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Q fever patients are often reported to experience a long-term impaired health status, including fatigue, which can persist for many years. During the large Q fever epidemic in The Netherlands, many patients with a laboratory-confirmed Coxiella burnetii infection were not notified as acute Q fever because they did not fulfil the clinical criteria of the acute Q fever case definition (fever, pneumonia and/or hepatitis). Our study assessed and compared the long-term health status of notified and non-notified Q fever patients at 4 years after onset of illness, using the Nijmegen Clinical Screening Instrument (NCSI). The study included 448 notified and 193 non-notified Q fever patients. The most severely affected subdomain in both patient groups was ‘Fatigue’ (50·5% of the notified and 54·6% of the non-notified patients had severe fatigue). Long-term health status did not differ significantly between the notified and non-notified patient groups, and patients scored worse on all subdomains compared to a healthy reference group. Our findings suggest that the magnitude of the 2007–2009 Q fever outbreak in The Netherlands was underestimated when only notified patients according to the European Union case definition are considered.
Patients with a lower respiratory tract infection (LRTI) might be at risk for long-term impaired health status. We assessed whether LRTI patients without Q fever are equally at risk for developing long-term symptoms compared to LRTI patients with Q fever. The study was a cross-sectional cohort design. Long-term health status information of 50 Q fever-positive and 32 Q fever-negative LRTI patients was obtained. Health status was measured by the Nijmegen Clinical Screening Instrument. The most severely affected subdomains of the Q fever-positive group were ‘general quality of life’ (40%) and ‘fatigue’ (40%). The most severely affected subdomains of the Q fever-negative group were ‘fatigue’ (64%) and ‘subjective pulmonary symptoms’ (35%). Health status did not differ significantly between Q fever-positive LRTI patients and Q fever-negative LRTI patients for all subdomains, except for ‘subjective pulmonary symptoms’ (P = 0·048).
In this study, Coxiella burnetii seroprevalence was assessed for dairy and non-dairy sheep farm residents in The Netherlands for 2009–2010. Risk factors for seropositivity were identified for non-dairy sheep farm residents. Participants completed farm-based and individual questionnaires. In addition, participants were tested for IgG and IgM C. burnetii antibodies using immunofluorescent assay. Risk factors were identified by univariate, multivariate logistic regression, and multivariate multilevel analyses. In dairy and non-dairy sheep farm residents, seroprevalence was 66·7% and 51·3%, respectively. Significant risk factors were cattle contact, high goat density near the farm, sheep supplied from two provinces, high frequency of refreshing stable bedding, farm started before 1990 and presence of the Blessumer breed. Most risk factors indicate current or past goat and cattle exposure, with limited factors involving sheep. Subtyping human, cattle, goat, and sheep C. burnetii strains might elucidate their role in the infection risk of sheep farm residents.
We investigated the positive predictive value (PPV) of a solitary positive immunoglobulin M (IgM) phase II response for the serodiagnosis of acute Q fever detected with either an indirect immunofluorescence assay (IFA) or an enzyme-linked immunosorbent assay (ELISA). Initial and follow-up sera from patients suspected of acute Q fever were included if initially only IgM phase II tested positive with IFA in 2008 (n=92), or ELISA in 2009 (n=85). A seroconversion for Q fever was defined as an initial sample being IgG phase II negative but positive in the follow-up sample. The PPV of an initial isolated IgM phase II result detected by IFA or ELISA was 65% and 51%, respectively, and therefore appeared not to adequately predict acute Q fever. For this reason it cannot be used as a diagnostic criterion nor should it be included in public health notification without confirmation with other markers or a follow-up serum sample.
In May 2008 the Nijmegen Municipal Health Service (MHS) was informed about an outbreak of atypical pneumonia in three in-patients of a long-term psychiatric institution. The patients had been hospitalized and had laboratory confirmation of acute Q fever infection. The MHS started active case finding among in-patients, employees of and visitors to the institution. In a small meadow on the institution premises a flock of sheep was present. One of the lambs in the flock had been abandoned by its mother and cuddled by the in-patients. Samples were taken of the flock. Forty-five clinical cases were identified in employees, in-patients and visitors; 28 were laboratory confirmed as Q fever. Laboratory screening of pregnant women and persons with valvular heart disease resulted in one confirmed Q fever case in a pregnant woman. Of 27 samples from animals, seven were positive and 15 suspect for Coxiella burnetii infection. This outbreak of Q fever in a unique psychiatric setting pointed to a small flock of sheep with newborn lambs as the most likely source of exposure. Care institutions that have vulnerable residents and keep flocks of sheep should be careful to take adequate hygienic measures during delivery of lambs and handling of birth products.
The relationship of skinfold thicknesses to body density and of skinfold thicknesses to densitometrically determined body fat was evaluated in a group of 378 boys and girls, aged 7–20 years. According to their maturation level, they were divided into a prepubertal, a pubertal and a post-pubertal group. In each maturation group boys were older, had higher body-weights and body heights, higher body densities, lower percentage body fat, higher waist:hips ratios and higher trunk:total skinfolds ratios than girls. Body density in each maturation level could be quite precisely predicted by skinfold thicknesses. In prepubertal and pubertal boys and girls but not in post-pubertal boys and girls, age was also an important predicting variable for body density. The assessment of percentage body fat from skinfold thicknesses had a prediction error of 3–5 %, which was highest in the prepubertal children. The prediction error is comparable to the prediction error of percentage body fat from skinfold thicknesses in adults, as reported in the literature. Only in post-pubertal boys and girls was the waist:hip ratio correlated with measures of body fatness. Moreover, only in the post-pubertal boys and in the pubertal and post-pubertal girls was the waist:hips ratio correlated with another measure of body fat distribution, the trunk:total skinfold ratio. The relative amount of internal body fat was found to be higher in the younger maturation groups. It is concluded that at younger ages the waist:hips ratio is a poor indicator of body fat distribution.
1. Complete 24 h energy and nitrogen balances were measured for fifteen subjects at three levels of energy intake and for two other subjects at two levels of intake.
2. At each level, the fifteen subjects ate diets consisting of fifteen to twenty separate foods for 7 or 8 d. Faeces and urine were collected for the final 4 d. Respiratory gas exchange was measured during the final 72 h while the subjects stayed in an 11 m3 open-circuit respiration chamber, and simulated office or light household work. The energy balance of the other two subjects was determined initially in a similar way when they consumed a diet which was sufficient for energy equilibrium. Subsequently, the measurements were repeated twice at the same high level of metabolizable energy (ME) intake after 4 and 18 d on that diet.
3. Neither energy nor N digestibilities were significantly affected by intake level or subject. Due to relatively small urinary energy losses the ME content of the gross energy increased slightly at the higher intake.
4. Respiratory quotient increased with intake level from 0.78 to 0.87.
5. The efficiencies of utilization of ME were approximately 1.0 for maintenance (from the low to the intermediate intake level) and decreased to about 0.9 for maintenance and energy deposition (from the intermediate to the high intake level).
6. Estimates of daily ME requirements at energy equilibrium were 149 (SD 13) kJ ME/kg body-weight, 432 (SD 33) kJ ME/kg body-weight0.75 and 204 (SD 22) kJ/kg lean body mass. The former two values were negatively correlated with percentage body fat although not significantly so.
7. ME utilization and heat production of the other two subjects were nearly equal after 6 and 20 d on a diet supplying 1.5–1.7 times the ME needed for energy equilibrium.
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