Sheila B Buijs1, Chantal P Bleeker-Rovers2, Sonja E van Roeden1, Linda M Kampschreur3, Andy I M Hoepelman1, Peter C Wever4, Jan Jelrik Oosterheert1. 1. Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands. 2. Department of Internal Medicine and Infectious Diseases, Radboud Expertise Centre for Q Fever, Radboud university medical center, Nijmegen, the Netherlands. 3. Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands. 4. Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.
Abstract
BACKGROUND: Chronic Q fever usually develops within two years after primary infection with Coxiella burnetii. We determined the interval between acute Q fever and diagnosis of chronic infection, assessed what factors contribute to a longer interval, and evaluated the long-term follow-up. METHODS: From 2007-2018, patients with chronic Q fever were included from 45 participating hospitals. The interval between acute and chronic infection was calculated in patients with a known day of first symptoms and/or serological confirmation of acute Q fever. Chronic Q fever-related complications and mortality were assessed by two investigators based on predefined criteria. RESULTS: In total, 313 (60.3%) proven, 81 (15.6%) probable and 125 (24.1%) possible chronic Q fever patients were identified. The date of acute Q fever was known in 200 patients: in 45 (22.5%) the interval was longer than two years with the longest observed interval being 9.2 years. Patients in whom serological follow-up was performed after acute Q fever were diagnosed less often after this two-year interval (OR 0.26, 95% CI 0.12-0.54). Chronic Q fever-related complications occurred in 216 patients (41.6%). Chronic Q fever-related mortality occurred in 83 (26.5%) of proven and 3 (3.7%) of probable chronic Q fever patients. CONCLUSIONS: Chronic Q fever is still being diagnosed and mortality keeps occurring eight years after a large outbreak. Intervals between acute Q fever and diagnosis of chronic infection can reach over 9 years. We urge physicians to perform microbiological testing for chronic Q fever even many years after an outbreak or acute Q fever disease.
BACKGROUND: Chronic Q fever usually develops within two years after primary infection with Coxiella burnetii. We determined the interval between acute Q fever and diagnosis of chronic infection, assessed what factors contribute to a longer interval, and evaluated the long-term follow-up. METHODS: From 2007-2018, patients with chronic Q fever were included from 45 participating hospitals. The interval between acute and chronic infection was calculated in patients with a known day of first symptoms and/or serological confirmation of acute Q fever. Chronic Q fever-related complications and mortality were assessed by two investigators based on predefined criteria. RESULTS: In total, 313 (60.3%) proven, 81 (15.6%) probable and 125 (24.1%) possible chronic Q feverpatients were identified. The date of acute Q fever was known in 200 patients: in 45 (22.5%) the interval was longer than two years with the longest observed interval being 9.2 years. Patients in whom serological follow-up was performed after acute Q fever were diagnosed less often after this two-year interval (OR 0.26, 95% CI 0.12-0.54). Chronic Q fever-related complications occurred in 216 patients (41.6%). Chronic Q fever-related mortality occurred in 83 (26.5%) of proven and 3 (3.7%) of probable chronic Q feverpatients. CONCLUSIONS: Chronic Q fever is still being diagnosed and mortality keeps occurring eight years after a large outbreak. Intervals between acute Q fever and diagnosis of chronic infection can reach over 9 years. We urge physicians to perform microbiological testing for chronic Q fever even many years after an outbreak or acute Q fever disease.
Authors: Daphne F M Reukers; Pieter T de Boer; Alfons O Loohuis; Peter C Wever; Chantal P Bleeker-Rovers; Arianne B van Gageldonk-Lafeber; Wim van der Hoek; Aura Timen Journal: Emerg Infect Dis Date: 2022-07 Impact factor: 16.126