko osobom powyżej 15. roku życia i wymaga rygorystycznej oceny przeszczepiennej w celu wykluczenia wcześniejszej ekspozycji na C. burnetii. ⁵⁷

Zaleca się szczepienie wszystkich osób, które mogą być narażone na C. burnetii w oparciu o ocenę ryzyka środowiskowego, aktywności lub zawodowego. ⁵⁸

Podsumowanie zasad leczenia gorączki Q

Postać choroby	Populacja	Lek pierwszego wyboru	Alternatywne leki	Czas leczenia
Ostra gorączka Q	Dorośli i dzieci >8 r.ż.	Doksycyklina 100 mg 2 razy dziennie	Fluorochinolony, makrolidy	14-21 dni
	Dzieci <8 r.ż.	Kotrimoksazol (TMP-SMX)	–	14 dni
	Kobiety w ciąży	Kotrimoksazol (TMP-SMX)	–	Do 32. tygodnia ciąży
Przewlekła gorączka Q	Zastawki natywne	Doksycyklina 100 mg 2 razy dziennie + hydroksychlorochina 200 mg 3 razy dziennie	Doksycyklina + fluorochinolon	≥18 miesięcy
Przewlekła gorączka Q	Protezy zastawkowe	Doksycyklina 100 mg 2 razy dziennie + hydroksychlorochina 200 mg 3 razy dziennie	Doksycyklina + fluorochinolon	≥24 miesiące
Zespół przewlekłego zmęczenia po gorączce Q	–	Terapia poznawczo-behawioralna, programy ćwiczeń	Doksycyklina (w badaniach klinicznych)	–

Leczenie gorączki Q powinno być prowadzone pod nadzorem specjalisty chorób zakaźnych, szczególnie w przypadkach przewlekłej infekcji lub powikłań. ⁵⁹⁶⁰ Wczesna diagnostyka i szybkie rozpoczęcie odpowiedniego leczenia są kluczowe dla zmniejszenia czasu trwania objawów, ciężkości choroby i prawdopodobieństwa rozwoju przewlekłego zmęczenia. ⁶¹

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Materiały źródłowe

#1 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.
#2 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. […] Doxycycline has been the agent most frequently investigated, and it is the treatment of choice.
#3
https://www.atsu.edu/faculty/chamberlain/website/lectures/qfever.htm
Doxycycline is the drug of choice for treating Q fever, although quinolones have also been shown to be effective. Treatment outcomes are most effective if therapy begins within the first 3 days of symptomatic disease. Relapses are not uncommon; if relapse occurs, the patient must begin treatment again. […] Chronic Q fever is much more difficult to treat than acute Q fever. Endocarditis caused by C burnetii usually requires the use of two different antimicrobial agents for extended periods of time. Currently, two treatment regimens have been examined: The first is doxycycline given in combination with quinolones for at least 4 years. The second regimen, which results in fewer relapses, is doxycycline given in combination with hydroxychloroquine for 1 to 3 years.
#4 Q fever: etiology, diagnosis, and treatment
https://jzd.tabrizu.ac.ir/article_16329.html
In humans, Q fever can be seen in acute and chronic forms. The duration of treatment is determined according to the patient’s serological titers. When there is an acute form of the disease, the use of antibiotics is effective, but when the infection reaches its chronic form, more time is needed for treatment, and as a result, the probability of disease recurrence and mortality is high. Although this disease is self-limiting, early diagnosis and prescribing of appropriate antibiotics can reduce the infection duration and the symptoms severity. One of the best drugs used is doxycycline at a dose of 100 mg twice a day for 2 to 3 weeks for patients with the acute form of the disease. Another drug is hydroxychloroquine, which is usually used together with doxycycline. Hydroxychloroquine is lysosomotropic and increases the phagolysosome pH. As a result, it acts as a bacteriostat because C. burnetii needs an acidic environment to multiply. Other antibiotics, such as erythromycin, clarithromycin, and rifampin, can be used as alternative treatments. In the case of pregnant women and children less than eight years of age, cotrimoxazole can be used to treat Q fever.
#5 Antimicrobial therapies for Q fever
https://pmc.ncbi.nlm.nih.gov/articles/PMC4608426/
Q fever is caused by the bacterium Coxiella burnetii and has both acute and chronic forms. The normal therapy for the acute disease is a two week course of doxycycline, whereas chronic disease requires 18-24 months of doxycycline in combination with hydroxychloroquine. […] Doxycycline has been shown to result in a mean time to defervescence of 2-3 days after the start of treatment, whereas untreated patients resolve the fever after a mean of 12.5 days. […] Recent guidelines for treatment and management of Q fever from the US Centers for Disease Control and Q fever working group recommend a primary treatment for acute Q fever in adults of 100 mg doxycycline twice a day for two weeks. […] Current recommendations for treatment of chronic Q fever are 100 mg doxycycline twice per day combined with hydroxychloroquine three times per day at 200 mg per dose for at least 18 months.
#6 Department of Health
https://www.health.ny.gov/diseases/communicable/q_fever/fact_sheet.htm
Doxycycline is the treatment of choice for Q fever and should be administered for 15-21 days. […] Treatment of chronic infections like endocarditis require longer courses of antibiotic therapy.
#7 Antimicrobial therapies for Q fever
https://pmc.ncbi.nlm.nih.gov/articles/PMC4608426/
Q fever is caused by the bacterium Coxiella burnetii and has both acute and chronic forms. The normal therapy for the acute disease is a two week course of doxycycline, whereas chronic disease requires 18-24 months of doxycycline in combination with hydroxychloroquine. […] Doxycycline has been shown to result in a mean time to defervescence of 2-3 days after the start of treatment, whereas untreated patients resolve the fever after a mean of 12.5 days. […] Recent guidelines for treatment and management of Q fever from the US Centers for Disease Control and Q fever working group recommend a primary treatment for acute Q fever in adults of 100 mg doxycycline twice a day for two weeks. […] Current recommendations for treatment of chronic Q fever are 100 mg doxycycline twice per day combined with hydroxychloroquine three times per day at 200 mg per dose for at least 18 months.
