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1.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33542018

RESUMO

We report a case of chronic Q fever presenting with catastrophic bleeding from an infected abdominal aortic aneurysm causing a primary aortoduodenal fistula in an 80-year-old retired farmer. This presentation is rarely reported in literature and only through case reports. Early diagnosis and definitive surgery were critical to a successful outcome. Serological diagnosis of Q fever was initiated on the patient's past exposure to animal reservoirs. Complicating the case was ongoing gastrointestinal bleeding postsurgery, with multiple endoscopies undertaken before a culprit remnant fistula was found. This case highlights the value in considering Coxiella burnetii as an underlying cause in patients with known risk factors presenting with primary aortoduodenal fistulas. Though rare, it represents a readily treatable cause.


Assuntos
Aneurisma da Aorta Abdominal/complicações , Hemorragia Gastrointestinal/etiologia , Fístula Intestinal/cirurgia , Febre Q/diagnóstico , Fístula Vascular/cirurgia , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Antimaláricos/uso terapêutico , Coxiella burnetii/isolamento & purificação , Doxiciclina/uso terapêutico , Duodenopatias/cirurgia , Humanos , Hidroxicloroquina/uso terapêutico , Masculino , Febre Q/tratamento farmacológico , Tomografia Computadorizada por Raios X
2.
Praxis (Bern 1994) ; 109(14): 1150-1152, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-33108999

RESUMO

For Once Not Corona Virus - an Uncommon Cause of Fever and Hepatitis Abstract. Our case reports acute Q fever as uncommon cause of fever, typically accompanied by pneumonia and/or hepatitis. It is caused by Coxiella burnetii, a bacterium which is generally hosted by live stock and affects humans by inhaling aerosols of the animals' excrements. If detected, it may be treated effectively. It should be considered in patients living in a typical environment or with a typical history. The route of our patient's infection remains unclear since he plausibly denied contact with any animals.


Assuntos
Coronavirus , Coxiella burnetii , Hepatite , Pneumonia , Febre Q , Animais , Infecções por Coronavirus/diagnóstico , Hepatite/diagnóstico , Humanos , Masculino , Febre Q/diagnóstico , Febre Q/tratamento farmacológico
3.
BMC Infect Dis ; 20(1): 690, 2020 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-32957938

RESUMO

BACKGROUND: From early 2009, the Dutch region of South Limburg experienced a massive outbreak of Q fever, overlapping with the influenza A(H1N1)pdm09 pandemic during the second half of the year and affecting approximately 2.9% of a 300,000 population. Acute Q fever shares clinical features with other respiratory conditions. Most symptomatic acute infections are characterized by mild symptoms, or an isolated febrile syndrome. Pneumonia was present in a majority of hospitalized patients during the Dutch 2007-2010 Q fever epidemic. Early empiric doxycycline, guided by signs and symptoms and patient history, should not be delayed awaiting laboratory confirmation, as it may shorten disease and prevent progression to focalized persistent Q fever. We assessed signs' and symptoms' association with acute Q fever to guide early empiric treatment in primary care patients. METHODS: In response to the outbreak, regional primary care physicians and hospital-based medical specialists tested a total of 1218 subjects for Q fever. Testing activity was bimodal, a first "wave" lasting from March to December 2009, followed by a second "wave" which lasted into 2010 and coincided with peak pandemic influenza activity. We approached all 253 notified acute Q fever cases and a random sample of 457 Q fever negative individuals for signs and symptoms of disease. Using data from 140/229(61.1%) Q fever positive and 194/391(49.6%) Q fever negative respondents from wave 1, we built symptom-based models predictive of Q-fever outcome, validated against subsets of data from wave 1 and wave 2. RESULTS: Our models had poor to moderate AUC scores (0.68 to 0.72%), with low positive (4.6-8.3%), but high negative predictive values (91.7-99.5%). Male sex, fever, and pneumonia were strong positive predictors, while cough was a strong negative predictor of acute Q fever in these models. CONCLUSION: Whereas signs and symptoms of disease do not appear to predict acute Q fever, they may help rule it out in favour of other respiratory conditions, prompting a delayed or non-prescribing approach instead of early empiric doxycycline in primary care patients with non-severe presentations. Signs and symptoms thus may help reduce the overuse of antibiotics in primary care during and following outbreaks of Q fever.


