{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T06:16:25Z","timestamp":1790403385677,"version":"4.1.0"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2021,5,24]],"date-time":"2021-05-24T00:00:00Z","timestamp":1621814400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100002999","name":"Dutch Ministry of Health, Welfare and Sport","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002999","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,10,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Chronic Q fever usually develops within 2 years after primary infection with Coxiella burnetii. We determined the interval between acute Q fever and diagnosis of chronic infection, assessed what factors contribute to a longer interval, and evaluated the long-term follow-up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>From 2007 to 2018, patients with chronic Q fever were included from 45 participating hospitals. The interval between acute and chronic infection was calculated in patients with a known day of first symptoms and\/or serological confirmation of acute Q fever. Chronic Q fever-related complications and mortality were assessed by 2 investigators based on predefined criteria.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In total, 313 (60.3%) proven, 81 (15.6%) probable, and 125 (24.1%) possible chronic Q fever patients were identified. The date of acute Q fever was known in 200 patients: in 45 (22.5%), the interval was longer than 2 years, with the longest observed interval being 9.2 years. Patients in whom serological follow-up was performed after acute Q fever were diagnosed less often after this 2-year interval (odds ratio, 0.26; 95% confidence interval, 0.12\u20130.54). Chronic Q fever-related complications occurred in 216 patients (41.6%). Chronic Q fever-related mortality occurred in 83 (26.5%) of proven and 3 (3.7%) of probable chronic Q fever patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Chronic Q fever is still being diagnosed and mortality keeps occurring 8 years after a large outbreak. Intervals between acute Q fever and diagnosis of chronic infection can reach more than 9 years. We urge physicians to perform microbiological testing for chronic Q fever even many years after an outbreak or acute Q fever disease.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciab476","type":"journal-article","created":{"date-parts":[[2021,5,23]],"date-time":"2021-05-23T19:06:41Z","timestamp":1621796801000},"page":"1476-1483","source":"Crossref","is-referenced-by-count":19,"title":["Still New Chronic Q Fever Cases Diagnosed 8 Years After a Large Q Fever Outbreak"],"prefix":"10.1093","volume":"73","author":[{"given":"Sheila B","family":"Buijs","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantal P","family":"Bleeker-Rovers","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Infectious Diseases, Radboud Expertise Centre for Q Fever, Radboud university medical center, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja E","family":"van Roeden","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda M","family":"Kampschreur","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andy I M","family":"Hoepelman","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter C","family":"Wever","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, \u2018s-Hertogenbosch, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Jelrik","family":"Oosterheert","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,5,24]]},"reference":[{"key":"2021102017444409600_CIT0001","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1128\/CMR.12.4.518","article-title":"Q fever","volume":"12","author":"Maurin","year":"1999","journal-title":"Clin Microbiol Rev"},{"key":"2021102017444409600_CIT0002","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.jinf.2011.12.014","article-title":"Chronic Q fever: review of the literature and a proposal of new diagnostic criteria","volume":"64","author":"Wegdam-Blans","year":"2012","journal-title":"J Infect"},{"key":"2021102017444409600_CIT0003","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1093\/cid\/cix886","article-title":"Treatment of chronic Q fever: clinical efficacy and toxicity of antibiotic regimens","volume":"66","author":"van Roeden","year":"2018","journal-title":"Clin Infect Dis"},{"key":"2021102017444409600_CIT0004","doi-asserted-by":"crossref","first-page":"1390","DOI":"10.1016\/j.cmi.2018.11.023","article-title":"Chronic Q fever-related complications and mortality: data from a nationwide cohort","volume":"25","author":"van Roeden","year":"2019","journal-title":"Clin Microbiol Infect"},{"key":"2021102017444409600_CIT0005","first-page":"791","article-title":"Chronic Q fever: patient and treatment-related factors influencing long-term quality of life","volume":"111","author":"van 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