#8 Q Fever – Infectious Diseases – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/infectious-diseases/rickettsiae-and-related-organisms/q-fever
For acute Q fever, primary treatment is doxycycline until the patient improves, has been afebrile for about 5 days, and has received treatment for 14 days; longer treatment may be needed for severe disease. Tetracycline resistance has not been documented. […] For endocarditis, treatment needs to be prolonged (months to years to lifelong), typically for at least 18 months. Doxycycline plus hydroxychloroquine is currently recommended. Owing to the cardiac adverse effects of hydroxychloroquine, patients on this medication should have their QTc interval monitored with repeated ECGs. Clinical signs, erythrocyte sedimentation rate, blood count, and antibody titers should be monitored to help determine when to stop treatment. Consultation with an infectious disease specialist may help with managing the complexities of the disease and its treatment. Frequently, antibiotic treatment is only partially effective, and damaged valves must be replaced surgically, although some cures have occurred without surgery. […] For chronic granulomatous hepatitis, the optimal regimen has not been determined.
#9 Department of Health
https://www.health.ny.gov/diseases/communicable/q_fever/fact_sheet.htm
Doxycycline is the treatment of choice for Q fever and should be administered for 15-21 days. […] Treatment of chronic infections like endocarditis require longer courses of antibiotic therapy.
#10 Q Fever Treatment & Management: Approach Considerations, Management of Acute Q Fever, Management of Chronic Q Fever
https://emedicine.medscape.com/article/227156-treatment
Fluoroquinolones can be used as alternative antibiotic agents. Ofloxacin and pefloxacin have been used with success in patients. […] 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. […] 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. […] Endovascular complications should be treated with doxycycline and hydroxychloroquine in combination, although the optimal regimen is not well defined. […] Adjuvant corticosteroid treatment has been used in antimicrobial-nonresponsive hepatitis.
#11 Q Fever: Causes, Symptoms, Diagnosis, Prevention & Treatment
https://my.clevelandclinic.org/health/diseases/17883-q-fever
How is Q fever treated? Acute Q fever is treated with antibiotics. Chronic Q fever is often treated with a combination of antibiotics and anti-inflammatory medications, but it can be hard to treat. Your provider will create a treatment plan based on your specific illness. […] If you’ve 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. […] What medications/treatments are used? Your provider may prescribe: Doxycycline. Hydroxychloroquine. Trimethoprim-sulfamethoxazole (TMP-SMX). Rifampin. Fluoroquinolones (ciprofloxacin, ofloxacin). Clarithromycin. […] Can Q fever be cured? Yes, antibiotics can cure acute Q fever in most people. A small number of people with acute Q fever may have symptoms that last months or years, even with treatment. Chronic Q fever can be harder to cure.
#12 Antimicrobial therapies for Q fever
https://pmc.ncbi.nlm.nih.gov/articles/PMC4608426/
The usage of doxycycline plus hydroxychloroquine has reduced the time of treatment in chronic Q fever patients to 18 months for those with native heart valves and 24 months for patients with prosthetic valves. […] Treatment for children with acute Q fever is recommended and current treatment guidelines for children over 8 years old call for a two week treatment of doxycycline at a dose of 2.2 mg/kg twice per day (not to exceed 100 mg per dose). […] For children under 8 years old, treatment with doxycycline raises additional questions because of the perceived risk of dental staining. Therefore for children under 8, a mixture of trimethoprim and sulfamethoxazole at a 1:5 ratio (co-trimoxazole) is recommended by the CDC. […] The current recommendation from the CDC is to treat women with acute Q fever with co-trimoxazole up until the final six weeks of pregnancy, and to give doxycycline and hydroxychloroquine postpartum for 12 months to women that develop a serologic profile of chronic Q fever (Phase 1 IgG titer 1:1024).
#13
https://www.health.nsw.gov.au/Infectious/controlguideline/Pages/qfever.aspx
Case management: Q fever cases can be treated with appropriate antibiotics. […] 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. […] 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.
#14 Q Fever: Causes, Symptoms, Diagnosis, Prevention & Treatment
https://my.clevelandclinic.org/health/diseases/17883-q-fever
How is Q fever treated? Acute Q fever is treated with antibiotics. Chronic Q fever is often treated with a combination of antibiotics and anti-inflammatory medications, but it can be hard to treat. Your provider will create a treatment plan based on your specific illness. […] If you’ve 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. […] What medications/treatments are used? Your provider may prescribe: Doxycycline. Hydroxychloroquine. Trimethoprim-sulfamethoxazole (TMP-SMX). Rifampin. Fluoroquinolones (ciprofloxacin, ofloxacin). Clarithromycin. […] Can Q fever be cured? Yes, antibiotics can cure acute Q fever in most people. A small number of people with acute Q fever may have symptoms that last months or years, even with treatment. Chronic Q fever can be harder to cure.
#15 Antimicrobial therapies for Q fever
https://pmc.ncbi.nlm.nih.gov/articles/PMC4608426/
Although doxycycline is effective for Q fever treatment, there are reasons to seek alternative therapies. […] Co-trimoxazole is an alternative antimicrobial that is recommended for children less than 8 years old and for pregnant women diagnosed with Q fever. […] Quinolones, co-trimoxazole, rifampin, and some macrolides are possible alternative drug treatments for Q fever, but none perform as well as doxycycline.
#16 Q Fever: Causes, Symptoms, Diagnosis, Prevention & Treatment
https://my.clevelandclinic.org/health/diseases/17883-q-fever
How is Q fever treated? Acute Q fever is treated with antibiotics. Chronic Q fever is often treated with a combination of antibiotics and anti-inflammatory medications, but it can be hard to treat. Your provider will create a treatment plan based on your specific illness. […] If you’ve 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. […] What medications/treatments are used? Your provider may prescribe: Doxycycline. Hydroxychloroquine. Trimethoprim-sulfamethoxazole (TMP-SMX). Rifampin. Fluoroquinolones (ciprofloxacin, ofloxacin). Clarithromycin. […] Can Q fever be cured? Yes, antibiotics can cure acute Q fever in most people. A small number of people with acute Q fever may have symptoms that last months or years, even with treatment. Chronic Q fever can be harder to cure.
