Management of Q fever complicated by lack of clinical guidelines
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Key takeaways:
- Over a 10-year period, 31 adult patients were identified as having Q fever at Mayo Clinic.
- Patients presented with a variety of symptoms, with many receiving antibiotic prophylaxis based on varying indications.
Experts say that the management of Q fever, a zoonotic disease caused by Coxiella burnetii, is complicated by the lack of clinical guidance on screening protocols, treatment regimens and durations.
“Identifying and treating patients with acute Q fever who are at an increased risk of progressing to persistent disease is crucial for preventing disease progression and future complications,” Said El Zein, MD, an infectious disease fellow at Mayo Clinic, told Healio. “Nonetheless, ambiguities surround the choice of diagnostic tests for patient risk stratification and the determination of specific host conditions that constitute a high risk for disease progression.”
El Zein added, “Our study describes our decade-long experience with acute Q fever infections, highlighting the challenges faced by clinicians from initial diagnosis and risk stratification to determining the appropriate prophylaxis regimen and duration.”
El Zein and colleagues gathered and assessed medical records of adult patients at the Mayo Clinic with positive Coxiella burnetii serologies between Jan. 1, 2012, and March 31, 2022. They then conducted further analyses of patients with Q fever.
The researchers identified a total of 31 patients with Q fever over the 10-year study period. Among these patients, acute hepatitis (29%), influenza-like illness (25.8%) and pneumonia (16%) were the most common presentations, though one patient was diagnosed with acute Q fever endocarditis.
Of the 31 patients, 13 (42%) were given antibiotic prophylaxis. The decision to administer antibiotics “varied significantly” across physicians with variation in indications and duration, the researchers wrote.
Physicians did, however, predominantly prescribe a combination of doxycycline and hydroxychloroquine (n = 9), though doxycycline monotherapy and doxycycline with rifampin were also used. The median duration of prophylaxis was 333 days (interquartile range = 168-414 days).
“Diagnosing acute Q fever can be challenging due to non-specific clinical presentations, and this disease should be considered in the differential diagnosis for patients with exposure risk factors,” El Zein said. “There is a critical need for randomized controlled trials to standardize factors considered ‘high risk’ for disease progression, as well as to establish screening protocols, treatment regimens and durations.”
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