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-
1.
Raoult D, Marrie T, Mege J, 2005. Natural history and pathophysiology of Q fever. Lancet Infect Dis 5: 219–226.
-
2.
Vanderburg S, Rubach MP, Halliday JE, Cleaveland S, Reddy EA, Crump JA, 2014. Epidemiology of Coxiella burnetii infection in Africa: A OneHealth systematic review. PLoS Negl Trop Dis 8: e2787.
-
3.
Kersh GJ, 2022. Tropical Q fever. Am J Trop Med Hyg 107: 219–220.
-
4.
Pisharody S et al., 2021. Incidence estimates of acute Q fever and spotted fever group rickettsioses, Kilimanjaro, Tanzania, from 2007 to 2008 and from 2012 to 2014. Am J Trop Med Hyg 106: 494–503.
-
5.
Anderson A et al., 2013. Diagnosis and management of Q fever–United States, 2013: Recommendations from CDC and the Q Fever Working Group. MMWR Recomm Rep 62: 1–30.
-
6.
Kassam NA, Kaaya RD, Damian DJ, Schmiegelow C, Kavishe RA, Alifrangis M, Wang CW, 2021. Ten years of monitoring malaria trend and factors associated with malaria test positivity rates in Lower Moshi. Malar J 20: 193.
-
7.
World Health Organization, 2021. Yaws. Available at: https://www.who.int/news-room/fact-sheets/detail/yaws. Accessed March 6, 2021.
-
8.
Eldin C, Melenotte C, Mediannikov O, Ghigo E, Million M, Edouard S, Mege JL, Maurin M, Raoult D, 2017. From Q fever to Coxiella burnetii infection: A paradigm change. Clin Microbiol Rev 30: 115–190.
-
9.
Yeaman MR, Mitscher LA, Baca OG, 1987. In vitro susceptibility of Coxiella burnetii to antibiotics, including several quinolones. Antimicrob Agents Chemother 31: 1079–1084.
-
10.
Whitty CJ, Glasgow KW, Sadiq ST, Mabey DC, Bailey R, 1999. Impact of community-based mass treatment for trachoma with oral azithromycin on general morbidity in Gambian children. Pediatr Infect Dis J 18: 955–958.
-
11.
Loftis AD, Reeves WK, Szumlas DE, Abbassy MM, Helmy IM, Moriarity JR, Dasch GA, 2006. Surveillance of Egyptian fleas for agents of public health significance: Anaplasma, Bartonella, Coxiella, Ehrlichia, Rickettsia, and Yersinia pestis. Am J Trop Med Hyg 75: 41–48.
-
12.
MedCalc Software Ltd. Diagnostic Test Evaluation Calculator Version 22.001. Available at: https://www.medcalc.org/calc/diagnostic_test.php. Accessed May 15, 2023.
-
13.
Pradeep J, Stephen S, Ambroise S, Gunasekaran D, 2017. Diagnosis of acute Q fever by detection of Coxiella burnetii DNA using real-time PCR, employing a commercial Genesig Easy Kit. J Clin Diagn Res 11: DC10–DC13.
-
14.
Boden K, Wagner-Wiening C, Seidel T, Baier M, Bischof W, Straube E, Kimmig P, 2010. Diagnosis of acute Q fever with emphasis on enzyme-linked immunosorbent assay and nested polymerase chain reaction regarding the time of serum collection. Diagn Microbiol Infect Dis 68: 110–116.
-
15.
Schneeberger PM, Hermans MH, van Hannen EJ, Schellekens JJ, Leenders AC, Wever PC, 2010. Real-time PCR with serum samples is indispensable for early diagnosis of acute Q fever. Clin Vaccine Immunol 17: 286–290.
-
16.
Wielders CC, Wijnbergen PC, Renders NH, Schellekens JJ, Schneeberger PM, Wever PC, Hermans MH, 2013. High Coxiella burnetii DNA load in serum during acute Q fever is associated with progression to a serologic profile indicative of chronic Q fever. J Clin Microbiol 51: 3192–3198.
-
17.
Harris AM et al., 2017. Influence of antibiotics on the detection of bacteria by culture-based and culture-independent diagnostic tests in patients hospitalized with community-acquired pneumonia. Open Forum Infect Dis 4: ofx014.
-
18.
Kim DM, Byun JN, 2008. Effects of antibiotic treatment on the results of nested PCRs for scrub typhus. J Clin Microbiol 46: 3465–3466.
-
19.
