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DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Disease Control
and Prevention (CDC)
Atlanta, Georgia 30333
Q Fever Case Report
Use for: Acute Q Fever and Chronic Q Fever
Visit http://www.cdc.gov and use "Search" for complete Case Definition or to visit the
(1-4) Q Fever disease web site for a fillable/downloadable PDF version of this Case Report.
CDC#
Form Approved
OMB 0920-0009
– PATIENT/PHYSICIAN INFORMATION –
Patient's
name:
Date submitted: __ __05/18/2011
__ __ __ __ __ __ (mm/dd/yyyy)
(5-6)
(7-8)
(9-12)
Physician’s
Phone
name:
no.:
Address:
(number, street)
NETSS ID No.: (if reported)
City:
Case ID
Site (19-21)
(13-18)
State (22-23)
– DEMOGRAPHICS –
1. State of
2. County of
residence:
residence:
4. Date of birth:
3. Zip code:
5. Sex:
(mm/dd/yyyy)
__ __ __ __ __ __ __ __ __
(26-50)
(24-25)
(51-59)
__ __ __ __ __ __ __ __
(60-61) (62-63)
(64-67)
■ White
4 ■ Asian
2 ■ Black
5 ■ Pacific Islander
American Indian 9 ■ Not specified
3■
Alaskan Native
1
8. Occupation at date of onset of illness (Check all that apply)
1 ■ wool or felt plant (71)
6 ■ animal research (76)
1 0 ■ live in household with person
occupationally related to above? (80)
2 ■ tannery or rendering plant (72) 7 ■ slaughterhouse worker (77)
3 ■ dairy (73)
8 ■ laboratory worker (78)
8 8 ■ other (please specify) (81)
4 ■ veterinarian (74)
9 ■ rancher (79)
________________________________
5 ■ medical research (75)
10. Any exposure to birthing animals?
(89)
1 ■ Yes 2 ■ No 9 ■ Unk
If yes, which
animal _____________________
11. Exposure to unpasteurized milk?
(90)
1 ■ Yes 2 ■ No 9 ■ Unk
If yes, which
animal _____________________
12. Any travel in last year?
If yes, State
7. Hispanic
ethnicity:
6. Race: (69)
(68)
■ Male
2 ■ Female
9 ■ Not
specified
1
■ Yes (70)
■ No
9 ■ Unk
1
2
9. Any contact with animals within
2 months prior to onset? (check all that apply)
1 ■ Cattle (82)
3 ■ Goats (84)
5 ■ Cats (86)
2 ■ Sheep (83)
4 ■ Pigeons (85) 6 ■ Rabbits (87)
8 ■ Other (please specify) (88)
_______________________________________
13. Other family member with
similar illness in last year?
(91-92)
County __________________
Foreign Country _____________________________
1
■ Yes
2
■ No
(93)
9
■ Unk
– CLINICAL FINDINGS –
14. Date of Onset of Symptoms:
15. Clinical Signs and syndromes (check all that apply)
Evidence of clinically compatible illness is necessary. See CSTE/CDC Q Fever case definition, and case categorization summaries below.
■ fever (>100.5) (102) 4 ■ malaise (105) 7 ■ headache (108)
■ myalgia (103)
5 ■ rash (106)
8 ■ splenomegaly (109)
3 ■ retrobulbar pain (104) 6 ■ cough (107) 9 ■ hepatomegaly (110)
__ __ __ __ __ __ __ __
(94-95)
(96-97)
(98-101)
(mm/dd/yyyy)
■ pneumonia (111) 8 8 ■ Other (please specify) (114)
■ hepatitis (112)
__________________________________
1 2 ■ endocarditis (113)
1
10
2
11
Acute Q fever: Acute fever and one or more of the following: Rigors (febrile shivering), severe retrobulbar headache, acute hepatitis, pneumonia, or elevated liver enzyme levels.
