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Moroșan D, Șerban A, Trifan C, Encica S, Pop S, Șerban TC, Rednic S, Damian L. Frenemies within: An Endocarditis Case in Behçet's Disease. J Pers Med 2021; 11:728. [PMID: 34442371 PMCID: PMC8402229 DOI: 10.3390/jpm11080728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/14/2021] [Accepted: 07/25/2021] [Indexed: 01/05/2023] Open
Abstract
A 57-year female patient diagnosed with Behçet's disease, on azathioprine, was noticed to have at a routine examination antinuclear and antiphospholipid antibodies. An overlapping lupus-like syndrome was diagnosed; hydroxychloroquine and aspirin were added. Three years later, the patient presented with dyspnea and sweating, with no fever. A cardiac bruit was noted; a giant vegetation was detected by echocardiography. Laboratory revealed severe thrombocytopenia, antiphospholipid antibodies and low complement. Blood cultures were positive for Abiotrophia defectiva serology and also revealed a chronic Coxiella burnetii infection. Antibiotic therapy, low-dose anticoagulation and control of the underlying disease mildly improved the platelet count, which fully recovered only after cardiac valve replacement. However, the Behçet's disease, initially quiescent, flared after the therapy of infections. We discuss potential links between Behçet's disease and the occurrence of antinuclear and antiphospholipid antibodies and Coxiella endocarditis in this setting. We also highlight the differences between the endocarditis in Behçet's disease, antiphospholipid syndrome, Coxiella burnetii and Abiotrophia defectiva infection, respectively. Intracellular infections may modify the presentation of autoimmune diseases. Confounding clinical features of Coxiella persistent infection and non-bacterial thrombotic endocarditis in Behçet's disease warrant further insight.
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Affiliation(s)
- Diana Moroșan
- Department of Rheumatology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 8 Victor Babeș St., 400012 Cluj-Napoca, Romania; (D.M.); (S.R.)
| | - Adela Șerban
- Department of Cardiology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 8 Victor Babeș St., 400012 Cluj-Napoca, Romania;
- Department of Cardiology, “Niculae Stancioiu” Heart Institute Cluj-Napoca, 19-21, Calea Moților St., 400001 Cluj-Napoca, Romania;
| | - Cătălin Trifan
- Department of Cardiovascular Surgery, “Niculae Stancioiu” Heart Institute Cluj-Napoca, 19-21, Calea Moților St., 400001 Cluj-Napoca, Romania;
| | - Svetlana Encica
- Department of Pathology, “Niculae Stancioiu” Heart Institute Cluj-Napoca, 19-21, Calea Moților St., 400001 Cluj-Napoca, Romania
| | - Sorin Pop
- 1st Internal Medicine Department, Emergency Clinical County Hospital Cluj, 3-5 Clinicilor St., 400006 Cluj-Napoca, Romania;
| | - Tudor Costinel Șerban
- Department of Cardiology, “Niculae Stancioiu” Heart Institute Cluj-Napoca, 19-21, Calea Moților St., 400001 Cluj-Napoca, Romania;
| | - Simona Rednic
- Department of Rheumatology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 8 Victor Babeș St., 400012 Cluj-Napoca, Romania; (D.M.); (S.R.)
- Department of Rheumatology, Centre for Rare Musculoskeletal Autoimmune and Autoinflammatory Diseases, Emergency Clinical County Hospital Cluj, 2-4 Clinicilor St., 400006 Cluj-Napoca, Romania;
| | - Laura Damian
- Department of Rheumatology, Centre for Rare Musculoskeletal Autoimmune and Autoinflammatory Diseases, Emergency Clinical County Hospital Cluj, 2-4 Clinicilor St., 400006 Cluj-Napoca, Romania;
- CMI Reumatologie Dr. Damian, 6-8 P. Maior St., 400002 Cluj-Napoca, Romania
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Acute Q Fever in an Ankylosing Spondyloarthritis Patient Treated with Etanercept. Case Rep Rheumatol 2021; 2021:9944387. [PMID: 34158982 PMCID: PMC8187044 DOI: 10.1155/2021/9944387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/04/2021] [Accepted: 05/22/2021] [Indexed: 11/23/2022] Open
Abstract
Q fever is a rare zoonotic infection caused by Coxiella burnetii. Tumor necrosis factor-alpha (TNF-α) has an important role in the early control of this infection. However, TNF-α blockers increase the risk of infectious diseases. We present herein a patient who developed acute Q fever under anti-TNF-α who had a good evolution after anti-TNF stoppage and treatment with doxycycline.