#17 Antimicrobial therapies for Q fever
https://pmc.ncbi.nlm.nih.gov/articles/PMC4608426/
Although doxycycline is effective for Q fever treatment, there are reasons to seek alternative therapies. […] Co-trimoxazole is an alternative antimicrobial that is recommended for children less than 8 years old and for pregnant women diagnosed with Q fever. […] Quinolones, co-trimoxazole, rifampin, and some macrolides are possible alternative drug treatments for Q fever, but none perform as well as doxycycline.
#18 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. […] Doxycycline has been the agent most frequently investigated, and it is the treatment of choice.
#19 Antimicrobial therapies for Q fever
https://pmc.ncbi.nlm.nih.gov/articles/PMC4608426/
The usage of doxycycline plus hydroxychloroquine has reduced the time of treatment in chronic Q fever patients to 18 months for those with native heart valves and 24 months for patients with prosthetic valves. […] Treatment for children with acute Q fever is recommended and current treatment guidelines for children over 8 years old call for a two week treatment of doxycycline at a dose of 2.2 mg/kg twice per day (not to exceed 100 mg per dose). […] For children under 8 years old, treatment with doxycycline raises additional questions because of the perceived risk of dental staining. Therefore for children under 8, a mixture of trimethoprim and sulfamethoxazole at a 1:5 ratio (co-trimoxazole) is recommended by the CDC. […] The current recommendation from the CDC is to treat women with acute Q fever with co-trimoxazole up until the final six weeks of pregnancy, and to give doxycycline and hydroxychloroquine postpartum for 12 months to women that develop a serologic profile of chronic Q fever (Phase 1 IgG titer 1:1024).
#20 Antimicrobial therapies for Q fever
https://pmc.ncbi.nlm.nih.gov/articles/PMC4608426/
The usage of doxycycline plus hydroxychloroquine has reduced the time of treatment in chronic Q fever patients to 18 months for those with native heart valves and 24 months for patients with prosthetic valves. […] Treatment for children with acute Q fever is recommended and current treatment guidelines for children over 8 years old call for a two week treatment of doxycycline at a dose of 2.2 mg/kg twice per day (not to exceed 100 mg per dose). […] For children under 8 years old, treatment with doxycycline raises additional questions because of the perceived risk of dental staining. Therefore for children under 8, a mixture of trimethoprim and sulfamethoxazole at a 1:5 ratio (co-trimoxazole) is recommended by the CDC. […] The current recommendation from the CDC is to treat women with acute Q fever with co-trimoxazole up until the final six weeks of pregnancy, and to give doxycycline and hydroxychloroquine postpartum for 12 months to women that develop a serologic profile of chronic Q fever (Phase 1 IgG titer 1:1024).
#21 Coxiella burnetii Infection (Q Fever) – MD Searchlight
https://mdsearchlight.com/infectious-disease/coxiella-burnetii-infection-q-fever/
If a person shows symptoms or is pregnant and doesn’t show any symptoms, they should receive treatment for acute Q fever. It’s ideal if treatment starts within three days of the symptoms appearing. […] The following treatments are suggested for acute Q fever: Children: a 10 to 14 day course of Doxycycline at 100mg per day, or a treatment of trimethoprim-sulfamethoxazole (TMP-SMX) at 8 to 12 mg per kg each day. Adults: a 14 day course of Doxycycline at 100mg per day (preferred); other options include fluoroquinolones, minocycline, or TMP-SMX. Pregnant women: a treatment of TMP-SMX ranging from 320mg to 1600mg until the 7th month of pregnancy has ended. […] Fluoroquinolones are recommended for Q fever that has spread to the brain and spinal cord, as these can penetrate these areas. For chronic Q fever, doxycycline combined with hydroxychloroquine is given for a minimum of 18 months.
#22 Antimicrobial therapies for Q fever
https://pmc.ncbi.nlm.nih.gov/articles/PMC4608426/
The usage of doxycycline plus hydroxychloroquine has reduced the time of treatment in chronic Q fever patients to 18 months for those with native heart valves and 24 months for patients with prosthetic valves. […] Treatment for children with acute Q fever is recommended and current treatment guidelines for children over 8 years old call for a two week treatment of doxycycline at a dose of 2.2 mg/kg twice per day (not to exceed 100 mg per dose). […] For children under 8 years old, treatment with doxycycline raises additional questions because of the perceived risk of dental staining. Therefore for children under 8, a mixture of trimethoprim and sulfamethoxazole at a 1:5 ratio (co-trimoxazole) is recommended by the CDC. […] The current recommendation from the CDC is to treat women with acute Q fever with co-trimoxazole up until the final six weeks of pregnancy, and to give doxycycline and hydroxychloroquine postpartum for 12 months to women that develop a serologic profile of chronic Q fever (Phase 1 IgG titer 1:1024).
#23
https://www.health.nsw.gov.au/Infectious/controlguideline/Pages/qfever.aspx
Case management: Q fever cases can be treated with appropriate antibiotics. […] 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. […] 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.
#24 Antimicrobial therapies for Q fever
https://pmc.ncbi.nlm.nih.gov/articles/PMC4608426/
The usage of doxycycline plus hydroxychloroquine has reduced the time of treatment in chronic Q fever patients to 18 months for those with native heart valves and 24 months for patients with prosthetic valves. […] Treatment for children with acute Q fever is recommended and current treatment guidelines for children over 8 years old call for a two week treatment of doxycycline at a dose of 2.2 mg/kg twice per day (not to exceed 100 mg per dose). […] For children under 8 years old, treatment with doxycycline raises additional questions because of the perceived risk of dental staining. Therefore for children under 8, a mixture of trimethoprim and sulfamethoxazole at a 1:5 ratio (co-trimoxazole) is recommended by the CDC. […] The current recommendation from the CDC is to treat women with acute Q fever with co-trimoxazole up until the final six weeks of pregnancy, and to give doxycycline and hydroxychloroquine postpartum for 12 months to women that develop a serologic profile of chronic Q fever (Phase 1 IgG titer 1:1024).
