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PLoS One. 2016 May 25;11(5):e0155884. doi: 10.1371/journal.pone.0155884. eCollection 2016.

Fatigue following Acute Q-Fever: A Systematic Literature Review.

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Department of Infectious Diseases, Municipal Health Service Hart voor Brabant, 's-Hertogenbosch, the Netherlands.
Radboud Expertise Centre for Q fever, Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, Nijmegen, the Netherlands.
Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, Nijmegen, the Netherlands.
Expert Centre for Chronic Fatigue, Radboud university medical center, Nijmegen, the Netherlands.
Department of Internal Medicine, Medisch Spectrum Twente, Enschede, the Netherlands.
Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, the Netherlands.
Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.



Long-term fatigue with detrimental effects on daily functioning often occurs following acute Q-fever. Following the 2007-2010 Q-fever outbreak in the Netherlands with over 4000 notified cases, the emphasis on long-term consequences of Q-fever increased. The aim of this study was to provide an overview of all relevant available literature, and to identify knowledge gaps regarding the definition, diagnosis, background, description, aetiology, prevention, therapy, and prognosis, of fatigue following acute Q-fever.


A systematic review was conducted through searching Pubmed, Embase, and PsycInfo for relevant literature up to 26th May 2015. References of included articles were hand searched for additional documents, and included articles were quality assessed.


Fifty-seven articles were included and four documents classified as grey literature. The quality of most studies was low. The studies suggest that although most patients recover from fatigue within 6-12 months after acute Q-fever, approximately 20% remain chronically fatigued. Several names are used indicating fatigue following acute Q-fever, of which Q-fever fatigue syndrome (QFS) is most customary. Although QFS is described to occur frequently in many countries, a uniform definition is lacking. The studies report major health and work-related consequences, and is frequently accompanied by nonspecific complaints. There is no consensus with regard to aetiology, prevention, treatment, and prognosis.


Long-term fatigue following acute Q-fever, generally referred to as QFS, has major health-related consequences. However, information on aetiology, prevention, treatment, and prognosis of QFS is underrepresented in the international literature. In order to facilitate comparison of findings, and as platform for future studies, a uniform definition and diagnostic work-up and uniform measurement tools for QFS are proposed.

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