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Q Fever Endocarditis in Northeast Iran. Case Rep Infect Dis 2021; 2021:5519164. [PMID: 34136293 PMCID: PMC8177991 DOI: 10.1155/2021/5519164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/16/2021] [Indexed: 11/17/2022] Open
Abstract
This report presents a case of chronic Q fever endocarditis. A 60-year-old male farmer and rancher was admitted to the hospital with symptoms of weight loss, fever, severe sweating, weakness, and anorexia. PCR was negative for C. burnetii in the blood sample, but phase I and II IgG antibodies against C. burnetii were positive (1 : 16384 and 1 : 2048, respectively) by the indirect immunofluorescent assay (IFA). According to the adjusted Duke criteria, Q fever endocarditis was confirmed, and the patient was successfully treated with doxycycline and hydroxychloroquine.
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Mahajan P, Pant K, Majdizadeh S. Q fever: a rare but potentially life-threatening zoonotic disease. BMJ Case Rep 2021; 14:e237155. [PMID: 33602758 PMCID: PMC7896566 DOI: 10.1136/bcr-2020-237155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2021] [Indexed: 11/04/2022] Open
Abstract
Q fever can present as a fever of unknown aetiology and can be challenging to diagnose because of the rare incidence. It can present as an acute illness with manifestations, including influenza-like symptoms, hepatitis, pneumonia or chronic disease involving the cardiovascular system. We present a case of a 39-year-old woman in the USA, who developed acute Q fever with associated sepsis and severe hepatitis. She received treatment with recovery from acute infection but currently has symptoms of post Q fever syndrome.
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Affiliation(s)
- Pranav Mahajan
- Internal Medicine, Carle Foundation Hospital, Urbana, Illinois, USA
| | - Kailash Pant
- Internal Medicine, Carle Foundation Hospital, Urbana, Illinois, USA
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Comparison of Different Commercially Available Enzyme-Linked Immunosorbent Assays with Immunofluorescence Test for Detection of Phase II IgG and IgM Antibodies to Coxiella burnetii. J Clin Microbiol 2020; 58:JCM.00951-19. [PMID: 31748325 DOI: 10.1128/jcm.00951-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/08/2019] [Indexed: 11/20/2022] Open
Abstract
Several commercially available enzyme-linked immunosorbent assays (ELISAs) for the detection of phase II IgG or IgM antibodies against Coxiella burnetii were compared. In addition, an indirect immunofluorescence test was used as a confirmation test. In all, 70 serum samples for IgG and 43 serum samples for IgM were tested. The ELISAs showed large differences in sensitivity and specificity, which led to a partially high ratio of false-negative determinations. The most convincing test was PanBio from Abbott, which unfortunately can only test IgG but not IgM.
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Gerhards V, Reiner MF, Beer JH, Greiner M. [For Once Not Corona Virus - an Uncommon Cause of Fever and Hepatitis]. PRAXIS 2020; 109:1150-1152. [PMID: 33108999 DOI: 10.1024/1661-8157/a003557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
For Once Not Corona Virus - an Uncommon Cause of Fever and Hepatitis Abstract. Our case reports acute Q fever as uncommon cause of fever, typically accompanied by pneumonia and/or hepatitis. It is caused by Coxiella burnetii, a bacterium which is generally hosted by live stock and affects humans by inhaling aerosols of the animals' excrements. If detected, it may be treated effectively. It should be considered in patients living in a typical environment or with a typical history. The route of our patient's infection remains unclear since he plausibly denied contact with any animals.
