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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)

Main Article

Table 4

Characteristics and outcome of patients diagnosed with chronic Q fever using the Dutch consensus guideline* but without (definite) chronic Q fever according to alternative criteria†

Dutch consensus guideline
Alternative criteria
Possible Q fever endocarditis or vascular infection, no. (%), n =14
No diagnosis, no. (%), n = 173
Proven Q fever 8 (57.1) 46 (26.6)
Endocarditis 8 (57.1) 18 (10.4);
PCR positive for Coxiella burnetii in blood 6 (42.9) 18 (10.4)
Evidence of endocardial involvement 2 (14.3) 0
Vascular infection 0 24 (13.9)‡
PCR positive in blood 0 7 (4.0)
Vascular focus on imaging 0 17 (9.8)
Other or no focus§ 0 7 (4.1)
Deceased 2 (14.3) 8 (4.6)
Death probably due to Q fever
2 (14.3)
4 (2.3)¶
Probable Q fever 6 (42.9) 58 (33.5)
Endocarditis 4 (28.6) 22 (12.7)
Vascular infection 2 (14.3) 16 (9.3)
Other or no focus 0 20 (11.6)
Deceased 2 (14.3) 4 (2.3)
Death probably due to Q fever 1 (7.1) 0
Possible Q fever 0 69 (39.9)

*Source (14).
†Source (16).
‡In 3 patients with proven chronic Q fever, imaging studies showed that the focus of infection was in both the heart valves and the vascular structures.
§All were PCR positive.
¶For 2 patients, PCR of vascular and heart valve tissue obtained at autopsy was positive for C. burnetii.

Main Article

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

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