Volume 21, Number 8—August 2015
Research
Differentiation of Acute Q Fever from Other Infections in Patients Presenting to Hospitals, the Netherlands1
, Elmer Krijger, Corine E. Delsing, Tom Sprong, Marrigje H. Nabuurs-Franssen, and Chantal P. Bleeker-Rovers
Table 8
Characteristics of 16 patients with acute Q fever with an indication for prophylaxis, the Netherlands*
| 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 |
| 12 | 64/F | Yes | Vascular prosthesis | No | Yes | Yes§ |
| 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.