Screening for Coxiella burnetii seroprevalence in chronic Q fever high-risk groups reveals the magnitude of the Dutch Q fever outbreak.

The Netherlands experienced an unprecedented outbreak of Q fever between 2007 and 2010. The Jeroen Bosch Hospital (JBH) in 's-Hertogenbosch is located in the centre of the epidemic area. Based on Q fever screening programmes, seroprevalence of IgG phase II antibodies to Coxiella burnetii in the JBH catchment area was 10·7% [785 tested, 84 seropositive, 95% confidence interval (CI) 8·5-12·9]. Seroprevalence appeared not to be influenced by age, gender or area of residence. Extrapolating these data, an estimated 40 600 persons (95% CI 32 200-48 900) in the JBH catchment area have been infected by C. burnetii and are, therefore, potentially at risk for chronic Q fever. This figure by far exceeds the nationwide number of notified symptomatic acute Q fever patients and illustrates the magnitude of the Dutch Q fever outbreak. Clinicians in epidemic Q fever areas should be alert for chronic Q fever, even if no acute Q fever is reported.

[Hoarseness in a recent visitor to the tropics through infection of the larynx by Histoplasma capsulatum]. / Heesheid bij een tropenganger door infectie van de larynx met Histoplasma capsulatum.

A 58-year-old man presented with hoarseness and a sore throat for the previous 3 months, which were caused by a laryngeal infection with the fungus Histoplasma capsulatum. He had been infected during a stay in Indonesia. Both his hoarseness as well as the Histoplasma antigen titres in serum responded to therapy with itraconazol. H. capsulatum is found in tropical and subtropical areas worldwide, but infections are most commonly reported from the south of the United States of America. If not asymptomatic, the disease most often presents with pulmonary symptoms. A histoplasmosis presenting as a laryngeal infection is relatively uncommon and can be mistaken for papillomatosis or carcinoma. The diagnosis can be made by microscopy and culture of the fungus; an antigen test is available in the United States.

Chronic Q fever: review of the literature and a proposal of new diagnostic criteria.

A review was performed to determine clinical aspects and diagnostic tools for chronic Q fever. We present a Dutch guideline based on literature and clinical experience with chronic Q fever patients in The Netherlands so far. In this guideline diagnosis is categorized as proven, possible or probable chronic infection based on serology, PCR, clinical symptoms, risk factors and diagnostic imaging.