Highlights & Basics
- Coxiella burnetii infection is a notifiable condition in the US and some other countries.
- People whose occupations put them at high risk of infection include abattoir workers, meat handlers, farmers, veterinarians, laboratory personnel, and military personnel.
- Symptoms and complications correspond to either an acute infection or persistent focalized infections.
- Infection during pregnancy may be associated with severe obstetric and fetal complications and endocarditis in the mother.
- Acute infection can be treated with a short course of doxycycline, but persistent focalized infections require long-term therapy with doxycycline plus hydroxychloroquine. Surgical resection of infected vascular tissue or prosthetic material may also be required.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Liver "doughnut granuloma" characteristic of acute Coxiella burnetii hepatitis. Note the specific granuloma morphology as a doughnut. No bacteria may be seen in this granuloma
Coxiella burnetii in the vacuole. A dry fracture of a vero cell exposing the contents of a vacuole where Coxiella burnetiii are growing
Natural history of Coxiella burnetii and serologic/PCR results. Ac+: positive for antibodies to C burnetii, Ac++: strongly positive for antibodies to C burnetii, Ac-: negative for antibodies to C burnetii, PCR+: positive PCR for C burnetii, PCR++: strongly positive PCR for C burnetii, PCR-: negative PCR for C burnetii
Algorithm for the diagnosis and management of C burnetii infection. TTE: transthoracic echocardiography; IgG aCL: IgG anticardiolipin antibodies; 18 F-FDG PET/CT: 18F-fluorodeoxyglucose PET combined with CT
Coxiella burnetii pneumonia. CXR and CT scan from a 21-year-old woman with Coxiella burnetii pneumonia; CXR shows multiple areas of soft consolidation in the middle-to-lower lung fields bilaterally; CT scan shows poorly defined centrilobular nodules and air space consolidation
Q fever endocarditis diagnosed at PET scan: 18F-fluorodeoxyglucose PET/CT. In this asymptomatic patient with heart valve history with elevated serology, the PET scan diagnosed an aortic endocarditis on native valve with thoracic and lumbar aortic mycotic aneurysms
Q fever aortic mycotic thoracic aneurysm diagnosed at PET scan: 18F-fluorodeoxyglucose PET/CT. In this asymptomatic patient with heart valve history with elevated serology, the PET scan diagnosed an aortic endocarditis on native valve with thoracic and lumbar aortic mycotic aneurysms
Q fever aortic mycotic lumbar aneurysm diagnosed at PET scan: 18F-fluorodeoxyglucose PET/CT. In this asymptomatic patient with heart valve history with elevated serology, the PET scan diagnosed an aortic endocarditis on native valve with thoracic and lumbar aortic mycotic aneurysms
Coxiella burnetii osteitis: immunohistochemistry: brown coloration identifies bacteria in monocytes/macrophages
Coxiella burnetii lung fibrosis: immunohistochemistry; brown coloration identifies bacteria in monocytes/macrophages
Coxiella burnetii endocarditis: immunohistochemistry. Note the low level of inflammation. Brown coloration identifies bacteria in monocytes/macrophages inside. Vegetation is usually lacking
Coxiella burnetii chronic lymphadenitis: immunohistochemistry. Note the isolated infected cell (monocytes/macrophages) in the lymph node. Brown coloration identifies bacteria in monocytes/macrophages
Coxiella burnetii chronic hepatitis of a patient with endocarditis: immunohiostochemistry. Note the absence of doughnut granuloma seen in acute Q fever. Brown coloration identifies bacteria in monocytes/macrophages
Coxiella burnetii lung pseudotumor: fluorescence in situ hybridization (FISH). Red: immunofluorescence (IF). Green: FISH with a specific 16S rRNA probe. Yellow: colocalization of IF and FISH confirms the presence of bacteria in the cytoplasm of 2 cells in a lung pseudotumor
Citations
Anderson A, Bijlmer H, Fournier PE, et al. Diagnosis and management of Q fever - United States, 2013: recommendations from CDC and the Q fever working group. MMWR Recomm Rep. 2013 Mar 29;62(RR-03):1-23.[Abstract][Full Text]
National Association of State Public Health Veterinarians, National Assembly of State Animal Health Officials. Prevention and control of coxiella burnetii infection among humans and animals: guidance for a coordinated public health and animal health response, 2013. 2013 [internet publication].[Full Text]
Centers for Disease Control and Prevention. Q fever: information for healthcare providers. Jan 2019 [internet publication].[Full Text]
1. Marrie TJ, Raoult D. Coxiella burnetii. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and practice of infectious diseases. 6th ed. Philadelphia, PA: Churchill Livingstone; 2005.
