Chronic Q-fever in Patients With an Abdominal Aortic Disease (QAAD-study)
Chronic Q-fever in Patients With an Abdominal Aortic Disease (QAAD-study)
Q-fever is a zoonosis caused by Coxiella burnetii, an intracellular bacterium. Since the
 epidemic outbreak of acute Q-fever in Holland nearly 4030 people have been registered with
 the acute form of the disease. Knowing that only 40% of all infected people develop symptoms,
 the number of infected people (and potential candidates for chronic Q-fever) are much higher.
 Chronic Q-fever generally manifest itself after a couple of months or years after the primary
 infection (in 1-5% of all cases). The clinical presentation can be a life-threatening and
 frequently underdiagnosed disease, as endocarditis, infected aneurysm and vascular prosthesis
 or chronic Q-fever related to pregnancy and immunecompromised patients. That's why a
 screening program is started in the endemic area and trace patients with chronic Q-fever. So
 eventually, a greater group of patients with chronic vascular Q-fever can be described. In
 addition, there is still no therapeutic guideline for management of chronic Q-fever in
 patient with a vascular chronic Q-fever.

 Patients with an aneurysm or vascular graft will be screened for chronic Q-fever. Patients
 with chronic Q-fever will be included in a follow-up program, in which additional research
 and treatment will start. The initial treatment of patients with chronic Q-fever is
 doxycycline and hydroxychloroquine for at least 18 months. In addition, patients will be
 monitored in 3-monthly controls, blood samples and imaging will be done. Parameters as
 complaints, titers, circulating DNA, grow of aneurysm, complications etc. will be
 investigated.

 Ultimately, the current therapeutic guideline for management of C. burnetii will be evaluated
 if it can also be applied for patients with vascular chronic Q-fever.
Study design:

 Prospective observational survey

 Domain:

 Patients with an abdominal aneurysm or central vascular reconstruction in an endemic area
 after an outbreak of acute Q-fever.

 Data collection:

 In Jeroen Bosch Hospital and Bernhoven Hospital all patients with an aneurysm or central
 vascular reconstruction will be screened for Q-fever. Other hospitals in Holland will only
 check for Q-fever, if they suspect a patient of having an infected aneurysm or prosthesis.

 A patient with chronic Q-fever will enter a multidisciplinary follow-up program. First, a
 PET/CT-scan will be provided (question; signs of an infected aneurysm/prosthesis)and chronic
 Q-fever endocarditis will be excluded. The patients will initially be treated with
 doxycycline 2 dd 100mg and plaquenil 200mg 3dd for at least 18 months. A 3-monthly follow-up
 will start, in which bloodsample, ultrasounds and PET/CTscan will be performed. Data will be
 collected in SPSS for analyses.

 Definitions; Past resolved Q-fever: Any IgG phase 2 and IgG phase 1 <1:1024 Chronic Q-fever:
 IgG phase 1 >= 1:1024
Inclusion Criteria:

 -  Patients with an aneurysm of the abdominal aorta or iliac arteries of any size.

 -  Patients with a central vascular reconstruction, such as EVAR, aortic graft and
 bifurcation graft.

 Exclusion Criteria:

 - Patients with a recent central vascular reconstruction (after 1-1-2010) due to a stenoses
 or occlusion