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Follow-up of 686 patients with acute Q fever and detection of chronic infection.
- Source :
-
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2011 Jun 15; Vol. 52 (12), pp. 1431-6. - Publication Year :
- 2011
-
Abstract
- Background: Recent outbreaks in the Netherlands allowed for laboratory follow-up of a large series of patients with acute Q fever and for evaluation of test algorithms to detect chronic Q fever, a condition with considerable morbidity and mortality.<br />Methods: For 686 patients with acute Q fever, IgG antibodies to Coxiella burnetii were determined using an immunofluorescence assay at 3, 6, and 12 months of follow-up. Polymerase chain reaction (PCR) was performed after 12 months and on earlier serum samples with an IgG phase I antibody titer ≥ 1:1024.<br />Results: In 43% of patients, the IgG phase II antibody titers remained high (≥ 1:1024) at 3, 6, and 12 months of follow-up. Three months after acute Q fever, 14% of the patients had an IgG phase I titer ≥ 1:1024, which became negative later in 81%. IgG phase I antibody titers were rarely higher than phase II titers. Eleven cases of chronic Q fever were identified on the basis of serological profile, PCR results, and clinical presentation. Six of these patients were known to have clinical risk factors at the time of acute Q fever. In a comparison of various serological algorithms, IgG phase I titer ≥ 1:1024 at 6 months had the most favorable sensitivity and positive predictive value for the detection of chronic Q fever.<br />Conclusions: The wide variation of serological and PCR results during the follow-up of acute Q fever implies that the diagnosis of chronic Q fever, necessitating long-term antibiotic treatment, must be based primarily on clinical grounds. Different serological follow-up strategies are needed for patients with and without known risk factors for chronic Q fever.
- Subjects :
- Aged
Aged, 80 and over
Chronic Disease
Female
Fluorescent Antibody Technique, Indirect methods
Follow-Up Studies
Humans
Male
Middle Aged
Netherlands
Polymerase Chain Reaction methods
Q Fever immunology
Q Fever microbiology
Q Fever pathology
Sensitivity and Specificity
Antibodies, Bacterial blood
Clinical Laboratory Techniques methods
Coxiella burnetii immunology
Immunoglobulin G blood
Q Fever diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1537-6591
- Volume :
- 52
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
- Publication Type :
- Academic Journal
- Accession number :
- 21628483
- Full Text :
- https://doi.org/10.1093/cid/cir234