Chronic Q fever: Newly recognized, culture-negative endocarditis - particularly in patients with previous valvulopathies or compromised immune systems, suspected infections of
vascular aneurysms or vascular prostheses, or chronic hepatitis in the absence of other known etiology.
16. Any pre-existing medical conditions? (check all that apply)
1 ■ immunocompromised (115) 3 ■ valvular heart disease or vascular graft (117)
2 ■ pregnancy (116) 8 ■ Other __________________________________ (118)
17. Was patient hospitalized
18. Did patient die from complications
because of this illness? (119)
of this illness? (120) (If yes, date)
(mm/dd/yyyy)
__ __ __ __ __ __ __ __
1 ■ Yes 2 ■ No 9 ■ Unk
1 ■ Yes 2 ■ No 9 ■ Unk
(121-22) (123-24)
(125-28)
– LABORATORY DATA –
19. Laboratory Name: ________________________________________________ City: ________________________________ State: __ __ Zip: __ __ __ __ __ - __ __ __ __
* Check only if specific assay was performed.
Phase I Antigen
Phase II Antigen
20.
22. Other Diagnostic Tests?*
Serology 1 (mm/dd/yyyy)
Serology 2 (mm/dd/yyyy)
Serology 1 (mm/dd/yyyy)
Serology 2 (mm/dd/yyyy)
Serology
(Check only if specific
assay was performed)
(Use #20, S1 to indicate collection date.)
__ __ __ __ __ __ __ __
__ __ __ __ __ __ __ __
__ __ __ __ __ __ __ __
__ __ __ __ __ __ __ __
(129-30) (131-32)
(141-42) (143-44)
(153-54) (155-56)
(165-66) (167-68)
(133-36)
Titer or OD* Positive?
IFA - IgG
Other
test: ______________
Titer or OD* Positive?
■ Yes
_ _ _ _ _ 2■ No (137) _ _ _ _ _
1■ Yes
_ _ _ _ _ 2■ No (138) _ _ _ _ _
1■ Yes
_ _ _ _ _ 2■ No (140) _ _ _ _ _
1
Titer or OD* Positive?
■ Yes
2■ No (149)
_____
1■ Yes
2■ No (150)
_____
1■ Yes
2■ No (152)
_____
1
(157-60)
Titer or OD* Positive?
■ Yes
2■ No (161)
_____
1■ Yes
2■ No (162)
_____
1■ Yes
2■ No (164)
_____
1
Positive?
(169-72)
■ Yes
2■ No (173)
1■ Yes
2■ No (174)
1■ Yes
2■ No (176)
1
PCR
Immunostain
Culture
➮
IFA - IgM
(145-48)
■ Yes
1 ■ Yes
1 ■ Yes
1
■ No (178)
■ No (179)
2 ■ No (180)
2
2
Sample(s) tested:
*IFA “Titer” or Other test: if CF, "Titer", if ELISA (EIA), Optical Density "OD" value..
21. Was there a fourfold change in antibody titer between the two serum specimens?
■ Yes 2■ No (177)
1
– FINAL DIAGNOSIS –
23. Classify case based on the CSTE/CDC case definition (see 15 above and criteria below):
■ Confirmed acute Q Fever 2 ■ Probable acute Q Fever
1
3
■
Confirmed chronic Q Fever
4
■
Probable chronic Q Fever
(181)
State Health Department Official who reviewed this report:
Name: _______________________________________________________
Title: _______________________________ Date: __ __ __ __ __ __ __ __
(mm/dd/yyyy)
See CSTE/CDC Q Fever Case Definition effective 1/1/2008 for details of the following categories:
Confirmed acute Q Fever: A laboratory confirmed case that either meets clinical case criteria or is epidemiologically linked to lab confirmed case.
Probable acute Q Fever: A clinically compatible case of acute illness that is not laboratory confirmed but has lab supportive evidence (antibody to Phase II higher than Phase I [if latter present]).
Confirmed chronic Q Fever: A clinically compatible case of chronic illness that is laboratory confirmed.
