title: Evaluation of a diagnostic algorithm for acute Q fever in an outbreak setting.
abstract: In the peak of the 2009 Q fever outbreak in the Netherlands, we introduced a diagnostic algorithm for acute Q fever with an enzyme-linked immunosorbent assay for immunoglobulin M antibodies to Coxiella burnetii phase II antigens (MII screen) as an initial step. Subsequently, an immunofluorescence assay or PCR was performed depending on the MII screen outcome, date of onset of disease, and inpatient or outpatient setting. The impact of MII screen on the number of immunofluorescence assays performed and the contribution of PCR to diagnosis were retrospectively evaluated in 825 patients referred in a 17-day period. Acute Q fever was diagnosed in 256 patients. The introduction of MII screen reduced the number of immunofluorescence assays performed by more than 80%. In 103 patients, PCR analysis contributed to the diagnosis of acute Q fever. Q fever diagnostics were hampered by the fact that for a high number of patients the date of onset of disease was not provided and the requested follow-up serum samples were not received.
authors.affiliation: Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 5200 ME 's-Hertogenbosch, Netherlands.
authors.forename: Mischa M
authors.initials: MM
authors.lastname: Jager
authors.forename: Gezina
authors.initials: G
authors.lastname: Weers-Pothoff
authors.forename: Mirjam H A
authors.initials: MH
authors.lastname: Hermans
authors.forename: Jamie C E
authors.initials: JC
authors.lastname: Meekelenkamp
authors.forename: Jeroen J A
authors.initials: JJ
authors.lastname: Schellekens
authors.forename: Nicole H M
authors.initials: NH
authors.lastname: Renders
authors.forename: Alexander C A P
authors.initials: AC
authors.lastname: Leenders
authors.forename: Peter M
authors.initials: PM
authors.lastname: Schneeberger
authors.forename: Peter C
authors.initials: PC
authors.lastname: Wever
mesh_terms: D000465:Algorithms; D000907:Antibodies, Bacterial / Q000097:blood; D019411:Clinical Laboratory Techniques / Q000379:methods*; D016997:Coxiella burnetii / Q000276:immunology; D004196:Disease Outbreaks; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D005260:Female; D019085:Fluorescent Antibody Technique, Direct / Q000379:methods; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D016133:Polymerase Chain Reaction / Q000379:methods; D011778:Q Fever / Q000175:diagnosis* / Q000453:epidemiology*; D012189:Retrospective Studies
chemical_list: D000907:Antibodies, Bacterial; D007075:Immunoglobulin M