Thesis defense Bianca Buijs

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From 2007 to 2010, a large Q fever outbreak occurred in The Netherlands. Eight years later, we are still diagnosing patients with chronic Q fever. In 2018, 519 chronic Q fever patients were identified with an incidence of approximately 20 new cases per year. Diagnosis of chronic Q remains difficult, resulting in a long period between initial infection and diagnosis of chronic Q fever. The diagnostic value of FISH, a time consuming test where the bacterium is labeled with fluorescent dye and identified through a microscope, turned out to be lower than the test already in place. Chronic Q fever is a life threatening disease: 26% of patients with proven chronic Q fever die because of the disease. Two genetic variations were found to be associated with clinical outcomes in chronic Q fever patients. Patients with proven and probable chronic Q fever have an indication for long term treatment with antibiotics. The effect of this treatment was monitored using antibody titres. However, these titres have no predictive value for clinical outcomes and effect of treatment should be monitored using other parameters. A warning was issued about one of the antibiotics frequently prescribed, quinolones, deeming it a risk factor for aneurysm or dissection. Luckily, we could not find this association in our high risk group of patients; prescription should therefore not be withheld. Screening for chronic Q fever in high-risk patients can still identify new patients, as we found one patient in our revaluation program. Therefore, clinicians should stay vigilant for chronic Q fever - especially in patients with risk factors for chronic Q fever. In future Q fever outbreaks, it is recommended to follow-up all acute Q fever patients for at least two years, but also screen high-risk patients for primary infection and follow-up those that turn out to be positive as well.