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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 4

Characteristics and outcome of patients diagnosed with chronic Q fever using the Dutch consensus guideline* but without (definite) chronic Q fever according to alternative criteria†

Dutch consensus guideline
Alternative criteria
Possible Q fever endocarditis or vascular infection, no. (%), n =14
No diagnosis, no. (%), n = 173
Proven Q fever 8 (57.1) 46 (26.6)
Endocarditis 8 (57.1) 18 (10.4);
PCR positive for Coxiella burnetii in blood 6 (42.9) 18 (10.4)
Evidence of endocardial involvement 2 (14.3) 0
Vascular infection 0 24 (13.9)‡
PCR positive in blood 0 7 (4.0)
Vascular focus on imaging 0 17 (9.8)
Other or no focus§ 0 7 (4.1)
Deceased 2 (14.3) 8 (4.6)
Death probably due to Q fever
2 (14.3)
4 (2.3)¶
Probable Q fever 6 (42.9) 58 (33.5)
Endocarditis 4 (28.6) 22 (12.7)
Vascular infection 2 (14.3) 16 (9.3)
Other or no focus 0 20 (11.6)
Deceased 2 (14.3) 4 (2.3)
Death probably due to Q fever 1 (7.1) 0
Possible Q fever 0 69 (39.9)

*Source (14).
†Source (16).
‡In 3 patients with proven chronic Q fever, imaging studies showed that the focus of infection was in both the heart valves and the vascular structures.
§All were PCR positive.
¶For 2 patients, PCR of vascular and heart valve tissue obtained at autopsy was positive for C. burnetii.

Main Article

References
  1. Maurin  M, Raoult  D. Q fever. Clin Microbiol Rev. 1999;12:51853.PubMedGoogle Scholar
  2. van der Hoek  W, Dijkstra  F, Schimmer  B, Schneeberger  PM, Vellema  P, Wijkmans  C, Q fever in the Netherlands: an update on the epidemiology and control measures. Euro Surveill. 2010;15:19520.PubMedGoogle Scholar
  3. Delsing  CE, Kullberg  BJ, Bleeker-Rovers  CP. Q fever in the Netherlands from 2007 to 2010. Neth J Med. 2010;68:3827.PubMedGoogle Scholar
  4. Landais  C, Fenollar  F, Thuny  F, Raoult  D. From acute Q fever to endocarditis: serological follow-up strategy. Clin Infect Dis. 2007;44:133740. DOIPubMedGoogle Scholar
  5. Raoult  D, Tissot-Dupont  H, Foucault  C, Gouvernet  J, Fournier  PE, Bernit  E, Q fever 1985–1998. Clinical and epidemiologic features of 1,383 infections. Medicine (Baltimore). 2000;79:10923. DOIPubMedGoogle Scholar
  6. Botelho-Nevers  E, Fournier  PE, Richet  H, Fenollar  F, Lepidi  H, Foucault  C, Coxiella burnetii infection of aortic aneurysms or vascular grafts: report of 30 new cases and evaluation of outcome. Eur J Clin Microbiol Infect Dis. 2007;26:63540. DOIPubMedGoogle Scholar
  7. Million  M, Thuny  F, Richet  H, Raoult  D. Long-term outcome of Q fever endocarditis: a 26-year personal survey. Lancet Infect Dis. 2010;10:52735. DOIPubMedGoogle Scholar
  8. Raoult  D, Houpikian  P, Tissot  DH, Riss  JM, Arditi-Djiane  J, Brouqui  P. Treatment of Q fever endocarditis: comparison of 2 regimens containing doxycycline and ofloxacin or hydroxychloroquine. Arch Intern Med. 1999;159:16773. DOIPubMedGoogle Scholar
  9. Wegdam-Blans  MC, Vainas  T, van Sambeek  MR, Cuypers  PW, Tjhie  HT, van Straten  AH, Vascular complications of Q-fever infections. Eur J Vasc Endovasc Surg. 2011;42:38492. DOIPubMedGoogle Scholar
  10. Fenollar  F, Fournier  PE, Raoult  D. Molecular detection of Coxiella burnetii in the sera of patients with Q fever endocarditis or vascular infection. J Clin Microbiol. 2004;42:491924. DOIPubMedGoogle Scholar
  11. Musso  D, Raoult  D. Coxiella burnetii blood cultures from acute and chronic Q-fever patients. J Clin Microbiol. 1995;33:312932.PubMedGoogle Scholar
  12. Dupont  HT, Thirion  X, Raoult  D. Q fever serology: cutoff determination for microimmunofluorescence. Clin Diagn Lab Immunol. 1994;1:18996.PubMedGoogle Scholar
  13. Li  JS, Sexton  DJ, Mick  N, Nettles  R, Fowler  VG Jr, Ryan  T, Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30:6338. DOIPubMedGoogle Scholar
  14. Wegdam-Blans  MC, Kampschreur  LM, Delsing  CE, Bleeker-Rovers  CP, Sprong  T, van Kasteren  ME, Chronic Q fever: review of the literature and a proposal of new diagnostic criteria. J Infect. 2012;64:24759. DOIPubMedGoogle Scholar
  15. Kampschreur  LM, Oosterheert  JJ, Koop  AM, Wegdam-Blans  MC, Delsing  CE, Bleeker-Rovers  CP, Microbiological challenges in the diagnosis of chronic Q fever. Clin Vaccine Immunol. 2012;19:78790. DOIPubMedGoogle Scholar
  16. Raoult  D. Chronic Q fever: expert opinion versus literature analysis and consensus. J Infect. 2012;65:1028. DOIPubMedGoogle Scholar

Main Article

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

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Page updated: June 12, 2015
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