title: Chronic Q fever in the Netherlands 5 years after the start of the Q fever epidemic: results from the Dutch chronic Q fever database.
abstract: Coxiella burnetii causes Q fever, a zoonosis, which has acute and chronic manifestations. From 2007 to 2010, the Netherlands experienced a large Q fever outbreak, which has offered a unique opportunity to analyze chronic Q fever cases. In an observational cohort study, baseline characteristics and clinical characteristics, as well as mortality, of patients with proven, probable, or possible chronic Q fever in the Netherlands, were analyzed. In total, 284 chronic Q fever patients were identified, of which 151 (53.7%) had proven, 64 (22.5%) probable, and 69 (24.3%) possible chronic Q fever. Among proven and probable chronic Q fever patients, vascular infection focus (56.7%) was more prevalent than endocarditis (34.9%). An acute Q fever episode was recalled by 27.0% of the patients. The all-cause mortality rate was 19.1%, while the chronic Q fever-related mortality rate was 13.0%, with mortality rates of 9.3% among endocarditis patients and 18% among patients with a vascular focus of infection. Increasing age (P=0.004 and 0.010), proven chronic Q fever (P=0.020 and 0.002), vascular chronic Q fever (P=0.024 and 0.005), acute presentation with chronic Q fever (P=0.002 and P<0.001), and surgical treatment of chronic Q fever (P=0.025 and P<0.001) were significantly associated with all-cause mortality and chronic Q fever-related mortality, respectively.
authors.affiliation: Division of Medicine, Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht, the Netherlands.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Kampschreur
authors.forename: Corine E
authors.initials: CE
authors.lastname: Delsing
authors.forename: Rolf H H
authors.initials: RH
authors.lastname: Groenwold
authors.forename: Marjolijn C A
authors.initials: MC
authors.lastname: Wegdam-Blans
authors.forename: Chantal P
authors.initials: CP
authors.lastname: Bleeker-Rovers
authors.forename: Monique G L
authors.initials: MG
authors.lastname: de Jager-Leclercq
authors.forename: Andy I M
authors.initials: AI
authors.lastname: Hoepelman
authors.forename: Marjo E
authors.initials: ME
authors.lastname: van Kasteren
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Buijs
authors.forename: Nicole H M
authors.initials: NH
authors.lastname: Renders
authors.forename: Marrigje H
authors.initials: MH
authors.lastname: Nabuurs-Franssen
authors.forename: Jan Jelrik
authors.initials: JJ
authors.lastname: Oosterheert
authors.forename: Peter C
authors.initials: PC
authors.lastname: Wever
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology*; D015331:Cohort Studies; D016997:Coxiella burnetii / Q000302:isolation & purification; D016208:Databases, Factual; D004196:Disease Outbreaks; D004696:Endocarditis / Q000453:epidemiology / Q000382:microbiology; D058872:Epidemics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011778:Q Fever / Q000453:epidemiology* / Q000382:microbiology