#25 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.
#26 Q Fever: Causes, Symptoms, Diagnosis, Prevention & Treatment
https://my.clevelandclinic.org/health/diseases/17883-q-fever
How is Q fever treated? Acute Q fever is treated with antibiotics. Chronic Q fever is often treated with a combination of antibiotics and anti-inflammatory medications, but it can be hard to treat. Your provider will create a treatment plan based on your specific illness. […] If you’ve 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. […] What medications/treatments are used? Your provider may prescribe: Doxycycline. Hydroxychloroquine. Trimethoprim-sulfamethoxazole (TMP-SMX). Rifampin. Fluoroquinolones (ciprofloxacin, ofloxacin). Clarithromycin. […] Can Q fever be cured? Yes, antibiotics can cure acute Q fever in most people. A small number of people with acute Q fever may have symptoms that last months or years, even with treatment. Chronic Q fever can be harder to cure.
#27 Antimicrobial therapies for Q fever
https://pmc.ncbi.nlm.nih.gov/articles/PMC4608426/
Q fever is caused by the bacterium Coxiella burnetii and has both acute and chronic forms. The normal therapy for the acute disease is a two week course of doxycycline, whereas chronic disease requires 18-24 months of doxycycline in combination with hydroxychloroquine. […] Doxycycline has been shown to result in a mean time to defervescence of 2-3 days after the start of treatment, whereas untreated patients resolve the fever after a mean of 12.5 days. […] Recent guidelines for treatment and management of Q fever from the US Centers for Disease Control and Q fever working group recommend a primary treatment for acute Q fever in adults of 100 mg doxycycline twice a day for two weeks. […] Current recommendations for treatment of chronic Q fever are 100 mg doxycycline twice per day combined with hydroxychloroquine three times per day at 200 mg per dose for at least 18 months.
#28 Q Fever: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/227156-overview
Doxycycline is the treatment of choice for acute Q fever, and 2 weeks of treatment is recommended for adults, children aged 8 years or older, and for severe infections in patients of any age. […] Chronic Q fever is difficult to treat, therefore a prolonged antimicrobial regimen is recommended. 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. An alternative option is combination of doxycycline and a fluoroquinolone for at least 3-4 years.
#29 Antimicrobial therapies for Q fever
https://pmc.ncbi.nlm.nih.gov/articles/PMC4608426/
The usage of doxycycline plus hydroxychloroquine has reduced the time of treatment in chronic Q fever patients to 18 months for those with native heart valves and 24 months for patients with prosthetic valves. […] Treatment for children with acute Q fever is recommended and current treatment guidelines for children over 8 years old call for a two week treatment of doxycycline at a dose of 2.2 mg/kg twice per day (not to exceed 100 mg per dose). […] For children under 8 years old, treatment with doxycycline raises additional questions because of the perceived risk of dental staining. Therefore for children under 8, a mixture of trimethoprim and sulfamethoxazole at a 1:5 ratio (co-trimoxazole) is recommended by the CDC. […] The current recommendation from the CDC is to treat women with acute Q fever with co-trimoxazole up until the final six weeks of pregnancy, and to give doxycycline and hydroxychloroquine postpartum for 12 months to women that develop a serologic profile of chronic Q fever (Phase 1 IgG titer 1:1024).
#30 Q Fever – Infectious Diseases – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/infectious-diseases/rickettsiae-and-related-organisms/q-fever
For acute Q fever, primary treatment is doxycycline until the patient improves, has been afebrile for about 5 days, and has received treatment for 14 days; longer treatment may be needed for severe disease. Tetracycline resistance has not been documented. […] For endocarditis, treatment needs to be prolonged (months to years to lifelong), typically for at least 18 months. Doxycycline plus hydroxychloroquine is currently recommended. Owing to the cardiac adverse effects of hydroxychloroquine, patients on this medication should have their QTc interval monitored with repeated ECGs. Clinical signs, erythrocyte sedimentation rate, blood count, and antibody titers should be monitored to help determine when to stop treatment. Consultation with an infectious disease specialist may help with managing the complexities of the disease and its treatment. Frequently, antibiotic treatment is only partially effective, and damaged valves must be replaced surgically, although some cures have occurred without surgery. […] For chronic granulomatous hepatitis, the optimal regimen has not been determined.
#31 Q Fever: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/227156-overview
Doxycycline is the treatment of choice for acute Q fever, and 2 weeks of treatment is recommended for adults, children aged 8 years or older, and for severe infections in patients of any age. […] Chronic Q fever is difficult to treat, therefore a prolonged antimicrobial regimen is recommended. 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. An alternative option is combination of doxycycline and a fluoroquinolone for at least 3-4 years.
#32 Two Regimens in the Treatment of Q Fever Endocarditis | AAFP
https://www.aafp.org/pubs/afp/issues/1999/0701/p281.html
Q fever endocarditis is a serious and often fatal condition caused by the gram-negative bacterium Coxiella burnetii. […] Eradicating C. burnetii is difficult, making Q fever endocarditis fatal in 25 to 60 percent of patients. Combination therapy with tetracycline and a quinolone increases survival, but patients often must take the medication for the rest of their lives. […] Raoult and associates compared the effectiveness of the standard combination therapy with that of doxycycline and hydroxychloroquine to assess whether the latter resulted in a shorter period of treatment. […] The authors conclude that treatment with doxycycline-hydroxychloroquine was more effective and resulted in a shorter duration of treatment than the standard regimen. Doxycycline and ofloxacin should be given for at least four years, whereas doxycycline-hydroxychloroquine requires a period of no less than 18 months but no longer than four years.