2. Hartzell JD, Wood-Morris RN, Martinez LJ, et al. Q fever: epidemiology, diagnosis, and treatment. Mayo Clin Proc. 2008 May;83(5):574-9.[Abstract][Full Text]
3. Eldin C, Mélenotte C, Mediannikov O, et al. From Q fever to Coxiella burnetii infection: a paradigm change. Clin Microbiol Rev. 2017 Jan;30(1):115-90.[Abstract][Full Text]
4. Million M, Roblot F, Carles D, et al. Reevaluation of the risk of fetal death and malformation after Q fever. Clin Infect Dis. 2014 Jul 15;59(2):256-60.[Abstract][Full Text]
5. Parker NR, Barralet JH, Bell AM. Q fever. Lancet. 2006 Feb 25;367(9511):679-88.[Abstract]
6. Centers for Disease Control and Prevention. CDC Yellow Book 2024: health information for international travel. Section 5: travel-associated infectious and diseases - Q fever. May 2023 [internet publication].[Full Text]
7. Ohlopkova OV, Yakovlev SA, Emmanuel K, et al. Epidemiology of zoonotic coxiella burnetii in the republic of Guinea. Microorganisms. 2023 May 29;11(6):1433.[Abstract][Full Text]
8. Körner S, Makert GR, Ulbert S, et al. The prevalence of coxiella burnetii in hard ticks in Europe and their role in Q fever transmission revisited-a systematic review. Front Vet Sci. 2021;8:655715.[Abstract][Full Text]
9. European Centre for Disease Prevention and Control. Surveillance report: Q fever: annual epidemiological report for 2019. Jan 2021 [internet publication]. [Full Text]
10. Gidding HF, Wallace C, Lawrence GL, et al. Australia's national Q fever vaccination program. Vaccine. 2009 Mar 23;27(14):2037-41.[Abstract]
11. Dahlgren FS, McQuiston JH, Massung RF, et al. Q fever in the United States: summary of case reports from two national surveillance systems, 2000-2012. Am J Trop Med Hyg. 2015 Feb;92(2):247-55.[Abstract][Full Text]
12. Centers for Disease Control and Prevention. Q fever: epidemiology and statistics. Aug 2021 [internet publication].[Full Text]
13. Limonard GJ, Peters JB, Nabuurs-Franssen MH, et al. Detailed analysis of health status of Q fever patients 1 year after the first Dutch outbreak: a case-control study. QJM. 2010 Dec;103(12):953-8.[Abstract][Full Text]
14. Morroy G, Peters JB, van Nieuwenhof M, et al. The health status of Q-fever patients after long-term follow-up. BMC Infect Dis. 2011 Apr 18;11:97.[Abstract][Full Text]
15. Van Steenbergen JE, Morroy G, Groot CA, et al. An outbreak of Q fever in The Netherlands - possible link to goats [in Dutch]. Ned Tijdschr Geneeskd. 2007 Sep 8;151(36):1998-2003.[Abstract]
16. Klaassen CH, Nabuurs-Franssen MH, Tilburg JJ, et al. Multigenotype Q fever outbreak, the Netherlands. Emerg Infect Dis. 2009 Apr;15(4):613-4.[Abstract][Full Text]
17. Voelker R. Risk of exposure to Q fever pathogen boosted by travel in Iraq or Netherlands. JAMA. 2010 Jun 16;303(23):2345.[Abstract]
18. Amitai Z, Bromberg M, Bernstein M, et al. A large Q fever outbreak in an urban school in central Israel. Clin Infect Dis. 2010 Jun 1;50(11):1433-8.[Abstract]
19. Ergas D, Keysari A, Edelstein V, et al. Acute Q fever in Israel: clinical and laboratory study of 100 hospitalized patients. Isr Med Assoc J. 2006 May;8(5):337-41.[Abstract][Full Text]
20. Lai CH, Huang CK, Chin C. Acute Q fever: an emerging and endemic disease in southern Taiwan. Scand J Infect Dis. 2008;40(2):105-10.[Abstract]
21. Gleeson TD, Decker CF, Johnson MD, et al. Q fever in US military returning from Iraq. Am J Med. 2007 Sep;120(9):e11-2.[Abstract][Full Text]
22. Anderson AD, Baker TR, Littrell AC, et al. Seroepidemiologic survey for Coxiella burnetii among hospitalized US troops deployed to Iraq. Zoonoses Public Health. 2011 Jun;58(4):276-83.[Abstract]
