Volume 21, Number 8—August 2015
Differentiation of Acute Q Fever from Other Infections in Patients Presenting to Hospitals, the Netherlands1
|Patient no.||Age, y/sex||Hospitalized||Indication at presentation for prophylactic treatment||Prophylactic treatment and duration, mo||Chronic Q fever||Died|
|1||42/M||Yes||Valvular dysfunction (AS)||D + H, 12||No||No|
|2||49/M||Yes||Cardiac bioprosthesis and vascular prosthesis||D + H, 12||No||No|
|3||51/M||Yes||Cardiac bioprosthesis and TOF||D 12 + H 4 (added after 8)||No||No|
|4||54/M||Yes||Aneurysm common iliac artery||D + H, 9||No||No|
|5||43/M||Yes||Valvular dysfunction (TI) and TGV||D + H, 7||No||No|
|6||78/F||Yes||Cardiac bioprosthesis||D + H, 1, switched to Mox, 3||No||Yes†|
|7||26/M||No||Vascular prosthesis||D + H, 2.5||No||No|
|8||81/F||Yes||Valvular dysfunction (MI)||D + H, 12||No||Yes‡|
|9||65/M||Yes||Valvular dysfunction (MI)||No||No||No|
|10||80/M||Yes||Valvular dysfunction (MI)||No||No||No|
|11||78/F||No||Valvular dysfunction (MI)||No||No||No|
|13||75/F||Yes||New cardiac murmur||No||Yes||No|
|14||75/M||No||New cardiac murmur||No||Yes||No|
|15||57/F||No||Valvular dysfunction (AS)||No||Unknown¶||No|
|16||58/M||Yes||Valvular dysfunction (MI)||No||Unknown¶||No|
*AS, aortic valve sclerosis; D, doxycycline 100 mg 2×/d; H, hydroxychloroquine 200 mg 3×/d; TOF, tetralogy of Fallot; TI, tricuspid insufficiency; TGV, transposition of the great vessels; Mox, moxifloxacine 400 mg 1×/d; MI, mitral insufficiency; CFA, complement fixation assay; IFA, immunofluorescence assay.
†This patient was rehospitalized shortly after the acute Q fever episode and died because of a reason unrelated to Q fever. The last available serologic follow-up showed no signs of chronic Q fever (negative PCR result; CFA titer 1:10, IFA IgG phase I negative result; IgG phase II titer 1:256; IgM phase I negative result; and IgM phase II titer 1:64).
‡This patient eventually died because of a reason unrelated to Q fever. The last available serologic follow-up 1 year after the acute Q fever episode showed no signs of chronic Q fever (negative PCR result; CFA titer 1:10; IFA IgG phase I titer 1:64; IgG phase II titer 1:512; IgM phase I titer 1:16, and IgM phase II titer 1:16).
§This patient was hospitalized and admitted to the intensive care unit for 5 d. She was treated with several antimicrobial drugs (penicillin, ciprofloxacin, cefuroxim, metronidazol, ceftazidim, and teicoplanin) before given a diagnosis of an infected vascular prosthesis caused by chronic Q fever. Although doxycycline and hydroxychloroquine were given after the diagnosis was made, this patient eventually died from consequences of an infected vascular prosthesis caused by chronic Q fever.
¶No follow-up with reference to Q fever was performed for this patient.
1Preliminary results from this study were presented as a poster (P1851) at the 22th annual European Congress of Clinical Microbiology and Infectious Diseases, March 31–April 3, 2012, London, UK.