#33 Coxiella burnetii – Q fever – Swissticks
https://swissticks.ch/en/pathogens/coxiella-burnetii-q-fever/
Q fever is a disease caused by bacteria. It is a zoonosis. This means that infection in humans usually occurs by the passage of the bacteria from animals to humans. The transmission is done by inhalation of dust or droplets, by ingestion of soiled food or more rarely by tick bite. Symptoms of the acute phase are usually prolonged fever and signs of hepatitis. Some people may develop chronic disease. Endocarditis is one of the most common forms of chronic Q fever. The infection can be treated with antibiotics. Treatment is very long, several months, for the chronic form. […] Acute Q fever is usually treated with 2 weeks of doxycycline while chronic Q fever requires a prolonged treatment of at least 1 year with a dual therapy combining for example doxycycline and hydroxychloroquine. Note that in this duo, only doxycycline has a real antibacterial effect, hydroxychloroquine being added only to increase the pH of the vacuole containing Coxiella (a phagolysosome). This increases the efficacy of doxycyline which is not very active at acidic pH. These drugs must be dosed regularly to ensure that therapeutic doses are below the toxicity threshold; the indication for this prolonged treatment should be the subject of a specialized consultation with an infectious disease specialist.
#34 Treatment of persistent focalized Q fever: time has come for an international randomized controlled trial – PubMed
https://pubmed.ncbi.nlm.nih.gov/38888195/
Q fever is a worldwide zoonosis due to Coxiella burnetii, responsible for endocarditis and endovascular infections. Since the 1990s, the combination hydroxychloroquine + doxycycline has constituted the curative and prophylactic treatment in persistent focalized Q fever. This combination appears to have significantly reduced the treatment’s duration (from 60 to 26 months), yet substantial evidence of effectiveness remains lacking. […] The main studies supporting this treatment are retrospective cohorts, dating back to the 1990s-2000s. Retrospective studies from the large Dutch outbreak of Q fever (4000 cases between 2007 and 2010) did not corroborate a clear benefit of this combination, notably in comparison with other regimens. Thus, there is still no consensus among the medical community on this issue. However insufficient the evidence, today the doxycycline + hydroxychloroquine combination remains the regimen with the largest clinical experience in the treatment of 'chronic’ Q fever. […] We herein propose the creation of an extensive international registry, followed by a prospective cohort or ideally a randomized controlled trial.
#35 Q Fever: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/227156-overview
Doxycycline is the treatment of choice for acute Q fever, and 2 weeks of treatment is recommended for adults, children aged 8 years or older, and for severe infections in patients of any age. […] Chronic Q fever is difficult to treat, therefore a prolonged antimicrobial regimen is recommended. 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. An alternative option is combination of doxycycline and a fluoroquinolone for at least 3-4 years.
#36 SciELO Brazil – Overview of Q fever in Brazil: an underestimated zoonosis Overview of Q fever in Brazil: an underestimated zoonosis
https://www.scielo.br/j/rimtsp/a/TLHJX3cK9dKqwyQyNFRYRcR/
The treatment of acute infection is very important to prevent the development of endovascular disease, even in patients with previous cardiac disease. As mentioned previously, there is a discussion about the association of hydroxychloroquine and doxycycline for the treatment of persistent Q fever, however, only treating with doxycycline, 200 mg daily, depending on the specificity of the patient, is currently the safest alternative for this condition. Associated with antibiotic therapy, the surgical procedure directed to the affected valves is necessary. […] Due to their ability to cross the blood-brain barrier, fluoroquinolones are recommended for patients with neurological signs. […] Pregnant women should undergo combination therapy with trimethoprim and sulfamethoxazole as soon as possible. In addition, a study confirmed that prolonged treatment of these women for more than five months could prevent complications during pregnancy.
#37 Q Fever – Infectious Diseases – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/infectious-diseases/rickettsiae-and-related-organisms/q-fever
For acute Q fever, primary treatment is doxycycline until the patient improves, has been afebrile for about 5 days, and has received treatment for 14 days; longer treatment may be needed for severe disease. Tetracycline resistance has not been documented. […] For endocarditis, treatment needs to be prolonged (months to years to lifelong), typically for at least 18 months. Doxycycline plus hydroxychloroquine is currently recommended. Owing to the cardiac adverse effects of hydroxychloroquine, patients on this medication should have their QTc interval monitored with repeated ECGs. Clinical signs, erythrocyte sedimentation rate, blood count, and antibody titers should be monitored to help determine when to stop treatment. Consultation with an infectious disease specialist may help with managing the complexities of the disease and its treatment. Frequently, antibiotic treatment is only partially effective, and damaged valves must be replaced surgically, although some cures have occurred without surgery. […] For chronic granulomatous hepatitis, the optimal regimen has not been determined.
#38 Q-Fever – NYC Health
https://www.nyc.gov/site/doh/health/health-topics/q-fever.page
Q fever typically is treated with a common antibiotic. Treatment is most effective when started within the first three days of illness. […] Complications related to chronic Q fever (such as damaged heart valves) are much more difficult to treat effectively and often require the use of more than one drug. Surgery to replace damaged heart valves may be required in some cases.
#39 Q Fever – Infectious Diseases – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/infectious-diseases/rickettsiae-and-related-organisms/q-fever
For acute Q fever, primary treatment is doxycycline until the patient improves, has been afebrile for about 5 days, and has received treatment for 14 days; longer treatment may be needed for severe disease. Tetracycline resistance has not been documented. […] For endocarditis, treatment needs to be prolonged (months to years to lifelong), typically for at least 18 months. Doxycycline plus hydroxychloroquine is currently recommended. Owing to the cardiac adverse effects of hydroxychloroquine, patients on this medication should have their QTc interval monitored with repeated ECGs. Clinical signs, erythrocyte sedimentation rate, blood count, and antibody titers should be monitored to help determine when to stop treatment. Consultation with an infectious disease specialist may help with managing the complexities of the disease and its treatment. Frequently, antibiotic treatment is only partially effective, and damaged valves must be replaced surgically, although some cures have occurred without surgery. […] For chronic granulomatous hepatitis, the optimal regimen has not been determined.
