Q fever is an infectious disease caused by the bacterium Coxiella burnetii
People with Q fever fatigue syndrome have abnormalities in their immune system compared to healthy people. Ruud Raijmakers conducted research into various elements of Q fever fatigue syndrome, including the role of the central nervous system and cognitive behavioral therapy as a treatment. He obtained his doctorate on Wednesday 8 December.
Q fever is an infectious disease caused by the bacterium Coxiella burnetii. The disease is transmitted from animals to humans (zoonosis), often by goats or sheep. The bacteria is mainly spread through the air. When people become infected with C. burnetii, about 40% develop flu-like complaints, sometimes with pneumonia or liver inflammation. We call this an acute Q fever infection. During the Q fever outbreak from 2007 to 2011, tens of thousands of people were infected with C. burnetii and more than 4,000 reports of acute Q fever infections were made. Q fever has two long-term complications: chronic Q fever, in which the bacteria do not disappear from the patient’s body after infection, and Q fever fatigue syndrome (QVS), in which people have long-term (fatigue) complaints after an acute Q fever infection. although the bacteria has disappeared from the body.
Fatigue and high disease burden
More than 20% of people who have experienced an acute Q fever infection develop long-term complaints, such as fatigue, muscle and joint pain, headache, night sweats and rapidly recurring upper respiratory tract infections. If the fatigue persists for more than six months and there is no other explanation, it is called QVS. Why some patients get this and others don’t is unknown. Within the Radboudumc Q-fever Expertise Center, PhD student Ruud Raijmakers has conducted research into QVS in recent years. Raijmakers: “We still know relatively little about many infectious diseases that cause chronic fatigue. That is why my research touches on various aspects of QVS, the body seems out of balance in several areas.”
Long-term Effects of Cognitive Behavioral Therapy
Raijmakers investigated, among other things, the long-term effects of cognitive behavioral therapy, a treatment that focuses on thoughts and behaviors that maintain fatigue symptoms. This treatment is known to benefit patients with chronic fatigue syndrome (CFS), a disease with similar symptoms. Raijmakers: “Remarkably, our research showed that the beneficial effects of the therapy in QVS patients disappear faster than expected. We don’t know exactly why, but it may pay to focus therapy more on QVS and to plan ‘maintenance sessions’.”
Abnormalities in the first-line immune cells
Raijmakers also looked at the origins of QVS. In the immune system, he found abnormalities in the first-line immune cells, the monocytes. They behave slightly differently in QVS patients than in people without QVS; for example, two genes responsible for the production of essential proteins are less expressed. “Since these proteins are involved in the protection of cells, the inhibition of inflammation, the regulation of the metabolism and recovery after exercise, it is worthwhile to further investigate the role of these genes”, argues Raijmakers in his thesis. “This may link some theories about the origin of chronic fatigue.”
As far as QVS is concerned, there is still a lot of work to be done. According to Raijmakers, larger and better studies are needed for more knowledge about the disease, for example into the theory that QVS is caused by inflammation of the central nervous system (neuroinflammation). “Our study was unable to demonstrate this, while a Japanese study previously provided indications for this. There are now better research methods, so a follow-up study into this is of great value.”
Although he has now started his training as a general practitioner, he wants to remain involved in research into post-infectious fatigue syndromes such as QVS. Raijmakers: “I have seen many QVS patients and have worked with them. We can still do so much for them. Ultimately, I hope to contribute to a better understanding of this disease and thus a better understanding of patients with chronic fatigue.”
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