Assuntos
Antibacterianos/uso terapêutico , Febre Q/tratamento farmacológico , Febre Q/etiologia , Infecções Respiratórias/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Criança , Pré-Escolar , Tosse/tratamento farmacológico , Tosse/microbiologia , Surtos de Doenças/estatística & dados numéricos , Doxiciclina/uso terapêutico , Feminino , Febre/tratamento farmacológico , Febre/microbiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Países Baixos/epidemiologia , Atenção Primária à Saúde , Febre Q/epidemiologia , Febre Q/microbiologia , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Adulto Jovem
5.
BMC Infect Dis ; 20(1): 334, 2020 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-32398008

RESUMO

BACKGROUND: Although C-reactive protein (CRP) and procalcitonin (PCT) are widely used inflammatory markers for infectious diseases, their role and potential application for rickettsioses were rarely studied. METHODS: A retrospective chart review and serological study were conducted in patients with rickettsioses. The clinical presentations, characteristics, laboratory data, and treatment responses were recorded and their associations with CRP and PCT values were analyzed. RESULTS: A total of 189 cases of rickettsioses, including 115 cases of acute Q fever (60.8%), 55 cases of scrub typhus (29.1%), and 19 cases of murine typhus (10.1%) were investigated. Both CRP and PCT values increased in the acute phase and declined in the convalescent phase. In the acute phase, mean CRP and PCT values were 78.2 ± 63.7 mg/L and 1.05 ± 1.40 ng/mL, respectively. Percentages of patients falling under different cut-off values of CRP and PCT were calculated systematically. Only 10.8% of CRP was > 150 mg/L and 14.2% of PCT was > 2.0 ng/mL. Patients with delayed responses to doxycycline treatment (> 3 days from treatment to defervescence) had significantly higher CRP values (102.7 ± 77.1 vs. 72.2 ± 58.2 mg/L, p = 0.041) and more PCT > 1.0 ng/ml (48.4% vs. 26.0%, p = 0.019) in the acute phase; higher CRP values (19.1 ± 37.4 vs. 3.6 ± 13.1 mg/L, p = 0.049) and more PCT > 0.5 ng/ml (19.2% vs. 1.4%, p = 0.005) in the convalescent phase. Correlation analysis was conducted for patients with acute Q fever. CRP and PCT values were positively correlated to each other, and both markers also had a positive correlation with serum aspartate transaminase values. Both CRP and PCT values and white blood cell counts were positively correlated to the days needed from doxycycline treatment to defervescence. CONCLUSION: CRP and PCT values might be useful in clinical investigations for patients with suspected rickettsioses and in predicting the response to doxycycline treatment for rickettsioses.


Assuntos
Proteína C-Reativa/análise , Coxiella burnetii/imunologia , Orientia tsutsugamushi/imunologia , Pró-Calcitonina/sangue , Febre Q/sangue , Rickettsia typhi/imunologia , Tifo por Ácaros/sangue , Tifo Endêmico Transmitido por Pulgas/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Biomarcadores/sangue , Doxiciclina/uso terapêutico , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Febre Q/tratamento farmacológico , Febre Q/microbiologia , Estudos Retrospectivos , Tifo por Ácaros/tratamento farmacológico , Tifo por Ácaros/microbiologia , Tifo Endêmico Transmitido por Pulgas/tratamento farmacológico , Tifo Endêmico Transmitido por Pulgas/microbiologia , Adulto Jovem
7.
Pediatr Infect Dis J ; 38(12): e336-e337, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31738731

RESUMO

A toddler after tetralogy of Fallot graft repair in infancy was diagnosed with endocarditis. Blood cultures were positive for Kingella kingae and serology was positive Coxiella burnetii. He was treated medically and surgically. A postoperative specimen polymerase chain reaction confirmed a coinfection. A comprehensive patient history was imperative for identification of an unlikely infection at this age.


