{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T12:54:23Z","timestamp":1791809663345,"version":"4.3.4"},"reference-count":21,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,5]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Acute Q fever diagnosis via paired serology is problematic because it requires follow-up for convalescent sample collection; as such, it cannot provide a diagnosis to inform a treatment decision at the time of acute presentation. Real-time polymerase chain reaction (PCR) may be a useful approach for the diagnosis of acute Q fever in endemic settings. Among febrile patients enrolled in a sentinel surveillance study for Q fever at two referral hospitals in Moshi, Tanzania, from 2012 to 2014, we analyzed those with paired sera for IgG to <jats:italic>Coxiella burnetii<\/jats:italic> (<jats:italic>C. burnetii<\/jats:italic>) phase II antigens using immunofluorescent antibody (IFA) testing, and acute serum was tested for <jats:italic>C. burnetii<\/jats:italic> with PCR. Acute Q fever was defined as a fourfold or greater rise from the acute to convalescent sample in IFA reciprocal titer or PCR detection that was confirmed through repeat testing. Test characteristics were tabulated. Among 496 participants tested using both paired IFA and PCR testing, 463 (93.3%) tested negative on both IFA and PCR, five (1.0%) tested positive for Q fever on both IFA and PCR, and 28 (5.6%) tested positive for Q fever on IFA alone. The sensitivity of PCR testing using paired IFA testing as an index was 0.15 (5\/33), and the specificity was 1 (463\/463). <jats:italic>C. burnetii<\/jats:italic> PCR testing provides a clinically specific method that may aid in timely diagnosis in settings in which acute Q fever is a common cause of febrile illness. However, we found a low clinical sensitivity of PCR testing on serum when compared with paired IFA serology.<\/jats:p>","DOI":"10.4269\/ajtmh.23-0860","type":"journal-article","created":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T14:50:05Z","timestamp":1735743005000},"page":"533-538","source":"Crossref","is-referenced-by-count":2,"title":["Comparison of Paired Immunofluorescent Antibody Serology and Real-Time Polymerase Chain Reaction Testing for the Detection of Acute Q Fever among Febrile Patients in Kilimanjaro, Tanzania, 2012\u20132014"],"prefix":"10.4269","volume":"112","author":[{"given":"Robert J.","family":"Rolfe","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases and International Health, Department of Medicine, Duke University, Durham, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Crump","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and International Health, Department of Medicine, Duke University, Durham, North Carolina;"},{"name":"Duke University Global Health Institute, Durham, North Carolina;"},{"name":"Centre for International Health, University of Otago, Dunedin, New Zealand;"},{"name":"Kilimanjaro Christian Medical Centre, Moshi, Tanzania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venance P.","family":"Maro","sequence":"additional","affiliation":[{"name":"Kilimanjaro Christian Medical Centre, Moshi, Tanzania;"},{"name":"Kilimanjaro Christian Medical University College, Moshi, Tanzania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blandina T.","family":"Mmbaga","sequence":"additional","affiliation":[{"name":"Kilimanjaro Christian Medical Centre, Moshi, Tanzania;"},{"name":"Kilimanjaro Christian Medical University College, Moshi, Tanzania;"},{"name":"Kilimanjaro Clinical Research Institute, Moshi, Tanzania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilbrod","family":"Saganda","sequence":"additional","affiliation":[{"name":"Mawenzi Regional Referral Hospital, Moshi, Tanzania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingileki F.","family":"Lwezaula","sequence":"additional","affiliation":[{"name":"Mawenzi Regional Referral Hospital, Moshi, Tanzania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc Roger","family":"Couturier","sequence":"additional","affiliation":[{"name":"Associated Regional and University Pathologists, Inc, Salt Lake City, Utah;"},{"name":"Department of Pathology, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weston C.","family":"Hymas","sequence":"additional","affiliation":[{"name":"Associated Regional and University Pathologists, Inc, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie L.","family":"Perniciaro","sequence":"additional","affiliation":[{"name":"Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William L.","family":"Nicholson","sequence":"additional","affiliation":[{"name":"Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilbert J.","family":"Kersh","sequence":"additional","affiliation":[{"name":"Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew P.","family":"Rubach","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and International Health, Department of Medicine, Duke University, Durham, North Carolina;"},{"name":"Duke University Global Health Institute, Durham, North Carolina;"},{"name":"Kilimanjaro Christian Medical Centre, Moshi, Tanzania;"},{"name":"Kilimanjaro Clinical Research Institute, Moshi, Tanzania;"},{"name":"Duke-National