Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
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)

Main Article

Table 2

Diagnostic guideline for chronic Q fever proposed by Raoult*

Q fever endocarditis
A. Definite criteria
Positive culture, PCR, or immunochemistry of a cardiac valve
B. Major criteria
Microbiology: positive culture or PCR of the blood or an emboli 
or serology with IgG I antibodies ≥6,400
Evidence of endocardial involvement:
Echocardiogram positive for IE: oscillating intra-cardiac 
mass on valve or supporting structure, in the path of 
regurgitant jets, or on implanted material in the absence of
an alternative anatomic explanation; or abscess; or new 
partial dehiscence of prosthetic vale; or new valvular 
regurgitation (worsening or changing of pre-existent murmur
not sufficient)
PET scan showing a specific valve fixation and mycotic 
aneurysm
C. Minor criteria
Predisposing heart condition (known or found on 
echocardiograph)
Fever, temperature >38°C
Vascular phenomena, major arterial emboli, septic pulmonary 
infarcts, mycotic aneurysm (see at PET scan), intracranial 
hemorrhage, conjunctival hemorrhages, and Janeway lesions
Immunologic phenomena: glomerulonephritis, Osle nodes, 
Roth spots, or rheumatoid factor
Serologic evidence: IgG I antibodies ≥800 <6,400
Diagnosis definite
1. 1A criterion
2. 2B criterion
3. 1B, and 3C criterion
Diagnosis possible
1. 1B criterion, 2C criteria (including microbiology evidence, 
and cardiac predisposition)
2. 3C criteria (including positive serology, and cardiac 
predisposition)
Q fever vascular infection
A. Definite criteria
Positive culture, PCR, or immunochemistry of an arterial 
sample (prosthesis or aneurysm) or a periarterial abscess or a
spondylodiscitis linked to aorta
B. Major criteria
Microbiology: positive culture or PCR of the blood or an emboli
or serology with IgG I antibodies ≥6,400
Evidence of vascular involvement
   CT scan: aneurysm or vascular prosthesis + periarterial 
abscess, fistula, or spondylodiscitis
   PET scan: specific fixation on an aneurysm or vascular 
prosthesis
C. Minor criteria
Serological IgG I ≥800 <6,400
Fever, temperature >38°C
Emboli
Underlying vascular predisposition (aneurysm or vascular 
prosthesis)
Diagnosis definite
1. 1A criterion
2. 2B criterion
3. 1B and 2C criterion (including microbiology findings and 
vascular predisposition)
Diagnosis possible
Vascular predisposition, serological evidence and fever or 
emboli
*Source (16). IE, infective endocarditis; PET, positron emission tomography; IFA, immunofluorescence assay; CT, computed tomography.

Main Article

References
  1. Maurin  M, Raoult  D. Q fever. Clin Microbiol Rev. 1999;12:51853.PubMed
  2. van der Hoek  W, Dijkstra  F, Schimmer  B, Schneeberger  PM, Vellema  P, Wijkmans  C, Q fever in the Netherlands: an update on the epidemiology and control measures. Euro Surveill. 2010;15:19520.PubMed
  3. Delsing  CE, Kullberg  BJ, Bleeker-Rovers  CP. Q fever in the Netherlands from 2007 to 2010. Neth J Med. 2010;68:3827.PubMed
  4. Landais  C, Fenollar  F, Thuny  F, Raoult  D. From acute Q fever to endocarditis: serological follow-up strategy. Clin Infect Dis. 2007;44:133740. DOIPubMed
  5. Raoult  D, Tissot-Dupont  H, Foucault  C, Gouvernet  J, Fournier  PE, Bernit  E, Q fever 1985–1998. Clinical and epidemiologic features of 1,383 infections. Medicine (Baltimore). 2000;79:10923. DOIPubMed
  6. Botelho-Nevers  E, Fournier  PE, Richet  H, Fenollar  F, Lepidi  H, Foucault  C, Coxiella burnetii infection of aortic aneurysms or vascular grafts: report of 30 new cases and evaluation of outcome. Eur J Clin Microbiol Infect Dis. 2007;26:63540. DOIPubMed
  7. Million  M, Thuny  F, Richet  H, Raoult  D. Long-term outcome of Q fever endocarditis: a 26-year personal survey. Lancet Infect Dis. 2010;10:52735. DOIPubMed
  8. Raoult  D, Houpikian  P, Tissot  DH, Riss  JM, Arditi-Djiane  J, Brouqui  P. Treatment of Q fever endocarditis: comparison of 2 regimens containing doxycycline and ofloxacin or hydroxychloroquine. Arch Intern Med. 1999;159:16773. DOIPubMed
  9. Wegdam-Blans  MC, Vainas  T, van Sambeek  MR, Cuypers  PW, Tjhie  HT, van Straten  AH, Vascular complications of Q-fever infections. Eur J Vasc Endovasc Surg. 2011;42:38492. DOIPubMed
  10. Fenollar  F, Fournier  PE, Raoult  D. Molecular detection of Coxiella burnetii in the sera of patients with Q fever endocarditis or vascular infection. J Clin Microbiol. 2004;42:491924. DOIPubMed
  11. Musso  D, Raoult  D. Coxiella burnetii blood cultures from acute and chronic Q-fever patients. J Clin Microbiol. 1995;33:312932.PubMed
  12. Dupont  HT, Thirion  X, Raoult  D. Q fever serology: cutoff determination for microimmunofluorescence. Clin Diagn Lab Immunol. 1994;1:18996.PubMed
  13. Li  JS, Sexton  DJ, Mick  N, Nettles  R, Fowler  VG Jr, Ryan  T, Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30:6338. DOIPubMed
  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
  16. Raoult  D. Chronic Q fever: expert opinion versus literature analysis and consensus. J Infect. 2012;65:1028. DOIPubMed

Main Article

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
Page reviewed: June 12, 2015
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.
file_external