Follow-up of 686 patients with acute Q fever and detection of chronic infection.
Clin Infect Dis
; 52(12): 1431-6, 2011 Jun 15.
Article
em En
| MEDLINE
| ID: mdl-21628483
ABSTRACT
BACKGROUND:
Recent outbreaks in the Netherlands allowed for laboratory follow-up of a large series of patients with acute Q fever and for evaluation of test algorithms to detect chronic Q fever, a condition with considerable morbidity and mortality.METHODS:
For 686 patients with acute Q fever, IgG antibodies to Coxiella burnetii were determined using an immunofluorescence assay at 3, 6, and 12 months of follow-up. Polymerase chain reaction (PCR) was performed after 12 months and on earlier serum samples with an IgG phase I antibody titer ≥ 11024.RESULTS:
In 43% of patients, the IgG phase II antibody titers remained high (≥ 11024) at 3, 6, and 12 months of follow-up. Three months after acute Q fever, 14% of the patients had an IgG phase I titer ≥ 11024, which became negative later in 81%. IgG phase I antibody titers were rarely higher than phase II titers. Eleven cases of chronic Q fever were identified on the basis of serological profile, PCR results, and clinical presentation. Six of these patients were known to have clinical risk factors at the time of acute Q fever. In a comparison of various serological algorithms, IgG phase I titer ≥ 11024 at 6 months had the most favorable sensitivity and positive predictive value for the detection of chronic Q fever.CONCLUSIONS:
The wide variation of serological and PCR results during the follow-up of acute Q fever implies that the diagnosis of chronic Q fever, necessitating long-term antibiotic treatment, must be based primarily on clinical grounds. Different serological follow-up strategies are needed for patients with and without known risk factors for chronic Q fever.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Febre Q
/
Imunoglobulina G
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Coxiella burnetii
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Técnicas de Laboratório Clínico
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Anticorpos Antibacterianos
Idioma:
En
Ano de publicação:
2011
Tipo de documento:
Article