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Differentiation of Acute Q Fever from Other Infections in Patients Presenting to Hospitals, the Netherlands1 - Volume 21, Number 8—August 2015 - Emerging Infectious Disease journal - CDC

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Differentiation of Acute Q Fever from Other Infections in Patients Presenting to Hospitals, the Netherlands1 - Volume 21, Number 8—August 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 8—August 2015


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)


Differentiating acute Q fever from infections caused by other pathogens is essential. We conducted a retrospective case–control study to evaluate differences in clinical signs, symptoms, and outcomes for 82 patients with acute Q fever and 52 control patients who had pneumonia, fever and lower respiratory tract symptoms, or fever and hepatitis, but had negative serologic results for Q fever. Patients with acute Q fever were younger and had higher C-reactive protein levels but lower leukocyte counts. However, a large overlap was found. In patients with an indication for prophylaxis, chronic Q fever did not develop after patients received prophylaxis but did develop in 50% of patients who did not receive prophylaxis. Differentiating acute Q fever from other respiratory infections, fever, or hepatitis is not possible without serologic testing or PCR. If risk factors for chronic Q fever are present, prophylactic treatment is advised.
Q fever is a zoonosis caused by the bacterium Coxiella burnetii. During 2007–2010, the southern part of the Netherlands had the largest outbreak of Q fever ever reported (1,2). Infection with C. burnetii is symptomatic in ≈40% of all patients (3). Clinical signs range from a mild influenza-like illness to pneumonia or a hepatitis-like syndrome and can differ by region (4,5). After initial infection, chronic Q fever will develop in 1%–5% of patients (1,3). Furthermore, long-lasting fatigue will develop in ≈20% of all patients with symptomatic acute Q fever (68) without development of chronic Q fever (9).
Treatment for acute infection decreases the duration of fever, increases recovery from pneumonia (10), and might lead to a lower percentage of patients in whom chronic Q fever will develop (1013). In addition, several reports indicate that, in acute Q fever patients at risk for development of chronic Q fever, prophylactic treatment might prevent persistent infection (12,14). Therefore, recognizing Q fever in an early stage is a useful strategy.
The only available data on symptoms of acute Q fever in the Netherlands were obtained from a retrospective study that collected data several months after onset of disease by sending questionnaires to patients with acute Q fever (15). However, this method for obtaining data is limited by a high risk for recall bias. To help physicians differentiate acute Q fever from other diseases, a clear description of signs and symptoms compatible with C. burnetii infection is desirable.
The purpose of this case–control study was to evaluate differences in clinical signs and symptoms between patients with acute Q fever referred to a hospital and a control group of patients with signs and symptoms that led to addition of Q fever in the differential diagnosis. Furthermore, outcome of patients hospitalized with acute Q fever were evaluated, and the effect of prophylactic treatment for those patients with an indication to prevent development of chronic Q fever was analyzed.

Mr. Keijmel is an MD/PhD candidate at the Radboud university medical center, Nijmegen, the Netherlands. His research activities focus on long-term consequences of Q fever.


We thank Ton Dofferhoff for collecting data and treating several patients.


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Suggested citation for this article: Keijmel SP, Krijger E, Delsing CE, Sprong T, Nabuurs-Franssen MH, Bleeker-Rovers CP. Differentiation of acute Q fever from other infections in patients presenting to hospitals, the Netherlands. Emerg Infect Dis. 2015 Aug [date cited].
DOI: 10.3201/eid2108.140196
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.

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