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Chronic Q Fever

November 3rd, 2015

I often get emails, phone calls etc from patients having trouble with Q Fever causing long term persistent problems, or saying their Q fever is recurring.

From my understanding of Q Fever, the disease does not ‘come back’  and  patients cannot get ‘reinfected’ ( that is why vaccination is effective – once you have cleared the infection, the body is resistant to getting it again).

The major trouble is that about 10% of persons with Q fever disease go on to get what is called QFS (post Q fever Fatigue Syndrome ).  Current knowledge suggests that even if the organism is dead,  fragments of the dead germ/ bits of the DNA of the organism hang about in the cells of the sufferer, which causes the immune system to ‘overreact’. It is like the control centre of the immune system is broken and it does not react to the world the way it should.

Doxycycline is given to make sure the organism is really dead. The trouble is that the Q fever germ may be dead but may not be gone.

 

This is the sort of thing that this causes

• The dominant symptom is an incapacitating fatigue out of all proportion to the degree of exertion that caused it (the exertion prior to illness would have been managed without difficulty).

•  The debilitating fatigue may occur not during exertion, but later, even the next day, with the patient becoming bed-bound.

•  Importantly, the term ‘fatigue syndrome’ is misleading. QFS is characterised by a complex of symptoms that are not limited to fatigue (see Table below )

• For example: alcohol intolerance occurs in about 50% of QFS cases,  – patients often report ‘distressing hangovers’ after consumption of modest amounts of alcohol.

 

A number of patients will experience some of the symptoms listed i.e. fatigue and other features (without rigors or fever), for 6 months to a year after the initial attack of acute Q fever – followed by full recovery.However, QFS is an incapacitating, longer-lasting version of this symptom set – the difference being that the fatigue and disability of QFS last beyond a year and frequently more than 5 to 10 years.

In the early stages of the disease I always tell my patients that we hope that the disease will burn out within the year, and usually this is the case.

As a general rule,  I recommend my patients look after themselves as well as possible to give their immune system the best chance to get back ‘into kilter’. However, there is no current evidence base for this advice. We cannot yet know if looking after yourself will help or not help, but it make sense to me from all my understanding of the way the human immune system works, and there is not much else that we know does work. There is no recommended drug or treatment once the Doxycycline is finished.

Looking after the immune system means: good balanced diet, avoid too much meat, consume very limited processed sugar, but have lots fresh fruit, vegetables and salads, and lots water. Some of my patients need to see a dietician if they are not familiar with the most recent guidelines on a good diet.

 

Also I advise my patients to avoid spirits, wine, beer, sugary drinks, and to stop smoking if they are smoking. Alcohol and cigarettes put stress on the immune system and the immune system is what is causing the problem, so the last thing sufferers need is to stress the immune system with anything else.

Also have an influenza vaccine… as  contracting influenza on top of chronic Q fever would be especially miserable.

 

I tell my patients, …ideally what you want to avoid at all costs, is this problem hanging around for 5 years or more.  Looking after themselves properly is huge shift for some persons but it makes sense to me to be really diligent at this “look after the immune system plan” early on so the immune system will get things back on track before things ‘set in’.

 

If people say ‘ oh go on have a drink’ – sufferers may be well advised to just think of the possibility of 5 or 10 more years of feeling bad…….the drink or smoke is not worth it.

 

I cannot give more specifics to the situation without a consultation of course, but above is the gist of what I tell my patients.

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