Edouard S, Raoult D, 2016. Lyophilization to improve the sensitivity of qPCR for bacterial DNA detection in serum: The Q fever paradigm. J Med Microbiol 65: 462–467.
-
20.
Raoult D, Tissot-Dupont H, Foucault C, Gouvernet J, Fournier PE, Bernit E, Stein A, Nesri M, Harle JR, Weiller PJ, 2000. Q fever 1985–1998. Clinical and epidemiologic features of 1,383 infections. Medicine (Baltimore) 79: 109–123.
-
21.
Cherry CC, Kersh GJ, 2020. Pediatric Q fever. Curr Infect Dis Rep 22: 10.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1268 | 1268 | 593 |
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| PDF Downloads | 36 | 36 | 18 |
Comparison of Paired Immunofluorescent Antibody Serology and Real-Time Polymerase Chain Reaction Testing for the Detection of Acute Q Fever among Febrile Patients in Kilimanjaro, Tanzania, 2012–2014
Robert J. Rolfe
Robert J. Rolfe
Division of Infectious Diseases and International Health, Department of Medicine, Duke University, Durham, North Carolina;
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John A. Crump
John A. Crump
Division of Infectious Diseases and International Health, Department of Medicine, Duke University, Durham, North Carolina;
Duke University Global Health Institute, Durham, North Carolina;
Centre for International Health, University of Otago, Dunedin, New Zealand;
Kilimanjaro Christian Medical Centre, Moshi, Tanzania;
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Duke University Global Health Institute, Durham, North Carolina;
Centre for International Health, University of Otago, Dunedin, New Zealand;
Kilimanjaro Christian Medical Centre, Moshi, Tanzania;
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Venance P. Maro
Venance P. Maro
Kilimanjaro Christian Medical Centre, Moshi, Tanzania;
Kilimanjaro Christian Medical University College, Moshi, Tanzania;
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Kilimanjaro Christian Medical University College, Moshi, Tanzania;
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Blandina T. Mmbaga
Blandina T. Mmbaga
Kilimanjaro Christian Medical Centre, Moshi, Tanzania;
Kilimanjaro Christian Medical University College, Moshi, Tanzania;
Kilimanjaro Clinical Research Institute, Moshi, Tanzania;
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Kilimanjaro Christian Medical University College, Moshi, Tanzania;
Kilimanjaro Clinical Research Institute, Moshi, Tanzania;
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Wilbrod Saganda
Wilbrod Saganda
Mawenzi Regional Referral Hospital, Moshi, Tanzania;
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Bingileki F. Lwezaula
Bingileki F. Lwezaula
Mawenzi Regional Referral Hospital, Moshi, Tanzania;
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Marc Roger Couturier
Marc Roger Couturier
Associated Regional and University Pathologists, Inc, Salt Lake City, Utah;
Department of Pathology, University of Utah, Salt Lake City, Utah;
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Department of Pathology, University of Utah, Salt Lake City, Utah;
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Weston C. Hymas
Weston C. Hymas
Associated Regional and University Pathologists, Inc, Salt Lake City, Utah;
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Jamie L. Perniciaro
Jamie L. Perniciaro
Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
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William L. Nicholson
William L. Nicholson
Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
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Gilbert J. Kersh
Gilbert J. Kersh
Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
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Matthew P. Rubach
matthew.rubach@duke.edu
Matthew P. Rubach
Division of Infectious Diseases and International Health, Department of Medicine, Duke University, Durham, North Carolina;
Duke University Global Health Institute, Durham, North Carolina;
Kilimanjaro Christian Medical Centre, Moshi, Tanzania;
Kilimanjaro Clinical Research Institute, Moshi, Tanzania;
Duke-National University of Singapore Medical School, Singapore
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Duke University Global Health Institute, Durham, North Carolina;
Kilimanjaro Christian Medical Centre, Moshi, Tanzania;
Kilimanjaro Clinical Research Institute, Moshi, Tanzania;
Duke-National University of Singapore Medical School, Singapore
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ABSTRACT.