Probable chronic Q Fever: A clinically compatible case of chronic illness that is not laboratory confirmed but has lab supportive evidence (antibody to Phase I higher than Phase II [if latter present]).
Note: Samples from suspected chronic patients should be evaluated for IgG titers to both phase I and phase II antigens. Current commercially available ELISA tests (which test only for phase II) are not
quantitative and thus can, at best, indicate a probable infection. IgM tests may be unreliable because they lack specificity. IgM antibody may persist for lengthy periods of time. Older test methods are
neither readily available nor commonly used. For acute testing, CDC uses in-house IFA IgG testing (cutoff of ≥ 1:128), preferring simultaneous testing of paired specimens, and does not use IgM results
for routine diagnostic testing. Interpret serologic test results with caution, because antibodies acquired as a result of historical exposure to Q fever may exist, especially in rural and farming areas.
Public reporting burden of this collection of information is estimated to average 10 minutes per response. An agency may not conduct or sponsor, and a person is not required to respond to, a collection
of information unless it displays a currently valid OMB control number. Please send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden, to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Rd., NE (MS D-74); Atlanta, GA 30333; ATTN: PRA (0920-0009).
CDC 55.1 Rev. 2/2008
Save Data
Print
1st COPY – STATE HEALTH DEPARTMENT
Email Form
Next Page
Q FEVER CASE REPORT
Retrieve Data
Reset Form
Previous Page
DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Disease Control
and Prevention (CDC)
Atlanta, Georgia 30333
Q Fever Case Report
Use for: Acute Q Fever and Chronic Q Fever
Visit http://www.cdc.gov and use "Search" for complete Case Definition or to visit the
(1-4) Q Fever disease web site for a fillable/downloadable PDF version of this Case Report.
Form Approved
OMB 0920-0009
CDC#
PATIENT/PHY
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__ __ __ __ __ __ (mm/dd/yyyy)
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j OGRAPHICS –
–DvR
1. State of
2. County of
residence:
residence:
4. Date of birth:
3. Zip code:
5. Sex:
(mm/dd/yyyy)
__ __ __ __ __ __ __ __ __
(26-50)
(24-25)
(51-59)
(60-61) (62-63)
(64-67)
■ White
4 ■ Asian
2 ■ Black
5 ■ Pacific Islander
American Indian 9 ■ Not specified
3■
Alaskan Native
1
8. Occupation at date of onset of illness (Check all that apply)
1 ■ wool or felt plant (71)
6 ■ animal research (76)
1 0 ■ live in household with person
occupationally related to above? (80)
2 ■ tannery or rendering plant (72) 7 ■ slaughterhouse worker (77)
3 ■ dairy (73)
8 ■ laboratory worker (78)
8 8 ■ other (please specify) (81)
4 ■ veterinarian (74)
9 ■ rancher (79)
________________________________
5 ■ medical research (75)
10. Any exposure to birthing animals?
(89)
1 ■ Yes 2 ■ No 9 ■ Unk
If yes, which
animal _____________________
11. Exposure to unpasteurized milk?
(90)
1 ■ Yes 2 ■ No 9 ■ Unk
If yes, which
animal _____________________
12. Any travel in last year?
If yes, State
7. Hispanic
ethnicity:
6. Race: (69)
(68)
■ Male
2 ■ Female
9 ■ Not
specified
1
__ __ __ __ __ __ __ __
State (22-23)
■ Yes (70)
■ No
9 ■ Unk
1
2
9. Any contact with animals within
2 months prior to onset? (check all that apply)
1 ■ Cattle (82)
3 ■ Goats (84)
5 ■ Cats (86)
2 ■ Sheep (83)
4 ■ Pigeons (85) 6 ■ Rabbits (87)
8 ■ Other (please specify) (88)
_______________________________________
13. Other family member with
similar illness in last year?
