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Delahaye A, Eldin C, Bleibtreu A, Djossou F, Marrie TJ, Ghanem-Zoubi N, Roeden S, Epelboin L. Treatment of persistent focalized Q fever: time has come for an international randomized controlled trial. J Antimicrob Chemother 2024; 79:1725-1747. [PMID: 38888195 DOI: 10.1093/jac/dkae145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/15/2024] [Indexed: 06/20/2024] Open
Abstract
Q fever is a worldwide zoonosis due to Coxiella burnetii, responsible for endocarditis and endovascular infections. Since the 1990s, the combination hydroxychloroquine + doxycycline has constituted the curative and prophylactic treatment in persistent focalized Q fever. This combination appears to have significantly reduced the treatment's duration (from 60 to 26 months), yet substantial evidence of effectiveness remains lacking. Data are mostly based on in vitro and observational studies. We conducted a literature review to assess the effectiveness of this therapy, along with potential alternatives. The proposed in vitro mechanism of action describes the inhibition of Coxiella replication by doxycycline through the restoration of its bactericidal activity (inhibited in acidic environment) by alkalinization of phagolysosome-like vacuoles with hydroxychloroquine. So far, the rarity and heterogeneous presentation of cases have made it challenging to design prospective studies with statistical power. The main studies supporting this treatment are retrospective cohorts, dating back to the 1990s-2000s. Retrospective studies from the large Dutch outbreak of Q fever (>4000 cases between 2007 and 2010) did not corroborate a clear benefit of this combination, notably in comparison with other regimens. Thus, there is still no consensus among the medical community on this issue. However insufficient the evidence, today the doxycycline + hydroxychloroquine combination remains the regimen with the largest clinical experience in the treatment of 'chronic' Q fever. Reinforcing the guidelines' level of evidence is critical. We herein propose the creation of an extensive international registry, followed by a prospective cohort or ideally a randomized controlled trial.
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Affiliation(s)
- Audrey Delahaye
- Department of Infectious and Tropical Diseases, Andrée Rosemon Hospital, Cayenne, French Guiana
| | - Carole Eldin
- UMR UVE, Aix Marseille University, IRD 190 Inserm, 1207 EFS-IRBA, Marseille, France
| | - Alexandre Bleibtreu
- Department of Infectious and Tropical Diseases, University Hospitals Pitié Salpêtrière-Charles Foix, AP-HP, Paris, France
| | - Félix Djossou
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Thomas J Marrie
- Faculty of Medicine, Dalhousie University, 1459 Oxford Street, Halifax, NS B3H 4R2, Canada
| | - Nesrin Ghanem-Zoubi
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Sonja Roeden
- Internal Medicine and Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Loïc Epelboin
- Department of Infectious and Tropical Diseases, Andrée Rosemon Hospital, Cayenne, French Guiana
- Clinical Investigation Center Antilles Guyane, Inserm 1424, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
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Bauer BU, Peters M, Herms TL, Runge M, Wohlsein P, Jensen TK, Ganter M. Detection of Coxiella burnetii in the mammary gland of a dairy goat. Vet Res Commun 2024; 48:1341-1352. [PMID: 38236458 PMCID: PMC11147866 DOI: 10.1007/s11259-023-10233-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/06/2023] [Indexed: 01/19/2024]
Abstract
The zoonotic bacterium Coxiella (C.) burnetii can be excreted by infected goats through birth products and milk. The detection of C. burnetii DNA in the mammary gland tissue of infected dairy goats and intermittent milk shedders has been reported, but confirmation of C. burnetii bacteria in the udder remained pending. The pathogen caused abortions in a 152-head dairy goat herd, resulting in the vaccination against C. burnetii of the entire herd with annual boosters. To monitor the C. burnetii shedding at herd level, monthly bulk tank milk (BTM) samples were analyzed using PCR (IS1111). Despite vaccination, C. burnetii DNA was detected in BTM samples within the first 16 months of the study. Therefore, individual milk samples were tested on four different occasions several months apart to identify potential intermittent milk shedders. Only one goat (#67455) tested positive three times. This goat was necropsied to investigate the presence of C. burnetii in the udder and other organs. PCR detected C. burnetii DNA solely in both mammary glands and the left teat cistern. Immunohistological examination identified C. burnetii antigen in mammary gland tissue, confirmed by the detection of C. burnetii bacteria in the mammary epithelial cells using fluorescence in situ hybridization. The removal of goat #67455 led to negative BTM samples until the end of the study. The findings demonstrate the occurrence of C. burnetii in the mammary gland of a naturally infected and vaccinated goat. The presence possibly contributed to intermittent milk shedding of goat #67455, and the mammary gland tissue may serve as a replicative niche for C. burnetii.
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Affiliation(s)
- Benjamin Ulrich Bauer
- University of Veterinary Medicine Hannover, Foundation, Clinic for Swine and Small Ruminants, Bischofsholer Damm 15, Hannover, 30173, Germany.
| | - Martin Peters
- Chemisches und Veterinäruntersuchungsamt Westfalen, Zur Taubeneiche 10-12, Arnsberg, 59821, Germany
| | - T Louise Herms
- Lower Saxony State Office for Consumer Protection and Food Safety (LAVES), Food and Veterinary Institute Braunschweig/Hannover, Eintrachtweg 17, Hannover, 30173, Germany
| | - Martin Runge
- Lower Saxony State Office for Consumer Protection and Food Safety (LAVES), Food and Veterinary Institute Braunschweig/Hannover, Eintrachtweg 17, Hannover, 30173, Germany
| | - Peter Wohlsein
- Department of Pathology, University of Veterinary Medicine Hannover, Foundation, Bünteweg 17, Hannover, 30559, Germany
| | - Tim K Jensen
- Center for Diagnostic, Technical University of Denmark, Henrik Dams Allé, Kongens Lyngby, 2800, Denmark
- Department of Veterinary and Animal Sciences, University of Copenhagen, Grønnegårdsvej 15, Frederiksberg C, 1870, Denmark
| | - Martin Ganter
- University of Veterinary Medicine Hannover, Foundation, Clinic for Swine and Small Ruminants, Bischofsholer Damm 15, Hannover, 30173, Germany
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Dolcé P, de Beaumont-Dupont A, Jutras P, Mailhot-Léonard F, Alexandra Rosca M, Aubé-Maurice J. The lower Saint Lawrence River region of Quebec, a hot spot for sheepfold-associated Q fever in Canada: Review of 258 cases. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2023; 8:201-213. [PMID: 38058500 PMCID: PMC10697106 DOI: 10.3138/jammi-2023-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/18/2023] [Indexed: 12/08/2023]
Abstract
Background The lower Saint Lawrence river region (LSLRR), in Quebec, has a 10-fold higher incidence of Q fever compared to the provincial rate. This study aimed to review clinical cases and the Q fever risk exposure in this region. Methods Data were retrieved from microbiology laboratory, medical records from Rimouski Regional Hospital and Public Health reports between 1991 and 2018. They were analyzed with Epi Info 7.2.2.6. Patients with confirmed acute, probable acute, and chronic Q fever were classified using standard case definitions and mapped according to the postal code, to assess the correlation between cases and sheep distribution. Results Out of 295 cases, 258 were included (241 confirmed acute, seven probable acute, 10 chronic). Median age was 49 years, 76% were male. For acute cases, the prominent symptoms were fever (99%), headache (83%), chills (80%), sweating (72%), myalgia (69%), and fatigue (67%). Clinical presentation was mostly febrile syndrome with mild hepatitis (84%). A seasonal peak was observed from May to July (56% of acute cases). Most cases (56%) occurred within the two counties where sheep production was highest. Exposure to sheep was prominent 93%, including 64% direct contact (15% shepherds, 49% sheepfold visitors), 14% indirect contact, and 15% sheepfold neighbors. Conclusions To our knowledge, this is one of the largest retrospective studies of Q fever cases reported in Canada. Q fever in Quebec LSLRR is associated mainly with sheep exposure. Fever and hepatitis were the most common manifestations. Preventive measures should be considered in this region to protect sheepfold workers, visitors, and their neighbors.
