Advertisement

Serology in chronic Q fever is still surrounded by question marks

  • M. C. A. Wegdam-BlansEmail author
  • H. T. Tjhie
  • J. M. Korbeeck
  • M. N. Nabuurs-Franssen
  • L. M. Kampschreur
  • T. Sprong
  • J. A. W. Teijink
  • M. P. Koopmans
Article

Abstract

Detection of antibodies using immunofluoresence tests (IFAT) is recommended for diagnosis of chronic Q fever, but other commercial antibody assays are also available. We compared an enzyme-linked immunosorbent assay (ELISA) (Virion/Serion) and a complement fixation test (CFT) (Virion/Serion) for the detection of Coxiella burnetii IgG phase I and IgA phase I in early- and follow-up serum samples from patients with chronic Q fever, diagnosed according to an algorithm that involves IFAT. For this, we tested sera of 49 patients, including 30 proven, 14 probable and five possible chronic Q fever cases. Sensitivity of CFT for diagnosis of chronic Q fever was suboptimal (85 %), as eight patients, including five with chronic Q fever, tested negative at time of diagnosis, whereas IgG phase I antibodies were detected in these five patients by ELISA. Sensitivity of ELISA was higher, although three probable patients were missed. No differences in ELISA IgA phase I detection between proven chronic Q fever and probable were observed; instead possible patients were in majority IgA negative (60 %). Serological examination using ELISA and CFT in follow-up sera from 26 patients on treatment was unsatisfactory. Like IFAT, all kinetic options were possible: decreasing, remaining stable or even increase during time. This study demonstrated that the sensitivity of CFT-based phase I antibody detection is low and therefore not recommended for diagnosis of chronic Q fever. Based on our results, serological follow-up to guide treatment decisions was of limited value.

Keywords

Complement Fixation Test Indirect Fluorescent Antibody Test Serological Response Fever Case Coxiella Burnetii 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Contributor statement

All authors are involved in the (1) conception and design and acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, and (3) final approval of the version to be published.

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical statement

Not applicable.