(91-92)
County __________________
Foreign Country _____________________________
1
■ Yes
2
■ No
(93)
9
■ Unk
– CLINICAL FINDINGS –
14. Date of Onset of Symptoms:
15. Clinical Signs and syndromes (check all that apply)
Evidence of clinically compatible illness is necessary. See CSTE/CDC Q Fever case definition, and case categorization summaries below.
■ fever (>100.5) (102) 4 ■ malaise (105) 7 ■ headache (108)
■ myalgia (103)
5 ■ rash (106)
8 ■ splenomegaly (109)
3 ■ retrobulbar pain (104) 6 ■ cough (107) 9 ■ hepatomegaly (110)
__ __ __ __ __ __ __ __
(94-95)
(96-97)
(98-101)
(mm/dd/yyyy)
■ pneumonia (111) 8 8 ■ Other (please specify) (114)
■ hepatitis (112)
__________________________________
1 2 ■ endocarditis (113)
1
10
2
11
Acute Q fever: Acute fever and one or more of the following: Rigors (febrile shivering), severe retrobulbar headache, acute hepatitis, pneumonia, or elevated liver enzyme levels.
Chronic Q fever: Newly recognized, culture-negative endocarditis - particularly in patients with previous valvulopathies or compromised immune systems, suspected infections of
vascular aneurysms or vascular prostheses, or chronic hepatitis in the absence of other known etiology.
16. Any pre-existing medical conditions? (check all that apply)
1 ■ immunocompromised (115) 3 ■ valvular heart disease or vascular graft (117)
2 ■ pregnancy (116) 8 ■ Other __________________________________ (118)
17. Was patient hospitalized
18. Did patient die from complications
because of this illness? (119)
of this illness? (120) (If yes, date)
(mm/dd/yyyy)
__ __ __ __ __ __ __ __
1 ■ Yes 2 ■ No 9 ■ Unk
1 ■ Yes 2 ■ No 9 ■ Unk
(121-22) (123-24)
(125-28)
– LABORATORY DATA –
19. Laboratory Name: ________________________________________________ City: ________________________________ State: __ __ Zip: __ __ __ __ __ - __ __ __ __
* Check only if specific assay was performed.
Phase I Antigen
Phase II Antigen
20.
22. Other Diagnostic Tests?*
Serology 1 (mm/dd/yyyy)
Serology 2 (mm/dd/yyyy)
Serology 1 (mm/dd/yyyy)
Serology 2 (mm/dd/yyyy)
Serology
(Check only if specific
assay was performed)
(Use #20, S1 to indicate collection date.)
__ __ __ __ __ __ __ __
__ __ __ __ __ __ __ __
__ __ __ __ __ __ __ __
__ __ __ __ __ __ __ __
(129-30) (131-32)
(141-42) (143-44)
(153-54) (155-56)
(165-66) (167-68)
(133-36)
Titer or OD* Positive?
IFA - IgG
Other
test: ______________
Titer or OD* Positive?
■ Yes
_ _ _ _ _ 2■ No (137) _ _ _ _ _
1■ Yes
_ _ _ _ _ 2■ No (138) _ _ _ _ _
1■ Yes
_ _ _ _ _ 2■ No (140) _ _ _ _ _
1
Titer or OD* Positive?
■ Yes
2■ No (149)
_____
1■ Yes
2■ No (150)
_____
1■ Yes
2■ No (152)
_____
1
(157-60)
Titer or OD* Positive?
■ Yes
2■ No (161)
_____
1■ Yes
2■ No (162)
_____
1■ Yes
2■ No (164)
_____
1
Positive?
(169-72)
■ Yes
2■ No (173)
1■ Yes
2■ No (174)
1■ Yes
2■ No (176)
1
PCR
Immunostain
Culture
➮
IFA - IgM
(145-48)
■ Yes
1 ■ Yes
1 ■ Yes
1
■ No (178)
■ No (179)
2 ■ No (180)
2
2
Sample(s) tested:
*IFA “Titer” or Other test: if CF, "Titer", if ELISA (EIA), Optical Density "OD" value..
