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


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.


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.


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.


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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

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