title: Targeted screening as a tool for the early detection of chronic Q fever patients after a large outbreak.
abstract: In the aftermath of the Dutch Q fever outbreak, an increasing number of patients are being diagnosed with chronic Q fever. Most of these patients are unaware of being infected with Coxiella burnetii, the causative agent of Q fever. To find patients in an earlier, asymptomatic stage, a targeted screening strategy (TSS) for patients with risk factors for chronic Q fever was started in the southeast region of Noord-Brabant. In total, 763 patients were tested using an IgG phase II indirect fluorescent antibody test (IFAT), of which 52 (7 %) patients tested positive. Ten of these 52 patients displayed a chronic Q fever serological profile. All of these 10 patients had a heart valve(s) or (endo-)vascular prosthesis. All except one were asymptomatic. Suggestive signs for chronic infections on positron emission tomography-computed tomography (PET-CT) were demonstrated in 5 (50 %) of these patients. Forty-two out of the 52 patients with a positive screening test showed a past Q fever serological profile. After a year of follow-up (every 3 months), none of these patients showed elevation of antibody titres and no new chronic Q fever patients were found in this group. A targeted screening programme is a useful instrument for detecting patients at risk of developing chronic Q fever.
authors.affiliation: Department of Medical Microbiology, Laboratory for Pathology and Medical Microbiology (PAMM), de Run 6250, 5504 DL, Veldhoven, The Netherlands. m.wegdam@pamm.nl
authors.forename: M C A
authors.initials: MC
authors.lastname: Wegdam-Blans
authors.forename: R A
authors.initials: RA
authors.lastname: Stokmans
authors.forename: J H T
authors.initials: JH
authors.lastname: Tjhie
authors.forename: J M
authors.initials: JM
authors.lastname: Korbeeck
authors.forename: M P
authors.initials: MP
authors.lastname: Koopmans
authors.forename: S M A A
authors.initials: SM
authors.lastname: Evers
authors.forename: P H
authors.initials: PH
authors.lastname: van der Voort
authors.forename: J A W
authors.initials: JA
authors.lastname: Teijink
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000097:blood*; D016997:Coxiella burnetii / Q000276:immunology*; D004196:Disease Outbreaks; D005260:Female; D005455:Fluorescent Antibody Technique / Q000379:methods; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011778:Q Fever / Q000175:diagnosis* / Q000453:epidemiology*
chemical_list: D000907:Antibodies, Bacterial; D007074:Immunoglobulin G