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Affiliation(s)
- Patrick Dolcé
- Department of Medical Microbiology and Infectious Diseases, Centre hospitalier régional de Rimouski, Rimouski, Quebec, Canada
| | - Annie de Beaumont-Dupont
- Department of Medical Microbiology and Infectious Diseases, Centre hospitalier régional de Rimouski, Rimouski, Quebec, Canada
- Department of Biology, Université du Québec à Rimouski, Rimouski, Quebec, Canada
| | - Philippe Jutras
- Department of Medical Microbiology and Infectious Diseases, Centre hospitalier régional de Rimouski, Rimouski, Quebec, Canada
| | - Florence Mailhot-Léonard
- Department of Medical Microbiology and Infectious Diseases, Centre hospitalier régional de Rimouski, Rimouski, Quebec, Canada
| | - Maria Alexandra Rosca
- Department of Medical Microbiology and Infectious Diseases, Centre hospitalier régional de Rimouski, Rimouski, Quebec, Canada
- Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Joanne Aubé-Maurice
- Department of Public Health, CISSS du Bas-St-Laurent, Kamouraska, Quebec, Canada
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Dold C, Zhu H, Silva-Reyes L, Blackwell L, Linder A, Bewley K, Godwin K, Fotheringham S, Charlton S, Kim YC, Pollard AJ, Rollier CS. Immunisation with purified Coxiella burnetii phase I lipopolysaccharide confers partial protection in mice independently of co-administered adenovirus vectored vaccines. Vaccine 2023; 41:3047-3057. [PMID: 37037709 PMCID: PMC10914673 DOI: 10.1016/j.vaccine.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/25/2023] [Accepted: 04/04/2023] [Indexed: 04/12/2023]
Abstract
Q fever is a highly infectious zoonosis caused by the Gram-negative bacterium Coxiella burnetii. The worldwide distribution of Q fever suggests a need for vaccines that are more efficacious, affordable, and does not induce severe adverse reactions in vaccine recipients with pre-existing immunity against Q fever. Potential Q fever vaccine antigens include lipopolysaccharide (LPS) and several C. burnetii surface proteins. Antibodies elicited by purified C. burnetii lipopolysaccharide (LPS) correlate with protection against Q fever, while antigens encoded by adenoviral vectored vaccines can induce cellular immune responses which aid clearing of intracellular pathogens. In the present study, the immunogenicity and the protection induced by adenoviral vectored constructs formulated with the addition of LPS were assessed. Multiple vaccine constructs encoding single or fusion antigens from C. burnetii were synthesised. The adenoviral vectored vaccine constructs alone elicited strong cellular immunity, but this response was not correlative with protection in mice. However, vaccination with LPS was significantly associated with lower weight loss post-bacterial challenge independent of co-administration with adenoviral vaccine constructs, supporting further vaccine development based on LPS.
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Affiliation(s)
- Christina Dold
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford, UK
| | - Henderson Zhu
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford, UK.
| | - Laura Silva-Reyes
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford, UK
| | - Luke Blackwell
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford, UK
| | - Aline Linder
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford, UK
| | - Kevin Bewley
- UKHSA Porton Down, Medical Interventions Group, Salisbury, Wiltshire, UK
| | - Kerry Godwin
- UKHSA Porton Down, Medical Interventions Group, Salisbury, Wiltshire, UK
| | - Susan Fotheringham
- UKHSA Porton Down, Medical Interventions Group, Salisbury, Wiltshire, UK
| | - Sue Charlton
- UKHSA Porton Down, Medical Interventions Group, Salisbury, Wiltshire, UK
| | - Young Chan Kim
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford, UK
| | - Christine S Rollier
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford, UK; Section of Immunology, School of Biosciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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Christodoulou M, Malli F, Tsaras K, Billinis C, Papagiannis D. A Narrative Review of Q Fever in Europe. Cureus 2023; 15:e38031. [PMID: 37228530 PMCID: PMC10207987 DOI: 10.7759/cureus.38031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2023] [Indexed: 05/27/2023] Open
Abstract
Coxiella burnetii, the causative agent of Q fever, causes abortions in animals. Its effects on humans and the management of Q fever in certain conditions like pregnancy are undetermined. The World Health Organization has estimated that zoonotic diseases cause around one billion cases of infections and millions of deaths globally each year. It is worth noting that many emerging infectious diseases currently being reported worldwide are zoonoses. We reviewed studies reporting on Q fever prevalence and incidence in Europe. Articles from 1937 to 2023 with the following terms "Coxiella burnetii and Europe and Q fever, and seroprevalence studies" were identified in the PubMed database and reports by organizations such as the European Centre for Disease Prevention and Control (ECDC). We included randomized and observational studies, seroprevalence studies, case series, and case reports. According to the ECDC in 2019, 23 countries reported 1069 cases, the majority of which were classified as confirmed cases. The number of reports per 100,000 inhabitants in the EU/EEA was 0.2 for 2019, the same as the previous four years. The highest report rate (0.7 cases per 100,000 population) was observed in Spain, followed by Romania (0.6), Bulgaria (0.5), and Hungary. Considering the typically asymptomatic nature of Q fever infection, it is imperative to strengthen the existing systems to promote the rapid identification and reporting of Q fever outbreaks in animals, particularly in cases of abortion. It is also essential to consider the facilitation of early information exchange between veterinarians and public health counterparts to ensure the timely detection and prevention of potential zoonotic events, including Q fever.
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Affiliation(s)
| | - Foteini Malli
- Department of Nursing, University of Thessaly, Larissa, GRC
| | | | - Charalambos Billinis
- Department of Microbiology and Parasitology, Faculty of Veterinary Science, University of Thessaly, Karditsa, GRC
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Voss L, Huaman J, Pacioni C, Tolpinrud A, Helbig K, Carvalho TG, Firestone SM. Seroprevalence of Coxiella burnetii antibodies in wild deer populations in eastern Australia. Aust Vet J 2023; 101:106-114. [PMID: 36544232 DOI: 10.1111/avj.13223] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022]
Abstract
Coxiella burnetii causes significant reproduction losses in livestock and the disease Q fever in humans. Transmission of C. burnetii is facilitated by the stability of the bacterium in the environment and the susceptibility of a variety of host species to infection. Consequently, inter-species transmission occurs frequently through either direct or indirect contact. Wildlife may represent reservoirs of C. burnetii and could therefore be a source of infection for domestic animals. Understanding the prevalence of C. burnetii infections at the wildlife-livestock interface is important for disease control. This study aimed to investigate the extent of C. burnetii exposure in wild deer in eastern Australia. Serum samples were obtained from 413 wild deer from seven regions in four eastern Australian states from 2017 to 2020. Antibodies were detected using a commercial Q fever antibody kit validated for ruminants. Seroprevalence of C. burnetii antibodies in deer was determined and true prevalence estimated, for each region. The overall seroprevalence of C. burnetii antibodies in wild deer was 3.4% (14 seropositive of 413 deer sampled) with true prevalence estimated to be 4.3% (95% credible interval: 0.6%, 10.9%). Seropositive deer were identified only in Queensland (7/108 seropositive) and northern New South Wales (7/120 seropositive). This geospatial distribution is consistent with seropositivity in other animal species and indicative of the level of C. burnetii in the environment. The low seroprevalence suggests that wild deer are unlikely to be a major reservoir species for C. burnetii in eastern Australia but may still be implicated in inter-species transmission cycles.
