Early diagnosis and treatment of patients with symptomatic acute Q fever do not prohibit IgG antibody responses to Coxiella burnetii

Abstract

Little is known about the effect of timing of antibiotic treatment on development of IgG antibodies following acute Q fever. We studied IgG antibody responses in symptomatic patients diagnosed either before or during development of the serologic response to Coxiella burnetii. Between 15 and 31 May 2009, 186 patients presented with acute Q fever, of which 181 were included in this retrospective study: 91 early-diagnosed (ED) acute Q fever patients, defined as negative IgM phase II enzyme-linked immunosorbent assay (ELISA) and positive PCR, and 90 late-diagnosed (LD) acute Q fever patients, defined as positive/dubious IgM phase II ELISA and positive immunofluorescence assay (IFA). Follow-up serology at 3, 6, and 12 months was performed using IFA (IgG phase I and II). High IgG antibody titers were defined as IgG phase II titers of ≥1:1,024 together with IgG phase I titers of ≥1:256. At 12 months, 28.6% of ED patients and 19.5% of LD patients had high IgG antibody titers (P = 0.17). No statistically significant differences were found in frequencies of IgG phase I and IgG phase II antibody titers at all follow-up appointments for adequately and inadequately treated patients overall, as well as for ED and LD patients analyzed separately. Additionally, no significant difference was found in frequencies of high antibody titers and between early (treatment started within 7 days after seeking medical attention) and late timing of treatment. This study indicates that early diagnosis and antibiotic treatment of acute Q fever do not prohibit development of the IgG antibody response.

Fig 1

Distribution of IgG phase I and phase II antibody titers as determined by immunofluorescence assay at 12-month follow-up in acute Q fever patients. (a) Early-diagnosed group (negative ELISA IgM phase II and positive PCR), n = 84 samples; (b) late-diagnosed group (positive or dubious ELISA IgM phase II confirmed by positive IFA (IgG phase II and/or IgM phase II titers of ≥1:32), n = 82 samples. The dashed box indicates high antibody titers. *, Patient with proven chronic Q fever infection.

Fig 2

Percentage of acute Q fever patients with IgG phase I (a) and IgG phase II (b) antibody titers as determined by immunofluorescence assay at 12-month follow-up in the early-diagnosed and late-diagnosed group.