[Acute Q Fever in Patients with Risk Factors for a Focalized Persistent Infection - Can Prolonged Antimicrobial...

Q fever is a zoonotic disease, which is endemic in Israel. Most patients have an acute infection, but some cases manifest as a persistent focalized infection. Risk factors for a persistent focalized infection include significant valvular diseases, and aortic aneurism or vascular grafts, immunosuppression or malignancy, pregnancy, elevated anticardiolipin IgG. Recommendations for these high-risk patients after acute Q fever vary from clinical and serological follow-up to combined prolonged antimicrobial therapy, mostly with doxycycline and hydroxychloroquine. Retrospective studies involving a few dozen patients have found this treatment to significantly reduce the rates of endocarditis in patients with significant valvular abnormalities and in reducing obstetric complications in pregnant women. There is no data regarding antimicrobial prophylaxis and vascular graft infections or in patients with aortic aneurysms or malignancy; thus, some experts recommend prophylactic antimicrobial therapy in these patients as well. This paper reviews the current literature regarding the risk factors for persistent localized infection, and the efficacy of prolonged antimicrobial therapy after acute Q fever in these populations. In conclusion, risk factors for a persistent focalized infection, along with risk factors for side effects associated with prolonged antimicrobial therapy, should be taken into consideration and discussed with the patient to help the clinician decide about antimicrobial prophylaxis after acute Q fever.