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Q Fever PVE Duration — SCE Infectious Diseases MCQ

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HardBone & Joint InfectionQ Fever PVE DurationSCE Infectious Diseases

A 60-year-old man with a metallic aortic valve develops endocarditis with an organism identified as Coxiella burnetii (chronic Q fever). Phase I IgG is 1:4096. Echocardiography shows a small vegetation on the prosthetic valve. He is started on Doxycycline plus Hydroxychloroquine. What is the minimum treatment duration for Q fever prosthetic valve endocarditis?

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Correct answer: B — At least 24 months (some experts recommend longer — until Phase I IgG declines to <1:200)

Q fever PVE requires the longest antibiotic course of any endocarditis: Doxycycline 100 mg BD plus Hydroxychloroquine 200 mg TDS for a minimum of 24 months. Some centres continue until Phase I IgG titre drops below 1:200 (which may take 3–5 years). Regular monitoring includes: Phase I IgG titres (quarterly), renal function, ophthalmological review for Hydroxychloroquine retinal toxicity, and echocardiographic surveillance. Valve surgery may be required if haemodynamic deterioration occurs.

Reference: ESC 2023 – Endocarditis; UKHSA 2022 – Q fever