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POLICY REVIEWDutch Consensus GuidelineFaced with a large Q fever outbreak in the Netherlands anda rising number of (presumed) chronic Q fever patients, wewere not able to find answers to all our questions aboutthis complex disease in the literature. Moreover, randomizedtrials on diagnosis and treatment of this disease werelacking, and available data were not all applicable to theDutch situation. For example, we found far more vascularlocalizations of chronic Q fever, with often severe complications,than had been described previously. Therefore,the Dutch Q Fever Consensus Group was initiated in 2010,in which diagnosis and subsequent treatment consequencesfor suspected chronic Q fever were discussed. We performeda thorough literature review and constructed a newguideline for the diagnosis of chronic Q fever, differentiatingbetween proven, probable, and possible chronic Q fever(Table 1). We added advice for treatment and follow-upregimes for these 3 groups of patients. Antibiotic treatmentand, if indicated, surgical treatment are recommended forall patients with proven chronic Q fever. The decision tostart antibiotic treatment in patients with probable chronicQ fever depends on clinical characteristics and the conditionof the patient, and should be determined by a multidisciplinaryteam. For possible chronic Q fever patients,antibiotic treatment should not be initiated, but follow-upis indicated.After the Dutch consensus guideline was reported(14), a reaction by French researcher Didier Raoult waspublished; he did not agree with this proposed guidelineand formulated alternative diagnostic criteria on the basisof his expert opinion (Table 2) (16). Professor Raoult is theundisputed leading authority on Q fever, and his opinionand the scientific publications from his research groupshould be considered by anyone working in the field ofQ fever. Here, we attempt to resolve these differences ofopinion by applying both criteria to cases from the DutchNational Chronic Q Fever Database.Dutch Consensus Guideline versus ExpertOpinion GuidelineA critical difference in the diagnostic criteria proposed byRaoult and those of the Dutch Q Fever Consensus Groupis the diagnostic value attributed to C. burnetii PCRpositivity of blood samples. Because we are unaware ofclinical entities, other than acute and chronic Q fever, forwhich a PCR positive for C. burnetii in blood would beexhibited, we believe that positive blood PCR findings, inthe absence of acute Q fever, prove chronic Q fever. Thealternative criteria, on the other hand, state that a positivePCR finding in blood should be accompanied by a clearendocarditis focus shown on echocardiograph, a clearvascular focus on imaging studies, or at least 2 or 3 “minorcriteria” (Table 2). Moreover, the alternative criteriaattribute great value to the phase I IgG titer, proposinga phase I IgG ≥1:6,400 as a major criterion for Q feverendocarditis and Q fever vascular infection, in contrast toa phase I IgG ≥1:800 and
Chronic Q Fever DiagnosisTable 2. Diagnostic guideline for chronic Q fever proposedby Raoult*Q fever endocarditisA. Definite criteriaPositive culture, PCR, or immunochemistry of a cardiac valveB. Major criteriaMicrobiology: positive culture or PCR of the blood or an embolior serology with IgG I antibodies ≥6,400Evidence of endocardial involvement:Echocardiogram positive for IE: oscillating intra-cardiacmass on valve or supporting structure, in the path ofregurgitant jets, or on implanted material in the absence ofan alternative anatomic explanation; or abscess; or newpartial dehiscence of prosthetic vale; or new valvularregurgitation (worsening or changing of pre-existent murmurnot sufficient)PET scan showing a specific valve fixation and mycoticaneurysmC. Minor criteriaPredisposing heart condition (known or found onechocardiograph)Fever, temperature >38°CVascular phenomena, major arterial emboli, septic pulmonaryinfarcts, mycotic aneurysm (see at PET scan), intracranialhemorrhage, conjunctival hemorrhages, and Janeway lesionsImmunologic phenomena: glomerulonephritis, Osle nodes,Roth spots, or rheumatoid factorSerologic evidence: IgG I antibodies ≥800
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July 2015SynopsisOn the CoverMarian
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1240 Gastroenteritis OutbreaksCause
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SYNOPSISDisseminated Infections wit
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Disseminated Infections with Talaro
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Disseminated Infections with Talaro
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Macacine Herpesvirus 1 inLong-Taile
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Macacine Herpesvirus 1 in Macaques,
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Malaria among Young Infants, Africa
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RESEARCHFigure 3. Dynamics of 19-kD
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Transdermal Diagnosis of MalariaUsi
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RESEARCHFigure 2. A) Acoustic trace
