Volume 21, Number 7—July 2015
Policy Review
Chronic Q Fever Diagnosis—Consensus Guideline versus Expert Opinion
Table 1
Dutch consensus guideline on chronic Q fever diagnostics*
Proven chronic Q fever | Probable chronic Q fever | Possible chronic Q fever |
---|---|---|
1. Positive Coxiella burnetii PCR of blood or tissue† | IFA ≥1:1,024 for C. burnetii phase I IgG‡ | IFA ≥ 1:1,024 for C. burnetii phase I IgG‡ without manifestations meeting the criteria for proven or probable chronic Q fever |
OR | AND any of the following: | |
2. IFA ≥1:800 or 1:1,024 for C. burnetii phase I IgG† | Valvulopathy not meeting the major criteria of the modified Duke criteria (13) | |
AND | Known aneurysm and/or vascular or cardiac valve prosthesis without signs of infection by means of TEE/ TTE, FDG-PET, CT, MRI, or AUS | |
Definite endocarditis according to the modified Duke criteria (13) | ||
OR | ||
Proven large vessel or prosthetic infection by imaging studies (FDG-PET, CT, MRI, or AUS) | Suspected osteomyelitis or hepatitis as manifestation of chronic Q fever | |
Pregnancy | ||
Symptoms and signs of chronic infection, such as fever, weight loss and night sweats, hepato-splenomegaly, persistent raised ESR and CRP | ||
Granulomatous tissue inflammation, proven by histological examination | ||
Immunocompromised state |
*Source (14). IFA, immunofluorescence assay; TEE, transesophageal echocardiography; TTE, transthoracic echocardiography; FDG-PET, fluorodeoxyglucose positron emission tomography; CT, computed tomography; MRI, magnetic resonance imaging; AUS, abdominal ultrasound; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein.
†In the absence of acute infection.
‡Cut-off depends on the IFA technique used, whether in-house developed or commercial.
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1A complete list of the group members is provided at the end of this article.
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