Cognitive behavioral therapy for Q fever fatigue syndrome


Cognitive behavioral therapy (CBT) is effective in reducing fatigue severity in patients with Q fever fatigue syndrome (QFS). Long-term treatment with doxycycline, the antibiotic used for patients with acute and chronic Q fever, does not reduce fatigue severity compared to placebo in QFS patients. This is the result of the Qure study, a randomized controlled clinical trial, published in the journal Clinical Infectious Diseases on the 27th of February.
Approximately 20% of patients with acute Q fever will develop chronic fatigue, referred to as QFS. The pathophysiology of QFS remains to be elucidated, hampering treatment based on etiology. A considerable overlap in complaints between QFS and chronic fatigue syndrome, imply that CBT might also reduce fatigue severity in QFS. In addition, long-term treatment with tetracyclines has been reported to improve performance status and reduce fatigue in QFS. 

Qure study
Therefore, the objective of this randomized controlled clinical trial, “the Qure study”, was to assess the efficacy of either long-term treatment with doxycycline or CBT in reducing fatigue severity in patients with QFS. The trial started in 2011 and included 155 QFS patients. Patients were randomly assigned to receive doxycycline, placebo, or CBT. 

Longterm treatment with doxycycline did not significantly reduce fatigue severity in QFS patients compared to treatment with placebo. However, CBT proved effective in reducing fatigue severity compared to placebo. Clinical significant improvement was reached by more than 50% of the patients in the CBT group. 

Future perspectives
Chantal Bleeker: “The effectiveness of CBT does not imply that the cause of QFS is psychological. But these results are positive for all QFS patients, who now know that there is a treatment that might reduce the experienced fatigue severity. Still several hypotheses regarding the etiology of QFS exist, and further research into the etiology is necessary.”


Involved RIHS researchers are Stephan Keijmel en Chantal Bleeker (photo below), department Internal Medicine, within the theme Infectious diseases and global health.


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