#40 Q Fever – Infectious Diseases – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/infectious-diseases/rickettsiae-and-related-organisms/q-fever
For acute Q fever, primary treatment is doxycycline until the patient improves, has been afebrile for about 5 days, and has received treatment for 14 days; longer treatment may be needed for severe disease. Tetracycline resistance has not been documented. […] For endocarditis, treatment needs to be prolonged (months to years to lifelong), typically for at least 18 months. Doxycycline plus hydroxychloroquine is currently recommended. Owing to the cardiac adverse effects of hydroxychloroquine, patients on this medication should have their QTc interval monitored with repeated ECGs. Clinical signs, erythrocyte sedimentation rate, blood count, and antibody titers should be monitored to help determine when to stop treatment. Consultation with an infectious disease specialist may help with managing the complexities of the disease and its treatment. Frequently, antibiotic treatment is only partially effective, and damaged valves must be replaced surgically, although some cures have occurred without surgery. […] For chronic granulomatous hepatitis, the optimal regimen has not been determined.
#41 Q Fever Treatment & Management: Approach Considerations, Management of Acute Q Fever, Management of Chronic Q Fever
https://emedicine.medscape.com/article/227156-treatment
Fluoroquinolones can be used as alternative antibiotic agents. Ofloxacin and pefloxacin have been used with success in patients. […] 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. […] 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. […] Endovascular complications should be treated with doxycycline and hydroxychloroquine in combination, although the optimal regimen is not well defined. […] Adjuvant corticosteroid treatment has been used in antimicrobial-nonresponsive hepatitis.
#42 Q Fever Treatment & Management: Approach Considerations, Management of Acute Q Fever, Management of Chronic Q Fever
https://emedicine.medscape.com/article/227156-treatment
Fluoroquinolones can be used as alternative antibiotic agents. Ofloxacin and pefloxacin have been used with success in patients. […] 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. […] 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. […] Endovascular complications should be treated with doxycycline and hydroxychloroquine in combination, although the optimal regimen is not well defined. […] Adjuvant corticosteroid treatment has been used in antimicrobial-nonresponsive hepatitis.
#43 Coxiella burnetii infection – Symptoms, diagnosis and treatment | BMJ Best Practice
https://bestpractice.bmj.com/topics/en-gb/1139
Acute infection can be treated with a short course of doxycycline, but persistent focalised infections require long-term therapy with doxycycline plus hydroxychloroquine. […] Surgical resection of infected vascular tissue or prosthetic material may also be required.
#44 Q Fever – Infectious Diseases – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/infectious-diseases/rickettsiae-and-related-organisms/q-fever
For acute Q fever, primary treatment is doxycycline until the patient improves, has been afebrile for about 5 days, and has received treatment for 14 days; longer treatment may be needed for severe disease. Tetracycline resistance has not been documented. […] For endocarditis, treatment needs to be prolonged (months to years to lifelong), typically for at least 18 months. Doxycycline plus hydroxychloroquine is currently recommended. Owing to the cardiac adverse effects of hydroxychloroquine, patients on this medication should have their QTc interval monitored with repeated ECGs. Clinical signs, erythrocyte sedimentation rate, blood count, and antibody titers should be monitored to help determine when to stop treatment. Consultation with an infectious disease specialist may help with managing the complexities of the disease and its treatment. Frequently, antibiotic treatment is only partially effective, and damaged valves must be replaced surgically, although some cures have occurred without surgery. […] For chronic granulomatous hepatitis, the optimal regimen has not been determined.
#45 Q Fever – Infectious Diseases – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/infectious-diseases/rickettsiae-and-related-organisms/q-fever
For acute Q fever, primary treatment is doxycycline until the patient improves, has been afebrile for about 5 days, and has received treatment for 14 days; longer treatment may be needed for severe disease. Tetracycline resistance has not been documented. […] For endocarditis, treatment needs to be prolonged (months to years to lifelong), typically for at least 18 months. Doxycycline plus hydroxychloroquine is currently recommended. Owing to the cardiac adverse effects of hydroxychloroquine, patients on this medication should have their QTc interval monitored with repeated ECGs. Clinical signs, erythrocyte sedimentation rate, blood count, and antibody titers should be monitored to help determine when to stop treatment. Consultation with an infectious disease specialist may help with managing the complexities of the disease and its treatment. Frequently, antibiotic treatment is only partially effective, and damaged valves must be replaced surgically, although some cures have occurred without surgery. […] For chronic granulomatous hepatitis, the optimal regimen has not been determined.
#46 Coxiella burnetii – Q fever – Swissticks
https://swissticks.ch/en/pathogens/coxiella-burnetii-q-fever/
Q fever is a disease caused by bacteria. It is a zoonosis. This means that infection in humans usually occurs by the passage of the bacteria from animals to humans. The transmission is done by inhalation of dust or droplets, by ingestion of soiled food or more rarely by tick bite. Symptoms of the acute phase are usually prolonged fever and signs of hepatitis. Some people may develop chronic disease. Endocarditis is one of the most common forms of chronic Q fever. The infection can be treated with antibiotics. Treatment is very long, several months, for the chronic form. […] Acute Q fever is usually treated with 2 weeks of doxycycline while chronic Q fever requires a prolonged treatment of at least 1 year with a dual therapy combining for example doxycycline and hydroxychloroquine. Note that in this duo, only doxycycline has a real antibacterial effect, hydroxychloroquine being added only to increase the pH of the vacuole containing Coxiella (a phagolysosome). This increases the efficacy of doxycyline which is not very active at acidic pH. These drugs must be dosed regularly to ensure that therapeutic doses are below the toxicity threshold; the indication for this prolonged treatment should be the subject of a specialized consultation with an infectious disease specialist.
