Follow-up of 686 patients with acute Q fever and detection of chronic infection

Clin Infect Dis. 2011 Jun 15;52(12):1431-6. doi: 10.1093/cid/cir234.


Background: Recent outbreaks in the Netherlands allowed for laboratory follow-up of a large series of patients with acute Q fever and for evaluation of test algorithms to detect chronic Q fever, a condition with considerable morbidity and mortality.

Methods: For 686 patients with acute Q fever, IgG antibodies to Coxiella burnetii were determined using an immunofluorescence assay at 3, 6, and 12 months of follow-up. Polymerase chain reaction (PCR) was performed after 12 months and on earlier serum samples with an IgG phase I antibody titer ≥ 1:1024.

Results: In 43% of patients, the IgG phase II antibody titers remained high (≥ 1:1024) at 3, 6, and 12 months of follow-up. Three months after acute Q fever, 14% of the patients had an IgG phase I titer ≥ 1:1024, which became negative later in 81%. IgG phase I antibody titers were rarely higher than phase II titers. Eleven cases of chronic Q fever were identified on the basis of serological profile, PCR results, and clinical presentation. Six of these patients were known to have clinical risk factors at the time of acute Q fever. In a comparison of various serological algorithms, IgG phase I titer ≥ 1:1024 at 6 months had the most favorable sensitivity and positive predictive value for the detection of chronic Q fever.

Conclusions: The wide variation of serological and PCR results during the follow-up of acute Q fever implies that the diagnosis of chronic Q fever, necessitating long-term antibiotic treatment, must be based primarily on clinical grounds. Different serological follow-up strategies are needed for patients with and without known risk factors for chronic Q fever.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antibodies, Bacterial / blood*
  • Chronic Disease
  • Clinical Laboratory Techniques / methods*
  • Coxiella burnetii / immunology*
  • Female
  • Fluorescent Antibody Technique, Indirect / methods
  • Follow-Up Studies
  • Humans
  • Immunoglobulin G / blood*
  • Male
  • Middle Aged
  • Netherlands
  • Polymerase Chain Reaction / methods
  • Q Fever / diagnosis*
  • Q Fever / immunology
  • Q Fever / microbiology
  • Q Fever / pathology
  • Sensitivity and Specificity


  • Antibodies, Bacterial
  • Immunoglobulin G