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RESEARCHof malaria-infected mosquit
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Lack of Transmission amongClose Con
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RESEARCH(IFA) and microneutralizati
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RESEARCHoropharyngeal, and serum sa
Page 40 and 41: RESEARCH6. Assiri A, McGeer A, Perl
Page 42 and 43: RESEARCHadvanced genomic sequencing
Page 44 and 45: RESEARCHTable 2. Next-generation se
Page 46 and 47: RESEARCHTable 3. Mutation analysis
Page 48 and 49: RESEARCHReferences1. Baize S, Panne
Page 50 and 51: Parechovirus Genotype 3 Outbreakamo
Page 52 and 53: RESEARCHFigure 1. Venn diagramshowi
Page 54 and 55: RESEARCHTable 2. HPeV testing of sp
Page 56 and 57: RESEARCHFigure 5. Distribution of h
Page 58 and 59: RESEARCHReferences1. Selvarangan R,
Page 60 and 61: RESEARCHthe left lobe was sampled b
Page 62 and 63: RESEARCHTable 2. Middle East respir
Page 64 and 65: RESEARCHseroprevalence in domestic
Page 66 and 67: RESEARCHmeasure their current surve
Page 68 and 69: RESEARCHTable 2. States with labora
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Page 72 and 73: RESEARCH9. Centers for Disease Cont
Page 74 and 75: RESEARCHthe analyses. Cases in pers
Page 76 and 77: RESEARCHTable 3. Sampling results (
Page 78 and 79: RESEARCHpresence of Legionella spp.
Page 80 and 81: Seroprevalence for Hepatitis Eand O
Page 82 and 83: RESEARCHTable 1. Description of stu
Page 84 and 85: RESEARCHTable 3. Crude and adjusted
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Page 88 and 89: RESEARCH25. Taha TE, Kumwenda N, Ka
Page 92 and 93: POLICY REVIEWTable 3. Comparison of
Page 94 and 95: POLICY REVIEW6. Botelho-Nevers E, F
Page 96 and 97: DISPATCHESFigure 1. Phylogenetic tr
Page 98 and 99: DISPATCHESSevere Pediatric Adenovir
Page 100 and 101: DISPATCHESTable 1. Demographics and
Page 102 and 103: DISPATCHES13. Kim YJ, Hong JY, Lee
Page 104 and 105: DISPATCHESTable. Alignment of resid
Page 106 and 107: DISPATCHESFigure 2. Interaction of
Page 108 and 109: DISPATCHESSchmallenberg Virus Recur
Page 110 and 111: DISPATCHESFigure 2. Detection of Sc
Page 112 and 113: DISPATCHESFigure 1. Histopathologic
Page 114: DISPATCHESFigure 2. Detection of fo
Page 117 and 118: Influenza Virus Strains in the Amer
Page 119 and 120: Novel Arenavirus Isolates from Nama
Page 121 and 122: Novel Arenaviruses, Southern Africa
Page 123 and 124: Readability of Ebola Informationon
Page 125 and 126: Readability of Ebola Information on
Page 127 and 128: Patients under investigation for ME
Page 129 and 130: Patients under investigation for ME
Page 131 and 132: Wildlife Reservoir for Hepatitis E
Page 133 and 134: Asymptomatic Malaria and Other Infe
Page 135 and 136: Asymptomatic Malaria in Children fr
Page 137 and 138: Bufavirus in Wild Shrews and Nonhum
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Range Expansion for Rat Lungworm in
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Slow Clearance of Plasmodium falcip
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Slow Clearance of Plasmodium falcip
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Gastroenteritis Caused by Norovirus
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Ebola Virus Stability on Surfaces a
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Ebola Virus Stability on Surfaces a
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Outbreak of Ciprofloxacin-Resistant
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Outbreak of S. sonnei, South KoreaT
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Rapidly Expanding Range of Highly P
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Cluster of Ebola Virus Disease, Bon
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Cluster of Ebola Virus Disease, Lib
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ANOTHER DIMENSIONThe Past Is Never
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Measles Epidemic, Boston, Massachus
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LETTERSInfluenza A(H5N6)Virus Reass
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LETTERSsystem (8 kb-span paired-end
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LETTERS3. Van Hong N, Amambua-Ngwa
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LETTERSTable. Prevalence of Bartone
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LETTERSavian influenza A(H5N1) viru
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LETTERSprovinces and a total of 200
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LETTERS7. Manian FA. Bloodstream in
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LETTERSforward projections. N Engl
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LETTERS3. Guindon S, Gascuel OA. Si
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BOOKS AND MEDIAin the port cities o
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ABOUT THE COVERNorth was not intere
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Earning CME CreditTo obtain credit,
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Emerging Infectious Diseases is a p
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