Péter O, Dupuis G, Bee D, Lüthy R, Nicolet J, Burgdorfer W
Division of Clinical Microbiology and Infectious Diseases, Valais Central Institute, Sion, Switzerland.
J Clin Microbiol. 1988 Oct;26(10):1978-82. doi: 10.1128/jcm.26.10.1978-1982.1988.
From 1982 through 1987 we diagnosed 13 chronic Q fever cases. Clinically these patients presented a culture-negative endocarditis, and all but two had high complement-fixing antibody titers to Coxiella burnetii phase I (reciprocal titer above 200). With the enzyme-linked immunosorbent assay (ELISA), titers of immunoglobulin G (IgG) to phases I and II of C. burnetii averaged 158,000 and 69,900, respectively, whereas they reached 300 and 3,200 in acute Q fever cases. Similarly, IgA to both phases of C. burnetii and IgM to phase I were consistently higher during chronic than acute Q fever. The serological follow-up of one patient with chronic Q fever over a 4-year period showed a good correlation between the titers of IgG and IgM antibody titers detected by ELISA and indirect fluorescent-antibody test (IFA) to both phases of C. burnetii. Few discrepancies appeared with IgA. Shortly after initiation of antibiotic treatment, a slow and steady decrease of the antibody titers to C. burnetii phases I and II was observed. The complement fixation, IFA, and ELISA tests showed the same type of antibody response. The ELISA proved to be an excellent diagnostic test for chronic Q fever. It distinguished negative from positive reactions clearly, and results were highly reproducible. The reading is objective, and the test is simple to perform and more sensitive than the IFA and complement fixation tests. The ELISA is recommended for serologic evaluation of patients with chronic Q fever.
从1982年到1987年，我们诊断出13例慢性Q热病例。临床上，这些患者表现为血培养阴性的心内膜炎，除两例外，所有患者对伯纳特立克次体I相的补体结合抗体滴度都很高（滴度倒数高于200）。采用酶联免疫吸附测定（ELISA）法，针对伯纳特立克次体I相和II相的免疫球蛋白G（IgG）滴度平均分别为158,000和69,900，而在急性Q热病例中，这两个滴度分别为300和3,200。同样，在慢性Q热期间，针对伯纳特立克次体两个相的IgA以及针对I相的IgM始终高于急性Q热。对一名慢性Q热患者进行的4年血清学随访显示，通过ELISA和间接荧光抗体试验（IFA）检测到的针对伯纳特立克次体两个相的IgG和IgM抗体滴度之间具有良好的相关性。IgA出现的差异很少。在开始抗生素治疗后不久，观察到针对伯纳特立克次体I相和II相的抗体滴度缓慢而稳定地下降。补体结合试验、IFA和ELISA检测显示出相同类型的抗体反应。ELISA被证明是诊断慢性Q热的极佳检测方法。它能清晰地区分阴性和阳性反应，结果具有高度可重复性。读数客观，该检测操作简单，且比IFA和补体结合试验更灵敏。建议使用ELISA对慢性Q热患者进行血清学评估。