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Affiliation(s)
| | | | - Jürg H Beer
- Departement Innere Medizin, Kantonsspital Baden
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de Lange MMA, Gijsen LEV, Wielders CCH, van der Hoek W, Scheepmaker A, Schneeberger PM. Should Acute Q-Fever Patients be Screened for Valvulopathy to Prevent Endocarditis? Clin Infect Dis 2019; 67:360-366. [PMID: 29471496 PMCID: PMC6051461 DOI: 10.1093/cid/ciy128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 02/19/2018] [Indexed: 01/09/2023] Open
Abstract
Background Echocardiographic screening of acute Q-fever patients and antibiotic prophylaxis for patients with cardiac valvulopathy is considered an important approach to prevent chronic Q-fever-related endocarditis. During a large Q-fever epidemic in the Netherlands, routine screening echocardiography was discontinued, raising controversy in the international literature. We followed a cohort of acute Q-fever patients to estimate the risk for developing chronic Q-fever, and we evaluated the impact of screening in patients who were not yet known to have a valvulopathy. Methods The study population consisted of patients diagnosed with acute Q-fever in 2007 and 2008. We retrospectively reviewed all screening echocardiographs and checked for development of chronic Q-fever 8 years after the acute episode. Risks of developing chronic Q-fever in relation to the presence or absence of valvulopathy were analyzed with logistic regression. Results The cohort included 509 patients, of whom 306 received echocardiographic screening. There was no significant difference (P-value = .22) in occurrence of chronic Q-fever between patients with a newly detected valvulopathy (2/84, 2.4%) and those with no valvulopathy (12/202, 5.9%). Two patients with a newly detected valvulopathy, who did not receive antibiotic prophylaxis, developed chronic Q-fever at a later stage. Conclusions We found no difference in outcome between patients with and without a valvulopathy newly detected by echocardiographic screening. In retrospect, the 2 above-mentioned patients could have benefitted from antibiotic prophylaxis, but its omission must be weighed against the unnecessary large-scale and long-term use of antibiotics that would have resulted from universal echocardiographic screening.
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Affiliation(s)
- Marit M A de Lange
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven
| | | | - Cornelia C H Wielders
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven
| | - Wim van der Hoek
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven
| | | | - Peter M Schneeberger
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
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de Lange MMA, Scheepmaker A, van der Hoek W, Leclercq M, Schneeberger PM. Risk of chronic Q fever in patients with cardiac valvulopathy, seven years after a large epidemic in the Netherlands. PLoS One 2019; 14:e0221247. [PMID: 31437175 PMCID: PMC6705838 DOI: 10.1371/journal.pone.0221247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 08/04/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND From 2007 through 2010, a large epidemic of acute Q fever occurred in the Netherlands. Patients with cardiac valvulopathy are at high risk to develop chronic Q fever after an acute infection. This patient group was not routinely screened, so it is unknown whether all their chronic infections were diagnosed. This study aims to investigate how many chronic Q fever patients can be identified by routinely screening patients with valvulopathy and to establish whether the policy of not screening should be changed. METHODS In a cross-sectional study (2016-2017) in a hospital at the epicentre of the Q fever epidemic, a blood sample was taken from patients 18 years and older who presented with cardiac valvulopathy. The sample was tested for IgG antibodies against phase I and II of Coxiella burnetii using an immunofluorescence assay. An IgG phase II titre of ≥1:64 was considered serological evidence of a previous Q fever infection. An IgG phase I titre of ≥1:512 was considered suspicious for a chronic infection, and these patients were referred for medical examination. RESULTS Of the 904 included patients, 133 (15%) had evidence of a previous C. burnetii infection, of whom 6 (5%) had a chronic infection on medical examination. CONCLUSIONS In a group of high-risk patients with a heart valve defect, we diagnosed new chronic Q fever infections seven years after the epidemic, emphasizing the need for screening of this group to prevent complications in those not yet diagnosed in epidemic areas.