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Affiliation(s)
- L Voss
- Melbourne Veterinary School, Faculty of Science, The University of Melbourne, Parkville, Victoria, Australia
| | - J Huaman
- Department of Microbiology, Anatomy, Physiology and Pharmacology, School of Agriculture, Biomedicine and Environment, La Trobe University, Melbourne, Victoria, Australia
| | - C Pacioni
- Department of Environment, Land, Water and Planning, Arthur Rylah Institute for Environmental Research, Heidelberg, Victoria, Australia.,Environmental and Conservation Sciences, Murdoch University, Murdoch, Western Australia, Australia
| | - A Tolpinrud
- Melbourne Veterinary School, Faculty of Science, The University of Melbourne, Parkville, Victoria, Australia
| | - K Helbig
- Department of Microbiology, Anatomy, Physiology and Pharmacology, School of Agriculture, Biomedicine and Environment, La Trobe University, Melbourne, Victoria, Australia
| | - T G Carvalho
- Department of Microbiology, Anatomy, Physiology and Pharmacology, School of Agriculture, Biomedicine and Environment, La Trobe University, Melbourne, Victoria, Australia
| | - S M Firestone
- Melbourne Veterinary School, Faculty of Science, The University of Melbourne, Parkville, Victoria, Australia
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Geography and prevalence of rickettsial infections in Northern Tamil Nadu, India: a cross-sectional study. Sci Rep 2022; 12:20798. [PMID: 36460687 PMCID: PMC9718799 DOI: 10.1038/s41598-022-21191-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/23/2022] [Indexed: 12/03/2022] Open
Abstract
Rickettsial infections and Q fever are a common cause of acute febrile illness globally. Data on the role of climate and altitude on the prevalence of these infections in lacking from Southern India. In this study, we determined the sero-prevalence of scrub typhus (ST), spotted fever (SF), murine typhus (MT) and Q Fever (QF) in 8 eight geographical regions of North Tamil Nadu by detecting IgG antibodies using ELISA. Totally we tested 2565 people from 86 localities. Among the 27.3% positives, approximately 5% were IgG positive for two or more infections. Sero-prevalence to rickettsioses and Q fever was highest for individuals from rural areas and increased with age (> 30 years). Those in the Nilgiris highlands (wetter and cooler) and Erode, which has the most land under irrigation, demonstrated the least exposure to rickettsioses and Q fever. Lowland plains (AOR: 8.4-22.9; 95% CI 3.1-55.3) and highland areas up to 1000 m (AOR: 6.1-10.3; 95% CI 2.4-23.9) showed the highest risk of exposure to scrub typhus. For spotted fever, the risk of exposure was highest in Jawadhi (AOR:10.8; 95% CI 2.6-44.3) and Kalrayan (AOR:16.6; 95% CI 4.1-66.2). Q fever positivity was most likely to be encountered in Salem (AOR: 5.60; 95% CI 1.01-31.08) and Kalrayan hills (AOR:12.3; 95% CI 2.9-51.6). Murine typhus risk was significant only in Tiruvannamalai (AOR:24.2; 95% CI 3.3-178.6). Our study suggests that prevalence of rickettsial infections and Q fever is low in areas which receive rainfall of ≥ 150 cm/year, with average minimum and maximum temperatures between 15 and 25 °C and elevation in excess of 2000 m. It is also less in well irrigated lowlands with dry climate. These preliminary findings need confirmation by active surveillance in these areas.
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Tokarevich NK, Blinova OV, Stoyanova NA, Baimova RR, Siuziumova EA, Lomonosova VI, Tronin AA, Buzinov RV, Sokolova OV, Gnativ BR, Buts LV, Bubnova LA, Safonova OS, Stankevich AI, Kalinina EL, Vikse R, Andreassen AK. Seroprevalence of tick-borne diseases in the Northwest Federal District of the Russian Federation. RUSSIAN JOURNAL OF INFECTION AND IMMUNITY 2022. [DOI: 10.15789/2220-7619-sot-1953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction. Knowledge about tick-borne disease (TBD) distribution is necessary to improve prevention, whereas detection of human serum IgG antibodies against relevant pathogens is a method for monitoring TBD prevalence in local population. The study objective was to estimate seroprevalence of IgG antibodies against tick-borne encephalitis virus (TBEV), Borrelia burgdorferi sensu lato, Coxiella burnetii, Anaplasma phagocytophilum, and Ehrlichia chaffeensis/E. muris in healthy residents from the five territories of the Northwestern Federal District of the Russian Federation (Arkhangelsk Oblast, Leningrad Oblast, Pskov Oblast, the Republic of Komi and the Republic of Karelia). Materials and methods. In 20172019, a total of 1244 serum samples from healthy residents, not vaccinated against TBDs or other flavivirus-caused infections was studied by ELISA. Results. 21.7% of the sera samples contained IgG antibodies against a single TBD pathogen, whereas 2.1% showed signs of coinfection with two or more pathogens. The most common were IgG antibodies against TBEV (5 territories, 12.2%), followed by Borrelia burgdorferi sensu lato (5 territories, 3.5%), C. burnetii (4 territories, 2.9%), Anaplasma phagoсytophilum (3 territories, 1.6%), E. chaffeensis/E. muris (5 territories, 1.5%). The IgG antibodies were more common in men (55.2%) than in women (44.8%), being found virtually evenly in age-independent manner (from juniors under 18 to seniors over 60). Conclusion. The results of this first comprehensive serosurveillance study in the Northwestern Federal District of the Russian Federation assessing serum IgG antibodies against tick-borne diseases indicate a wide distribution of such pathogens. Moreover, infections caused by C. burnetii, Anaplasma phagocytophilum, and Ehrlichia chaffeensis/E. muris might be highly underdiagnosed.
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Abstract
There is a growing awareness of the importance of sex and gender in medicine and research. Women typically have stronger immune responses to self and foreign antigens than men, resulting in sex-based differences in autoimmunity and infectious diseases. In both animals and humans, males are generally more susceptible than females to bacterial infections. At the same time, gender differences in health-seeking behavior, quality of health care, and adherence to treatment recommendations have been reported. This review explores our current understanding of differences between males and females in bacterial diseases. We describe how genetic, immunological, hormonal, and anatomical factors interact to influence sex-based differences in pathophysiology, epidemiology, clinical presentation, disease severity, and prognosis, and how gender roles affect the behavior of patients and providers in the health care system.
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Serological Prevalence of and Risk Factors for Coxiella burnetti Infection in Women of Punjab Province, Pakistan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084576. [PMID: 35457443 PMCID: PMC9027314 DOI: 10.3390/ijerph19084576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/01/2022] [Accepted: 04/07/2022] [Indexed: 01/09/2023]
Abstract
Background: Coxiella burnetii, the etiological agent of Q (query) fever, provokes abortions in ruminants and is suspected to cause adverse pregnancy outcomes in women. Infection of pregnant women is linked with high mortality and morbidity of the fetus and the mother is at high risk to acquire chronic Q fever. This research was conducted to evaluate the prevalence of Q fever in women and to detect associated risk factors in four districts of Punjab Province, Pakistan. Methods: A total of 297 blood samples were obtained from 147 pregnant and 150 non-pregnant women of the districts Okara, Jhang, Chiniot and Faisalabad of Punjab, Pakistan. Data related to risk factors and demographic parameters were collected using a questionnaire. Serum samples were screened for phase I and phase II specific IgG antibodies for antigens of phase I and phase II using ELISA tests. Univariate and binary regression were used to analyze important risk factors of Q fever. Results: Twenty-five serum samples (8.4%) were found seropositive for Q fever. Seventeen women were positive for Phase-I and twenty-one were positive for phase-II antibodies. Highest and statistically significant (p < 0.05) seroprevalence of 17.1% was observed in Faisalabad. Age, urbanicity, living status, pregnancy status, abortion history, occupation, and consumption of tap water were positively correlated (p < 0.05) with Q fever, while being aged, urbanity, low income, contact with animals and consumption of tap water was identified as potential risk factors. Conclusions: Q fever is prevalent in women of Pakistan. There is a need for an awareness program about the importance of C. burnetii infections and prevention strategies in women during pregnancy to minimize adverse pregnancy outcomes.
