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Wegdam-blans M.C.A.,Laboratory for Pathology and Medical Microbiology PAMM | Ter woorst J.F.,Catharina Hospital | Klompenhouwer E.G.,Catharina Hospital | Teijink J.A.,Catharina Hospital | Teijink J.A.,Maastricht University
European Journal of Cardio-thoracic Surgery | Year: 2012

Chronic Q fever infections, caused by Coxiella burnetii, are associated with cardiovascular complications, mainly endocarditis and vascular (graft) infections. We report a case of a patient with a C. burnetii infected thoracic aorta graft treated initially in a conservative way. However, surgical excision of the infected graft was eventually necessary. This case report highlights the challenges regarding the treatment of patients with chronic vascular C. burnetii infections. In the absence of practical guidelines, treatment is tailored to the individual patient. Furthermore, we want to emphasize the need to include chronic Q fever in the differential diagnosis in patients with culture negative aortitis, especially in the regions with Q fever epidemics in the recent past. © The Author 2012. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

van der Hoek W.,National Institute for Public Health and the Environment RIVM | Schneeberger P.M.,Robert Bosch GmbH | Oomen T.,National Institute for Public Health and the Environment RIVM | Wegdam-Blans M.C.,Laboratory for Pathology and Medical Microbiology PAMM | And 8 more authors.
Eurosurveillance | Year: 2012

From 2007 to 2009, the Netherlands faced large seasonal outbreaks of Q fever, in which infected dairy goat farms were identified as the primary sources. Veterinary measures including vaccination of goats and sheep and culling of pregnant animals on infected farms seem to have brought the Q fever problem under control. However, the epidemic is expected to result in more cases of chronic Q fever among risk groups in the coming years. In the most affected area, in the south of the country, more than 12% of the population now have antibodies against Coxiella burnetii. Questions remain about the follow-up of acute Q fever patients, screening of groups at risk for chronic Q fever, screening of donors of blood and tissue, and human vaccination. There is a considerable ongoing research effort as well as enhanced veterinary and human surveillance.

Schoffelen T.,Radboud University Nijmegen | Sprong T.,Canisius Wilhelmina Hospital | Bleeker-Rovers C.P.,Radboud University Nijmegen | Wegdam-Blans M.C.A.,Laboratory for Pathology and Medical Microbiology PAMM | And 10 more authors.
Clinical Microbiology and Infection | Year: 2014

Infection with Coxiella burnetii may lead to life-threatening chronic Q fever endocarditis or vascular infections, which are often difficult to diagnose. The present study aims to investigate whether measurement of in-vitro interferon-gamma (IFN-γ) production, a key cytokine in the immune response against C. burnetii, differentiates chronic from a past cleared infection, and whether measurement of other cytokines would improve the discriminative power. First, C. burnetii-specific IFN-γ production was measured in whole blood of 28 definite chronic Q fever patients and compared with 135 individuals with past Q fever (seropositive controls) and 908 seronegative controls. IFN-γ production was significantly higher in chronic Q fever patients than in controls, but with overlapping values between patients and seropositives. Secondly, the production of a series of other cytokines was measured in a subset of patients and controls, which showed that interleukin (IL)-2 production was significantly lower in patients than in seropositive controls. Subsequently, measuring IL-2 in all patients and all controls with substantial IFN-γ production showed that an IFN-γ/IL-2 ratio >11 had a sensitivity and specificity of 79% and 96%, respectively, to diagnose chronic Q fever. This indicates that a high IFN-γ/IL-2 ratio is highly suggestive for chronic Q fever. In an additional group of 25 individuals with persistent high anti-Coxiella phase I IgG titres without definite chronic infection, all but six showed an IFN-γ/IL-2 ratio <11. In conclusion, these findings hold promise for the often difficult diagnostic work-up of Q fever and the IFN-γ/IL-2 ratio may be used as an additional diagnostic marker. Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

Wegdam-Blans M.C.A.,Laboratory for Pathology and Medical Microbiology PAMM | Stokmans R.A.,Catharina Hospital | Stokmans R.A.,Maastricht University | Tjhie J.H.T.,Laboratory for Pathology and Medical Microbiology PAMM | And 6 more authors.
European Journal of Clinical Microbiology and Infectious Diseases | Year: 2013

In the aftermath of the Dutch Q fever outbreak, an increasing number of patients are being diagnosed with chronic Q fever. Most of these patients are unaware of being infected with Coxiella burnetii, the causative agent of Q fever. To find patients in an earlier, asymptomatic stage, a targeted screening strategy (TSS) for patients with risk factors for chronic Q fever was started in the southeast region of Noord-Brabant. In total, 763 patients were tested using an IgG phase II indirect fluorescent antibody test (IFAT), of which 52 (7 %) patients tested positive. Ten of these 52 patients displayed a chronic Q fever serological profile. All of these 10 patients had a heart valve(s) or (endo-)vascular prosthesis. All except one were asymptomatic. Suggestive signs for chronic infections on positron emission tomography-computed tomography (PET-CT) were demonstrated in 5 (50 %) of these patients. Forty-two out of the 52 patients with a positive screening test showed a past Q fever serological profile. After a year of follow-up (every 3 months), none of these patients showed elevation of antibody titres and no new chronic Q fever patients were found in this group. A targeted screening programme is a useful instrument for detecting patients at risk of developing chronic Q fever. © 2012 Springer-Verlag.

De Jong E.,University Medical Center Nijmegen | Erkens-Hulshof S.,Laboratory for Pathology and Medical Microbiology PAMM | Van Der Velden L.B.J.,University Medical Center Nijmegen | Voss A.,University Medical Center Nijmegen | And 4 more authors.
Scandinavian Journal of Infectious Diseases | Year: 2014

A case series of 14 patients with Raoultella bacteremia was compared with 28 Klebsiella oxytoca and 28 Klebsiella pneumoniae bacteremia cases. Forty-three percent of Raoultella bacteremia cases were associated with biliary tract disease, compared to 32% and 22% of patients with K. oxytoca and K. pneumoniae bacteremia, respectively. © 2014 Informa Healthcare.

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