Assuntos
Coinfecção/diagnóstico , Coinfecção/microbiologia , Endocardite Bacteriana/diagnóstico , Infecções por Neisseriaceae/diagnóstico , Febre Q/diagnóstico , Antibacterianos/uso terapêutico , Hemocultura , Pré-Escolar , Coinfecção/tratamento farmacológico , Coxiella burnetii , Ecocardiografia , Endocardite Bacteriana/tratamento farmacológico , Humanos , Kingella kingae , Masculino , Infecções por Neisseriaceae/tratamento farmacológico , Febre Q/tratamento farmacológico , Tetralogia de Fallot/complicações , Tetralogia de Fallot/cirurgia
8.
BMC Infect Dis ; 19(1): 903, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660875

RESUMO

BACKGROUND: Acute Q fever usually presents as a nonspecific febrile illness, and its occurrence is rapidly increasing in South Korea. This study investigated the clinical characteristics of acute Q fever patients in South Korea and the time from symptom onset to serologic diagnosis. The clinical courses were examined according to antibiotic treatment. METHODS: Data of patients diagnosed with acute Q fever at Chungbuk National University Hospital between January 2015 and February 2018 were retrospectively collected. Demographic and epidemiologic data were reviewed. The time from symptom onset to serologic diagnosis by an immunofluorescence assay (IFA) was analyzed. Clinical courses and the percentage of patients with a high phase I immunoglobulin G titer (≥ 1:1024) were compared between patients administered antibiotics with anti-Coxiella burnetii activity and patients not administered such antibiotics. RESULTS: Forty-eight patients (median age: 51.5 years) were included. Most were male (95.8%) and had no history of animal contact (91.7%). The median time from illness onset to serologic diagnosis was 21 days. Thirty-nine patients received antibiotics with anti-C. burnetii activity. The length of hospital stay and fever duration did not significantly differ between patients who received antibiotics with anti-C. burnetii activity (7 and 15 days) and those who did not (5 and 8 days) (P = 0.110 and P = 0.137, respectively). The percentage of patients with a high phase I immunoglobulin G titer (≥ 1:1024) did not significantly differ between patients who received antibiotics with anti-C. burnetii activity and those who did not (P = 0.340). CONCLUSIONS: Most acute Q fever patients had a nonspecific febrile illness with mild elevation of transaminases and no history of animal contact or occupational risk. The time from symptom onset to a positive IFA test was longer than the fever duration in most acute Q fever patients. Consequently, it may be difficult for clinicians to serologically diagnose acute Q fever. However, inappropriate antibiotic treatment was not associated with prolongation of symptoms or progression to chronic Q fever.


Assuntos
Diagnóstico Tardio , Febre Q/diagnóstico , Febre Q/epidemiologia , Testes Sorológicos , Animais , Antibacterianos/uso terapêutico , Anticorpos Antibacterianos/sangue , Coxiella burnetii/imunologia , Feminino , Imunofluorescência , Seguimentos , Hospitalização , Hospitais Universitários , Humanos , Imunoglobulina G/sangue , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Febre Q/tratamento farmacológico , República da Coreia/epidemiologia , Estudos Retrospectivos
9.
Tidsskr Nor Laegeforen ; 139(12)2019 09 10.
Artigo em No | MEDLINE | ID: mdl-31502778