University of Singapore Medical School, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Lancet Infect Dis","first-page":"219","article-title":"Natural history and pathophysiology of Q fever","volume":"5","author":"Raoult","year":"2005"},{"key":"b2","series-title":"PLoS Negl Trop Dis","first-page":"e2787","article-title":"Epidemiology of Coxiella burnetii infection in Africa: A OneHealth systematic review","volume":"8","author":"Vanderburg","year":"2014"},{"key":"b3","series-title":"Am J Trop Med Hyg","first-page":"219","article-title":"Tropical Q fever","volume":"107","author":"Kersh","year":"2022"},{"key":"b4","series-title":"Am J Trop Med Hyg","first-page":"494","article-title":"Incidence estimates of acute Q fever and spotted fever group rickettsioses, Kilimanjaro, Tanzania, from 2007 to 2008 and from 2012 to 2014","volume":"106","author":"Pisharody","year":"2021"},{"key":"b5","series-title":"MMWR Recomm Rep","first-page":"1","article-title":"Diagnosis and management of Q fever\u2013United States, 2013: Recommendations from CDC and the Q Fever Working Group","volume":"62","author":"Anderson","year":"2013"},{"key":"b6","series-title":"Malar J","first-page":"193","article-title":"Ten years of monitoring malaria trend and factors associated with malaria test positivity rates in Lower Moshi","volume":"20","author":"Kassam","year":"2021"},{"key":"b7","series-title":"Yaws","year":"2021"},{"key":"b8","series-title":"Clin Microbiol Rev","first-page":"115","article-title":"From Q fever to Coxiella burnetii infection: A paradigm change","volume":"30","author":"Eldin","year":"2017"},{"key":"b9","series-title":"Antimicrob Agents Chemother","first-page":"1079","article-title":"In vitro susceptibility of Coxiella burnetii to antibiotics, including several quinolones","volume":"31","author":"Yeaman","year":"1987"},{"key":"b10","series-title":"Pediatr Infect Dis J","first-page":"955","article-title":"Impact of community-based mass treatment for trachoma with oral azithromycin on general morbidity in Gambian children","volume":"18","author":"Whitty","year":"1999"},{"key":"b11","series-title":"Am J Trop Med Hyg","first-page":"41","article-title":"Surveillance of Egyptian fleas for agents of public health significance: Anaplasma, Bartonella, Coxiella, Ehrlichia, Rickettsia, and Yersinia pestis","volume":"75","author":"Loftis","year":"2006"},{"key":"b12","series-title":"Diagnostic Test Evaluation Calculator Version 22.001"},{"key":"b13","series-title":"J Clin Diagn Res","first-page":"DC10","article-title":"Diagnosis of acute Q fever by detection of Coxiella burnetii DNA using real-time PCR, employing a commercial Genesig Easy Kit","volume":"11","author":"Pradeep","year":"2017"},{"key":"b14","series-title":"Diagn Microbiol Infect Dis","first-page":"110","article-title":"Diagnosis of acute Q fever with emphasis on enzyme-linked immunosorbent assay and nested polymerase chain reaction regarding the time of serum collection","volume":"68","author":"Boden","year":"2010"},{"key":"b15","series-title":"Clin Vaccine Immunol","first-page":"286","article-title":"Real-time PCR with serum samples is indispensable for early diagnosis of acute Q fever","volume":"17","author":"Schneeberger","year":"2010"},{"key":"b16","series-title":"J Clin Microbiol","first-page":"3192","article-title":"High Coxiella burnetii DNA load in serum during acute Q fever is associated with progression to a serologic profile indicative of chronic Q fever","volume":"51","author":"Wielders","year":"2013"},{"key":"b17","series-title":"Open Forum Infect Dis","first-page":"ofx014","article-title":"Influence of antibiotics on the detection of bacteria by culture-based and culture-independent diagnostic tests in patients hospitalized with community-acquired pneumonia","volume":"4","author":"Harris","year":"2017"},{"key":"b18","series-title":"J Clin Microbiol","first-page":"3465","article-title":"Effects of antibiotic treatment on the results of nested PCRs for scrub typhus","volume":"46","author":"Kim","year":"2008"},{"key":"b19","series-title":"J Med Microbiol","first-page":"462","article-title":"Lyophilization to improve the sensitivity of qPCR for bacterial DNA detection in serum: The Q fever paradigm","volume":"65","author":"Edouard","year":"2016"},{"key":"b20","series-title":"Medicine (Baltimore)","first-page":"109","article-title":"Q fever 1985\u20131998. Clinical and epidemiologic features of 1,383 infections","volume":"79","author":"Raoult","year":"2000"},{"key":"b21","series-title":"Curr Infect Dis Rep","first-page":"10","article-title":"Pediatric Q fever","volume":"22","author":"Cherry","year":"2020"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/112\/3\/article-p533.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/112\/3\/article-p533.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/112\/3\/article-p533.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T14:31:53Z","timestamp":1741185113000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/112\/3\/article-p533.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,5]]},"references-count":21,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.23-0860","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,5]]}}}