21. Was there a fourfold change in antibody titer between the two serum specimens?
■ Yes 2■ No (177)
1
– FINAL DIAGNOSIS –
23. Classify case based on the CSTE/CDC case definition (see 15 above and criteria below):
■ Confirmed acute Q Fever 2 ■ Probable acute Q Fever
1
3
■
Confirmed chronic Q Fever
4
■
Probable chronic Q Fever
State Health Department Official who reviewed this report:
Name: _______________________________________________________
Title: _______________________________ Date: __ __ __ __ __ __ __ __
(181)
(mm/dd/yyyy)
See CSTE/CDC Q Fever Case Definition effective 1/1/2008 for details of the following categories:
Confirmed acute Q Fever: A laboratory confirmed case that either meets clinical case criteria or is epidemiologically linked to lab confirmed case.
Probable acute Q Fever: A clinically compatible case of acute illness that is not laboratory confirmed but has lab supportive evidence (antibody to Phase II higher than Phase I [if latter present]).
Confirmed chronic Q Fever: A clinically compatible case of chronic illness that is laboratory confirmed.
Probable chronic Q Fever: A clinically compatible case of chronic illness that is not laboratory confirmed but has lab supportive evidence (antibody to Phase I higher than Phase II [if latter present]).
Note: Samples from suspected chronic patients should be evaluated for IgG titers to both phase I and phase II antigens. Current commercially available ELISA tests (which test only for phase II) are not
quantitative and thus can, at best, indicate a probable infection. IgM tests may be unreliable because they lack specificity. IgM antibody may persist for lengthy periods of time. Older test methods are
neither readily available nor commonly used. For acute testing, CDC uses in-house IFA IgG testing (cutoff of ≥ 1:128), preferring simultaneous testing of paired specimens, and does not use IgM results
for routine diagnostic testing. Interpret serologic test results with caution, because antibodies acquired as a result of historical exposure to Q fever may exist, especially in rural and farming areas.
Public reporting burden of this collection of information is estimated to average 10 minutes per response. An agency may not conduct or sponsor, and a person is not required to respond to, a collection
of information unless it displays a currently valid OMB control number. Please send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden, to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Rd., NE (MS D-74); Atlanta, GA 30333; ATTN: PRA (0920-0009).
CDC 55.1 Rev. 2/2008
Save Data
Print
2nd COPY – CDC
Email Form
Next Page
Q FEVER CASE REPORT
Retrieve Data
Reset Form
Previous Page
DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Disease Control
and Prevention (CDC)
Atlanta, Georgia 30333
Q Fever Case Report
Use for: Acute Q Fever and Chronic Q Fever
Visit http://www.cdc.gov and use "Search" for complete Case Definition or to visit the
(1-4) Q Fever disease web site for a fillable/downloadable PDF version of this Case Report.
CDC#
Form Approved
OMB 0920-0009
– PATIENT/PHYSICIAN INFORMATION –
Patient's
name:
Date submitted: __ __05/18/2011
__ __ __ __ __ __ (mm/dd/yyyy)
(5-6)
(7-8)
(9-12)
Physician’s
Phone
name:
no.:
Address:
(number, street)
NETSS ID No.: (if reported)
City:
Case ID
Site (19-21)
(13-18)
State (22-23)
– DEMOGRAPHICS –
1. State of
2. County of
residence:
residence:
4. Date of birth:
3. Zip code:
5. Sex:
(mm/dd/yyyy)
__ __ __ __ __ __ __ __ __
(26-50)
(24-25)
(51-59)
__ __ __ __ __ __ __ __
(60-61) (62-63)
(64-67)
■ White
4 ■ Asian
2 ■ Black
5 ■ Pacific Islander
American Indian 9 ■ Not specified
3■
Alaskan Native
1
8. Occupation at date of onset of illness (Check all that apply)
1 ■ wool or felt plant (71)
6 ■ animal research (76)
1 0 ■ live in household with person
occupationally related to above? (80)
2 ■ tannery or rendering plant (72) 7 ■ slaughterhouse worker (77)
3 ■ dairy (73)
8 ■ laboratory worker (78)
8 8 ■ other (please specify) (81)
4 ■ veterinarian (74)
9 ■ rancher (79)
________________________________
5 ■ medical research (75)