RESUMO

BACKGROUND: This case report presents one of the first documented incidents of chronic Q-fever (C. burnetii) in Norway. A comprehensive workup resulted in an unexpected finding. CASE PRESENTATION: A Norwegian woman in her eighties presented to a district general hospital with lower back pain, decreased general condition and weight loss. Computer tomography (CT) revealed a large thoracic aortic aneurysm presumed to be of mycotic origin, and later magnetic resonance imaging (MRI) scans revealed osteomyelitis in the surrounding vertebrae. Conventional diagnostic workup did not identify the causative agent. After more than 6 months of different examinations, surgery, exhausting invasive procedures and antimicrobial treatment, we were ultimately successful in determining the microbial cause of chronic mycotic aneurism and osteomyelitis to be C. Burnetii (Q-fever) through serological and PCR analysis. INTERPRETATION: An increasing proportion of the population in all age groups travel abroad, and clinicians should be aware of the increasing incidence of imported infectious diseases. Obtaining a thorough medical history is still an important tool in the diagnostic process.


Assuntos
Aneurisma da Aorta Torácica/microbiologia , Osteomielite/microbiologia , Febre Q , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Aneurisma da Aorta Torácica/diagnóstico por imagem , Coxiella burnetii/isolamento & purificação , Feminino , Humanos , Dor Lombar/microbiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/microbiologia , Imagem por Ressonância Magnética , Anamnese , Noruega , Osteomielite/diagnóstico por imagem , Febre Q/complicações , Febre Q/diagnóstico , Febre Q/tratamento farmacológico , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/microbiologia , Tomografia Computadorizada por Raios X , Doença Relacionada a Viagens , Perda de Peso
11.
Infect Immun ; 87(10)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31331958

RESUMO

Infection with Coxiella burnetii, the causative agent of Q fever, can result in life-threatening persistent infection. Reactogenicity hinders worldwide implementation of the only licensed human Q fever vaccine. We previously demonstrated long-lived immunoreactivity in individuals with past symptomatic and asymptomatic Coxiella infection (convalescents) to promiscuous HLA class II C. burnetii epitopes, providing the basis for a novel T-cell targeted subunit vaccine. In this study, we investigated in a cohort of 22 individuals treated for persistent infection (chronic Q fever) whether they recognize the same set of epitopes or distinct epitopes that could be candidates for a therapeutic vaccine or aid in the diagnosis of persistent infection. In cultured enzyme-linked immunosorbent spot (ELISpot) assays, individuals with chronic Q fever showed strong class II epitope-specific responses that were largely overlapping with the peptide repertoire identified previously for convalescents. Five additional peptides were recognized more frequently by chronic subjects, but there was no combination of epitopes uniquely recognized by or nonreactive in subjects with chronic Q fever. Consistent with more recent/prolonged exposure, we found, however, stronger ex vivo responses by direct ELISpot to both whole-cell C. burnetii and individual peptides in chronic patients than in convalescents. In conclusion, we have validated and expanded a previously published set of candidate epitopes for a novel T-cell targeted subunit Q fever vaccine in treated patients with chronic Q fever and demonstrated that they successfully mounted a T-cell response comparable to that of convalescents. Finally, we demonstrated that individuals treated for chronic Q fever mount a broader ex vivo response to class II epitopes than convalescents, which could be explored for diagnostic purposes.


Assuntos
Anticorpos Antibacterianos/biossíntese , Antígenos de Bactérias/imunologia , Coxiella burnetii/imunologia , Epitopos de Linfócito T/imunologia , Febre Q/imunologia , Idoso , Antibacterianos/uso terapêutico , Antígenos de Bactérias/química , Antígenos de Bactérias/genética , Vacinas Bacterianas/química , Vacinas Bacterianas/imunologia , Doença Crônica , Convalescença , Coxiella burnetii/patogenicidade , ELISPOT , Epitopos de Linfócito T/química , Epitopos de Linfócito T/genética , Feminino , Expressão Gênica , Antígenos de Histocompatibilidade Classe I/genética , Antígenos de Histocompatibilidade Classe I/imunologia , Antígenos de Histocompatibilidade Classe II/genética , Antígenos de Histocompatibilidade Classe II/imunologia , Teste de Histocompatibilidade , Humanos , Interferon gama/genética , Interferon gama/imunologia , Masculino , Pessoa de Meia-Idade , Peptídeos/genética , Peptídeos/imunologia , Febre Q/tratamento farmacológico , Febre Q/genética , Febre Q/prevenção & controle , Linfócitos T/imunologia , Linfócitos T/microbiologia
12.
Chest ; 156(1): e27-e31, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31279382