23. Farris CM, Pho N, Myers TE, et al. Seroconversions for Coxiella and rickettsial pathogens among US marines deployed to Afghanistan, 2001-2010. Emerg Infect Dis. 2016 Aug;22(8):1491-3.[Abstract][Full Text]
24. Ta TH, Jiménez B, Navarro M, et al. Q fever in returned febrile travelers. J Travel Med. 2008 Mar-Apr;15(2):126-9.[Abstract][Full Text]
25. Cohen NJ, Papernik M, Singleton J, et al. Q fever in an American tourist returned from Australia. Travel Med Infect Dis. 2007 May;5(3):194-5.[Abstract]
26. Anderson A, Bijlmer H, Fournier PE, et al. Diagnosis and management of Q fever - United States, 2013: recommendations from CDC and the Q fever working group. MMWR Recomm Rep. 2013 Mar 29;62(RR-03):1-23.[Abstract][Full Text]
27. Hall CJ, Richmond SJ, Caul EO, et al. Laboratory outbreak of Q fever acquired from sheep. Lancet. 1982 May 1;1(8279):1004-6.[Abstract]
28. Meiklejohn G, Reimer LG, Graves PS, et al. Cryptic epidemic of Q fever in a medical school. J Infect Dis. 1981 Aug;144(2):107-13.[Abstract]
29. Leone M, Honstettre A, Lepidi H, et al. Effect of sex on Coxiella burnetii infection: protective role of 17beta-estradiol. J Infect Dis. 2004 Jan 15;189(2):339-45.[Abstract][Full Text]
30. Houpikian P, Habib G, Mesana T, et al. Changing clinical presentation of Q fever endocarditis. Clin Infect Dis. 2002 Mar 1;34(5):e28-31.[Abstract][Full Text]
31. Tissot-Dupont H, Raoult D, Brouqui P, et al. Epidemiologic features and clinical presentation of acute Q fever in hospitalized patients: 323 French cases. Am J Med. 1992 Oct;93(4):427-34.[Abstract]
32. Stein A, Saunders NA, Taylor AG, et al. Phylogenic homogeneity of Coxiella burnetii strains as determinated by 16S ribosomal RNA sequencing. FEMS Microbiol Lett. 1993 Nov 1;113(3):339-44.[Abstract]
33. National Association of State Public Health Veterinarians, National Assembly of State Animal Health Officials. Prevention and control of coxiella burnetii infection among humans and animals: guidance for a coordinated public health and animal health response, 2013. 2013 [internet publication].[Full Text]
34. Salmon MM, Howells B, Glencross EJ, et al. Q fever in an urban area. Lancet. 1982 May 1;1(8279):1002-4.[Abstract]
35. Hassidim A, Elinav H, Michael-Gayego A, et al. Breast implant Q fever as a source of in-hospital transmission. Clin Infect Dis. 2018 Feb 10;66(5):793-5.[Abstract]
36. Milazzo A, Hall R, Storm PA, et al. Sexually transmitted Q fever. Clin Infect Dis. 2001 Aug 1;33(3):399-402.[Abstract][Full Text]
37. Pantanowitz L, Telford SR, Cannon ME. Tick-borne diseases in transfusion medicine. Transfus Med. 2002 Apr;12(2):85-106.[Abstract]
38. Maurin M, Raoult D. Q fever. Clin Microbiol Rev. 1999 Oct;12(4):518-53.[Abstract][Full Text]
39. Baca OG. Pathogenesis of rickettsial infections emphasis on Q fever. Eur J Epidemiol. 1991 May;7(3):222-8.[Abstract]
40. Honstettre A, Imbert G, Ghigo E, et al. Dysregulation of cytokines in acute Q fever: role of interleukin-10 and tumor necrosis factor in chronic evolution of Q fever. J Infect Dis. 2003 Mar 15;187(6):956-62.[Abstract]
41. Raoult D, Levy PY, Dupont HT, et al. Q fever and HIV infection. AIDS. 1993 Jan;7(1):81-6.[Abstract]
42. McCaul TF, Williams JC. Development cycle of Coxiella burnetii: structure and morphogenesis of vegetative and sporogenic differentiations. J Bacteriol. 1981 Sep;147(3):1063-76.[Abstract][Full Text]
43. Q fever. In: Christie AB, ed. Infectious diseases, epidemiology and clinical practice. Edinburgh, UK: Churchill Livingstone; 1974:876-91.