References

  1. 1.
    Parker NR, Barralet JH, Bell AM (2006) Q fever. Lancet 367:679–688PubMedCrossRefGoogle Scholar
  2. 2.
    Raoult D, Marrie T, Mege J (2005) Natural history and pathophysiology of Q fever. Lancet Infect Dis 5:219–226PubMedCrossRefGoogle Scholar
  3. 3.
    Tissot-Dupont H, Raoult D (2008) Q fever. Infect Dis Clin N Am 22:505–514CrossRefGoogle Scholar
  4. 4.
    Botelho-Nevers E, Fournier PE, Richet H, Fenollar F, Lepidi H, Foucault C et al (2007) Coxiella burnetii infection of aortic aneurysms or vascular grafts: report of 30 new cases and evaluation of outcome. Eur J Clin Microbiol Infect Dis 26:635–640PubMedCrossRefGoogle Scholar
  5. 5.
    Million M, Thuny F, Richet H, Raoult D (2010) Long-term outcome of Q fever endocarditis: a 26-year personal survey. Lancet Infect Dis 10:527–535PubMedCrossRefGoogle Scholar
  6. 6.
    Fenollar F, Fournier PE, Carrieri MP, Habib G, Messana T, Raoult D (2001) Risks factors and prevention of Q fever endocarditis. Clin Infect Dis 33:312–316PubMedCrossRefGoogle Scholar
  7. 7.
    Landais C, Fenollar F, Thuny F, Raoult D (2007) From acute Q fever to endocarditis: serological follow-up strategy. Clin Infect Dis 44:1337–1340PubMedCrossRefGoogle Scholar
  8. 8.
    Raoult D, Tissot-Dupont H, Foucault C, Gouvernet J, Fournier PE, Bernit E et al (2000) Q fever 1985-1998. Clinical and epidemiologic features of 1,383 infections. Medicine (Baltimore) 79:109–123CrossRefGoogle Scholar
  9. 9.
    van der Hoek W, Dijkstra F, Schimmer B, Schneeberger PM, Vellema P, Wijkmans C et al. (2010) Q fever in the Netherlands: an update on the epidemiology and control measures. Eur Surveill 15(12)Google Scholar
  10. 10.
    van der Hoek W, Morroy G, Renders NH, Wever PC, Hermans MH, Leenders AC et al (2012) Epidemic Q fever in humans in the Netherlands. Adv Exp Med Biol 984:329–364PubMedCrossRefGoogle Scholar
  11. 11.
    van der Hoek W, Schneeberger PM, Oomen T, Wegdam-Blans MC, Dijkstra F, Notermans DW et al (2012) Shifting priorities in the aftermath of a Q fever epidemic in 2007 to 2009 in The Netherlands: from acute to chronic infection. Eur Surveill 17:20059Google Scholar
  12. 12.
    Wegdam-Blans MC, Kampschreur LM, Delsing CE, Bleeker-Rovers CP, Sprong T, van Kasteren ME et al (2012) Chronic Q fever: review of the literature and a proposal of new diagnostic criteria. J Infect 64:247–259PubMedCrossRefGoogle Scholar
  13. 13.
    Kampschreur LM, Oosterheert JJ, Koop AM, Wegdam-Blans MC, Delsing CE, Bleeker-Rovers CP et al (2012) Microbiological challenges in the diagnosis of chronic Q fever. Clin Vaccine Immunol 19:787–790PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Wegdam-Blans MC, Vainas T, van Sambeek MR, Cuypers PW, Tjhie HT, van Straten AH et al (2012) Vascular complications of Q-fever infections. Eur J Vasc Endovasc Surg 42:384–392CrossRefGoogle Scholar
  15. 15.
    Peacock MG, Philip RN, Williams JC, Faulkner RS (1983) Serological evaluation of O fever in humans: enhanced phase I titers of immunoglobulins G and A are diagnostic for Q fever endocarditis. Infect Immun 41:1089–1098PubMedPubMedCentralGoogle Scholar
  16. 16.
    Dupont HT, Thirion X, Raoult D (1994) Q fever serology: cutoff determination for microimmunofluorescence. Clin Diagn Lab Immunol 1:189–196PubMedPubMedCentralGoogle Scholar
  17. 17.
    Raoult D, Levy PY, Harle JR, Etienne J, Massip P, Goldstein F et al (1990) Chronic Q fever: diagnosis and follow-up. Ann NY Acad Sci 590:51–60PubMedCrossRefGoogle Scholar
  18. 18.
    Frankel D, Richet H, Renvoise A, Raoult D (2011) Q fever in France, 1985-2009. Emerg Infect Dis 17:350–356PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    de Silva T, Chapman A, Kudesia G, McKendrick M (2006) Ongoing queries: interpretation of serology in asymptomatic or atypical chronic Q fever. J Infect 52:e113–e116PubMedCrossRefGoogle Scholar
  20. 20.
    Hung MN, Lin LJ, Hou MY, Lin PS, Wang YC, Shu PY et al (2011) Serologic assessment of the risk of developing chronic Q fever in cohorts of acutely infected individuals. J Infect 62:39–44PubMedCrossRefGoogle Scholar
  21. 21.
    van der Hoek W, Versteeg B, Meekelenkamp JC, Renders NH, Leenders AC, Weers-Pothoff I et al (2011) Follow-up of 686 patients with acute Q fever and detection of chronic infection. Clin Infect Dis 52:1431–1436PubMedCrossRefGoogle Scholar
  22. 22.
    Wegdam-Blans MC, Wielders CC, Meekelenkamp J, Korbeeck JM, Herremans T, Tjhie HT et al (2012) Evaluation of commonly used serological tests for detection of Coxiella burnetii antibodies in well-defined acute and follow-up sera. Clin Vaccine Immunol 19:1110–1115PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    van der Hoek W, Wielders CC, Schimmer B, Wegdam-Blans MC, Meekelenkamp J, Zaaijer HL et al (2012) Detection of phase I IgG antibodies to Coxiella burnetii with EIA as a screening test for blood donations. Eur J Clin Microbiol Infect Dis 31:3207–3209PubMedCrossRefGoogle Scholar
  24. 24.
    Dupuis G, Peter O, Luthy R, Nicolet J, Peacock M (1986) Burgdorfer W (1986) Serological diagnosis of Q fever endocarditis. Eur Heart J 7:1062–1066PubMedGoogle Scholar
  25. 25.
    Peter O, Dupuis G, Bee D, Luthy R, Nicolet J, Burgdorfer W (1988) Enzyme-linked immunosorbent assay for diagnosis of chronic Q fever. J Clin Microbiol 26:1978–1982PubMedPubMedCentralGoogle Scholar
  26. 26.
    Kokkini S, Kofteridis D, Psaroulaki A, Sipsas N, Tsiodras S, Giannitsiotiand E et al (2009) Q fever endocarditis in Greece: report of five cases. Clin Microbiol Infect 15(Suppl 2):136–137PubMedCrossRefGoogle Scholar
  27. 27.
    Worswick D, Marmion BP (1985) Antibody responses in acute and chronic Q fever and in subjects vaccinated against Q fever. J Med Microbiol 19:281–296PubMedCrossRefGoogle Scholar
  28. 28.
    Cowley R, Fernandez F, Freemantle W, Rutter D (1992) Enzyme immunoassay for Q fever: comparison with complement fixation and immunofluorescence tests and dot immunoblotting. J Clin Microbiol 30:2451–2455PubMedPubMedCentralGoogle Scholar
  29. 29.
    Field PR, Santiago A, Chan SW, Patel DB, Dickeson D, Mitchell JL et al (2002) Evaluation of a novel commercial enzyme-linked immunosorbent assay detecting Coxiella burnetii-specific immunoglobulin G for Q fever prevaccination screening and diagnosis. J Clin Microbiol 40:3526–3529PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • M. C. A. Wegdam-Blans
    • 1
    Email author
  • H. T. Tjhie
    • 1
  • J. M. Korbeeck
    • 1
  • M. N. Nabuurs-Franssen
    • 2
  • L. M. Kampschreur
    • 3
  • T. Sprong
    • 2
  • J. A. W. Teijink
    • 4
    • 5
  • M. P. Koopmans
    • 6
  1. 1.Department of Medical MicrobiologyLaboratory for Pathology and Medical Microbiology (PAMM)VeldhovenThe Netherlands
  2. 2.Department of Medical Microbiology and Infectious DiseasesCanisius-Wilhelmina ZiekenhuisNijmegenThe Netherlands
  3. 3.Department of Internal Medicine and Infectious DiseasesUniversity Medical Center UtrechtUtrechtThe Netherlands
  4. 4.Department of Vascular SurgeryCatharina Hospital EindhovenEindhovenThe Netherlands
  5. 5.Department of Epidemiology, Caphri Research SchoolMaastricht UniversityMaastrichtThe Netherlands
  6. 6.Centre for Infectious Disease ControlNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands

Personalised recommendations