RESUMO

CASE PRESENTATION: A 57-year-old homemaker and rural inhabitant of Central Greece (ex-smoker, 25 pack-years), was admitted to the ICU because of acute hypoxemic respiratory failure with diffuse bilateral alveolar infiltrates. Her medical history was unremarkable. She had been looking after her mother in a farmhouse with goats and a dog for the previous 6 months. She had not ingested any unpasteurized dairy products. She complained of fever and weight loss (8 kg) over the previous 2 months. She developed a nonproductive cough during the past 5 days and was referred to the hospital.


Assuntos
Leishmaniose Visceral/diagnóstico , Pneumonia Bacteriana/diagnóstico , Febre Q/diagnóstico , Caquexia , Diagnóstico Diferencial , Feminino , Febre , Humanos , Leishmaniose Visceral/tratamento farmacológico , Pessoa de Meia-Idade , Pneumonia Bacteriana/tratamento farmacológico , Febre Q/tratamento farmacológico
13.
Am J Trop Med Hyg ; 101(1): 33-39, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31115296

RESUMO

Query fever (Q fever), caused by Coxiella burnetii, was first described in southern California in 1947. It was found to be endemic and enzoonotic to the region and associated with exposure to livestock. We describe a series of 20 patients diagnosed with Q fever at a Veterans Affairs hospital in southern California, with the aim of contributing toward the understanding of Q fever in this region. Demographics, laboratory data, diagnostic imaging, risk factors, and treatment regimens were collected via a retrospective chart review of patients diagnosed with Q fever at our institution between 2000 and 2016. Cases were categorized as acute or chronic and confirmed or probable. The majority presented with an acute febrile illness (90%). There was a delay in ordering diagnostic serology from the time of symptom onset (acute cases, average 31.9 days; chronic cases, average 63 days), and 15% progressed from acute to chronic infection. Of the chronic cases, 22.2% had endocarditis, 22.2% had endovascular infection, and 11.1% had both endocarditis and endovascular infection. The geographic distribution revealed that 20% resided in rural areas. Of the cases of Q fever that died, death attributed to Q fever was associated with an average diagnostic delay of 65.5 days. Acute Q fever is underreported in this region largely because of its often nonspecific clinical presentation.


Assuntos
Antibacterianos/uso terapêutico , Doxiciclina/uso terapêutico , Hidroxicloroquina/uso terapêutico , Febre Q/diagnóstico , Febre Q/epidemiologia , Rifampina/uso terapêutico , Adulto , Idoso , California/epidemiologia , Doença Crônica , Doxiciclina/administração & dosagem , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/patologia , Hospitais de Veteranos , Humanos , Hidroxicloroquina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Febre Q/tratamento farmacológico , Febre Q/patologia , Estudos Retrospectivos , Rifampina/administração & dosagem
15.
Am J Trop Med Hyg ; 100(5): 1130-1133, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30915946

RESUMO

A 56-year-old female goat herder had scrub typhus that persisted after receiving doxycycline for 5 days. Her symptoms continued, prompting us to perform further examinations that revealed coinfection of Q fever and scrub typhus via molecular and serological testing. We also isolated Orientia tsutsugamushi using BALB/c mice and L929 cells.


