BACKGROUND: Recent outbreaks in the Netherlands allowed for laboratory follow-up of a large series of patients with acute Q fever and for evaluation of test algorithms to detect chronic Q fever, a condition with considerable morbidity and mortality. METHODS: For 686 patients with acute Q fever, IgG antibodies to Coxiella burnetii were determined using an immunofluorescence assay at 3, 6, and 12 months of follow-up. Polymerase chain reaction (PCR) was performed after 12 months and on earlier serum samples with an IgG phase I antibody titer ≥ 1:1024. RESULTS: In 43% of patients, the IgG phase II antibody titers remained high (≥ 1:1024) at 3, 6, and 12 months of follow-up. Three months after acute Q fever, 14% of the patients had an IgG phase I titer ≥ 1:1024, which became negative later in 81%. IgG phase I antibody titers were rarely higher than phase II titers. Eleven cases of chronic Q fever were identified on the basis of serological profile, PCR results, and clinical presentation. Six of these patients were known to have clinical risk factors at the time of acute Q fever. In a comparison of various serological algorithms, IgG phase I titer ≥ 1:1024 at 6 months had the most favorable sensitivity and positive predictive value for the detection of chronic Q fever. CONCLUSIONS: The wide variation of serological and PCR results during the follow-up of acute Q fever implies that the diagnosis of chronic Q fever, necessitating long-term antibiotic treatment, must be based primarily on clinical grounds. Different serological follow-up strategies are needed for patients with and without known risk factors for chronic Q fever.
BACKGROUND: Recent outbreaks in the Netherlands allowed for laboratory follow-up of a large series of patients with acute Q fever and for evaluation of test algorithms to detect chronic Q fever, a condition with considerable morbidity and mortality. METHODS: For 686 patients with acute Q fever, IgG antibodies to Coxiella burnetii were determined using an immunofluorescence assay at 3, 6, and 12 months of follow-up. Polymerase chain reaction (PCR) was performed after 12 months and on earlier serum samples with an IgG phase I antibody titer ≥ 1:1024. RESULTS: In 43% of patients, the IgG phase II antibody titers remained high (≥ 1:1024) at 3, 6, and 12 months of follow-up. Three months after acute Q fever, 14% of the patients had an IgG phase I titer ≥ 1:1024, which became negative later in 81%. IgG phase I antibody titers were rarely higher than phase II titers. Eleven cases of chronic Q fever were identified on the basis of serological profile, PCR results, and clinical presentation. Six of these patients were known to have clinical risk factors at the time of acute Q fever. In a comparison of various serological algorithms, IgG phase I titer ≥ 1:1024 at 6 months had the most favorable sensitivity and positive predictive value for the detection of chronic Q fever. CONCLUSIONS: The wide variation of serological and PCR results during the follow-up of acute Q fever implies that the diagnosis of chronic Q fever, necessitating long-term antibiotic treatment, must be based primarily on clinical grounds. Different serological follow-up strategies are needed for patients with and without known risk factors for chronic Q fever.
Authors: W van der Hoek; C C H Wielders; B Schimmer; M C A Wegdam-Blans; J Meekelenkamp; H L Zaaijer; P M Schneeberger Journal: Eur J Clin Microbiol Infect Dis Date: 2012-07-10 Impact factor: 3.267
Authors: Julia C J P Hagenaars; Olivier H J Koning; Ronald F F van den Haak; Bart A N Verhoeven; Nicole H M Renders; Mirjam H A Hermans; Peter C Wever; Robert Jan van Suylen Journal: Int J Exp Pathol Date: 2014-06-23 Impact factor: 1.925
Authors: Linda M Kampschreur; Jan Jelrik Oosterheert; Annemarie M C Koop; Marjolijn C A Wegdam-Blans; Corine E Delsing; Chantal P Bleeker-Rovers; Monique G L De Jager-Leclercq; Cornelis A R Groot; Tom Sprong; Marrigje H Nabuurs-Franssen; Nicole H M Renders; Marjo E van Kasteren; Yvonne Soethoudt; Sybrandus N Blank; Marjolijn J H Pronk; Rolf H H Groenwold; Andy I M Hoepelman; Peter C Wever Journal: Clin Vaccine Immunol Date: 2012-03-21
Authors: J C J P Hagenaars; N H M Renders; A S van Petersen; S O A Shamelian; M G L de Jager-Leclercq; F L Moll; P C Wever; O H J Koning Journal: Eur J Clin Microbiol Infect Dis Date: 2014-03-12 Impact factor: 3.267
Authors: M C A Wegdam-Blans; H T Tjhie; J M Korbeeck; M N Nabuurs-Franssen; L M Kampschreur; T Sprong; J A W Teijink; M P Koopmans Journal: Eur J Clin Microbiol Infect Dis Date: 2014-01-16 Impact factor: 3.267