44. Centers for Disease Control. Q fever outbreak - Switzerland. MMWR Morb Mortal Wkly Rep. 1984 Jun 29;33(25):355-6,361.[Abstract][Full Text]
45. Million M, Walter G, Thuny F, 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.[Abstract][Full Text]
46. Baud D, Greub G. Intracellular bacteria and adverse pregnancy outcomes. Clin Microbiol Infect. 2011 Sep;17(9):1312-22.[Abstract]
47. Chiu CK, Durrheim DN. A review of the efficacy of human Q fever vaccine registered in Australia. N S W Public Health Bull. 2007 Jul-Aug;18(7-8):133-6.[Abstract][Full Text]
48. Marmion B, Harris R, Strom P, et al. Q Fever Research Group (QRG), Adelaide, activities-exit summary 1980-2004. Ann N Y Acad Sci. 2005 Dec;1063:181-6.[Abstract]
49. Ackland JR, Worswick DA, Marmion BP. Vaccine prophylaxis of Q fever: a follow up study of the efficacy of Q-vax (CSL) 1985-1990. Med J Aust. 1994 Jun 6;160(11):704-8.[Abstract]
50. Gefenaite G, Munster JM, van Houdt R, et al. Effectiveness of the Q fever vaccine: a meta-analysis. Vaccine. 2011 Jan 10;29(3):395-8.[Abstract]
51. O'Neill TJ, Sargeant JM, Poljak Z. The effectiveness of Coxiella burnetii vaccines in occupationally exposed populations: a systematic review and meta-analysis. Zoonoses Public Health. 2014 Mar;61(2):81-96.[Abstract]
52. Raoult D, Marrie T, Mege J. Natural history and pathophysiology of Q fever. Lancet Inf Dis. 2005 Apr;5(4):219-26.[Abstract]
53. Drancourt M, Raoult D, Xeridat B, et al. Q fever meningoencephalitis in five patients. Eur J Epidemiol. 1991 Mar;7(2):134-8.[Abstract]
54. Bernit E, Pouget J, Janbon F, et al. Neurological involvement in acute Q fever: a report of 29 cases and review of the literature. Arch Intern Med. 2002 Mar 25;162(6):693-700.[Abstract][Full Text]
55. Ordi-Ros J, Selva-O'Callaghan A, Monegal-Ferran F, et al. Prevalence, significance, and specificity of antibodies to phospholipids in Q fever. Clin Infect Dis. 1994 Feb;18(2):213-8.[Abstract]
56. Newcombe JP, Gray PE, Palasanthiran P, et al. Q Fever with transient antiphospholipid antibodies associated with cholecystitis and splenic infarction. Pediatr Infect Dis J. 2013 Apr;32(4):415-6.[Abstract]
57. Million M, Thuny F, Bardin N, et al. Antiphospholipid antibody syndrome with valvular vegetations in acute Q fever. Clin Infect Dis. 2016 Mar 1;62(5):537-44.[Abstract]
58. Lee CH, Chuah SK, Pei SN, et al. Acute Q fever presenting as antiphospholipid syndrome, pneumonia, and acalculous cholecystitis and masquerading as Mycoplasma pneumoniae and hepatitis C viral infections. Jpn J Infect Dis. 2011;64(6):525-7.[Abstract]
59. Wildman MJ, Smith EG, Groves J, et al. Chronic fatigue following infection by Coxiella burnetii (Q fever): ten-year follow-up of the 1989 UK outbreak cohort. QJM. 2002 Aug;95(8):527-38.[Abstract][Full Text]
60. Ayres JG, Wildman M, Groves J, et al. Long-term follow-up of patients from the 1989 Q fever outbreak: no evidence of excess cardiac disease in those with fatigue. QJM. 2002 Aug;95(8):539-46.[Abstract][Full Text]
61. Morroy G, Keijmel SP, Delsing CE, et al. Fatigue following acute Q-fever: a systematic literature review. PLoS One. 2016;11(5):e0155884.[Abstract][Full Text]
