Chronic Q fever-related complications and mortality: data from a nationwide cohort

Roeden, Sonja E van; Wever, Peter C.; Kampschreur, Linda M.; Gruteke, P; Hoek, Wim van der; Hoepelman, Andy I. M.; Bleeker‐Rovers, Chantal P.; Oosterheert, Jan Jelrik

doi:10.1016/j.cmi.2018.11.023

Cited by 40 publications

(51 citation statements)

References 23 publications

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“…CQF, chronic Q fever; CVRF, cardiovascular risk factor; IA, incidence area; IC, immunocompromised; ICER, incremental cost-effectiveness ratio; IFA, immunofluorescence assay; QALY, quality-adjusted life year; RF, risk factor. CQF prevalence scenario estimated correspond with previous estimates from the literature (7) or CQF patients included in the national database until May 2016 (6). However, these numbers are thought to be the absolute minimum.…”

Section: Discussionsupporting

confidence: 78%

“…However, these numbers are thought to be the absolute minimum. Only 23% of the proven CQF patients had a diagnosed acute QF episode (6), and a postmortem study among patients with a history of heart valve surgery in the epidemic area indicates that CQF possibly contributed to the death in 15% of the patients (9). The high CQF prevalence scenario could be the upper range because it does not account for preexisting immunity from before the epidemic.…”

Section: Discussionmentioning

confidence: 99%

“…To avoid overestimation of the effect of screening, we conservatively assumed no effectiveness of screening for probable CQF patients and explored a scenario in which probable CQF patients benefit from screening in the sensitivity analysis. No clinical events were assumed in possible CQF patients (6). For undetected CQF patients, we used a higher risk for a late complication and death than for patients found through regular care.…”

Section: Outcome Probabilitiesmentioning

confidence: 99%

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Cost-effectiveness of Screening Program for Chronic Q Fever, the Netherlands

Boer¹,

Lange²,

Wielders³

et al. 2020

Emerg. Infect. Dis.

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C hronic Q fever (CQF) is a potentially lethal condition that develops in 2% of Q fever (QF) patients (1). QF is caused by infection with Coxiella burnetii, a gram-negative bacterium that has its main reservoir in livestock and can infect humans by airborne transmission. CQF can become apparent months to years after infection and usually manifests as endocarditis or vascular infection (2). Risk factors for CQF include heart valve disorders, aortic aneurysms, vascular prostheses, older age, and a compromised immune system (3-5). Prognosis is poor despite long-term antimicrobial drug treatment; 28% of patients need surgery, and 15% die from CQF-related complications (6). During 2007-2010, the Netherlands faced the world's largest QF epidemic ever documented. More than 4,000 patients with acute QF were notified. However, QF often occurs asymptomatically (1), and the total number of infections has been estimated at 50,000 (7). Through May 2016, a substantial number of CQF infections occurred, and at least 74 patients died (8). Because early detection of CQF might result in a better prognosis, local hospitals initiated multiple targeted screening studies for clinical risk groups living in areas affected by the epidemic. These studies revealed that 7%-20% of screened patients had serologic evidence of C. burnetii infection, of whom 5%-31% had CQF (9-11). In 2017, new diagnoses of CQF continued to appear in the Netherlands, often with severe complications, and led to a call from multiple concerned parties, including politicians, the QF patient association, and medical doctors for a national CQF screening program. One aspect considered for such a screening program is whether its costs are economically balanced with the expenditure (12,13). To answer this question, we assessed the cost-effectiveness of a screening program for CQF in the Netherlands. Methods Overview We developed a health-economic decision model to compare estimated costs and effects of a 1-time screening program for CQF with no such screening program (Figure 1). The screening was assumed to occur in 2017, seven years after the epidemic. We estimated comparative outcomes of the model in terms of clinical events, quality-adjusted life years (QALYs), and costs from a societal perspective. We used a lifetime time horizon. Costs were annually discounted at 4% and QALYs at 1.5% (14).

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Outcome Probabilitiesmentioning

confidence: 99%

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Cost-effectiveness of Screening Program for Chronic Q Fever, the Netherlands

Boer¹,

Lange²,

Wielders³

et al. 2020

Emerg. Infect. Dis.

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“…In this Dutch report, 37% of patients with chronic Q fever were not treated, which is surprising. The described treatments were heterogeneous in terms of the antibiotics prescribed and duration of treatment [1]. We use doxycycline in addition to hydroxychloroquine as a safe and effective first-line treatment for 18e24 months in cases of C. burnetii focalized cardiovascular infection.…”

mentioning

confidence: 99%

Re: chronic Q-fever-related complications and mortality: data from a nationwide cohort

Melenotte

Million

Raoult

2019

Clinical Microbiology and Infection

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We read with interest the article by van Roeden et al. about the chronic Q fever mortality rate in The Netherlands. We were surprised to observe that the mortality rate reported from The Netherlands was 3.3 times higher than that observed from the French National Reference Center for Q fever [1,2]. In our experience, among the 678 patients with persistent cardiovascular focalized infection diagnosed between 1991 and 2016, 55 died (55/678, 8%): 43 with endocarditis (43/533, 8%) and 16 with a vascular infection (16/145, 11%); among these four had both Coxiella burnetii endocarditis and vascular persistent infection (4/ 49, 8.1%) [2]. The mortality rate was 1.8 (95%CI 1.4e2 .3) per 100 person-years and the 5-year survival for cardiovascular persistent C. burnetii infection was 73%.(see Table 1) In The Netherlands after the 2009e2011 epidemics, of the 439 patients diagnosed with chronic Q fever 118 died (27%), and of these 54 (35%) had a vascular infection, 27 (32%) had endocarditis, and 20 (47%) had both C. burnetii endocarditis and vascular infection. The 5-year survival for proven and probable chronic Q fever was 64% [1]. Persistent C. burnetii cardiovascular infection is a deadly disease if left untreated, but is ultimately curable, so how can the high mortality rate in The Netherlands be explained?

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“…To the Editor, Melenotte et al point out that in patients with possible chronic Q fever, a PET-CT scan was not routinely performed and that an infectious focus had not been ruled out in all patients [1,2]. Diagnostic work-up in patients with possible chronic Q fever was not standardized: a PET-CT scan was performed in 52% (n ¼ 60) and echocardiography in 72% (n ¼ 83) of patients.…”

mentioning

confidence: 99%