Acute Q fever diagnosis via paired serology is problematic because it requires follow-up for convalescent sample collection; as such, it cannot provide a diagnosis to inform a treatment decision at the time of acute presentation. Real-time polymerase chain reaction (PCR) may be a useful approach for the diagnosis of acute Q fever in endemic settings. Among febrile patients enrolled in a sentinel surveillance study for Q fever at two referral hospitals in Moshi, Tanzania, from 2012 to 2014, we analyzed those with paired sera for IgG to Coxiella burnetii (C. burnetii) phase II antigens using immunofluorescent antibody (IFA) testing, and acute serum was tested for C. burnetii with PCR. Acute Q fever was defined as a fourfold or greater rise from the acute to convalescent sample in IFA reciprocal titer or PCR detection that was confirmed through repeat testing. Test characteristics were tabulated. Among 496 participants tested using both paired IFA and PCR testing, 463 (93.3%) tested negative on both IFA and PCR, five (1.0%) tested positive for Q fever on both IFA and PCR, and 28 (5.6%) tested positive for Q fever on IFA alone. The sensitivity of PCR testing using paired IFA testing as an index was 0.15 (5/33), and the specificity was 1 (463/463). C. burnetii PCR testing provides a clinically specific method that may aid in timely diagnosis in settings in which acute Q fever is a common cause of febrile illness. However, we found a low clinical sensitivity of PCR testing on serum when compared with paired IFA serology.
- Supplemental Materials (PDF 82.842 KB)
Author Notes
Financial support: This research was supported by the joint US NIH (www.nih.gov) and
Disclosures: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC. The use of trade names and commercial sources is for identification only and does not imply endorsement by the US Department of Health and Human Services or the CDC. This study was approved by the Kilimanjaro Christian Medical University College Health Research Ethics Committee, the Tanzania National Institute for Medical Research National Research Ethics Coordinating Committee, and an Institutional Review Board of the Duke University Hospital System. A material transfer agreement was fully executed between KCMC and ARUP Laboratories and between the KCMC and the United States CDC. Informed consent was obtained from all participants or the participant’s parent or guardian. The United States Department of Health and Human Services human subjects research guidelines were followed.
Current contact information: Robert J. Rolfe, Division of Infectious Diseases and International Health, Department of Medicine, Duke University, Durham, NC, E-mail: robert.rolfe@duke.edu. John A. Crump, Division of Infectious Diseases and International Health, Department of Medicine, Duke University, Durham, NC, Duke University Global Health Institute, Durham, NC, Centre for International Health, University of Otago, Dunedin, New Zealand, and Kilimanjaro Christian Medical Centre, Moshi, Tanzania, E-mail: john.crump@otago.ac.nz. Venance P. Maro, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, and Kilimanjaro Christian Medical University College, Moshi, Tanzania, E-mail: venmaro@ymail.com. Blandina T. Mmbaga, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, Kilimanjaro Christian Medical University College, Moshi, Tanzania, and Kilimanjaro Clinical Research Institute, Moshi, Tanzania, E-mail: blaymt@gmail.com. Wilbrod Saganda and Bingileki F. Lwezaula, Mawenzi Regional Referral Hospital, Moshi, Tanzania, E-mails: wilbrod.saganda@gmail.com and lwezaula@gmail.com. Marc Roger Couturier, Associated Regional and University Pathologists, Inc., Salt Lake City, UT, and Department of Pathology, University of Utah, Salt Lake City, UT, E-mail: marc.couturier@aruplab.com. Weston C. Hymas, Associated Regional and University Pathologists, Inc., Salt Lake City, UT, E-mail: hymasw@aruplab.com. Jamie L. Perniciaro, William L. Nicholson, and Gilbert J. Kersh, Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: uvo6@cdc.gov, wan6@cdc.gov, and hws7@cdc.gov. Matthew P. Rubach, Division of Infectious Diseases and International Health, Department of Medicine, Duke University, Durham, NC, Duke University Global Health Institute, Durham, NC, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, Kilimanjaro Clinical Research Institute, Moshi, Tanzania, and Duke-National University of Singapore Medical School, Singapore, E-mail: matthew.rubach@duke.edu.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Raoult D, Marrie T, Mege J, 2005. Natural history and pathophysiology of Q fever. Lancet Infect Dis 5: 219–226.
-
2.
Vanderburg S, Rubach MP, Halliday JE, Cleaveland S, Reddy EA, Crump JA, 2014. Epidemiology of Coxiella burnetii infection in Africa: A OneHealth systematic review. PLoS Negl Trop Dis 8: e2787.
-
3.
Kersh GJ, 2022. Tropical Q fever. Am J Trop Med Hyg 107: 219–220.
-
4.
Pisharody S et al., 2021. Incidence estimates of acute Q fever and spotted fever group rickettsioses, Kilimanjaro, Tanzania, from 2007 to 2008 and from 2012 to 2014. Am J Trop Med Hyg 106: 494–503.