62. Keijmel SP, Delsing CE, Bleijenberg G, et al. Effectiveness of long-term doxycycline treatment and cognitive-behavioral therapy on fatigue severity in patients with Q fever fatigue syndrome (Qure Study): a randomized controlled trial. Clin Infect Dis. 2017 Apr 15;64(8):998-1005.[Abstract]
63. Wilson HG, Neilson GH, Galea EG, et al. Q fever endocarditis in Queensland. Circulation. 1976 Apr;53(4):680-4.[Abstract]
64. Melenotte C, Million M, Audoly G, et al. B-cell non-Hodgkin lymphoma linked to Coxiella burnetii. Blood. 2016 Jan 7;127(1):113-21.[Abstract]
65. Million M, Halfon J, Le Lez ML, et al. Relapsing uveitis and optic neuritis due to chronic Q fever. Br J Ophthalmol. 2011 Jul;95(7):1026-7.[Abstract]
66. Odeh M, Oliven A. Temporal arteritis associated with acute Q fever. A case report. Angiology. 1994 Dec;45(12):1053-7.[Abstract]
67. Lefebvre M, Grossi O, Agard C, et al. Systemic immune presentations of Coxiella burnetii infection (Q fever). Semin Arthritis Rheum. 2010 Apr;39(5):405-9.[Abstract]
68. Baziaka F, Karaiskos I, Galani L, et al. Large vessel vasculitis in a patient with acute Q-fever: a case report. IDCases. 2014 Jul 31;1(3):56-9.[Abstract][Full Text]
69. Aarthi P, Bagyalakshmi R, Mohan R, et al. First case series of emerging Rickettsial neonatal sepsis identified by polymerase chain reaction-based deoxyribonucleic acid sequencing. Indian J Med Microbiol. 2013 Oct-Dec;31(4):343-8.[Abstract][Full Text]
70. Suárez Ortega S, Rivero Vera J, Hemmersbach M, et al. Severe cholestatic hepatitis due to Q fever: report of a case [in Spanish]. Gastroenterol Hepatol. 2010 Jan;33(1):21-4.[Abstract]
71. Million M, Walter G, Bardin N, et al. Immunoglobulin G anticardiolipin antibodies and progression to Q fever endocarditis. Clin Infect Dis. 2013 Jul;57(1):57-64.[Abstract][Full Text]
72. Marrie TJ, Raoult D. Rickettsial infections of the central nervous system. Semin Neurol. 1992 Sep;12(3):213-24.[Abstract]
73. Edouard S, Million M, Lepidi H, et al. Persistence of DNA in a cured patient and positive culture in cases with low antibody levels bring into question diagnosis of Q fever endocarditis. J Clin Microbiol. 2013 Sep;51(9):3012-7.[Abstract][Full Text]
74. Issartel B, Gauduchon V, Chalabreysse L. Clinically and histologically silent Q fever endocarditis accidentally diagnosed by PCR. Clin Microbiol Infect. 2002 Feb;8(2):113-4.[Abstract][Full Text]
75. Frangoulidis D, Rodolakis A, Heiser V. DNA microarray-chip based diagnosis of Q-fever (Coxiella burnetii). Clin Microbiol Infect. 2009 Dec;15 Suppl 2:165-6.[Abstract]
76. Edouard S, Raoult D. Lyophilization to improve the sensitivity of qPCR for bacterial DNA detection in serum: the Q fever paradigm. J Med Microbiol. 2016 Jun;65(6):462-7.[Abstract]
77. Million M, Raoult D. The pathogenesis of the antiphospholipid syndrome. N Engl J Med. 2013 Jun 13;368(24):2335.[Abstract]
78. Eldin C, Melenotte C, Million M, et al. 18F-FDG PET/CT as a central tool in the shift from chronic Q fever to Coxiella burnetii persistent focalized infection: a consecutive case series. Medicine (Baltimore). 2016 Aug;95(34):e4287.[Abstract]
