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Clinical research and prevention

Q fever treatment

Updated: 08/04/2016

Q Fever: Diagnostic criteria and treatment protocols.

 

 

I- Q fever diagnostic criteria – Primary infection.

 

Criteria

Diagnostic

Fever, hepatitis and/or pneumonia with microbiological criteria (Phase II IgG ≥ 200 and phase II IgM ≥50, seroconversion, or a positive PCR on blood/serum and no endocarditis)

Duration of symptoms < 3 months after symptoms onset or seroconversion  

Acute Q Fever

History of rheumatic fever, bicuspid aortic valve, congenital heart disease, prosthetic heart valves, valve regurgitation or stenosis ≥ grade II, mitral valve prolapse

Significant valvulopathy

Transplant patient, chemotherapy, HIV with < 200 CD4, hematologic malignancies, corticosteroid therapy

Severe immunodeficiency

Asymptomatic pregnant woman with Phase II IgG ≥ 200 AND IgM ≥ 50

Coxiella burnetii asymptomatic primary infection during pregnancy

 

 

II- Diagnostic criteria Q fever – Endocarditis.

 

 

 

Criteria

                              Diagnostic

Possible or definite endocarditis on prosthetic heart valve, Bentall surgery or Pacemaker

Possible or definite foreign body-related Q fever endocarditis

 

 

III- Diagnostic criteria Q fever – Vascular infection.

 

 

Criteria

Diagnostic

Possible or definite vascular infection on vascular prosthesis

Possible or definite foreign-body related Q fever vascular infection

 

 

IV- Diagnostic criteria Q fever – Prosthetic joint infection.

 

 

 

V- Diagnostic criteria Q fever – Others situation.

 

Others cases

Management

Symptoms of acute Q fever with negative serology

No evidence of Coxiella burnetii infection

Control serology at Day 15, Day 30 and Day 45

No therapeutic advice

For all other cases

Contact National Reference Center for expert opinion

 

 

Acute Q fever treatment recommendations.

 

Diagnostic

Treatment (D: doxycycline, P: Plaquenil, B: Bactrim)

P1A0: Acute Q fever without valvulopathy with spontaneous apyrexy

No treatment

P1A1: Febrile acute Q fever

D 21 days

P1APL: Acute Q fever with high levels of antiphospholipid antibodies (IgG anti-cardiolipin antibodies (IgG aCL) ≥ 75 GPLU)

DP until IgG aCL < 75 GPLU

P1B: Acute Q fever with significant valvulopathy*

DP 12 months

P1C: Acute Q fever in a patient with severe immunodeficiency **

D during immunodeficiency

 

*History of rheumatic fever, bicuspid aortic valve, congenital heart disease, prosthetic heart valves, valve regurgitation or stenosis ≥ grade II, mitral valve prolapse.

**Transplant patient, chemotherapy, HIV with < 200 CD4+ T cells, hematologic malignancy, corticosteroid therapy.

 

 

Q  Fever Endocarditis and vascular infection treatment recommendations.

 

Diagnostic

Treatment (D: doxycycline, P: Plaquenil, B: Bactrim)

P2A: Possible or definite endocarditis without intracardiac prosthetic material

DP 18 months

No infective recommendation for surgery

If a non-urgent surgery is required, wait 3 weeks of treatment

P2B:  Possible or definite foreign body-related Q fever endocarditis

DP 24 months

No infective recommendation for surgery*
If a non-urgent surgery is required, wait 3 weeks of treatment

P2ID: Possible or definite endocarditis with severe immunodeficiency**

D alone during immunodeficiency (minimal duration of 18 months if native valve and 24 months if foreign-body related endocarditis)

P3A: Vascular infection without vascular prosthetic material

DP 18 months

Systematic surgery to remove infected vascular tissue after 1 month of treatment

P3B: Vascular infection with vascular prosthetic material

DP 24 months

Systematic surgical remove of infected material after one month of treatment

 

*If there is a Pacemaker, a F18 FDG PET-CT scan (PET-CT) is recommended. If PET-CT shows high FDG uptake on pace maker, change the pacemaker pocket after one month of treatment.

If PET-CT shows high FDG uptake on intracavitary leads, no immediate removal; control PET-CT after 2 months of treatment. Expert opinion is necessary if high FDG uptake persists on PET-CT.

**Transplant patient, chemotherapy, HIV with < 200 CD4+ T cells, hematologic malignancy, corticosteroid therapy.

 

 

Treatment recommendations for Q Fever  infection during pregnancy .

 

Diagnostic

Treatment (D: doxycycline, P: Plaquenil, B: Bactrim)

P4: Infection during pregnancy

(Symptomatic Acute Q fever)

OR

 Serology with phase II IgG ≥ 200 and

 IgM ≥50)

Bactrim double strength (DS) 2/day until the end of the 8th month of pregnancy

After delivery: evaluation of the mother

-       If possible or definite endocarditis, P2A or P2B protocol

-       If there is no endocarditis but Phase I IgG ≥ 800, control serology, no treatment

-       Avoid breastfeeding

For all the other cases

Contact National Reference Center for expert opinion

 

Diagnostic criteria Q fever – Others situation.

 

Diagnostic

Treatment (D: doxycycline, P: Plaquenil, B: Bactrim)

For all the other cases

Call National Reference Center for opinion of the experts

 

 

Contact for French National referral center for Q Fever

 

Tel: +33 4 91 38 55 17

Fax: +33 4 91 38 77 72

E-mail: didier.raoult@gmail.com or matthieumillion@gmail.com

 

 

VII- References

 

 

  1. Eldin C., et al. Treatment and Prophylactic Strategy for Coxiella burnetii Infection of Aneurysms and Vascular Grafts: A Retrospective Cohort Study. Medicine (Baltimore). 2016 Mar; 95(12):e2810.
  2. Million M., et al. Antiphospholipid Antibody Syndrome With Valvular Vegetations in Acute Q Fever. Clin Infect Dis. 2016 Mar 1; 62(5):537-44.
  3. Million M., et al. Culture-negative prosthetic joint arthritis related to Coxiella burnetii. Am J Med. 2014 Aug; 127(8):786.e7-786.e10.
  4. Million M., et al. Immunoglobulin G anticardiolipin antibodies and progression to Q fever endocarditis. Clin Infect Dis. 2013 Jul; 57(1):57-64.
  5. Million M., et al. Evolution from acute Q fever to endocarditis is associated with underlying valvulopathy and age and can be prevented by prolonged antibiotic treatment. Clin Infect Dis. 2013 Sep; 57(6):836-44.
  6. Million M., et al. long-term outcome of Q fever endocarditis: a 26-year personal survey. Lancet Infect Dis. 2010 Aug; 10(8):527-35.
  7. Raoult D., J Infect. 2012 Aug;65(2):102-8, Chronic Q fever: Expert opinion versus literature analysis and consensus

 


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