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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)

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

Page created: June 12, 2015
Page updated: June 12, 2015
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The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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