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Evaluation of a diagnostic algorithm for acute Q fever in an outbreak setting

Mischa M Jager1, Gezina Weers-Pothoff, Mirjam H A Hermans

  • 1Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 5200 ME 's-Hertogenbosch, Netherlands.

Clinical and Vaccine Immunology : CVI
|April 22, 2011
PubMed

Insights

A new diagnostic algorithm for acute Q fever, utilizing an enzyme-linked immunosorbent assay for immunoglobulin M antibodies (MII screen), significantly reduced testing by over 80%. Polymerase chain reaction (PCR) also aided in diagnosing Q fever in many patients.

Area of Science:

  • Medical Microbiology
  • Infectious Diseases
  • Epidemiology

Background:

  • The 2009 Q fever outbreak in the Netherlands necessitated efficient diagnostic strategies.
  • Traditional diagnostic methods for Q fever can be resource-intensive.

Purpose of the Study:

  • To evaluate a novel diagnostic algorithm for acute Q fever.
  • To assess the impact of an enzyme-linked immunosorbent assay (MII screen) on diagnostic workflow.
  • To determine the contribution of polymerase chain reaction (PCR) to Q fever diagnosis.

Main Methods:

  • Retrospective evaluation of 825 patients during a 17-day period.
  • Implementation of a diagnostic algorithm starting with an MII screen for Coxiella burnetii antibodies.
  • Subsequent use of immunofluorescence assay or PCR based on MII screen results and clinical data.

Main Results:

  • Acute Q fever was diagnosed in 256 patients.
  • The MII screen reduced the number of immunofluorescence assays by over 80%.
  • PCR analysis contributed to the diagnosis in 103 patients.
  • Diagnostic challenges included missing onset dates and lack of follow-up samples.

Conclusions:

  • The MII screen is an effective initial step for diagnosing acute Q fever, significantly reducing workload.
  • PCR plays a valuable role in confirming Q fever diagnoses.
  • Improved data collection, such as date of onset and follow-up samples, is crucial for effective diagnostics.

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