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Volume 18, Number 4—April 2012


Identification of Risk Factors for Chronic Q Fever, the Netherlands

Linda M. KampschreurComments to Author , Sandra Dekker, Julia C.J.P. Hagenaars, Peter J. Lestrade, Nicole H.M. Renders, Monique G.L. de Jager-Leclercq, Mirjam H.A. Hermans, Cornelis A.R. Groot, Rolf H.H. Groenwold, Andy I.M. Hoepelman, Peter C. Wever, and Jan Jelrik Oosterheert
Author affiliations: University Medical Centre Utrecht, Utrecht, the Netherlands (L.M. Kampschreur, R.H.H. Groenwold, A.I.M Hoepelman, J.J. Oosterheert); VU University, Amsterdam, the Netherlands (S. Dekker); Jeroen Bosch Hospital, ’s-Hertogenbosch, the Netherlands (J.C.J.P. Hagenaars, P.J. Lestrade, N.H.M. Renders, M.H.A. Hermans, P.C. Wever); Bernhoven Hospital, Oss/Veghel, the Netherlands (M.G.L. de Jager-Leclercq, C.A.R. Groot)

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Table 1

Classification of chronic Q fever according to Dutch Q Fever Consensus Group guidelines*

Classification Definition
Proven Any of the following:
Positive PCR for Coxiella burnetii in serum, plasma, or tissue in the absence of acute Q fever
IFA phase I titer ≥1,024 with definite endocarditis according to the revised Duke criteria (21)
Indication of vascular infection on PET/CT, CT, MRI, or ultrasound testing
Probable IFA phase I IgG titer >1,024 and any of the following clinical manifestations:
Valvulopathy not meeting the criteria of endocardial involvement of the major modified Duke criteria (22)
Aneurysm, vascular prosthesis or prosthetic valve without signs of infection on PET/CT, CT, MRI, or ultrasound testing
Signs of possible chronic Q fever infection of noncardiac or vascular origin on PET/CT, CT, or ultrasound testing
Clinical symptoms of chronic infection (i.e., fever, night sweats, weight loss, hepatosplenomegaly)
Histopathologic proven granulomatous inflammation
Immune disorder
Possible IFA phase I IgG titer >1,024 without clinical manifestations as described above

*Described in (20). IFA, immunofluorescence assay; PET, positron emission tomography; CT, computed tomography; MRI, magnetic resonance imaging.

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