79. Grisoli D, Million M, Edouard S, et al. Latent Q fever endocarditis in patients undergoing routine valve surgery. J Heart Valve Dis. 2014 Nov;23(6):735-43.[Abstract]
80. Karakousis PC, Trucksis M, Dumler JS. Chronic Q fever in the United States. J Clin Microbiol. 2006 Jun;44(6):2283-7.[Abstract][Full Text]
81. Bailey MS, Trinick TR, Dunbar JA, et al. Undifferentiated febrile illnesses amongst British troops in Helmand, Afghanistan. J R Army Med Corps. 2011 Jun;157(2):150-5.[Abstract]
82. Raoult D. Chronic Q fever: expert opinion versus literature analysis and consensus. J Infect. 2012 Aug;65(2):102-8.[Abstract]
83. Million M, Bellevegue L, Labussiere AS, et al. Culture-negative prosthetic joint arthritis related to Coxiella burnetii. Am J Med. 2014 Aug;127(8):786.e7-e10.[Abstract]
84. Centers for Disease Control and Prevention. Q fever: information for healthcare providers. Jan 2019 [internet publication].[Full Text]
85. Miller JM, Binnicker MJ, Campbell S, et al. A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2018 update by the Infectious Diseases Society of America and the American Society for Microbiology. Clin Infect Dis. 2018 Aug 31;67(6):e1-94.[Abstract][Full Text]
86. Million M, Thuny F, Richet H, et al. Long-term outcome of Q fever endocarditis: a 26-year personal survey. Lancet Infect Dis. 2010 Aug;10(8):527-35.[Abstract]
87. Dijkstra F, Riphagen-Dalhuisen J, Wijers N, et al. Antibiotic therapy for acute Q fever in The Netherlands in 2007 and 2008 and its relation to hospitalization. Epidemiol Infect. 2011 Sep;139(9):1332-41.[Abstract]
88. Rusu A, Munteanu AC, Arbănași EM, et al. Overview of side-effects of antibacterial fluoroquinolones: new drugs versus old drugs, a step forward in the safety profile? Pharmaceutics. 2023 Mar 1;15(3):804.[Abstract][Full Text]
89. Schmidt-Tanguy A, Voswinkel J, Henrion D, et al. Antithrombotic effects of hydroxychloroquine in primary antiphospholipid syndrome patients. J Thromb Haemost. 2013 Oct;11(10):1927-9.[Abstract]
90. Espinola RG, Pierangeli SS, Gharavi AE, et al. Hydroxychloroquine reverses platelet activation induced by human IgG antiphospholipid antibodies. Thromb Haemost. 2002 Mar;87(3):518-22.[Abstract]
91. Edwards MH, Pierangeli S, Liu X, et al. Hydroxychloroquine reverses thrombogenic properties of antiphospholipid antibodies in mice. Circulation. 1997 Dec 16;96(12):4380-4.[Abstract][Full Text]
92. Belizna C. Hydroxychloroquine as an anti-thrombotic in antiphospholipid syndrome. Autoimmun Rev. 2015 Apr;14(4):358-62.[Abstract]
93. Nuri E, Taraborelli M, Andreoli L, et al. Long-term use of hydroxychloroquine reduces antiphospholipid antibodies levels in patients with primary antiphospholipid syndrome. Immunol Res. 2017 Feb;65(1):17-24.[Abstract]
94. Broder A, Putterman C. Hydroxychloroquine use is associated with lower odds of persistently positive antiphospholipid antibodies and/or lupus anticoagulant in systemic lupus erythematosus. J Rheumatol. 2013 Jan;40(1):30-3.[Abstract][Full Text]
95. Fenollar F, Fournier PE, Carrieri MP, et al. Risks factors and prevention of Q fever endocarditis. Clin Infect Dis. 2001 Aug 1;33(3):312-6.[Abstract][Full Text]
