Chronic Q fever: Review of the literature and a proposal of new diagnostic criteria

Wegdam-Blans, Marjolijn C A; Kampschreur, Linda M.; Delsing, Corine E.; Bleeker‐Rovers, Chantal P.; Sprong, Tom; Kasteren, M.E.E. van; Notermans, Daan W.; Renders, Nicole H. M.; Bijlmer, H. A.; Lestrade, P; Koopmans, Marion; Nabuurs-Franssen, Marrigje H.; Oosterheert, Jan Jelrik

doi:10.1016/j.jinf.2011.12.014

Cited by 171 publications

(213 citation statements)

References 53 publications

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“…Patients were included in the database if they were 18 years old or older and they fulfilled the criteria of proven, probable, or possible chronic Q fever according to the recent Dutch consensus guideline (Table 1) (15). In this guideline, the proven chronic Q fever group represents patients with the most definite form of chronic Q fever, in contrast to the possible chronic Q fever group, which represents patients with serology indicating chronic Q fever but without other manifestations of chronic disease.…”

Section: Methodsmentioning

confidence: 99%

“…A positive PCR or culture of C. burnetii in blood or tissue, in the absence of a serologic profile for acute Q fever, is considered diagnostic for chronic Q fever. However, PCR on blood has a limited sensitivity of only 50 to 60% (15)(16)(17). Therefore, serological analysis has an essential role in the diagnosis of chronic Q fever.…”

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confidence: 99%

“…Chronic Q fever is characterized by persistent high titers of IgG antibodies against C. burnetii phase I antigens (phase I IgG) (3). A phase I IgG cutoff titer of 800, based on an in-house-developed immunofluorescence assay (IFA), as well as a cutoff titer of 1,024 based on a commercially available IFA (Focus Diagnostics) have been used as standards for the serological diagnosis of chronic Q fever (15,(18)(19)(20). Recent studies show that serology alone, in the absence of PCR positivity, is not sufficient for the diagnosis of chronic Q fever and should therefore be combined with clinical data (21).…”

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confidence: 99%

“…The Dutch consensus group for the diagnosis of Q fever proposed to categorize patients into proven, probable, or possible chronic Q fever. This classification ranks the probability of having chronic Q fever based on PCR, serology, clinical parameters, imaging studies, and pathology (Table 1) (15).…”

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Chronic Q Fever in the Netherlands 5 Years after the Start of the Q Fever Epidemic: Results from the Dutch Chronic Q Fever Database

et al. 2014

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j Coxiella burnetii causes Q fever, a zoonosis, which has acute and chronic manifestations. From 2007 to 2010, the Netherlands experienced a large Q fever outbreak, which has offered a unique opportunity to analyze chronic Q fever cases. In an observational cohort study, baseline characteristics and clinical characteristics, as well as mortality, of patients with proven, probable, or possible chronic Q fever in the Netherlands, were analyzed. In total, 284 chronic Q fever patients were identified, of which 151 (53.7%) had proven, 64 (22.5%) probable, and 69 (24.3%) possible chronic Q fever. Among proven and probable chronic Q fever patients, vascular infection focus (56.7%) was more prevalent than endocarditis (34.9%). An acute Q fever episode was recalled by 27.0% of the patients. The all-cause mortality rate was 19.1%, while the chronic Q fever-related mortality rate was 13.0%, with mortality rates of 9.3% among endocarditis patients and 18% among patients with a vascular focus of infection. Increasing age (P ‫؍‬ 0.004 and 0.010), proven chronic Q fever (P ‫؍‬ 0.020 and 0.002), vascular chronic Q fever (P ‫؍‬ 0.024 and 0.005), acute presentation with chronic Q fever (P ‫؍‬ 0.002 and P < 0.001), and surgical treatment of chronic Q fever (P ‫؍‬ 0.025 and P < 0.001) were significantly associated with all-cause mortality and chronic Q fever-related mortality, respectively.

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Chronic Q Fever in the Netherlands 5 Years after the Start of the Q Fever Epidemic: Results from the Dutch Chronic Q Fever Database

et al. 2014

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“…Patients with preexisting valvular disease, aneurysms, or vascular grafts, immunocompromised patients, and pregnant women are most at risk for chronic infection (1). The diagnosis of chronic Q fever is difficult and relies mainly on serologic findings, blood or tissue PCR assay results, clinical findings, the presence of risk factors, and the results of diagnostic imaging techniques (18). Nevertheless, as chronic Q fever has high morbidity and mortality rates if left untreated, early detection and treatment are important (19).…”

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confidence: 99%

High Coxiella burnetii DNA Load in Serum during Acute Q Fever Is Associated with Progression to a Serologic Profile Indicative of Chronic Q Fever

et al. 2013

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Development of a high throughput PCR to detect Coxiella burnetii and its application in a diagnostic laboratory over a 7-year period

Jaton

Péter

Raoult

et al. 2013

New Microbes and New Infections

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Q fever is a worldwide zoonotic infectious disease due to Coxiella burnetii . The clinical presentation may be acute (pneumonia and/or hepatitis) or chronic (most commonly endocarditis). Diagnosis mainly relies on serology and PCR. We therefore developed a quantitative real-time PCR. We first tested blindly its performance on various clinical samples and then, when thoroughly validated, we applied it during a 7-year period for the diagnosis of both acute and persistent C. burnetii infection. Analytical sensitivity (< 10 copies/PCR) was excellent. When tested blindly on 183 samples, the specificity of the PCR was 100% (142/142) and the sensitivity was 71% (29/41). The sensitivity was 88% (7/8) on valvular samples, 69% (20/29) on blood samples and 50% (2/4) on urine samples. This new quantitative PCR was then successfully applied for the diagnosis of acute Q fever and endovascular infection due to C. burnetii , allowing the diagnosis of Q fever in six patients over a 7-year period. During a local small cluster of cases, the PCR was also applied to blood from 1355 blood donors; all were negative confirming the high specificity of this test. In conclusion, we developed a highly specific method with excellent sensitivity, which may be used on sera for the diagnosis of acute Q fever and on various samples such as sera, valvular samples, aortic specimens, bone and liver, for the diagnosis of persistent C. burnetii infection.

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Chronic Q fever: Review of the literature and a proposal of new diagnostic criteria

Cited by 171 publications

References 53 publications

Chronic Q Fever in the Netherlands 5 Years after the Start of the Q Fever Epidemic: Results from the Dutch Chronic Q Fever Database

Chronic Q Fever in the Netherlands 5 Years after the Start of the Q Fever Epidemic: Results from the Dutch Chronic Q Fever Database

High Coxiella burnetii DNA Load in Serum during Acute Q Fever Is Associated with Progression to a Serologic Profile Indicative of Chronic Q Fever

Development of a high throughput PCR to detect Coxiella burnetii and its application in a diagnostic laboratory over a 7-year period

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