One-year follow-up of patients of the ongoing Dutch Q fever outbreak: clinical, serological and echocardiographic findings

Contains fulltext : 89915.pdf (publisher's version ) (Open Access)PURPOSE: In 2007, a large goat-farming-associated Q fever outbreak occurred in the Netherlands. Data on the clinical outcome of Dutch Q fever patients are lacking. The current advocated follow-up strategy includes serological follow-up to detect evolution to chronic disease and cardiac screening at baseline to identify and prophylactically treat Q fever patients in case of valvulopathy. However, serological follow-up using commercially available tests is complicated by the lack of validated cut-off values. Furthermore, cardiac screening in the setting of a large outbreak has not been implemented previously. Therefore, we report here the clinical outcome, serological follow-up and cardiac screening data of the Q fever patients of the current ongoing outbreak. METHODS: The implementation of a protocol including clinical and serological follow-up at baseline and 3, 6 and 12 months after acute Q fever and screening echocardiography at baseline. RESULTS: Eighty-five patients with acute Q fever were identified (male 62%, female 38%). An aspecific, flu-like illness was the most common clinical presentation. Persistent symptoms after acute Q fever were reported by 59% of patients at 6 months and 30% at 12 months follow-up. We observed a typical serological response to Coxiella burnetii infection in both anti-phase I and anti-phase II IgG antibodies, with an increase in antibody titres up to 3 months and a subsequent decrease in the following 9 months. Screening echocardiography was available for 66 (78%) out of 85 Q fever patients. Cardiac valvulopathy was present in 39 (59%) patients. None of the 85 patients developed chronic Q fever. CONCLUSIONS: Clinical, serological and echocardiographic data of the current ongoing Dutch Q fever outbreak cohort are presented. Screening echocardiography is no longer part of the standard work-up of Q fever patients in the Netherlands.1 december 201

A proxy record of winter temperatures since 1836 from ice freeze-up/breakup in lake Näsijärvi, Finland

One obstacle on the way to a comprehensive spatial reconstruction of regional temperature changes over the past centuries is the sparseness of long winter temperature records. This paper reconstructs a proxy record of April and November–December temperatures in south-central Finland for the interval from 1836 to 1872 from breakup and freeze-up dates and ice-cover duration of a lake. Emphasis is on detecting the suitable winter months and quantifying the calibrations with measured temperatures (1873–2002). The calibration slope for the breakup date (0.158°C/day) is larger than for freeze-up date (0.119°C/day) or duration (0.090°C/day). A comparison with results from other proxy records shows that the slope may depend also on the geographical site. Trend analyses of the full temperature records (1836–2002) indicate the existence of minor change-points at around 1867 (April temperature) and 1874 (November–December temperature), with warming rates thereafter of 1.67°C per century (April) and 1.16°C per century (November–December). Spectral analyses reveal peaks in the band between 2 and 5 year period, which may point to influences of the North Atlantic Oscillation, and less power in the decadal band (up to 42 year period)

Localizing chronic Q fever: a challenging query

Contains fulltext : 125615.pdf (publisher's version ) (Open Access)BACKGROUND: Chronic Q fever usually presents as endocarditis or endovascular infection. We investigated whether 18F-FDG PET/CT and echocardiography were able to detect the localization of infection. Also, the utility of the modified Duke criteria was assessed. METHODS: Fifty-two patients, who had an IgG titre of >/= 1024 against C. burnetii phase I >/= 3 months after primary infection or a positive PCR >/= 1 month after primary infection, were retrospectively included. Data on serology, the results of all imaging studies, possible risk factors for developing proven chronic Q fever and clinical outcome were recorded. RESULTS: According to the Dutch consensus on Q fever diagnostics, 18 patients had proven chronic Q fever, 14 probable chronic Q fever, and 20 possible chronic Q fever. Of the patients with proven chronic Q fever, 22% were diagnosed with endocarditis, 17% with an infected vascular prosthesis, and 39% with a mycotic aneurysm. 56% of patients with proven chronic Q fever did not recall an episode of acute Q fever. Ten out of 13 18F-FDG PET/CT-scans in patients with proven chronic Q fever localized the infection. TTE and TEE were helpful in only 6% and 50% of patients, respectively. CONCLUSIONS: If chronic Q fever is diagnosed, 18F-FDG PET/CT is a helpful imaging technique for localization of vascular infections due to chronic Q fever. Patients with proven chronic Q fever were diagnosed significantly more often with mycotic aneurysms than in previous case series. Definite endocarditis due to chronic Q fever was less frequently diagnosed in the current study. Chronic Q fever often occurs in patients without a known episode of acute Q fever, so clinical suspicion should remain high, especially in endemic regions