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Gay L, Melenotte C, Lopez A, Desnues B, Raoult D, Leone M, Mezouar S, Mege JL. Impact of Sex Hormones on Macrophage Responses to Coxiella burnetii. Front Immunol 2021; 12:705088. [PMID: 34987498 PMCID: PMC8720845 DOI: 10.3389/fimmu.2021.705088] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 12/03/2021] [Indexed: 01/17/2023] Open
Abstract
Introduction Q fever, a zoonosis caused by Coxiella burnetii, affects more males than females despite a similar level of exposure. A protective role of estradiol has been reported in mice, suggesting that sex hormones are involved in C. burnetii infection. We wondered whether the responses of monocytes and monocyte-derived macrophages (MDMs) to C. burnetii are influenced by sex hormones. Materials and Methods The bacterial intracellular fate in monocytes was studied using quantitative PCR, and monocyte cytokine production in response to C. burnetii was assessed using qRT-PCR and immunoassays. Before infection, MDMs from males and females were incubated with testosterone and estradiol, respectively. Results Bacterial uptake and persistence were similar in monocytes from males and females but were slightly increased in male MDMs. The expression of inflammatory genes, including those encoding TNF and CXCL10, was higher in MDMs from females than in MDMs from males infected by C. burnetii. Adding testosterone to male MDMs amplified their immunoregulatory properties, including increased expression of IL10 and TGFB genes and TGF-β production in response to C. burnetii. In contrast, adding estradiol to MDMs from females had no effect on their inflammatory profile. Conclusion The stronger inflammatory profile of macrophages from females may have a protective role, likely under estrogen control, while testosterone may affect disease progression by promoting an anti-inflammatory response. This finding may have consequences for personalized management of patients with Q fever.
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Affiliation(s)
- Laetitia Gay
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique - Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogeny and Infection (MEPHI), Marseille, France
- Department of Immunology, Institut Hospitalo-Universitaire (IHU)-Méditerranée Infection, Marseille, France
| | - Cléa Melenotte
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique - Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogeny and Infection (MEPHI), Marseille, France
- Department of Immunology, Institut Hospitalo-Universitaire (IHU)-Méditerranée Infection, Marseille, France
| | - Alexandre Lopez
- Department of Anesthesia and Intensive Care, Hôpital Nord, Aix-Marseille Univ, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France
| | - Benoit Desnues
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique - Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogeny and Infection (MEPHI), Marseille, France
- Department of Immunology, Institut Hospitalo-Universitaire (IHU)-Méditerranée Infection, Marseille, France
| | - Didier Raoult
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique - Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogeny and Infection (MEPHI), Marseille, France
- Department of Immunology, Institut Hospitalo-Universitaire (IHU)-Méditerranée Infection, Marseille, France
| | - Marc Leone
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique - Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogeny and Infection (MEPHI), Marseille, France
- Department of Immunology, Institut Hospitalo-Universitaire (IHU)-Méditerranée Infection, Marseille, France
- Department of Anesthesia and Intensive Care, Hôpital Nord, Aix-Marseille Univ, Assistance Publique - Hôpitaux de Marseille (APHM), Marseille, France
| | - Soraya Mezouar
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique - Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogeny and Infection (MEPHI), Marseille, France
- Department of Immunology, Institut Hospitalo-Universitaire (IHU)-Méditerranée Infection, Marseille, France
| | - Jean-Louis Mege
- Aix-Marseille University, Institut de Recherche pour le Développement (IRD), Assistance Publique - Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogeny and Infection (MEPHI), Marseille, France
- Department of Immunology, Institut Hospitalo-Universitaire (IHU)-Méditerranée Infection, Marseille, France
- Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille (APHM), Hôpital de la Conception, Laboratoire d’Immunologie, Marseille, France
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12
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Lencastre Monteiro R, Nascimento R, Diogo J, Bernardino R, Nazário Leão R. Q Fever: An Emerging Reality in Portugal. Cureus 2021; 13:e19018. [PMID: 34853746 PMCID: PMC8608041 DOI: 10.7759/cureus.19018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2021] [Indexed: 11/05/2022] Open
Abstract
Q fever is a zoonosis caused by Coxiella burnetii with worldwide distribution at the increasing expression in Europe and endemic in Portugal. It is transmitted by inhalation of aerosols containing spores, main reservoir being cattle, goats and sheep as by ingesting cottage cheese or unpasteurized milk. The majority of patients are asymptomatic; however, they may present with fever, atypical pneumonia, acute hepatitis, cutaneous manifestations and rarely with cardiac or neurological involvement. Although most cases are self-limited, focal persistent or chronic Q fever can manifest years after the onset, wherefore follow-up is essential. The clinical heterogeneity may be so variable that the disease is often diagnosed only if it has been systematically considered. It should be especially taken into account in the presence of risk factors as valvular or joint prostheses, immunocompromised patients, pregnant women and epidemiological setting. The authors present a rare case of Coxiella burnetii pneumonia with cutaneous and hepatic manifestations without any risk factor. This case aims to emphasize the importance of Q fever in the differential diagnosis of fever or atypical pneumonia, even in the absence of known risk factors. The diagnosis is often challenging for clinicians and it is necessary to maintain a high index of suspicion. In Europe and specifically in Portugal is mandatory to report the cases to establish the real impact of this disease.
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Affiliation(s)
- Rita Lencastre Monteiro
- Internal Medicine, Hospital Santo António dos Capuchos - Centro Hospitalar Universitário Lisboa Central, Lisboa, PRT
| | - Rui Nascimento
- Radiology, Centro Hospitalar Universitário do Porto, Porto, PRT
| | - Joana Diogo
- Internal Medicine, Hospital Santo António dos Capuchos - Centro Hospitalar Universitário Lisboa Central, Lisboa, PRT
| | - Rita Bernardino
- Internal Medicine, Hospital Santo António dos Capuchos - Centro Hospitalar Universitário Lisboa Central, Lisboa, PRT
| | - Rodrigo Nazário Leão
- Internal Medicine, Hospital Santo António dos Capuchos - Centro Hospitalar Universitário Lisboa Central, Lisboa, PRT
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13
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Gay L, Melenotte C, Lakbar I, Mezouar S, Devaux C, Raoult D, Bendiane MK, Leone M, Mège JL. Sexual Dimorphism and Gender in Infectious Diseases. Front Immunol 2021; 12:698121. [PMID: 34367158 PMCID: PMC8339590 DOI: 10.3389/fimmu.2021.698121] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/08/2021] [Indexed: 12/19/2022] Open
Abstract
Epidemiological studies and clinical observations show evidence of sexual dimorphism in infectious diseases. Women are at less risk than men when it comes to developing most infectious diseases. However, understanding these observations requires a gender approach that takes into account an analysis of both biological and social factors. The host’s response to infection differs in males and females because sex differences have an impact on hormonal and chromosomal control of immunity. Estradiol appears to confer protective immunity, while progesterone and testosterone suppress anti-infectious responses. In addition, genetic factors, including those associated with sex chromosomes, also affect susceptibility to infections. Finally, differences in occupational activities, lifestyle, and comorbidities play major roles in exposure to pathogens and management of diseases. Hence, considering sexual dimorphism as a critical variable for infectious diseases should be one of the steps taken toward developing personalized therapeutic approaches.
