The immune response to phase I and phase II Coxiella burnetii antigens as measured by western immunoblotting.

To determine the utility of Western immunoblotting in distinguishing chronic Q fever from acute Q fever, we first examined serum samples from individuals who had no antibodies to Coxiella burnetii by either the indirect immunofluorescence antibody test or by the enzyme-linked immunosorbent assay. In these subjects, the IgG fraction in low dilutions of serum (1:8, 1:16) reacted with as many as 10 proteins in phase I and phase II antigens. This number of reacting bands seen in Western blots was reduced by using serum in a dilution of 1:1024. In contrast, IgA antibodies were uncommon even at low dilutions. Likewise, IgA antibodies were infrequently observed in patients with acute Q fever. However, in chronic Q fever there were many IgA antibodies to phase I and phase II proteins. Antibodies to phase I proteins were more common than those to phase II proteins. Several antigenic protein bands were recognized only by serum from chronic Q fever patients. Three of these antigens had molecular masses of, respectively, 50 kDa, 80 kDa, and 160 kDa. Serial serum samples from patients with chronic Q fever revealed that the number of antigens recognized by the IgA fraction decreased after the initiation of antibiotic therapy. The decline was faster for antibodies to phase II proteins. We conclude that immunoblotting is useful in the diagnosis of chronic Q fever.