#47 How Is Q Fever Transmitted? Causes, Symptoms, Treatment, and More
https://www.webmd.com/a-to-z-guides/what-is-q-fever
The standard Q fever treatment is the antibiotic doxycycline (Vibramycin). The duration of the treatment depends on the type of Q fever you have. For mild Q fever, the antibiotic treatment goes for two to three weeks, though this type of Q fever often gets better with no treatment. […] In the case of chronic Q fever, the treatment duration can extend to 18 months or more. People with chronic Q fever have to take a combination of antibiotics. […] Even after the chronic Q fever treatment, your doctor will ask you to visit for follow-up tests. These visits continue for years in case the infection recurs. […] If antibiotics don’t work, the doctor prescribes anti-inflammatory drugs to people with Q fever. The commonly-used medicine is hydroxychloroquine (Plaquenil). […] If the Q fever causes endocarditis, you may have to undergo surgery to replace damaged heart valves.
#48
https://www.health.nsw.gov.au/Infectious/controlguideline/Pages/qfever.aspx
Case management: Q fever cases can be treated with appropriate antibiotics. […] 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. […] 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.
#49 The Qure study: Q fever fatigue syndrome â response to treatment; a randomized placebo-controlled trial | BMC Infectious Diseases | Full Text
https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-13-157
Q fever fatigue syndrome (QFS) is characterized by persistent fatigue following an acute Q fever infection, leading to substantial morbidity and a high socio-economic burden. […] However, a treatment with proven efficacy is not available. Only a few uncontrolled studies have tested the efficacy of treatment with antibiotics on QFS. […] Cognitive behavioral therapy (CBT) has been proven to be an effective treatment modality for chronic fatigue in other diseases, but has not yet been tested in QFS. […] The Qure study is the first randomized placebo-controlled trial, which evaluates the efficacy of long-term doxycycline and of cognitive behavioral therapy in patients with QFS. […] The primary aim of our study is to determine the effect of different treatment modalities which have been suggested to be effective for patients with QFS.
#50 The Qure study: Q fever fatigue syndrome â response to treatment; a randomized placebo-controlled trial | BMC Infectious Diseases | Full Text
https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-13-157
Q fever fatigue syndrome (QFS) is characterized by persistent fatigue following an acute Q fever infection, leading to substantial morbidity and a high socio-economic burden. […] However, a treatment with proven efficacy is not available. Only a few uncontrolled studies have tested the efficacy of treatment with antibiotics on QFS. […] Cognitive behavioral therapy (CBT) has been proven to be an effective treatment modality for chronic fatigue in other diseases, but has not yet been tested in QFS. […] The Qure study is the first randomized placebo-controlled trial, which evaluates the efficacy of long-term doxycycline and of cognitive behavioral therapy in patients with QFS. […] The primary aim of our study is to determine the effect of different treatment modalities which have been suggested to be effective for patients with QFS.
#51 The Qure study: Q fever fatigue syndrome â response to treatment; a randomized placebo-controlled trial | BMC Infectious Diseases | Full Text
https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-13-157
A randomized placebo-controlled trial (RCT), the Qure study, will be performed to determine whether long-term treatment with doxycycline or CBT will lead to a reduction of fatigue and disabilities in patients with QFS. […] Both treatment modalities will be compared to a placebo group. […] Participants allocated to study medication will be treated at the Q fever outpatient clinic. Participants will receive either doxycycline (200 mg once daily) or placebo (once daily), both orally administered, for a period of 24 weeks. […] CBT for QFS is aimed at changing the beliefs and behaviors assumed to maintain fatigue. […] The Qure study will be the first randomized placebo-controlled clinical trial to assess the efficacy of long-term treatment with doxycycline and CBT in adult patients with QFS. […] If an effective treatment modality for QFS will be found, significant benefit can be achieved in quality of life, efficiency in treatment and cost-effectiveness.
#52 Q Fever Symptoms & Effective Management Tips
https://www.rupahealth.com/post/q-fever-symptoms-effective-management-tips
A serious complication of chronic Q fever is infective endocarditis. Patients with pre-existing heart disease or prosthetic heart valves are at an increased risk. Treatment typically consists of long-term antibiotic therapy (Doxycycline + Hydroxychloroquine) for at least 18 months. […] Some patients experience chronic fatigue and neurological symptoms, even after successful antibiotic treatment; this is known as Post-Q Fever Fatigue Syndrome (QFS). Management strategies include gradual exercise programs to rebuild stamina, nutritional support (anti-inflammatory diet), cognitive behavioral therapy (CBT) for mental health support, and vitamin and mineral supplementation. […] Q fever can also cause hepatitis (liver inflammation) and lung complications like pneumonia. In these cases, routine liver enzyme monitoring is recommended, and if pneumonia develops, hospitalization may be required for oxygen therapy.
#53 Q fever: A rural disease with potential urban consequences
https://www1.racgp.org.au/ajgp/2018/march/q-fever
Q fever, originally known as query fever, is a zoonotic disease caused by the Gram-negative, intracellular bacterium Coxiella burnetii. An effective vaccine is available for adults (aged 15 years), but can only be administered after a rigorous pre-vaccination assessment to exclude prior exposure to Coxiella burnetii, requiring a detailed medical history, skin test and serology. Doxycycline 100 mg twice daily for 14 days is recommended for adults. Chronic Q fever requires long-term antimicrobial treatment and specialist input. Treatment of post-Q fever fatigue syndrome is very challenging, and psychologist involvement, along with gentle, supervised exercises, may offer some relief to the patient. Vaccination is recommended for all people who are likely to be exposed to C. burnetii as assessed from their environmental, activity or occupational risk. The vaccination is safe and effective if used as recommended; local tenderness and erythema are common, and serious adverse events are rare.