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Affiliation(s)
- Laetitia Gay
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Cléa Melenotte
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France.,Aix-Marseille Univ, INSERM, IRD, SESSTIM, Economy and Social Science, Health Care Systems and Societies, Marseille, France
| | - Ines Lakbar
- Department of Anaesthesia and Intensive Care, Hôpital Nord, Aix-Marseille Univ, APHM, Marseille, France
| | - Soraya Mezouar
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Christian Devaux
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Didier Raoult
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Marc-Karim Bendiane
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Economy and Social Science, Health Care Systems and Societies, Marseille, France
| | - Marc Leone
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France.,Department of Anaesthesia and Intensive Care, Hôpital Nord, Aix-Marseille Univ, APHM, Marseille, France
| | - Jean-Louis Mège
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
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14
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Long CM, Beare PA, Cockrell DC, Fintzi J, Tesfamariam M, Shaia CI, Heinzen RA. Contributions of lipopolysaccharide and the type IVB secretion system to Coxiella burnetii vaccine efficacy and reactogenicity. NPJ Vaccines 2021; 6:38. [PMID: 33741986 PMCID: PMC7979919 DOI: 10.1038/s41541-021-00296-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/12/2021] [Indexed: 12/15/2022] Open
Abstract
Coxiella burnetii is the bacterial causative agent of the zoonosis Q fever. The current human Q fever vaccine, Q-VAX®, is a fixed, whole cell vaccine (WCV) licensed solely for use in Australia. C. burnetii WCV administration is associated with a dermal hypersensitivity reaction in people with pre-existing immunity to C. burnetii, limiting wider use. Consequently, a less reactogenic vaccine is needed. Here, we investigated contributions of the C. burnetii Dot/Icm type IVB secretion system (T4BSS) and lipopolysaccharide (LPS) in protection and reactogenicity of fixed WCVs. A 32.5 kb region containing 23 dot/icm genes was deleted in the virulent Nine Mile phase I (NMI) strain and the resulting mutant was evaluated in guinea pig models of C. burnetii infection, vaccination-challenge, and post-vaccination hypersensitivity. The NMI ∆dot/icm strain was avirulent, protective as a WCV against a robust C. burnetii challenge, and displayed potentially altered reactogenicity compared to NMI. Nine Mile phase II (NMII) strains of C. burnetii that produce rough LPS, were similarly tested. NMI was significantly more protective than NMII as a WCV; however, both vaccines exhibited similar reactogenicity. Collectively, our results indicate that, like phase I LPS, the T4BSS is required for full virulence by C. burnetii. Conversely, unlike phase I LPS, the T4BSS is not required for vaccine-induced protection. LPS length does not appear to contribute to reactogenicity while the T4BSS may contribute to this response. NMI ∆dot/icm represents an avirulent phase I strain with full vaccine efficacy, illustrating the potential of genetically modified C. burnetii as improved WCVs.
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Affiliation(s)
- Carrie M Long
- Coxiella Pathogenesis Section, Laboratory of Bacteriology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA.
| | - Paul A Beare
- Coxiella Pathogenesis Section, Laboratory of Bacteriology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Diane C Cockrell
- Coxiella Pathogenesis Section, Laboratory of Bacteriology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Jonathan Fintzi
- Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Mahelat Tesfamariam
- Coxiella Pathogenesis Section, Laboratory of Bacteriology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Carl I Shaia
- Rocky Mountain Veterinary Branch, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Robert A Heinzen
- Coxiella Pathogenesis Section, Laboratory of Bacteriology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
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15
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Wood CM, Perkins NR, Tozer SJ, Johnson W, Barnes TS, McGowan M, Gibson JS, Alawneh J, Firestone SM, Woldeyohannes SM. Prevalence and spatial distribution of Coxiella burnetii seropositivity in northern Australian beef cattle adjusted for diagnostic test uncertainty. Prev Vet Med 2021; 189:105282. [PMID: 33556799 DOI: 10.1016/j.prevetmed.2021.105282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 01/14/2021] [Accepted: 01/20/2021] [Indexed: 11/24/2022]
Abstract
Q fever is a zoonotic disease caused by infection with Coxiella burnetii transmitted from animals including, but not limited to, cattle, sheep and goats. The infection in cattle is typically sub-clinical with some evidence suggesting associated reproductive loss. There is currently limited data on the true prevalence and distribution of coxiellosis in beef cattle across northern Australia. During this study, 2,012 sera samples from beef cattle managed on commercial farms located in Queensland and the Northern Territory were tested using an indirect immunofluorescent assay (IFA) for serological evidence of IgG antibodies against C. burnetii. Bayesian latent class models were used to estimate the true prevalence, adjusted for diagnostic test sensitivity and specificity and incorporating the hierarchical structure of the cattle within farms and regions. In this study, cattle in the Northern Territory had lower estimated true prevalence than cattle within most regions of Queensland with the exception of south-east Queensland. Results from this study have described the geographic distribution and estimated the true prevalence of antibodies to C. burnetii in a sample of extensively managed beef cattle located across the tropical grazing regions of northern Australia.
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Affiliation(s)
- C M Wood
- The University of Queensland, School of Veterinary Science, Gatton, Queensland, 4343, Australia; Centre for Children's Health Research, Queensland Paediatric Infectious Disease Laboratory, Lady Cilento Research Precinct, South Brisbane, Queensland, 4101, Australia.
| | - N R Perkins
- The University of Queensland, School of Veterinary Science, Gatton, Queensland, 4343, Australia
| | - S J Tozer
- The University of Queensland, School of Veterinary Science, Gatton, Queensland, 4343, Australia; Centre for Children's Health Research, Queensland Paediatric Infectious Disease Laboratory, Lady Cilento Research Precinct, South Brisbane, Queensland, 4101, Australia
| | - W Johnson
- The University of California, Irvine, Department of Statistics, Irvine, CA, 92617, United States
| | - T S Barnes
- The University of Queensland, School of Veterinary Science, Gatton, Queensland, 4343, Australia; The University of Queensland, Queensland Alliance for Agriculture and Food Innovation, Gatton, Queensland, 4343, Australia
| | - M McGowan
- The University of Queensland, School of Veterinary Science, Gatton, Queensland, 4343, Australia
| | - J S Gibson
- The University of Queensland, School of Veterinary Science, Gatton, Queensland, 4343, Australia
| | - J Alawneh
- The University of Queensland, School of Veterinary Science, Gatton, Queensland, 4343, Australia
| | - S M Firestone
- The University of Melbourne, Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, Parkville, Victoria, 3010, Australia
| | - S M Woldeyohannes
- The University of Queensland, School of Veterinary Science, Gatton, Queensland, 4343, Australia
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16
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Alqallaf A, Alhashim A, Alajmi M, Alsaqobi A, Al-Adsani W. Coxiella burnetii Endocarditis in a Patient with Systemic Lupus Erythematosus: A Case Report of a Diagnostic Challenge. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e926699. [PMID: 33318463 PMCID: PMC7749446 DOI: 10.12659/ajcr.926699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 43-year-old Final Diagnosis: Q-fever endocarditis Symptoms: Lower limb edema • shortness of breath Medication: — Clinical Procedure: — Specialty: General and Internal Medicine
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Affiliation(s)
- Ahmed Alqallaf
- Division of Nephrology, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | | | - Mohammad Alajmi
- Department of Internal Medicine, Jaber Al-Ahmed Armed Forces Hospital, Kuwait City, Kuwait
| | - Ameerah Alsaqobi
- Department of Internal Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Wasl Al-Adsani
- Department of Internal Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
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17
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Devaux CA, Osman IO, Million M, Raoult D. Coxiella burnetii in Dromedary Camels ( Camelus dromedarius): A Possible Threat for Humans and Livestock in North Africa and the Near and Middle East? Front Vet Sci 2020; 7:558481. [PMID: 33251255 PMCID: PMC7674558 DOI: 10.3389/fvets.2020.558481] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/28/2020] [Indexed: 01/09/2023] Open
Abstract
The "One Health" concept recognizes that human health is connected to animal health and to the ecosystems. Coxiella burnetii-induced human Q fever is one of the most widespread neglected zoonosis. The main animal reservoirs responsible for C. burnetii transmission to humans are domesticated ruminants, primarily goats, sheep, and cattle. Although studies are still too sparse to draw definitive conclusions, the most recent C. burnetii serosurvey studies conducted in herds and farms in Africa, North Africa, Arabian Peninsula, and Asia highlighted that seroprevalence was strikingly higher in dromedary camels (Camelus dromedarius) than in other ruminants. The C. burnetii seroprevalence in camel herds can reach more than 60% in Egypt, Saudi Arabia, and Sudan, and 70 to 80% in Algeria and Chad, respectively. The highest seroprevalence was in female camels with a previous history of abortion. Moreover, C. burnetii infection was reported in ticks of the Hyalomma dromedarii and Hyalomma impeltatum species collected on camels. Even if dromedary camels represent <3% of the domesticated ruminants in the countries of the Mediterranean basin Southern coast, these animals play a major socioeconomic role for millions of people who live in the arid zones of Africa, Middle East, and Asia. In Chad and Somalia, camels account for about 7 and 21% of domesticated ruminants, respectively. To meet the growing consumers demand of camel meat and milk (>5 million tons/year of both raw and pasteurized milk according to the Food and Agriculture Organization) sustained by a rapid increase of population (growth rate: 2.26-3.76 per year in North Africa), dromedary camel breeding tends to increase from the Maghreb to the Arabic countries. Because of possible long-term persistence of C. burnetii in camel hump adipocytes, this pathogen could represent a threat for herds and breeding farms and ultimately for public health. Because this review highlights a hyperendemia of C. burnetii in dromedary camels, a proper screening of herds and breeding farms for C. burnetii is urgently needed in countries where camel breeding is on the rise. Moreover, the risk of C. burnetii transmission from camel to human should be further evaluated.