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Affiliation(s)
- Marit M. A. de Lange
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- * E-mail:
| | - Arko Scheepmaker
- Department of Cardiology, Bernhoven Hospital, Uden, the Netherlands
| | - Wim van der Hoek
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Monique Leclercq
- Department of Internal Medicine, Bernhoven Hospital, Uden, the Netherlands
| | - Peter M. Schneeberger
- Department of Medical Microbiology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands
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Alende-Castro V, Macía-Rodríguez C, Novo-Veleiro I, García-Fernández X, Treviño-Castellano M, Rodríguez-Fernández S, González-Quintela A. Q fever in Spain: Description of a new series, and systematic review. PLoS Negl Trop Dis 2018; 12:e0006338. [PMID: 29543806 PMCID: PMC5871012 DOI: 10.1371/journal.pntd.0006338] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 03/27/2018] [Accepted: 02/23/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Forms of presentation of Q fever vary widely across Spain, with differences between the north and south. In the absence of reported case series from Galicia (north-west Spain), this study sought to describe a Q-fever case series in this region for the first time, and conduct a systematic review to analyse all available data on the disease in Spain. METHODS Patients with positive serum antibodies to Coxiella burnetii from a single institution over a 5-year period (January 2011-December 2015) were included. Patients with phase II titres above 1/128 (or documented seroconversion) and compatible clinical criterial were considered as having Q fever. Patients with clinical suspicion of chronic Q-fever and IgG antibodies to phase I-antigen of over 1/1024, or persistently high levels six months after treatment were considered to be cases of probable chronic Q-fever. Systematic review: We conducted a search of the Pubmed/Medline database using the terms: Q Fever OR Coxiella burnetii AND Spain. Our search yielded a total of 318 studies: 244 were excluded because they failed to match the main criteria, and 41 were discarded due to methodological problems, incomplete information or duplication. Finally, 33 studies were included. RESULTS A total of 155 patients, all of them from Galicia, with positive serological determination were located during the study period; 116 (75%) were deemed to be serologically positive patients without Q fever and the remaining 39 (25%) were diagnosed with Q fever. A potential exposure risk was found in 2 patients (5%). The most frequent form of presentation was pneumonia (87%), followed by isolated fever (5%), diarrhoea (5%) and endocarditis (3%). The main symptoms were headache (100%), cough (77%) and fever (69%). A trend to a paucisymptomatic illness was observed in women. Hospital admission was required in 37 cases, and 6 patients died while in hospital. Only 2 patients developed chronic Q-fever. Systematic review: Most cases were sporadic, mainly presented during the winter and spring, as pneumonia in 37%, hepatitis in 31% and isolated fever in 29.6% of patients. In the north of Spain, 71% of patients had pneumonia, 13.2% isolated fever and 13% hepatitis. In the central and southern areas, isolated fever was the most frequent form of presentation (40%), followed by hepatitis (38.4%) and pneumonia (17.6%). Only 31.7% of patients reported risk factors, and an urban-environment was the most frequent place of origin. Overall mortality was 0.9%, and the percentage of patients with chronic forms of Q-fever was 2%. CONCLUSIONS This is the first study to report on a Q-fever case series in Galicia. It shows that in this region, the disease affects the elderly population -even in the absence of risk factors- and is linked to a higher mortality than reported by previous studies. While pneumonia is the most frequent form of presentation in the north of the country, isolated fever and hepatitis tend to be more frequent in the central and southern areas. In Spain, 32% of Q-fever cases do not report contact with traditional risk factors, and around 58% live in urban areas.
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Affiliation(s)
- Vanesa Alende-Castro
- Department of Internal Medicine, University Teaching Hospital, Santiago de Compostela, A Coruña, Spain
| | | | - Ignacio Novo-Veleiro
- Department of Internal Medicine, University Teaching Hospital, Santiago de Compostela, A Coruña, Spain
| | - Xana García-Fernández
- Department of Microbiology, University Teaching Hospital, Santiago de Compostela, A Coruña, Spain
| | | | | | - Arturo González-Quintela
- Department of Internal Medicine, University Teaching Hospital, Santiago de Compostela, A Coruña, Spain
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Q Fever Risk in Patients Treated with Chronic Antitumor Necrosis Factor-Alpha Therapy. Case Rep Infect Dis 2016; 2016:4586150. [PMID: 27656302 PMCID: PMC5021454 DOI: 10.1155/2016/4586150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 08/22/2016] [Indexed: 11/18/2022] Open
Abstract
Q fever is a zoonotic bacterial disease caused by Coxiella burnetii. Tumor necrosis factor-alpha (TNF-α) plays a pivotal role in the defense against infection with this Gram-negative coccobacillus. Theoretically, patients who are treated with anti-TNF-α medications are at risk for developing chronic Q fever. We present two patients who developed Q fever while being treated with anti-TNF-α agents and discuss the significance of timely diagnosis of C. burnetii infection in these patients.