#54 Q Fever: Causes, Symptoms, Diagnosis, Prevention & Treatment
https://my.clevelandclinic.org/health/diseases/17883-q-fever
How is Q fever treated? Acute Q fever is treated with antibiotics. Chronic Q fever is often treated with a combination of antibiotics and anti-inflammatory medications, but it can be hard to treat. Your provider will create a treatment plan based on your specific illness. […] If you’ve 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. […] What medications/treatments are used? Your provider may prescribe: Doxycycline. Hydroxychloroquine. Trimethoprim-sulfamethoxazole (TMP-SMX). Rifampin. Fluoroquinolones (ciprofloxacin, ofloxacin). Clarithromycin. […] Can Q fever be cured? Yes, antibiotics can cure acute Q fever in most people. A small number of people with acute Q fever may have symptoms that last months or years, even with treatment. Chronic Q fever can be harder to cure.
#55 Antibiotic therapy as prevention and treatment of Q fever – WRAP: Warwick Research Archive Portal
https://wrap.warwick.ac.uk/id/eprint/146289/
Q fever is caused by the intracellular Gram-negative bacterium, Coxiella burnetii. Novel in vitro and in vivo experiments were conducted to evaluate the efficacy of a range of antibiotics readily accessible to the military against C. burnetii. The benefit of using doxycycline, levofloxacin, ciprofloxacin and co-trimoxazole as chemoprophylaxis and treatment were assessed in two in vivo models of infection. […] The results suggest that antibiotic initiation around the time of symptom onset following exposure to C. burnetii provides the optimum outcome in the AJ mouse model. […] In conclusion, the studies conducted suggest that to improve the clinical outcome for future Q fever patients, timely diagnosis and early treatment at the point of symptom onset needs to be achieved. It is suggested that this will reduce symptom duration, disease severity and the likelihood of developing long term fatigue.
#56 Q fever – including symptoms, treatment and prevention | SA Health
https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/conditions/infectious+diseases/q+fever/q+fever+including+symptoms+treatment+and+prevention
Effective antibiotic therapy is available. With early diagnosis, treatment is simple and a good outcome can be expected. […] A Q fever vaccine is available in Australia and is 83 to 100% effective in preventing the disease. However, the vaccine can only be given to individuals 15 years of age and over.
#57 Q fever: A rural disease with potential urban consequences
https://www1.racgp.org.au/ajgp/2018/march/q-fever
Q fever, originally known as query fever, is a zoonotic disease caused by the Gram-negative, intracellular bacterium Coxiella burnetii. An effective vaccine is available for adults (aged 15 years), but can only be administered after a rigorous pre-vaccination assessment to exclude prior exposure to Coxiella burnetii, requiring a detailed medical history, skin test and serology. Doxycycline 100 mg twice daily for 14 days is recommended for adults. Chronic Q fever requires long-term antimicrobial treatment and specialist input. Treatment of post-Q fever fatigue syndrome is very challenging, and psychologist involvement, along with gentle, supervised exercises, may offer some relief to the patient. Vaccination is recommended for all people who are likely to be exposed to C. burnetii as assessed from their environmental, activity or occupational risk. The vaccination is safe and effective if used as recommended; local tenderness and erythema are common, and serious adverse events are rare.
#58 Q fever: A rural disease with potential urban consequences
https://www1.racgp.org.au/ajgp/2018/march/q-fever
Q fever, originally known as query fever, is a zoonotic disease caused by the Gram-negative, intracellular bacterium Coxiella burnetii. An effective vaccine is available for adults (aged 15 years), but can only be administered after a rigorous pre-vaccination assessment to exclude prior exposure to Coxiella burnetii, requiring a detailed medical history, skin test and serology. Doxycycline 100 mg twice daily for 14 days is recommended for adults. Chronic Q fever requires long-term antimicrobial treatment and specialist input. Treatment of post-Q fever fatigue syndrome is very challenging, and psychologist involvement, along with gentle, supervised exercises, may offer some relief to the patient. Vaccination is recommended for all people who are likely to be exposed to C. burnetii as assessed from their environmental, activity or occupational risk. The vaccination is safe and effective if used as recommended; local tenderness and erythema are common, and serious adverse events are rare.
#59
https://www.health.nsw.gov.au/Infectious/controlguideline/Pages/qfever.aspx
Case management: Q fever cases can be treated with appropriate antibiotics. […] 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. […] 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.
#60 Q Fever – Infectious Diseases – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/infectious-diseases/rickettsiae-and-related-organisms/q-fever
For acute Q fever, primary treatment is doxycycline until the patient improves, has been afebrile for about 5 days, and has received treatment for 14 days; longer treatment may be needed for severe disease. Tetracycline resistance has not been documented. […] For endocarditis, treatment needs to be prolonged (months to years to lifelong), typically for at least 18 months. Doxycycline plus hydroxychloroquine is currently recommended. Owing to the cardiac adverse effects of hydroxychloroquine, patients on this medication should have their QTc interval monitored with repeated ECGs. Clinical signs, erythrocyte sedimentation rate, blood count, and antibody titers should be monitored to help determine when to stop treatment. Consultation with an infectious disease specialist may help with managing the complexities of the disease and its treatment. Frequently, antibiotic treatment is only partially effective, and damaged valves must be replaced surgically, although some cures have occurred without surgery. […] For chronic granulomatous hepatitis, the optimal regimen has not been determined.
#61 Antibiotic therapy as prevention and treatment of Q fever – WRAP: Warwick Research Archive Portal
https://wrap.warwick.ac.uk/id/eprint/146289/
Q fever is caused by the intracellular Gram-negative bacterium, Coxiella burnetii. Novel in vitro and in vivo experiments were conducted to evaluate the efficacy of a range of antibiotics readily accessible to the military against C. burnetii. The benefit of using doxycycline, levofloxacin, ciprofloxacin and co-trimoxazole as chemoprophylaxis and treatment were assessed in two in vivo models of infection. […] The results suggest that antibiotic initiation around the time of symptom onset following exposure to C. burnetii provides the optimum outcome in the AJ mouse model. […] In conclusion, the studies conducted suggest that to improve the clinical outcome for future Q fever patients, timely diagnosis and early treatment at the point of symptom onset needs to be achieved. It is suggested that this will reduce symptom duration, disease severity and the likelihood of developing long term fatigue.