96. Carcopino X, Raoult D, Bretelle F, et al. Managing Q fever during pregnancy: the benefits of long term cotrimoxazole therapy. Clin Infect Dis. 2007 Sep 1;45(5):548-55.[Abstract][Full Text]
97. Cerar D, Karner P, Avsic-Zupanc T, et al. Azithromycin for acute Q fever in pregnancy. Wien Klin Wochenschr. 2009;121(13-14):469-72.[Abstract]
98. Raoult D, Tissot-Dupont H, Foucault C, et al. Q fever 1985-1998: clinical and epidemiologic features of 1,383 infections. Medicine. 2000 Mar;79(2):109-23.[Abstract]
99. Oteo JA, Pérez-Cortés S, Santibáñez P, et al. Q fever endocarditis associated with a cardiovascular implantable electronic device. Clin Microbiol Infect. 2012 Nov;18(11):E482-4.[Abstract][Full Text]
100. Eldin C, Mailhe M, Lions 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.[Abstract][Full Text]
101. Rolain JM, Mallet MN, Raoult D. Correlation between serum doxycycline concentrations and serologic evolution in patients with Coxiella burnetii endocarditis. J Infect Dis. 2003 Nov 1;188(9):1322-5.[Abstract][Full Text]
102. Rolain JM, Boulos A, Mallet MN, et al. Correlation between ratio of serum doxycycline concentration to MIC and rapid decline of antibody levels during treatment of Q fever endocarditis. Antimicrob Agents Chemother. 2005 Jul;49(7):2673-6.[Abstract][Full Text]
103. Lecaillet A, Mallet MN, Raoult D, et al. Therapeutic impact of the correlation of doxycycline serum concentrations and the decline of phase I antibodies in Q fever endocarditis. J Antimicrob Chemother. 2009 Apr;63(4):771-4.[Abstract][Full Text]
104. van Roeden SE, Bleeker-Rovers CP, Kampschreur LM, et al. The effect of measuring serum doxycycline concentrations on clinical outcomes during treatment of chronic Q fever. J Antimicrob Chemother. 2018 Apr 1;73(4):1068-76.[Abstract][Full Text]
105. Skiba V, Barner KC. Central nervous system manifestations of Q fever responsive to steroids. Mil Med. 2009 Aug;174(8):857-9.[Abstract]
106. Fernández-Ruiz M, López-Medrano F, Alonso-Navas F, et al. Coxiella burnetii infection of left atrial thrombus mimicking an atrial myxoma. Int J Infect Dis. 2010 Sep;14 Suppl 3:e319-21.[Abstract]
107. van Roeden SE, Bleeker-Rovers CP, de Regt MJ, et al. Treatment of chronic Q fever: clinical efficacy and toxicity of antibiotic regimens. Clin Infect Dis. 2018 Feb 10;66(5):719-26.[Abstract]
108. Kersh GJ. Antimicrobial therapies for Q fever. Expert Rev Anti Infect Ther. 2013 Nov;11(11):1207-14.[Abstract][Full Text]
109. Communicable Diseases Network Australia. CDNA national guidelines for public health units: Q fever. Nov 2018 [internet publication].[Full Text]
110. Langley JM, Marrie TJ, Leblanc JC, et al. Coxiella burnetii seropositivity in parturient women is associated with adverse pregnancy outcomes. Am J Obstet Gynecol. 2003 Jul;189(1):228-32.[Abstract]
111. Daly RF, House J, Stanek D, et al; National Association of State Public Health Veterinarians Animal Contact Compendium Committee. Compendium of measures to prevent disease associated with animals in public settings, 2017. J Am Vet Med Assoc. 2017 Dec 1;251(11):1268-92.[Abstract][Full Text]
112. Moodie CE, Thompson HA, Meltzer MI, et al. Prophylaxis after exposure to Coxiella burnetii. Emerg Infect Dis. 2008 Oct;14(10):1558-66.[Abstract][Full Text]
