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Volume 21, Number 7—July 2015
Policy Review

Chronic Q Fever Diagnosis—Consensus Guideline versus Expert Opinion

Linda M. KampschreurComments to Author , Marjolijn C.A. Wegdam-Blans, Peter C. Wever, Nicole H.M. Renders, Corine E. Delsing, Tom Sprong, Marjo E.E. van Kasteren, Henk Bijlmer, Daan Notermans, Jan Jelrik Oosterheert, Frans S. Stals, Marrigje H. Nabuurs-Franssen, Chantal P. Bleeker-Rovers, on behalf of the Dutch Q Fever Consensus Group
Author affiliations: Jeroen Bosch Hospital, ’s-Hertogenbosch, the Netherlands (L.M. Kampschreur, P.C. Wever, N.H.M. Renders); University Medical Center Utrecht, Utrecht, the Netherlands (L.M. Kampschreur, J.J. Oosterheert); Laboratory for Pathology and Medical Microbiology, Veldhoven, the Netherlands (M.C.A. Wegdam-Blans); Radboud University Medical Center, Nijmegen, the Netherlands (C.E. Delsing, C.P. Bleeker-Rovers); Canisius-Wilhelmina Ziekenhuis, Nijmegen (T. Sprong); Canisius-Wilhelmina Ziekenhuis, Nijmegen (T. Sprong, M.H. Nabuurs-Franssen); St. Elisabeth Hospital, Tilburg, the Netherlands (M.E.E. van Kasteren); National Institute for Public Health and the Environment, Bilthoven, the Netherlands (H. Bijlmer, D. Notermans); Atrium Medical Centre, Heerlen, the Netherlands (F.S. Stals)

Main Article

Table 2

Diagnostic guideline for chronic Q fever proposed by Raoult*

Q fever endocarditis
A. Definite criteria
Positive culture, PCR, or immunochemistry of a cardiac valve
B. Major criteria
Microbiology: positive culture or PCR of the blood or an emboli 
or serology with IgG I antibodies ≥6,400
Evidence of endocardial involvement:
Echocardiogram positive for IE: oscillating intra-cardiac 
mass on valve or supporting structure, in the path of 
regurgitant jets, or on implanted material in the absence of
an alternative anatomic explanation; or abscess; or new 
partial dehiscence of prosthetic vale; or new valvular 
regurgitation (worsening or changing of pre-existent murmur
not sufficient)
PET scan showing a specific valve fixation and mycotic 
C. Minor criteria
Predisposing heart condition (known or found on 
Fever, temperature >38°C
Vascular phenomena, major arterial emboli, septic pulmonary 
infarcts, mycotic aneurysm (see at PET scan), intracranial 
hemorrhage, conjunctival hemorrhages, and Janeway lesions
Immunologic phenomena: glomerulonephritis, Osle nodes, 
Roth spots, or rheumatoid factor
Serologic evidence: IgG I antibodies ≥800 <6,400
Diagnosis definite
1. 1A criterion
2. 2B criterion
3. 1B, and 3C criterion
Diagnosis possible
1. 1B criterion, 2C criteria (including microbiology evidence, 
and cardiac predisposition)
2. 3C criteria (including positive serology, and cardiac 
Q fever vascular infection
A. Definite criteria
Positive culture, PCR, or immunochemistry of an arterial 
sample (prosthesis or aneurysm) or a periarterial abscess or a
spondylodiscitis linked to aorta
B. Major criteria
Microbiology: positive culture or PCR of the blood or an emboli
or serology with IgG I antibodies ≥6,400
Evidence of vascular involvement
   CT scan: aneurysm or vascular prosthesis + periarterial 
abscess, fistula, or spondylodiscitis
   PET scan: specific fixation on an aneurysm or vascular 
C. Minor criteria
Serological IgG I ≥800 <6,400
Fever, temperature >38°C
Underlying vascular predisposition (aneurysm or vascular 
Diagnosis definite
1. 1A criterion
2. 2B criterion
3. 1B and 2C criterion (including microbiology findings and 
vascular predisposition)
Diagnosis possible
Vascular predisposition, serological evidence and fever or 
*Source (16). IE, infective endocarditis; PET, positron emission tomography; IFA, immunofluorescence assay; CT, computed tomography.

Main Article

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Main Article

1A complete list of the group members is provided at the end of this article.

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