Journal of IiME Volume 1 Issue 2 Chronic Fatigue Syndrome after Q fever (continued) Marmion’s et al. [15] while comparing slaughterhouse workers who had Q fever with a serologically negative control group. Fatigue, headache, disrupted sleep, and muscle and joint pain were significantly more frequent in the group of workers with previous Q fever. Ayres [14] associated shortness of breath in patients after Q fever with possible myocardial lesions after Coxiella burnetii infection, that were first referred to by Maisch in 1986 [16]. Lovey et al. [17] established a higher incidence of cardiovascular diseases in patients who had Q fever in comparison with a control group. Later studies by Ayres et al. did not show any significant difference in cardiological measurements that would suggest cardiomyopathy or other heart diseases when comparing a group with CFS after acute Q fever and a group without symptoms of CFS [18]. Thomas et al. did not find any significant differences in the frequencies of fatigue, depression, and lack of concentration between individuals with positive antibodies for Coxiella burnetii and serologically negative individuals. The imperfection of this study was that it included all Q-feverseropositive individuals without differentiation between patients who had asymptomatic and those who had symptomatic acute Q fever, as well as the fact that the study was done on a relatively healthy population with little neuropsychiatric morbidity [19]. Although Marmion et al. suggested that the diagnosis of QFS does not require serological criteria for chronic Q fever, low serological titers against C. burnetti were associated with chronic fatigue syndrome by Penttila et al. [15,11]. It is therefore not clear if patients with symptoms of CFS and positive serology of chronic Q fever, but lacking other clinical manifestations of chronic Q-fever such as endocarditis or osteitis, as described in the cases 2 and 3 of this paper, should be included in this syndrome. We therefore believe that patients with CFS criteria, positive phase I serology, and without other clinical manifestations of chronic Q fever should be diagnosed as QFS. Finally, is there any usefulness of antibiotic therapy of post-Q-fever CFS? The results of antibiotic therapy in patients presented in this paper were conflicting: in two cases the symptoms diminished, while the third patient continued to complain of CFS symptoms. These results are based on their clinical findings, before and after the therapy, as well as a questionnaire investigation. Up to now, there are two studies investigating the outcome of QFS therapy. Arashima et al. conducted treatment with minocycline for a period of three months in twenty patients with QFS. The result was satisfactory, and in all patients fatigue resolved, while seven patients with positive PCR test for Coxiella burnetii turned negative [20]. The limitation of this study is the absence of a placebo control group. One year later, Iwakami et al. Studied the effects of three months of antibiotic therapy in patients with post-Q-fever CFS. Although they became negative for C. burnetii DNA, in contrast to Arashima’s study no improvement of their symptoms was observed [21]. Another anecdotal attempt was the treatment of three-year-old girl with post-Q-fever CFS with interferon-g after unsuccessful antibiotic therapy [22]. Invest in ME Charity Nr 1114035 The idea for such therapy was based on the knowledge that interferon-g induces the killing of monocytes infected with Coxiella burnetii. The result of treatment was satisfying and encouraging for further investigations. Although Vissar et al. [23] accentuated the diversity of the immune response of peripheral mononuclear cells in patients with CFS after stimulation with dexamethasone, our patient treated with corticosteroids did not experience amelioration of his symptoms. CONCLUSIONS Our case series of patients from southern Croatia, where Q fever is endemic, is in concordance with more detailed data presented in the past from other areas of the world. Therefore we can conclude that a substantial number of patients develops CFS after acute Q fever in spite of appropriate antibiotic therapy during acute infection. The results of prolonged antibiotic therapy in such the patients are inconsistent. Efforts to establish diagnostic criteria as well as therapeutic recommendations for post-Q-fever CFS require further investigation. REFERENCES: 1. Brouqui P, Marrie TJ, Raoult D: Coxiella In: Murray PR, Baron EJ, Jorgenson JH, Phaler MA, Yolken RH (eds.) Manual of clinical microbiology. 8th ed. Washington D.C, ASM press; 2003; 1030–36 2. Marrie TJ, Raoult D: Coxiella burnetii (Q fever). In: Mandell GL, Douglas JE, Bennett JE (eds.) Principles and Practice of Infectious Diseases. 6th ed. New York: Churchill Livingstone, 2005; 2296–302 Med Sci Monit, 2007; 13(7): CS88-92 Ledina D et al – Chronic Fatigue Syndrome and Q fever CS91 3. Punda-Polić V, Radulović S: Sero-survey of Q fever in the north-western part of Bosnia and Herzegovina. Croat Med J, 1997; 38: 345–47 4. Medić A, Dželalija B, Punda Polić V et al: Q fever epidemic among employees in a factory in the suburb of Zadar, Croatia. Croat Med J, 2005; 46(2): 315–19 5. Lukšić B, Punda-Polić V, Ivić I et al: Clinical and epidemiological features of hospitalized acute Q fever cases from Split-Dalmatia County (Croatia), 1985–2002. Med Sci Monit, 2006; 12(3): CR126–31 6. Puljiz I, Kuzman I, Daković-Rode O: Clinical and epidemiological characteristics of Q fever in hospitalised patients. Infektol. Glasn, 2005; 25: 75–80 7. Raoult D, Marrie TJ, Mege JL: Natural history and pathophysiology of Q fever. Lancet Infect Dis, 2005; 5: 219–26 8. Fukuda K, Straus SE, Hickie I et al: The Chronic fatigue syndrome: A Comprehensive Approach to its Defi nition and Study. Ann Intern Med, 1994; 121: 953–59 9. Engelberg NC: Chronic Fatique Syndrome. In: Mandell GL, Douglas JE, Bennett JE (eds.) Principles and Practice of Infectious Diseases. 6th ed. New York: Churchill Livingstone; 2005; 120–25 10. Korzon M, Bukowska W, Szlogatys-Sidorkiewicz A: Chronic fatigue syndrome. Med Sci Monit, 1998; 4(2): 388–92 (continued on page 34) Page 33/72 www.investinme.org

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