| Microbiological challenges in the diagnosis of chronic Q fever. | |
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MedLine Citation:
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PMID: 22441385 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Diagnosis of chronic Q fever is difficult. PCR and culture lack sensitivity; hence, diagnosis relies mainly on serologic tests using an immunofluorescence assay (IFA). Optimal phase I IgG cutoff titers are debated but are estimated to be between 1:800 and 1:1,600. In patients with proven, probable, or possible chronic Q fever, we studied phase I IgG antibody titers at the time of positive blood PCR, at diagnosis, and at peak levels during chronic Q fever. We evaluated 200 patients, of whom 93 (46.5%) had proven, 51 (25.5%) had probable, and 56 (28.0%) had possible chronic Q fever. Sixty-five percent of proven cases had positive Coxiella burnetii PCR results for blood, which was associated with high phase I IgG. Median phase I IgG titers at diagnosis and peak titers in patients with proven chronic Q fever were significantly higher than those for patients with probable and possible chronic Q fever. The positive predictive values for proven chronic Q fever, compared to possible chronic Q fever, at titers 1:1,024, 1:2,048, 1:4,096, and ≥1:8,192 were 62.2%, 66.7%, 76.5%, and ≥86.2%, respectively. However, sensitivity dropped to <60% when cutoff titers of ≥1:8,192 were used. Although our study demonstrated a strong association between high phase I IgG titers and proven chronic Q fever, increasing the current diagnostic phase I IgG cutoff to >1:1,024 is not recommended due to increased false-negative findings (sensitivity < 60%) and the high morbidity and mortality of untreated chronic Q fever. Our study emphasizes that serologic results are not diagnostic on their own but should always be interpreted in combination with clinical parameters. |
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Authors:
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Linda M Kampschreur; Jan Jelrik Oosterheert; Annemarie M C Koop; Marjolijn C A Wegdam-Blans; Corine E Delsing; Chantal P Bleeker-Rovers; Monique G L De Jager-Leclercq; Cornelis A R Groot; Tom Sprong; Marrigje H Nabuurs-Franssen; Nicole H M Renders; Marjo E van Kasteren; Yvonne Soethoudt; Sybrandus N Blank; Marjolijn J H Pronk; Rolf H H Groenwold; Andy I M Hoepelman; Peter C Wever |
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Publication Detail:
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Type: Evaluation Studies; Journal Article Date: 2012-03-21 |
Journal Detail:
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Title: Clinical and vaccine immunology : CVI Volume: 19 ISSN: 1556-679X ISO Abbreviation: Clin. Vaccine Immunol. Publication Date: 2012 May |
Date Detail:
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Created Date: 2012-04-27 Completed Date: 2012-08-15 Revised Date: 2013-03-07 |
Medline Journal Info:
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Nlm Unique ID: 101252125 Medline TA: Clin Vaccine Immunol Country: United States |
Other Details:
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Languages: eng Pagination: 787-90 Citation Subset: IM |
Affiliation:
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Division of Medicine, Dept. of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, the Netherlands. l.m.kampschreur@umcutrecht.nl |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Antibodies, Bacterial / blood* Clinical Laboratory Techniques / methods* Coxiella burnetii / genetics, immunology*, isolation & purification DNA, Bacterial / blood Female Humans Immunoglobulin G / blood Male Middle Aged Polymerase Chain Reaction Predictive Value of Tests Q Fever / diagnosis* Sensitivity and Specificity |
| Chemical | |
Reg. No./Substance:
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0/Antibodies, Bacterial; 0/DNA, Bacterial; 0/Immunoglobulin G |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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