Document Detail

Microbiological challenges in the diagnosis of chronic Q fever.
MedLine Citation:
PMID:  22441385     Owner:  NLM     Status:  MEDLINE    
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.
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:
Type:  Evaluation Studies; Journal Article     Date:  2012-03-21
Journal Detail:
Title:  Clinical and vaccine immunology : CVI     Volume:  19     ISSN:  1556-679X     ISO Abbreviation:  Clin. Vaccine Immunol.     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-04-27     Completed Date:  2012-08-15     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  101252125     Medline TA:  Clin Vaccine Immunol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  787-90     Citation Subset:  IM    
Division of Medicine, Dept. of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, the Netherlands.
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MeSH Terms
Aged, 80 and over
Antibodies, Bacterial / blood*
Clinical Laboratory Techniques / methods*
Coxiella burnetii / genetics,  immunology*,  isolation & purification
DNA, Bacterial / blood
Immunoglobulin G / blood
Middle Aged
Polymerase Chain Reaction
Predictive Value of Tests
Q Fever / diagnosis*
Sensitivity and Specificity
Reg. No./Substance:
0/Antibodies, Bacterial; 0/DNA, Bacterial; 0/Immunoglobulin G

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