Assuntos
Coinfecção/diagnóstico , Coinfecção/microbiologia , Doxiciclina/uso terapêutico , Febre Q/tratamento farmacológico , Tifo por Ácaros/diagnóstico , Animais , Coinfecção/sangue , Coxiella burnetii , Feminino , Humanos , Camundongos , Camundongos Endogâmicos BALB C , Pessoa de Meia-Idade , Orientia tsutsugamushi/isolamento & purificação , Febre Q/diagnóstico , Tifo por Ácaros/sangue , Baço/microbiologia , Esplenomegalia/microbiologia
18.
QJM ; 111(11): 791-797, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30102400

RESUMO

Background: Chronic Q fever is accompanied by high mortality and morbidity, and requires prolonged antibiotic treatment. Little is known on long-term quality of life (LQOL) in chronic Q fever patients treated with antibiotics. Aim: To identify patient and treatment-related factors associated with impaired LQOL in chronic Q fever patients treated with antibiotics, and to assess patients' perception on treatment. Design: Cross-sectional study. Methods: LQOL was assessed with a validated questionnaire from the Nijmegen Clinical Screening Instrument. Patients' perception on treatment was measured with three newly developed questions. Results: We included 64 patients: LQOL was impaired in 55% (n = 35) after a median follow-up of 5 years. Median treatment duration was 27 months. In multivariable analysis, treatment duration was significantly associated with impaired LQOL (OR 1.07; 95%CI 1.02-1.12, P < 0.01 per month increase). Age, gender, number of antibiotic regimens, surgical intervention, complications, diagnostic classification, focus of infection or registration of side effects during treatment were not associated with impaired LQOL. After start of treatment, 17 patients (27%) perceived improvement of their condition. Disadvantages of treatment were experienced on a daily basis by 24 patients (69%) with impaired LQOL and 13 patients (46%) without impaired LQOL (P = 0.04). Conclusions: LQOL in chronic Q fever patients treated with antibiotics is impaired in more than half of patients 5 years after diagnosis. Antibiotic treatment duration was the only variable associated with impaired LQOL. The majority of patients experienced disadvantages on a daily basis, highlighting the high burden of disease and treatment.


Assuntos
Antibacterianos/uso terapêutico , Febre Q/diagnóstico , Febre Q/tratamento farmacológico , Qualidade de Vida , Idoso , Antibacterianos/efeitos adversos , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Países Baixos , Inquéritos e Questionários , Fatores de Tempo
20.
J Antimicrob Chemother ; 73(4): 1068-1076, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29325142

RESUMO

Background: First choice treatment for chronic Q fever is doxycycline plus hydroxychloroquine. Serum doxycycline concentration (SDC) >5 µg/mL has been associated with a favourable serological response, but the effect on clinical outcomes is unknown. Objectives: To assess the effect of measuring SDC during treatment of chronic Q fever on clinical outcomes. Methods: We performed a retrospective cohort study, to assess the effect of measuring SDC on clinical outcomes in patients treated with doxycycline and hydroxychloroquine for chronic Q fever. Primary outcome was the first disease-related event (new complication or chronic Q fever-related mortality); secondary outcomes were all-cause mortality and PCR-positivity. Multivariable analysis was performed with a Cox proportional hazards model, with shared-frailty terms for different hospitals included. Results: We included 201 patients (mean age 68 years, 83% male): in 167 patients (83%) SDC was measured, 34 patients (17%) were treated without SDC measurement. First SDC was >5 µg/mL in 106 patients (63%), all with 200 mg doxycycline daily. In patients with SDC measured, dosage was adjusted in 41% (n = 68), concerning an increase in 64 patients. Mean SDC was 4.1 µg/mL before dosage increase, and 5.9 µg/mL afterwards. SDC measurement was associated with a lower risk for disease-related events (HR 0.51, 95% CI 0.26-0.97, P = 0.04), but not with all-cause mortality or PCR-positivity. Conclusions: SDC measurement decreases the risk for disease-related events, potentially through more optimal dosing or improved compliance. We recommend measurement of SDC and striving for SDC >5 µg/mL and <10 µg/mL during treatment of chronic Q fever.


Assuntos
Antibacterianos/sangue , Doxiciclina/sangue , Monitoramento de Medicamentos , Febre Q/tratamento farmacológico , Soro/química , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Doxiciclina/administração & dosagem , Feminino , Humanos , Hidroxicloroquina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
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