Persistence of impaired health status of Q fever patients 4 years after the first Dutch outbreak.

A significant proportion of Q fever patients from the first Dutch Q fever outbreak in 2007 showed impairment in health status up to 1 year after infection. Interested in whether this decrease in health status persisted, we set out to determine the health status in the same cohort of patients, 4 years after primary infection and to compare health status scores at the individual patient level between 1 and 4 years follow-up. Health status was assessed with the Nijmegen Clinical Screening Instrument (NCSI). Patients were serologically tested to exclude patients with possible, probable or proven chronic Q fever. Results on the NCSI sub-domains at group level [2008 (n = 54) and 2011 (n = 46)] showed a persistent significant percentage of patients exhibiting clinically relevant ('severe') scores for all NCSI sub-domains. After 4 years, undue fatigue was present in 46% and exactly half of all patients experienced a severely impaired general quality of life. Patients with NCSI scores available in both 2008 and 2011 (n = 37) showed no difference in all sub-domain scores, except for a small decrease in dyspnoea emotions in 2011. In this group, a significant proportion of patients either improved or worsened in one or more sub-domains of health status. We conclude that at the group level, health status of Q fever patients remained impaired 4 years after primary infection. At the individual patient level, health status may change.

One-year follow-up of patients of the ongoing Dutch Q fever outbreak: clinical, serological and echocardiographic findings.

PURPOSE: In 2007, a large goat-farming-associated Q fever outbreak occurred in the Netherlands. Data on the clinical outcome of Dutch Q fever patients are lacking. The current advocated follow-up strategy includes serological follow-up to detect evolution to chronic disease and cardiac screening at baseline to identify and prophylactically treat Q fever patients in case of valvulopathy. However, serological follow-up using commercially available tests is complicated by the lack of validated cut-off values. Furthermore, cardiac screening in the setting of a large outbreak has not been implemented previously. Therefore, we report here the clinical outcome, serological follow-up and cardiac screening data of the Q fever patients of the current ongoing outbreak. METHODS: The implementation of a protocol including clinical and serological follow-up at baseline and 3, 6 and 12 months after acute Q fever and screening echocardiography at baseline. RESULTS: Eighty-five patients with acute Q fever were identified (male 62%, female 38%). An aspecific, flu-like illness was the most common clinical presentation. Persistent symptoms after acute Q fever were reported by 59% of patients at 6 months and 30% at 12 months follow-up. We observed a typical serological response to Coxiella burnetii infection in both anti-phase I and anti-phase II IgG antibodies, with an increase in antibody titres up to 3 months and a subsequent decrease in the following 9 months. Screening echocardiography was available for 66 (78%) out of 85 Q fever patients. Cardiac valvulopathy was present in 39 (59%) patients. None of the 85 patients developed chronic Q fever. CONCLUSIONS: Clinical, serological and echocardiographic data of the current ongoing Dutch Q fever outbreak cohort are presented. Screening echocardiography is no longer part of the standard work-up of Q fever patients in the Netherlands.

Detailed analysis of health status of Q fever patients 1 year after the first Dutch outbreak: a case-control study.

BACKGROUND: Q fever is a zoonosis caused by the obligate intracellular bacterium Coxiella burnetii. The two long-term complications, after primary infection, are chronic Q fever in ∼1% of patients, and a chronic fatigue syndrome in 10-20%. However, the existence of a protracted decreased health status after Q fever remains controversial. AIM: To determine the health status of the patients of the Q fever outbreak in The Netherlands in 2007, 1 year after primary infection. DESIGN: Cross-sectional case-control study. METHODS: Health status of the patients from the 2007 Dutch Q fever outbreak was compared to age-, sex- and geographically matched and Q fever seronegative controls. Health status of both patients and controls was assessed with the Nijmegen Clinical Screening Instrument (NCSI). RESULTS: Fifty-four Q fever patients provided 34 years of age- and sex-matched controls from the same neighbourhood. Eleven controls had positive Q fever serology and were excluded. Q fever patients had significantly more problems on the subdomains of symptoms and functional impairment. Overall quality of life was decreased in both patients and controls, 59% vs. 39%, respectively, ns). Severe fatigue levels were present in 52% of patients vs. 26% in controls (P < 0.05). CONCLUSION: These data support a sustained decrease in many aspects of health status in Q fever patients in The Netherlands, 1 year after primary infection.

Acute Q fever related in-hospital mortality in the Netherlands.

INTRODUCTION: A large outbreak of acute Q fever has been reported in the Netherlands with over 3500 cases from 2007 to 2009, during which 749 patients were hospitalised. In foreign cohorts, reported mortality rates in patients hospitalised with acute Q fever, ranged from 0.9 to 2.4%. We analysed mortality among hospitalised patients with acute Q fever in the Netherlands. METHODS: Physicians from hospitals in the afflicted region were asked to provide details about patients who died with a diagnosis of acute Q fever between 2007 and 2009. RESULTS: Nine patients (seven males, median age 72 years) from six hospitals were reported, who died within approximately one month following hospitalisation for acute Q fever. Six definite acute Q fever cases and three probable cases were identified. Six patients presented with infiltrates on the chest X-ray and a median CURB-65 score of 3. Median time of hospitalisation was 13 days (range 1-33). All patients had serious, often coinciding, underlying conditions including chronic cardiovascular disease, chronic lung disease, diabetes mellitus and malignancy. CONCLUSION: The mortality rate of patients hospitalised because of acute Q fever was estimated at approximately 1%. Patients who died with acute Q fever were often male, of older age, and had chronic coinciding underlying conditions, which gives an a priori higher risk of death.

[An outbreak of Q fever in The Netherlands--possible link to goats]. / Een uitbraak van Q-koorts in Nederland--mogelijk verband met geiten.

In 2007, 73 cases of Q fever were identified through reports and retrospective analyses; the affected region extended from Tilburg in the southwest to Arnhem in the northeast. The infections arose in late spring, particularly in May and June. Several spontaneous abortions due to Q fever occurred on 4 dairy goat farms in the same region. The national incidence of spontaneous abortion due to Q fever was 6 cases in 2006 and 7 in 2007. Climatically, this southern region was extraordinarily dry during April 2007. All pregnant women from a small region with the highest incidence in northeast North Brabant were called for diagnostic testing. Infected patients were followed for symptoms and ultrasound was performed as indicated. A definitive source of the infection could not yet be identified. Favourable climatic conditions were suspected as the cause for the combination of widespread dissemination among goats and transmission to humans. Q fever is a zoonosis caused by Coxiella burnetti, a microorganism dispersed in great numbers in the area in which an infected animal gives birth. C. burnetti is particularly resistant to chemical and physical factors and can disperse by air across large distances under dry climatic conditions. Q fever should be considered in patients in The Netherlands who present with lower airway infection and, in rare cases, hepatitis. Reporting atypical clusters ofpneumonia to the Municipal Health Service (GGD) is advisable. The GGD maintains close contact with Animal Health Services, which is aware of current infectious animal diseases. Targeted investigation can identify the source of infection and eliminate it. Greater awareness can prevent delays in diagnosis and treatment and help identify chronic forms at an early stage or prevent them.