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Affiliation(s)
- Christian A. Devaux
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
- CNRS, Marseille, France
| | - Ikram Omar Osman
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
- Faculty of Sciences Ben-Ben-M'Sik, University Hassan II, Casablanca, Morocco
| | - Matthieu Million
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Didier Raoult
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
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18
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Clark NJ, Tozer S, Wood C, Firestone SM, Stevenson M, Caraguel C, Chaber AL, Heller J, Soares Magalhães RJ. Unravelling animal exposure profiles of human Q fever cases in Queensland, Australia, using natural language processing. Transbound Emerg Dis 2020; 67:2133-2145. [PMID: 32259390 DOI: 10.1111/tbed.13565] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/11/2020] [Accepted: 03/28/2020] [Indexed: 11/28/2022]
Abstract
Q fever, caused by the zoonotic bacterium Coxiella burnetii, is a globally distributed emerging infectious disease. Livestock are the most important zoonotic transmission sources, yet infection in people without livestock exposure is common. Identifying potential exposure pathways is necessary to design effective interventions and aid outbreak prevention. We used natural language processing and graphical network methods to provide insights into how Q fever notifications are associated with variation in patient occupations or lifestyles. Using an 18-year time-series of Q fever notifications in Queensland, Australia, we used topic models to test whether compositions of patient answers to follow-up exposure questionnaires varied between demographic groups or across geographical areas. To determine heterogeneity in possible zoonotic exposures, we explored patterns of livestock and game animal co-exposures using Markov Random Fields models. Finally, to identify possible correlates of Q fever case severity, we modelled patient probabilities of being hospitalized as a function of particular exposures. Different demographic groups consistently reported distinct sets of exposure terms and were concentrated in different areas of the state, suggesting the presence of multiple transmission pathways. Macropod exposure was commonly reported among Q fever cases, even when exposure to cattle, sheep or goats was absent. Males, older patients and those that reported macropod exposure were more likely to be hospitalized due to Q fever infection. Our study indicates that follow-up surveillance combined with text modelling is useful for unravelling exposure pathways in the battle to reduce Q fever incidence and associated morbidity.
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Affiliation(s)
- Nicholas J Clark
- UQ Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Qld, Australia
| | - Sarah Tozer
- Queensland Centre for Gynaecological Cancer, The University of Queensland, Qld, Australia
| | - Caitlin Wood
- UQ Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Qld, Australia
| | - Simon M Firestone
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Vic., Australia
| | - Mark Stevenson
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Vic., Australia
| | - Charles Caraguel
- School of Animal and Veterinary Science, The University of Adelaide, Adelaide, SA, Australia
| | - Anne-Lise Chaber
- School of Animal and Veterinary Science, The University of Adelaide, Adelaide, SA, Australia
| | - Jane Heller
- Graham Centre for Agricultural Innovation, School of Animal and Veterinary Sciences, Charles Sturt University, Wagga, NSW, Australia
| | - Ricardo J Soares Magalhães
- UQ Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Qld, Australia
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Qld, Australia
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19
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Dhawan S, Robinson MT, Stenos J, Graves SR, Wangrangsimakul T, Newton PN, Day NPJ, Blacksell SD. Selection of Diagnostic Cutoffs for Murine Typhus IgM and IgG Immunofluorescence Assay: A Systematic Review. Am J Trop Med Hyg 2020; 103:55-63. [PMID: 32274984 PMCID: PMC7356422 DOI: 10.4269/ajtmh.19-0818] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/18/2020] [Indexed: 11/16/2022] Open
Abstract
Murine typhus is a neglected but widespread infectious disease that results in acute fever. The immunofluorescence assay (IFA) is the "gold standard" to identify IgM or IgG antibodies, although there is a lack of standardization in methodologies. The objective of this review is to summarize 1) the differences in published methodologies, 2) the diagnostic cutoff titers, and 3) the justification of diagnostic cutoffs. Searches were performed by combining the following search terms: "murine typhus," "rickettsia typhi," "immunofluorescence," "IFA," and "serologic" with restrictions (i.e., "rickettsia typhi" or "murine typhus," and "IFA" or "immunofluorescence," or "serologic*"). The search identified 78 studies that used IFA or immunoperoxidase assay (IIP) antibody cutoffs to diagnose murine typhus, 39 of which were case series. Overall, 45 studies (57.7%) provided little to no rationale as to how the cutoff was derived. Variation was seen locally in the cutoff titers used, but a 4-fold or greater increase was often applied. The cutoffs varied depending on the antibody target. No consensus was observed in establishing a cutoff, or for a single-value diagnostic cutoff. In conclusion, there is a lack of consensus in the establishment of a single-value cutoff. Further studies will need to be executed at each distinct geographic location to identify region-specific cutoffs, while also considering background antibody levels to distinguish between healthy and infected patients.
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Affiliation(s)
- Sandhya Dhawan
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Matthew T. Robinson
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - John Stenos
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, Australia
| | - Stephen R. Graves
- Australian Rickettsial Reference Laboratory, University Hospital Geelong, Geelong, Australia
| | - Tri Wangrangsimakul
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Paul N. Newton
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - Nicholas P. J. Day
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stuart D. Blacksell
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
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20
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Gong XQ, Xiao X, Liu JW, Han HJ, Qin XR, Lei SC, Yu XJ. Occurrence and Genotyping of Coxiella burnetii in Hedgehogs in China. Vector Borne Zoonotic Dis 2020; 20:580-585. [PMID: 32301684 DOI: 10.1089/vbz.2019.2589] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Coxiella burnetii is the causative agent of query fever (Q fever), and distributes broadly in environment. Livestock are identified as main reservoirs, which may infect people through their contaminative urine, feces, milk, and birth products. Wild animals can also be the potential carriers and transmitters of C. burnetii. To understand the geographic distribution and host species of C. burnetii in China, we investigated the prevalence of C. burnetii in hedgehogs (Erinaceus amurensis) in Hubei Province. Hedgehogs were tested for C. burnetii with PCR targeting three genes (com1, rrs, and icd) followed by multispacer sequence typing (MST). We found that 12.2% (5/41) hedgehogs were PCR positive for C. burnetii. MST revealed presence of two novel genotypes and phylogenetic analysis revealed that the strains were similar to a group of isolates from chronic Q fever patients and mammals. This study showed that C. burnetii are highly prevalent in hedgehogs in Hubei Province in central China, suggesting that hedgehogs may play an important role in the ecology and transmission of C. burnetii to humans because it is captured and used as traditional medicine in China.
