Aanhoudende vermoeidheid na een Q-koortsinfectie

In the Netherlands, more than 4000 patient cases of acute Q fever have been reported since 2007. Approximately 20% of these patients subsequently developed long-term fatigue. Such fatigue, as well as other physical symptoms and patient-perceived limitations in social functioning, have been compiled into what is known as the Q fever fatigue syndrome (QFS). The number of Dutch patients having QFS is expected to increase over the next years. The chance of a spontaneous recovery during the first six months following an acute Q fever infection is high. Allowing the fatigue to run its natural course is therefore justified. The diagnosis of QFS is based on history-taking, a physical examination and laboratory test results. The percentage of patients who recover spontaneously from QFS seems low. Data on outcome after treatment are not yet available. The recommendation is to refer patients with QFS to specialists who offer cognitive behavioural therapy for chronic fatigue syndrome or QFS. The objective of the recently published national guideline ‘Q fever fatigue syndrome (QFS)' is to achieve uniformity in its diagnosis and treatment

Summary of the six participants with an IgG I titre ≥1:512 and Q-fever status after clinical examination.

<p>*The age is not shown as the exact age of the participant as this could compromise the privacy of the individual. Participants 1, 2,3, and 6 were due this study referred for a comprehensive clinical examination to exclude chronic Q-fever. Participants number 4, 5 and 6 were diagnosed with chronic Q-fever; number 4 after the development of an aneurysm, number 5 during screening before vaccination of high risk groups and, number 6 as a consequence of screening during the current study.</p><p>Summary of the six participants with an IgG I titre ≥1:512 and Q-fever status after clinical examination.</p

Cumulative Q fever incidence in the Netherlands from 2007 up to and including 2010, marking the Municipal Health Service regions, highlighting the Municipal Health Service region Hart voor Brabant and the Laboratories of Medical Microbiology, A in 's-Hertogenbosch, B in Tilburg, and C in Veldhoven.

<p>Cumulative Q fever incidence in the Netherlands from 2007 up to and including 2010, marking the Municipal Health Service regions, highlighting the Municipal Health Service region Hart voor Brabant and the Laboratories of Medical Microbiology, A in 's-Hertogenbosch, B in Tilburg, and C in Veldhoven.</p

Regional differences in reported serological follow-up practices by GPs in regions with a Laboratory of Medical Microbiology (LMM) with or without an automatic follow-up system.

<p>Municipalities in the service area of a LMM with follow-up: Heusden, Oss, Maasdonk, Uden, Bernheze, Lith, Landerd, Vught, 's-Hertogenbosch (Den Bosch), Sint Michielsgestel, Veghel, Schijndel, Boekel, Boxtel.</p><p>Municipalities in the service area of a LMM without follow-up: Dongen, Waalwijk, Tilburg, Oisterwijk, Gilze Rijen, Loon op Zand, Sint Oedenrode, Cuijk, Boxmeer, Mill en Sint Hubert, Hilvarenbeek, Sint Anthonis, Haaren, Grave.</p

Answers to knowledge and practice questions of medical practitioners (MPs) comparing those with few (≤10) and many (>10) Q fever patients.

*<p>Excluded are medical practitioners without Q fever patients (n = 30), those who never request serological follow-up (n = 70) or gave not applicable (NA) answers.</p

Diagnosis and serological follow-up up to 15 months (450 days) after diagnosis of Q fever for three Laboratories of Medical Microbiology (LMM).

*<p>A sample taken within 60 days after diagnosis was not considered as a follow-up sample.</p>†<p>For 13 samples the applicant was unknown (request by an external laboratory).</p><p>NA: not applicable.</p

Flow chart of the four-year follow-up study (Q-HORT).

<p>Flow chart of the four-year follow-up study (Q-HORT).</p

Recommendations for serological and clinical follow-up in acute Q-fever patients regardless of compatible clinical presentation.

<p>^a Heart valve/vascular disease or prosthesis. ^b See [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0131848#pone.0131848.ref021" target="_blank">21</a>].</p