Prognosis

Up to 60% of people infected with Coxiella burnetii remain asymptomatic.​​[26]​ For those who experience symptoms, the majority will have a mild disease without need for hospitalisation. Hospitalised patients represent only 2% to 6% of infected individuals.[5][38] Around 2% of people with acute infection die of the disease.[11] Those who recover fully from infection may possess lifelong immunity against re-infection.

Prognosis of C burnetii endocarditis has much improved and mortality is as low as 5% at 5 years if diagnosis is timely, and if combination treatment with doxycycline and hydroxychloroquine is adequately prescribed and monitored.

Prognosis of C burnetii vascular infections is of concern if the patient does not undergo surgery to remove the infected vascular tissue or vascular prosthetic material; mortality is as high as 30%.[99] Mortality is reduced to around 7% with optimal management (i.e., routine surgery performed 3 weeks to 1 month after initiation of antibiotic treatment, and following an 18- to 24-month course of combination treatment with doxycycline plus hydroxychloroquine with close drug level monitoring).[99]

In patients with cardiovascular-related C burnetii infections, treatment should be stopped at 18 months in those who have native valve or vascular infection without vascular prosthetic material, or at 24 months in those with prosthetic valve or vascular infection with vascular prosthetic material, only if serological outcome is favourable (i.e., two-fold decrease in dilution titre of phase I IgG, and absence of phase II IgM at 1 year).[84] If serology is not favourable, antibiotic treatment should be continued, and observation and drug levels should be verified. An expert opinion should be obtained if therapeutic drug levels are achieved without improvement in serological outcomes.

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