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Affiliation(s)
- Xiao-Qing Gong
- State Key Laboratory of Virology, School of Health Sciences, Wuhan University, Wuhan, China
| | - Xiao Xiao
- State Key Laboratory of Virology, School of Health Sciences, Wuhan University, Wuhan, China.,Lab Animal Research Center, Hubei University of Chinese Medicine, Wuhan, China
| | - Jian-Wei Liu
- State Key Laboratory of Virology, School of Health Sciences, Wuhan University, Wuhan, China
| | - Hui-Ju Han
- State Key Laboratory of Virology, School of Health Sciences, Wuhan University, Wuhan, China
| | - Xiang-Rong Qin
- State Key Laboratory of Virology, School of Health Sciences, Wuhan University, Wuhan, China
| | - Si-Cong Lei
- State Key Laboratory of Virology, School of Health Sciences, Wuhan University, Wuhan, China
| | - Xue-Jie Yu
- State Key Laboratory of Virology, School of Health Sciences, Wuhan University, Wuhan, China
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21
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Abstract
Q fever (caused by Coxiella burnetii) is thought to have an almost world-wide distribution, but few countries have conducted national serosurveys. We measured Q fever seroprevalence using residual sera from diagnostic laboratories across Australia. Individuals aged 1–79 years in 2012–2013 were sampled to be proportional to the population distribution by region, distance from metropolitan areas and gender. A 1/50 serum dilution was tested for the Phase II IgG antibody against C. burnetii by indirect immunofluorescence. We calculated crude seroprevalence estimates by age group and gender, as well as age standardised national and metropolitan/non-metropolitan seroprevalence estimates. Of 2785 sera, 99 tested positive. Age standardised seroprevalence was 5.6% (95% confidence interval (CI 4.5%–6.8%), and similar in metropolitan (5.5%; 95% CI 4.1%–6.9%) and non-metropolitan regions (6.0%; 95%CI 4.0%–8.0%). More males were seropositive (6.9%; 95% CI 5.2%–8.6%) than females (4.2%; 95% CI 2.9%–5.5%) with peak seroprevalence at 50–59 years (9.2%; 95% CI 5.2%–13.3%). Q fever seroprevalence for Australia was higher than expected (especially in metropolitan regions) and higher than estimates from the Netherlands (2.4%; pre-outbreak) and US (3.1%), but lower than for Northern Ireland (12.8%). Robust country-specific seroprevalence estimates, with detailed exposure data, are required to better understand who is at risk and the need for preventive measures.
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22
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Long CM, Beare PA, Cockrell DC, Larson CL, Heinzen RA. Comparative virulence of diverse Coxiella burnetii strains. Virulence 2019; 10:133-150. [PMID: 30782062 PMCID: PMC6389282 DOI: 10.1080/21505594.2019.1575715] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/23/2019] [Accepted: 01/24/2019] [Indexed: 12/31/2022] Open
Abstract
Coxiella burnetii is an intracellular, gram-negative bacterium that causes the zoonosis Q fever. This disease typically presents as an acute flu-like illness with persistent, focalized infections occurring less frequently. Clinical outcomes of Q fever have been associated with distinct genomic groups of C. burnetii, suggesting that gene content is responsible for virulence potential. To investigate this hypothesis, the virulence of thirteen C. burnetii strains (representing genomic groups I-VI) was evaluated in a guinea pig infection model by intraperitoneal injection. Seven strains caused a sustained fever (at least two days ≥39.5°C) in at least half of the animals within each experimental group. At fourteen days post infection, animals were euthanized and additional endpoints were evaluated, including splenomegaly and serology. The magnitude of these endpoints roughly correlated with the onset, duration, and severity of fever. The most severe disease was caused by group I strains. Intermediate and no virulence were evidenced following infection with group II-V and group VI strains, respectively. Flow cytometric analysis of the mesenteric lymph nodes revealed decreased CD4+ T cell frequency following infection with highly virulent group I strains. These findings buttress the hypothesis that the pathogenic potential of C. burnetii strains correlates with genomic grouping. These data, combined with comparative genomics and genetic manipulation, will improve our understanding of C. burnetii virulence determinants.
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Affiliation(s)
- Carrie M Long
- Coxiella Pathogenesis Section, Laboratory of Bacteriology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Paul A Beare
- Coxiella Pathogenesis Section, Laboratory of Bacteriology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Diane C Cockrell
- Coxiella Pathogenesis Section, Laboratory of Bacteriology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Charles L Larson
- Coxiella Pathogenesis Section, Laboratory of Bacteriology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Robert A Heinzen
- Coxiella Pathogenesis Section, Laboratory of Bacteriology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
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23
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Gidding HF, Faddy HM, Durrheim DN, Graves SR, Nguyen C, Hutchinson P, Massey P, Wood N. Seroprevalence of Q fever among metropolitan and non‐metropolitan blood donors in New South Wales and Queensland, 2014–2015. Med J Aust 2019; 210:309-315. [DOI: 10.5694/mja2.13004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/13/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Heather F Gidding
- Northern Clinical SchoolUniversity of Sydney Sydney NSW
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases Sydney NSW
| | | | | | - Stephen R Graves
- Australian Rickettsial Reference LaboratoryUniversity Hospital Geelong VIC
| | - Chelsea Nguyen
- Australian Rickettsial Reference LaboratoryUniversity Hospital Geelong VIC
| | | | - Peter Massey
- Hunter New England Local Health District Newcastle NSW
- University of New England Armidale NSW
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases Sydney NSW
- University of Sydney Sydney NSW
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24
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Genova-Kalou P, Ivanova S, Pavlova A, Simeonov K, Pencheva D, Yotovska K. Role of Coxiella burnetii in the development of fever of unknown origin: А mini review. BULGARIAN JOURNAL OF VETERINARY MEDICINE 2019. [DOI: 10.15547/bjvm.2036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Q fever is a widespread zoonosis throughout the world in the form of numerous natural and agricul-tural outbreaks. C. burnetii infects various hosts, including humans, ruminants and pets and in rare cases, reptiles, birds, and ticks. This bacterium is excreted in urine, milk, faeces, and birth products. In humans Q fever occurs as acute or chronic disease with diverse clinical presentation, as isolated cases and epidemics. It affects various organs and systems, and in pregnant women can cause miscar-riage or premature birth. Untreated Q fever can become chronic with adverse effects on patients. Diversity in the clinical picture in the absence of specific pathological syndrome often hinders accurate diagnosis and proper etiological significance. Therefore, improvement of diagnostic methods and in particular the development and introduction of new molecular diagnostic methods is the basis of effective therapeutic and prophylactic approach. Тhe purpose of the review is to renew the interest to Q fever – on one hand, because of its serious impact on human health and agricultural systems, and on the other, the ability for development and introduction of new molecular diagnostic methods.
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25
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González-Barrio D, Ruiz-Fons F. Coxiella burnetii in wild mammals: A systematic review. Transbound Emerg Dis 2018; 66:662-671. [PMID: 30506629 DOI: 10.1111/tbed.13085] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 12/26/2022]
Abstract
Coxiella burnetii is a multi-host bacterium that causes Q fever in humans, a zoonosis that is emerging worldwide. The ecology of C. burnetii in wildlife is still poorly understood and the influence of host, environmental and pathogen factors is almost unknown. This study gathers current published information on different aspects of C. burnetii infection in wildlife, even in species with high reservoir potential and a high rate of interaction with livestock and humans, in order to partially fill the existing gap and highlight future needs. Exposure and/or infection by C. burnetii has, to date, been reported in 109 wild mammal species. The limited sample size of most of the existing studies could suggest an undervalued prevalence of C. burnetii infection. Knowledge on the clinical outcome of C. burnetii infection in wildlife is also very limited, but currently includes reproductive failure in waterbuck (Kobus ellipsiprymnus), roan antelope (Hippotragus niger), dama gazelle (Nanger dama) and water buffalo (Bubalus bubalis) and placentitis in the Pacific harbor seal (Phoca vitulina richardsi), Steller sea lion (Eumetopias jubatus) and red deer (Cervus elaphus). The currently available serological tests need to be optimised and validated for each wildlife species. Finally, there is a huge gap in the research on C. burnetii control in wildlife, despite of the increasing evidence that wildlife is a source of C. burnetii for both livestock and humans.