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Bråten LC, Reikvam DH. En mann i 30-årene med feber etter safari i Sør-Afrika. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2016; 136:328-30. [DOI: 10.4045/tidsskr.15.0431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Wielders CCH, van Loenhout JAF, Morroy G, Rietveld A, Notermans DW, Wever PC, Renders NHM, Leenders ACAP, van der Hoek W, Schneeberger PM. Long-Term Serological Follow-Up of Acute Q-Fever Patients after a Large Epidemic. PLoS One 2015; 10:e0131848. [PMID: 26161658 PMCID: PMC4498618 DOI: 10.1371/journal.pone.0131848] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 06/05/2015] [Indexed: 12/21/2022] Open
Abstract
Background Serological follow-up of acute Q-fever patients is important for detection of chronic infection but there is no consensus on its frequency and duration. The 2007–2009 Q-fever epidemic in the Netherlands allowed for long-term follow-up of a large cohort of acute Q-fever patients. The aim of this study was to validate the current follow-up strategy targeted to identify patients with chronic Q-fever. Methods A cohort of adult acute Q-fever patients, diagnosed between 2007 and 2009, for whom a twelve-month follow-up sample was available, was invited to complete a questionnaire and provide a blood sample, four years after the acute episode. Antibody profiles, determined by immunofluorescence assay in serum, were investigated with a special focus on high titres of IgG antibodies against phase I of Coxiella burnetii, as these are considered indicative for possible chronic Q-fever. Results Of the invited 1,907 patients fulfilling inclusion criteria, 1,289 (67.6%) were included in the analysis. At any time during the four-year follow-up period, 58 (4.5%) patients were classified as possible, probable, or proven chronic Q-fever according to the Dutch Q-fever Consensus Group criteria (which uses IgG phase I ≥1:1,024 to as serologic criterion for chronic Q-fever). Fifty-two (89.7%) of these were identified within the first year after the acute episode. Of the six patients that were detected for the first time at four-year follow-up, five had an IgG phase I titre of 1:512 at twelve months. Conclusions A twelve-month follow-up check after acute Q-fever is recommended as it adequately detects chronic Q-fever in patients without known risk factors. Additional serological and clinical follow-up is recommended for patients with IgG phase I ≥1:512, as they showed the highest risk to progress to chronic Q-fever.
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Affiliation(s)
- Cornelia C. H. Wielders
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Joris A. F. van Loenhout
- Academic Collaborative Centre AMPHI, Department of Primary and Community Care, Radboud university medical center (Radboudumc), Nijmegen, the Netherlands
| | - Gabriëlla Morroy
- Academic Collaborative Centre AMPHI, Department of Primary and Community Care, Radboud university medical center (Radboudumc), Nijmegen, the Netherlands
- Department of Infectious Disease Control, Municipal Health Service (GGD) Hart voor Brabant, ‘s-Hertogenbosch, the Netherlands
| | - Ariene Rietveld
- Department of Infectious Disease Control, Municipal Health Service (GGD) Hart voor Brabant, ‘s-Hertogenbosch, the Netherlands
| | - Daan W. Notermans
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Peter C. Wever
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands
| | - Nicole H. M. Renders
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands
| | - Alexander C. A. P. Leenders
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands
| | - Wim van der Hoek
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- * E-mail: (PMS); (WvdH)
| | - Peter M. Schneeberger
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- * E-mail: (PMS); (WvdH)
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Morroy G, van der Hoek W, Albers J, Coutinho RA, Bleeker-Rovers CP, Schneeberger PM. Population Screening for Chronic Q-Fever Seven Years after a Major Outbreak. PLoS One 2015; 10:e0131777. [PMID: 26132155 PMCID: PMC4489093 DOI: 10.1371/journal.pone.0131777] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/05/2015] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION From 2007 through 2010, the Netherlands experienced a large Q-fever epidemic, with 4,107 notifications. The most serious complication of Q-fever is chronic Q-fever. METHOD In 2014, we contacted all 2,161 adult inhabitants of the first village in the Netherlands affected by the Q-fever epidemic and offered to test for antibodies against Coxiella burnetii using immunofluorescence assay (IFA) to screen for chronic infections and assess whether large-scale population screening elsewhere is warranted. RESULTS Of the 1,517 participants, 33.8% were IFA-positive. Six IFA-positive participants had an IgG phase I titer ≥1:512. Two of these six participants were previously diagnosed with chronic Q-fever. Chronic infection was diagnosed in one of the other four participants after clinical examination. CONCLUSIONS Seven years after the initial outbreak, seroprevalence remains high, but the yield of screening the general population for chronic Q-fever is low. A policy of screening known high-risk groups for chronic Q-fever in outbreak areas directly following an outbreak might be more efficient than population screening. A cost-effectiveness analysis should also be performed before initiating a population screening program for chronic Q-fever.
