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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Editorial Board Member: Gillery, Philippe / Kazmierczak, Steven / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Schlattmann, Peter / Whitfield, John B.

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Markers of infection in inpatients and outpatients with acute Q-fever

Norbert C.J. de Wit1 / Cornelis P.C. de Jager2 / Jamie C.E. Meekelenkamp3 / Marianne Schoorl4 / Arianne B. van Gageldonk-Lafeber5 / Alexander C.A.P. Leenders3 / Ron Kusters1 / Peter C. Wever3

1Laboratory for Clinical Chemistry and Haematology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands

2Department of Intensive Care and Emergency Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands

3Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands

4Department of Clinical Chemistry, Haematology and Immunology, Medical Centre Alkmaar, Alkmaar, The Netherlands

5National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control Netherlands, Epidemiology and Surveillance Unit, Bilthoven, The Netherlands

Corresponding author: Norbert C.J. de Wit, Laboratory for Clinical Chemistry and Haematology, Jeroen Bosch Hospital, Postbus 90153, 5200 ME 's-Hertogenbosch, The Netherlands

Citation Information: Clinical Chemistry and Laboratory Medicine. Volume 47, Issue 11, Pages 1407–1409, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: 10.1515/CCLM.2009.307, September 2009

Publication History

Published Online:


Background: Query-fever (Q-fever) is a zoonotic infection caused by the intracellular Gram-negative coccobacillus Coxiella burnetii. A large ongoing outbreak of Q-fever has been reported in the Netherlands. We studied various markers of infection in inpatients (hospitalised) and outpatients (treated by a general physician) with acute Q-fever in relation to disease severity.

Methods: Leukocyte counts, C-reactive protein (CRP) and procalcitonin (PCT) concentrations were measured in 25 inpatients and 40 outpatients upon presentation with acute Q-fever. Chest X-rays, if available, were analysed and confusion, urea, respiratory rate, blood pressure-age 65 (CURB-65) scores, indicating severity of pneumonia, were calculated.

Results: CRP was the only marker that significantly differentiated between inpatients and outpatients. It was increased in all patients from both groups. Leukocyte counts and PCT concentrations did not differ between inpatients and outpatients. Overall, only 13/65 patients had an increased leukocyte count and only 11/65 patients presented with PCT concentrations indicative of possible bacterial respiratory tract infection. Infiltrative changes on the chest X-ray were observed in the majority of patients. CURB-65 score was 0±1 (mean±SD).

Conclusions: Acute Q-fever, a relatively mild pneumonia with low CURB-65 scores, specifically induces a response in CRP, while PCT concentrations and leukocytes are within the normal range or increased only marginally.

Clin Chem Lab Med 2009;47:1407–9.

Keywords: acute Query-fever (Q-fever); C-reactive protein; infection markers; leukocyte count; procalcitonin

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