-
5.
Anderson A et al., 2013. Diagnosis and management of Q fever–United States, 2013: Recommendations from CDC and the Q Fever Working Group. MMWR Recomm Rep 62: 1–30.
-
6.
Kassam NA, Kaaya RD, Damian DJ, Schmiegelow C, Kavishe RA, Alifrangis M, Wang CW, 2021. Ten years of monitoring malaria trend and factors associated with malaria test positivity rates in Lower Moshi. Malar J 20: 193.
-
7.
World Health Organization, 2021. Yaws. Available at: https://www.who.int/news-room/fact-sheets/detail/yaws. Accessed March 6, 2021.
-
8.
Eldin C, Melenotte C, Mediannikov O, Ghigo E, Million M, Edouard S, Mege JL, Maurin M, Raoult D, 2017. From Q fever to Coxiella burnetii infection: A paradigm change. Clin Microbiol Rev 30: 115–190.
-
9.
Yeaman MR, Mitscher LA, Baca OG, 1987. In vitro susceptibility of Coxiella burnetii to antibiotics, including several quinolones. Antimicrob Agents Chemother 31: 1079–1084.
-
10.
Whitty CJ, Glasgow KW, Sadiq ST, Mabey DC, Bailey R, 1999. Impact of community-based mass treatment for trachoma with oral azithromycin on general morbidity in Gambian children. Pediatr Infect Dis J 18: 955–958.
-
11.
Loftis AD, Reeves WK, Szumlas DE, Abbassy MM, Helmy IM, Moriarity JR, Dasch GA, 2006. Surveillance of Egyptian fleas for agents of public health significance: Anaplasma, Bartonella, Coxiella, Ehrlichia, Rickettsia, and Yersinia pestis. Am J Trop Med Hyg 75: 41–48.
-
12.
MedCalc Software Ltd. Diagnostic Test Evaluation Calculator Version 22.001. Available at: https://www.medcalc.org/calc/diagnostic_test.php. Accessed May 15, 2023.
-
13.
Pradeep J, Stephen S, Ambroise S, Gunasekaran D, 2017. Diagnosis of acute Q fever by detection of Coxiella burnetii DNA using real-time PCR, employing a commercial Genesig Easy Kit. J Clin Diagn Res 11: DC10–DC13.
-
14.
Boden K, Wagner-Wiening C, Seidel T, Baier M, Bischof W, Straube E, Kimmig P, 2010. Diagnosis of acute Q fever with emphasis on enzyme-linked immunosorbent assay and nested polymerase chain reaction regarding the time of serum collection. Diagn Microbiol Infect Dis 68: 110–116.
-
15.
Schneeberger PM, Hermans MH, van Hannen EJ, Schellekens JJ, Leenders AC, Wever PC, 2010. Real-time PCR with serum samples is indispensable for early diagnosis of acute Q fever. Clin Vaccine Immunol 17: 286–290.
-
16.
Wielders CC, Wijnbergen PC, Renders NH, Schellekens JJ, Schneeberger PM, Wever PC, Hermans MH, 2013. High Coxiella burnetii DNA load in serum during acute Q fever is associated with progression to a serologic profile indicative of chronic Q fever. J Clin Microbiol 51: 3192–3198.
-
17.
Harris AM et al., 2017. Influence of antibiotics on the detection of bacteria by culture-based and culture-independent diagnostic tests in patients hospitalized with community-acquired pneumonia. Open Forum Infect Dis 4: ofx014.
-
18.
Kim DM, Byun JN, 2008. Effects of antibiotic treatment on the results of nested PCRs for scrub typhus. J Clin Microbiol 46: 3465–3466.
-
19.
Edouard S, Raoult D, 2016. Lyophilization to improve the sensitivity of qPCR for bacterial DNA detection in serum: The Q fever paradigm. J Med Microbiol 65: 462–467.
-
20.
Raoult D, Tissot-Dupont H, Foucault C, Gouvernet J, Fournier PE, Bernit E, Stein A, Nesri M, Harle JR, Weiller PJ, 2000. Q fever 1985–1998. Clinical and epidemiologic features of 1,383 infections. Medicine (Baltimore) 79: 109–123.
-
21.
Cherry CC, Kersh GJ, 2020. Pediatric Q fever. Curr Infect Dis Rep 22: 10.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1268 | 1268 | 593 |
| Full Text Views | 40 | 40 | 13 |
| PDF Downloads | 36 | 36 | 18 |