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Affiliation(s)
- Gabriëlla Morroy
- Department of Infectious Disease Control, Municipal Health Service Hart voor Brabant, 's-Hertogenbosch, the Netherlands
- Department of Primary and Community Care, Academic Collaborative Centre AMPHI, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wim van der Hoek
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Jelle Albers
- Department of Infectious Disease Control, Municipal Health Service Hart voor Brabant, 's-Hertogenbosch, the Netherlands
| | - Roel A. Coutinho
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands
| | - Chantal P. Bleeker-Rovers
- Department of Internal Medicine, Division of Infectious Diseases, Radboud Expertise Center for Q-fever, Radboud university medical center, Nijmegen, the Netherlands
| | - Peter M. Schneeberger
- Department of Medical Microbiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
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Muniain Ezcurra MA, Gálvez-Acebal J. Q fever and fever of unknown origin. Are the chronic forms of these conditions preventable? Rev Clin Esp 2015; 215:274-5. [PMID: 25896258 DOI: 10.1016/j.rce.2015.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 03/15/2015] [Indexed: 11/19/2022]
Affiliation(s)
- M A Muniain Ezcurra
- Unidad Clínica conjunta de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen Macarena y Hospital Universitario Virgen del Rocío. Departamento de Medicina/SAS. Sevilla, España.
| | - J Gálvez-Acebal
- Unidad Clínica conjunta de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen Macarena y Hospital Universitario Virgen del Rocío. Departamento de Medicina/SAS. Sevilla, España
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Abstract
Brucella and Coxiella are similar; both are obligate intracellular, zoonotic pathogens with a broad geographic distribution. Infection in animals is usually asymptomatic, but causes fetal loss and therefore has significant economic impact. Human infection may be asymptomatic or give rise to either organ-specific or multi-system disease. Organism culture is challenging for Coxiella and can lack sensitivity for Brucella. Therefore, infection is most commonly diagnosed by serology, but this may be negative in early infection and serology results may be challenging to interpret. Both Brucella and Coxiella are typically susceptible to a wide range of antimicrobials, but long courses may be needed.
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Affiliation(s)
- Jonathan R Lambourne
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK
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Hagenaars JCJP, Renders NHM, van Petersen AS, Shamelian SOA, de Jager-Leclercq MGL, Moll FL, Wever PC, Koning OHJ. Serological follow-up in patients with aorto-iliac disease and evidence of Q fever infection. Eur J Clin Microbiol Infect Dis 2014; 33:1407-14. [PMID: 24619114 DOI: 10.1007/s10096-014-2084-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 02/21/2014] [Indexed: 12/16/2022]
Abstract
The aim of this study was to provide data on the risk of developing chronic Q fever in patients with aorto-iliac disease and evidence of previous Q fever infection. Patients with an aortic and/or iliac aneurysm or aorto-iliac reconstruction (aorto-iliac disease) and evidence of previous Q fever infection were included. The presence of phase I and II Coxiella burnetii IgG antibodies was assessed periodically using immunofluorescence assay. A total of 111 patients with aorto-iliac disease were divided into three groups, based upon the serological profile [mean follow-up: 16 ± 9 months (mean ± standard deviation)]. Group 1 consisted of 30 patients with a serological trace of C. burnetii infection (negative IgG phase I, IgG phase II titer of 1:32). Of these, 36.7% converted to serological profile matching past resolved Q fever. Group 2 included 49 patients with negative IgG phase I titer and IgG phase II titer ≥1:64. No patients developed chronic Q fever, but 14.3% converted to a positive IgG phase I titer. Group 3 consisted of 32 patients with positive IgG phase I and positive IgG phase II titers, of which 9.4% developed chronic Q fever (significantly different from group 2, p = 0.039). The IgG phase I titer increased in 28.1% of patients (from 1:64 to 1:4,096). The risk of developing chronic Q fever in patients with aorto-iliac disease and previous Q fever infection with a positive IgG phase I titer was 9.4%. The IgG phase I titer increases or becomes positive in a substantial number of patients. A standardized serological follow-up is proposed.
