Abstract
BackgroundFrom 2007 through 2010, a large epidemic of acute Q fever occurred in the Netherlands. Patients with cardiac valvulopathy are at high risk to develop chronic Q fever after an acute infection. This patient group was not routinely screened, so it is unknown whether all their chronic infections were diagnosed. This study aims to investigate how many chronic Q fever patients can be identified by routinely screening patients with valvulopathy and to establish whether the policy of not screening should be changed.MethodsIn a cross-sectional study (2016–2017) in a hospital at the epicentre of the Q fever epidemic, a blood sample was taken from patients 18 years and older who presented with cardiac valvulopathy. The sample was tested for IgG antibodies against phase I and II of Coxiella burnetii using an immunofluorescence assay. An IgG phase II titre of ≥1:64 was considered serological evidence of a previous Q fever infection. An IgG phase I titre of ≥1:512 was considered suspicious for a chronic infection, and these patients were referred for medical examination.ResultsOf the 904 included patients, 133 (15%) had evidence of a previous C. burnetii infection, of whom 6 (5%) had a chronic infection on medical examination.ConclusionsIn a group of high-risk patients with a heart valve defect, we diagnosed new chronic Q fever infections seven years after the epidemic, emphasizing the need for screening of this group to prevent complications in those not yet diagnosed in epidemic areas.
Highlights
This study aims to investigate how many chronic Q fever patients can be identified by routinely screening patients with valvulopathy and to establish whether the policy of not screening should be changed
Of the 904 included patients, 133 (15%) had evidence of a previous C. burnetii infection, of whom 6 (5%) had a chronic infection on medical examination
Chronic Q fever can develop in 5% of all symptomatic acute Q fever patients
Summary
In the Netherlands, a large epidemic of Q fever occurred from 2007 through 2010, with more than 4,000 reported acute Q fever patients [1], whose most common clinical presentation was pneumonia. [2] These 4,000 reported cases are estimated to reflect more than 50,000 acute infections with Coxiella burnetii, including asymptomatic patients and symptomatic patients not seeking medical care or not being diagnosed with C. burnetii infection. [3]Chronic Q fever can develop in 5% of all symptomatic acute Q fever patients. [4] A serious disease with high morbidity and mortality, it most often presents in patients with risk factors such as cardiac valve and vascular disease or immunodeficiency. [5,6,7] Long-term treatment with antibiotics of at least 18 months, consisting of the combination of doxycycline and hydroxychloroquine, and cardiovascular surgical procedures can improve the prognosis. [7,8,9] Predominant clinical presentations of chronic Q fever are endocarditis and endovascular infection. [5,6,7] In the aftermath of the Dutch epidemic, more vascular chronic infections were diagnosed, compared to endocarditis. [10] in the south of France, where much research on chronic Q fever has been performed, the opposite is seen: more endocarditis is diagnosed than vascular chronic infection. The objective of this study is to investigate how many chronic Q fever patients can still be identified, several years after the epidemic, by routinely screening of patients with valvulopathy in the high incidence area. This finding will be important to inform policy on screening during future Q fever outbreaks. Patients with cardiac valvulopathy are at high risk to develop chronic Q fever after an acute infection. This patient group was not routinely screened, so it is unknown whether all their chronic infections were diagnosed. This study aims to investigate how many chronic Q fever patients can be identified by routinely screening patients with valvulopathy and to establish whether the policy of not screening should be changed
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