10. Any exposure to birthing animals?
(89)
1 ■ Yes 2 ■ No 9 ■ Unk
If yes, which
animal _____________________
11. Exposure to unpasteurized milk?
(90)
1 ■ Yes 2 ■ No 9 ■ Unk
If yes, which
animal _____________________
12. Any travel in last year?
If yes, State
7. Hispanic
ethnicity:
6. Race: (69)
(68)
■ Male
2 ■ Female
9 ■ Not
specified
1
■ Yes (70)
■ No
9 ■ Unk
1
2
9. Any contact with animals within
2 months prior to onset? (check all that apply)
1 ■ Cattle (82)
3 ■ Goats (84)
5 ■ Cats (86)
2 ■ Sheep (83)
4 ■ Pigeons (85) 6 ■ Rabbits (87)
8 ■ Other (please specify) (88)
_______________________________________
13. Other family member with
similar illness in last year?
(91-92)
County __________________
Foreign Country _____________________________
1
■ Yes
2
■ No
(93)
9
■ Unk
– CLINICAL FINDINGS –
14. Date of Onset of Symptoms:
15. Clinical Signs and syndromes (check all that apply)
Evidence of clinically compatible illness is necessary. See CSTE/CDC Q Fever case definition, and case categorization summaries below.
■ fever (>100.5) (102) 4 ■ malaise (105) 7 ■ headache (108)
■ myalgia (103)
5 ■ rash (106)
8 ■ splenomegaly (109)
3 ■ retrobulbar pain (104) 6 ■ cough (107) 9 ■ hepatomegaly (110)
__ __ __ __ __ __ __ __
(94-95)
(96-97)
(98-101)
(mm/dd/yyyy)
■ pneumonia (111) 8 8 ■ Other (please specify) (114)
■ hepatitis (112)
__________________________________
1 2 ■ endocarditis (113)
1
10
2
11
Acute Q fever: Acute fever and one or more of the following: Rigors (febrile shivering), severe retrobulbar headache, acute hepatitis, pneumonia, or elevated liver enzyme levels.
Chronic Q fever: Newly recognized, culture-negative endocarditis - particularly in patients with previous valvulopathies or compromised immune systems, suspected infections of
vascular aneurysms or vascular prostheses, or chronic hepatitis in the absence of other known etiology.
16. Any pre-existing medical conditions? (check all that apply)
1 ■ immunocompromised (115) 3 ■ valvular heart disease or vascular graft (117)
2 ■ pregnancy (116) 8 ■ Other __________________________________ (118)
17. Was patient hospitalized
18. Did patient die from complications
because of this illness? (119)
of this illness? (120) (If yes, date)
(mm/dd/yyyy)
__ __ __ __ __ __ __ __
1 ■ Yes 2 ■ No 9 ■ Unk
1 ■ Yes 2 ■ No 9 ■ Unk
(121-22) (123-24)
(125-28)
– LABORATORY DATA –
19. Laboratory Name: ________________________________________________ City: ________________________________ State: __ __ Zip: __ __ __ __ __ - __ __ __ __
* Check only if specific assay was performed.
Phase I Antigen
Phase II Antigen
20.
22. Other Diagnostic Tests?*
Serology 1 (mm/dd/yyyy)
Serology 2 (mm/dd/yyyy)
Serology 1 (mm/dd/yyyy)
Serology 2 (mm/dd/yyyy)
Serology
(Check only if specific
assay was performed)
(Use #20, S1 to indicate collection date.)