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Affiliation(s)
- J C J P Hagenaars
- Department of Surgery, Jeroen Bosch Hospital, P.O. Box 90153, 5200 ME, 's-Hertogenbosch, The Netherlands,
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Wielders CCH, Wuister AMH, de Visser VL, de Jager-Leclercq MG, Groot CAR, Dijkstra F, van Gageldonk-Lafeber AB, van Leuken JPG, Wever PC, van der Hoek W, Schneeberger PM. Characteristics of hospitalized acute Q fever patients during a large epidemic, The Netherlands. PLoS One 2014; 9:e91764. [PMID: 24614585 PMCID: PMC3948881 DOI: 10.1371/journal.pone.0091764] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 02/13/2014] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND From 2007 to 2009, The Netherlands experienced a major Q fever epidemic, with higher hospitalization rates than the 2-5% reported in the literature for acute Q fever pneumonia and hepatitis. We describe epidemiological and clinical features of hospitalized acute Q fever patients and compared patients presenting with Q fever pneumonia with patients admitted for other forms of community-acquired pneumonia (CAP). We also examined whether proximity to infected ruminant farms was a risk factor for hospitalization. METHODS A retrospective cohort study was conducted for all patients diagnosed and hospitalized with acute Q fever between 2007 and 2009 in one general hospital situated in the high incidence area in the south of The Netherlands. Pneumonia severity scores (PSI and CURB-65) of acute Q fever pneumonia patients (defined as infiltrate on a chest x-ray) were compared with data from CAP patients. Hepatitis was defined as a >twofold the reference value for alanine aminotransferase and for bilirubin. RESULTS Among the 183 hospitalized acute Q fever patients, 86.0% had pneumonia. Elevated liver enzymes (alanine aminotransferase) were found in 32.3% of patients, although hepatitis was not observed in any of them. The most frequent clinical signs upon presentation were fever, cough and dyspnoea. The median duration of admission was five days. Acute Q fever pneumonia patients were younger, had less co-morbidity, and lower PSI and CURB-65 scores than other CAP patients. Anecdotal information from attending physicians suggests that some patients were admitted because of severe subjective dyspnoea, which was not included in the scoring systems. Proximity to an infected ruminant farm was not associated with hospitalization. CONCLUSION Hospitalized Dutch acute Q fever patients mostly presented with fever and pneumonia. Patients with acute Q fever pneumonia were hospitalized despite low PSI and CURB-65 scores, presumably because subjective dyspnoea was not included in the scoring systems.
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Affiliation(s)
- Cornelia C. H. Wielders
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, ’s-Hertogenbosch, the Netherlands
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- * E-mail:
| | - Annemarie M. H. Wuister
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Department of Internal Medicine, Bernhoven Hospital, Uden, the Netherlands
| | - Veerle L. de Visser
- Department of Pulmonary Diseases, Jeroen Bosch Hospital, ’s-Hertogenbosch, the Netherlands
| | | | | | - Frederika Dijkstra
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Arianne B. van Gageldonk-Lafeber
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Jeroen P. G. van Leuken
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Institute for Risk Assessment Sciences, Faculty of Veterinary Sciences, Utrecht University, Utrecht, the Netherlands
| | - Peter C. Wever
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, ’s-Hertogenbosch, the Netherlands
| | - Wim van der Hoek
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Peter M. Schneeberger
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, ’s-Hertogenbosch, the Netherlands
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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