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Volume 21, Number 8—August 2015
Research

Differentiation of Acute Q Fever from Other Infections in Patients Presenting to Hospitals, the Netherlands1

Stephan P. KeijmelComments to Author , Elmer Krijger, Corine E. Delsing, Tom Sprong, Marrigje H. Nabuurs-Franssen, and Chantal P. Bleeker-Rovers
Author affiliations: Radboud university medical center, Nijmegen, the Netherlands (S.P. Keijmel, E. Krijger, C.P. Bleeker-Rovers); Medical Spectrum Twente, Enschede, the Netherlands (C.E. Delsing); Canisius Wilhelmina Hospital, Nijmegen (T. Sprong, M.H. Nabuurs-Franssen)

Main Article

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.

Main Article

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.

Page created: July 14, 2015
Page updated: July 14, 2015
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