__ __ __ __ __ __ __ __
__ __ __ __ __ __ __ __
__ __ __ __ __ __ __ __
__ __ __ __ __ __ __ __
(129-30) (131-32)
(141-42) (143-44)
(153-54) (155-56)
(165-66) (167-68)
(133-36)
Titer or OD* Positive?
IFA - IgG
Other
test: ______________
Titer or OD* Positive?
■ Yes
_ _ _ _ _ 2■ No (137) _ _ _ _ _
1■ Yes
_ _ _ _ _ 2■ No (138) _ _ _ _ _
1■ Yes
_ _ _ _ _ 2■ No (140) _ _ _ _ _
1
Titer or OD* Positive?
■ Yes
2■ No (149)
_____
1■ Yes
2■ No (150)
_____
1■ Yes
2■ No (152)
_____
1
(157-60)
Titer or OD* Positive?
■ Yes
2■ No (161)
_____
1■ Yes
2■ No (162)
_____
1■ Yes
2■ No (164)
_____
1
Positive?
(169-72)
■ Yes
2■ No (173)
1■ Yes
2■ No (174)
1■ Yes
2■ No (176)
1
PCR
Immunostain
Culture
➮
IFA - IgM
(145-48)
■ Yes
1 ■ Yes
1 ■ Yes
1
■ No (178)
■ No (179)
2 ■ No (180)
2
2
Sample(s) tested:
*IFA “Titer” or Other test: if CF, "Titer", if ELISA (EIA), Optical Density "OD" value..
21. Was there a fourfold change in antibody titer between the two serum specimens?
■ Yes 2■ No (177)
1
– FINAL DIAGNOSIS –
23. Classify case based on the CSTE/CDC case definition (see 15 above and criteria below):
■ Confirmed acute Q Fever 2 ■ Probable acute Q Fever
1
3
■
Confirmed chronic Q Fever
4
■
Probable chronic Q Fever
(181)
State Health Department Official who reviewed this report:
Name: _______________________________________________________
Title: _______________________________ Date: __ __ __ __ __ __ __ __
(mm/dd/yyyy)
See CSTE/CDC Q Fever Case Definition effective 1/1/2008 for details of the following categories:
Confirmed acute Q Fever: A laboratory confirmed case that either meets clinical case criteria or is epidemiologically linked to lab confirmed case.
Probable acute Q Fever: A clinically compatible case of acute illness that is not laboratory confirmed but has lab supportive evidence (antibody to Phase II higher than Phase I [if latter present]).
Confirmed chronic Q Fever: A clinically compatible case of chronic illness that is laboratory confirmed.
Probable chronic Q Fever: A clinically compatible case of chronic illness that is not laboratory confirmed but has lab supportive evidence (antibody to Phase I higher than Phase II [if latter present]).
Note: Samples from suspected chronic patients should be evaluated for IgG titers to both phase I and phase II antigens. Current commercially available ELISA tests (which test only for phase II) are not
quantitative and thus can, at best, indicate a probable infection. IgM tests may be unreliable because they lack specificity. IgM antibody may persist for lengthy periods of time. Older test methods are
neither readily available nor commonly used. For acute testing, CDC uses in-house IFA IgG testing (cutoff of ≥ 1:128), preferring simultaneous testing of paired specimens, and does not use IgM results
for routine diagnostic testing. Interpret serologic test results with caution, because antibodies acquired as a result of historical exposure to Q fever may exist, especially in rural and farming areas.
Public reporting burden of this collection of information is estimated to average 10 minutes per response. An agency may not conduct or sponsor, and a person is not required to respond to, a collection
of information unless it displays a currently valid OMB control number. Please send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden, to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Rd., NE (MS D-74); Atlanta, GA 30333; ATTN: PRA (0920-0009).
CDC 55.1 Rev. 2/2008
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Q FEVER CASE REPORT
| File Type | application/pdf |
| File Title | Q-Fever Case Report |
| Subject | Q-Fever Case Report |
| Author | maw2/tgd2/dgg2 |
| File Modified | 2011-05-18 |
| File Created | 2002-03-18 |