eMedicine Specialties > Infectious Diseases > Bacterial Infections

Q Fever: Follow-up

Author: Alexandre Lacasse, MD, MSc, Fellow in Infectious Diseases, University of Tennessee at Memphis
Coauthor(s): Kerry O Cleveland, MD, Associate Professor of Medicine, University of Tennessee College of Medicine; Consulting Staff, Department of Internal Medicine, Division of Infectious Diseases, Methodist Healthcare of Memphis; Hari Polenakovik, MD, Consultant Physician in Infectious Diseases and General Medicine, Department of Medicine, Western Health, Australia; Annie Ruest, MD, FRCPC, Consultant Physician in Infectious Diseases and Medical Microbiology, Departments of Medicine and Medical Biology, Laval University, Quebec City, Canada; Christian P Sinave, MD, Associate Professor, Department of Medical Microbiology and Infectious Diseases, University of Sherbrooke, Canada
Contributor Information and Disclosures

Updated: Nov 18, 2008

Follow-up

Further Outpatient Care

  • Acute Q fever
    • Baseline transthoracic echocardiography should be performed to assess for vegetations.3
    • Follow-up serology should be performed at least twice over 6 months. If phase I IgG antibodies are found in titers of 1:800 or more, transesophageal echocardiography should be performed along with serum PCR measurements, when possible.3
  • Chronic Q fever
    • Monthly follow-up serology and clinical assessment are recommended during antimicrobial therapy and for the first 6 months following withdrawal, then every 6 months for 2 years, and possibly yearly thereafter.
    • Phase I IgG titers of 1:200 or less are the best predictor of cure.
    • Perform echocardiography every 3 months during antimicrobial therapy and every 6 months for the first 2 years following drug withdrawal.
    • High-risk populations should be screened for glucose-6-phosphate dehydrogenase deficiency before receiving hydroxychloroquine.
    • If hydroxychloroquine is used, a yearly ophthalmologic evaluation is required to rule out retinal toxicity.
    • Patients should be reminded of photosensitivity risk while on doxycycline therapy.

Deterrence/Prevention

  • Vaccine prophylaxis9,1,5
    • Vaccine is primarily used in at-risk people, such as veterinarians, abattoir workers, farmers, or others in occupations that require close contact with animals.
    • A whole-cell killed vaccine (Q-Vax) has been licensed in Australia since 1989. Prevaccination screening is essential and includes history, skin testing, and serology, usually by indirect immunofluorescence. All 3 components must be negative before vaccine administration. Occasionally, large local reactions are reported.
    • Acellular vaccines include a trichloroacetic extracted vaccine (Chemovaccine) from the former Czechoslovakia and a chloroform-methanol residue vaccine (CMR) from the United States. They have been promoted to be as effective as Q-Vax, but with fewer side effects. Phase I human trials using CMR proved that vaccination was safe. Although its efficacy has been demonstrated in rodents, sheep, and nonhuman primates, human data are lacking.
    • No vaccine is available for children.
  • Avoid ingestion of raw milk and exposure to animal birth products (eg, placenta), especially in the setting of immunosuppression, pregnancy, or known valvular heart disease.
  • C burnetii must be cultured in biosafety level 3 laboratories.

Complications

  • Chronic fatigue syndrome has been reported as a complication of acute Q fever.
  • Chronic Q fever endocarditis can lead to severe heart failure.
  • Reactivation of Q fever has been reported during pregnancy.

Prognosis

  • Acute Q fever is a self-limited disease.
  • Chronic Q fever carries mortality rates that can exceed 60%. Frequent relapses (50%) are observed despite adequate therapy.

Miscellaneous

Medicolegal Pitfalls

  • Failure to obtain a specific serology in patients presenting with culture-negative endocarditis
  • Failure to recognize specific host risk factors in patients with classic Q fever clinical presentations
 


More on Q Fever

Overview: Q Fever
Differential Diagnoses & Workup: Q Fever
Treatment & Medication: Q Fever
Follow-up: Q Fever
References
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References

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Further Reading

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Keywords

Q fever, query fever, Coxiella burnetii, C burnetii, Rickettsia burnetii, R burnetii, Rickettsia diaporica, R diaporica, zoonosis, zoonotic transmission, farm animals, livestock, bacterial infection, farm infection, chronic Q fever, chronic fatigue syndrome

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Contributor Information and Disclosures

Author

Alexandre Lacasse, MD, MSc, Fellow in Infectious Diseases, University of Tennessee at Memphis
Alexandre Lacasse, MD, MSc is a member of the following medical societies: American College of Physicians, American Medical Association, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Coauthor(s)

Kerry O Cleveland, MD, Associate Professor of Medicine, University of Tennessee College of Medicine; Consulting Staff, Department of Internal Medicine, Division of Infectious Diseases, Methodist Healthcare of Memphis
Kerry O Cleveland, MD is a member of the following medical societies: American College of Physicians, American Medical Association, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America
Disclosure: Nothing to disclose.

Hari Polenakovik, MD, Consultant Physician in Infectious Diseases and General Medicine, Department of Medicine, Western Health, Australia
Hari Polenakovik, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Annie Ruest, MD, FRCPC, Consultant Physician in Infectious Diseases and Medical Microbiology, Departments of Medicine and Medical Biology, Laval University, Quebec City, Canada
Annie Ruest, MD, FRCPC is a member of the following medical societies: Canadian Infectious Disease Society and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Christian P Sinave, MD, Associate Professor, Department of Medical Microbiology and Infectious Diseases, University of Sherbrooke, Canada
Christian P Sinave, MD is a member of the following medical societies: American Society for Microbiology and Canadian Infectious Disease Society
Disclosure: Nothing to disclose.

Medical Editor

John M Leedom, MD, Professor of Medicine, Keck School of Medicine, University of Southern California; Chief, Division of Infectious Diseases, Department of Internal Medicine, Los Angeles County, University of Southern California Medical Center
John M Leedom, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Joseph F John Jr, MD, FACP, FIDSA, FSHEA, Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center
Disclosure: BioMerieux Honoraria Review panel membership; Cubist Honoraria Review panel membership; Pfizer Honoraria Speaking and teaching; Merck Stock dividends stock holdings

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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