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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 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.

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

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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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