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Affiliation(s)
- David González-Barrio
- Health & Biotechnology (SaBio) Group, Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM), Ciudad Real, Spain
| | - Francisco Ruiz-Fons
- Health & Biotechnology (SaBio) Group, Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM), Ciudad Real, Spain
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26
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Sex and bacterial infectious diseases. New Microbes New Infect 2018; 26:S100-S103. [PMID: 30402251 PMCID: PMC6205577 DOI: 10.1016/j.nmni.2018.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/20/2018] [Accepted: 05/16/2018] [Indexed: 12/29/2022] Open
Abstract
Most infectious diseases are unequally distributed between male and female subjects. This sex dimorphism is confirmed by epidemiologic studies which suggest an increased number of male septic patients, while, due to the class age of septic patients, an overrepresentation of female patients would be expected. Lifestyle, recreational activities, professional exposition and access to care are plausible reasons for this dimorphism. However, biological differences should be carefully considered, particularly the weight of X-linked variability and the role of sex hormones. Animal models clearly show that clinical response to infection is more exuberant in males than in females. This is partly explained by an attenuation of the inflammatory response by female sex hormones. However, the translation from experimental studies to the bedside remains challenging as a result of confounding factors like age, hormone changes and response to treatment.
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27
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Pijnacker R, Reimerink J, Smit LAM, van Gageldonk-Lafeber AB, Zock JP, Borlée F, Yzermans J, Heederik DJJ, Maassen CBM, van der Hoek W. Remarkable spatial variation in the seroprevalence of Coxiella burnetii after a large Q fever epidemic. BMC Infect Dis 2017; 17:725. [PMID: 29157226 PMCID: PMC5697089 DOI: 10.1186/s12879-017-2813-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 11/02/2017] [Indexed: 11/25/2022] Open
Abstract
Background Prior to the 2007–2010 Q fever epidemic in the Netherlands, the seroprevalence of antibodies against Coxiella burnetii in the general population was 1.5%, which is low compared to other countries. We aimed to determine the seroprevalence after the Q fever epidemic among people living in the affected area, compare the seroprevalence with the incidence of Q fever notifications during the 2007–2010 Q fever epidemic, and to identify farm exposures associated with having antibodies against C. burnetii. Methods During the period March 2014–February 2015, residents aged 18–70 years from two provinces were invited by general practitioners to complete a questionnaire on their symptoms and personal characteristics and to submit a blood sample. We used the mandatory provincial database of livestock licences to calculate distance to farms/farm animals for each participant. To compare ELISA-positive participants for C. burnetii antibodies with those who were negative, we calculated prevalence ratios (PR) using binominal regression. We compared the C. burnetii seroprevalence in the period March 2014–February 2015 with the incidence of Q fever notifications during the 2007–2010 Q fever epidemic at municipal level by calculating the Spearman correlation coefficient. Results Of the 2296 participants (response rate: 34%), 6.1% (n = 139, 95% CI 5.1–7.1%) had C. burnetii antibodies (range in municipalities: 1.7–14.1%). C. burnetii seroprevalence was higher in individuals living within 1000 m of goat farms (PR 3.0; 95% CI 1.4–6.4) or within 1000 m of > 50 goats (PR 1.9; 95% CI 1.2–3.0). Seroprevalence increased with decreasing distance to the closest goat farm that was infected during the epidemic years (< 500 m, PR 9.5, 95% CI 2.8–32; 500–1000 m, PR 4.5, 95% CI 2.6–7.7; 1000–1500 m, PR 2.2, 95% CI 1.1–4.3, 1500–2000 m, PR 1.2, 95% CI 0.6–2.5; > 2000 reference group). There was no significant correlation between C. burnetii seroprevalence and Q fever incidence during the 2007–2010 epidemic (rs = 0.42, p = 0.156). Conclusions Results showed a remarkable spatial variation in C. burnetii seroprevalence in a relatively small livestock dense area. It confirms previous evidence that the Q fever epidemic was primarily the result of airborne C. burnetii transmission from Q fever affected goat farms.
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Affiliation(s)
- Roan Pijnacker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, (RIVM), PO Box 1, 3720 BA, Bilthoven, the Netherlands. .,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden.
| | - Johan Reimerink
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, (RIVM), PO Box 1, 3720 BA, Bilthoven, the Netherlands
| | - Lidwien A M Smit
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Arianne B van Gageldonk-Lafeber
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, (RIVM), PO Box 1, 3720 BA, Bilthoven, the Netherlands
| | - Jan-Paul Zock
- Netherlands Institute for Health Services Research, (NIVEL), Utrecht, the Netherlands
| | - Floor Borlée
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.,Netherlands Institute for Health Services Research, (NIVEL), Utrecht, the Netherlands
| | - Joris Yzermans
- Netherlands Institute for Health Services Research, (NIVEL), Utrecht, the Netherlands
| | - Dick J J Heederik
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Catharina B M Maassen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, (RIVM), PO Box 1, 3720 BA, Bilthoven, the Netherlands
| | - Wim van der Hoek
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, (RIVM), PO Box 1, 3720 BA, Bilthoven, the Netherlands
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28
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Oliveira RD, Mousel MR, Pabilonia KL, Highland MA, Taylor JB, Knowles DP, White SN. Domestic sheep show average Coxiella burnetii seropositivity generations after a sheep-associated human Q fever outbreak and lack detectable shedding by placental, vaginal, and fecal routes. PLoS One 2017; 12:e0188054. [PMID: 29141023 PMCID: PMC5687729 DOI: 10.1371/journal.pone.0188054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 10/31/2017] [Indexed: 12/21/2022] Open
Abstract
Coxiella burnetii is a globally distributed zoonotic bacterial pathogen that causes abortions in ruminant livestock. In humans, an influenza-like illness results with the potential for hospitalization, chronic infection, abortion, and fatal endocarditis. Ruminant livestock, particularly small ruminants, are hypothesized to be the primary transmission source to humans. A recent Netherlands outbreak from 2007–2010 traced to dairy goats resulted in over 4,100 human cases with estimated costs of more than 300 million euros. Smaller human Q fever outbreaks of small ruminant origin have occurred in the United States, and characterizing shedding is important to understand the risk of future outbreaks. In this study, we assessed bacterial shedding and seroprevalence in 100 sheep from an Idaho location associated with a 1984 human Q fever outbreak. We observed 5% seropositivity, which was not significantly different from the national average of 2.7% for the U.S. (P>0.05). Furthermore, C. burnetii was not detected by quantitative PCR from placentas, vaginal swabs, or fecal samples. Specifically, a three-target quantitative PCR of placenta identified 0.0% shedding (exact 95% confidence interval: 0.0%-2.9%). While presence of seropositive individuals demonstrates some historical C. burnetii exposure, the placental sample confidence interval suggests 2016 shedding events were rare or absent. The location maintained the flock with little or no depopulation in 1984 and without C. burnetii vaccination during or since 1984. It is not clear how a zero-shedding rate was achieved in these sheep beyond natural immunity, and more work is required to discover and assess possible factors that may contribute towards achieving zero-shedding status. We provide the first U.S. sheep placental C. burnetii shedding update in over 60 years and demonstrate potential for C. burnetii shedding to reach undetectable levels after an outbreak event even in the absence of targeted interventions, such as vaccination.
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Affiliation(s)
- Ryan D Oliveira
- Department of Veterinary Microbiology & Pathology, Washington State University, Pullman, Washington, United States of America
| | - Michelle R Mousel
- USDA-ARS Animal Disease Research, Pullman, Washington, United States of America.,Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
| | - Kristy L Pabilonia
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | - Margaret A Highland
- USDA-ARS Animal Disease Research, Pullman, Washington, United States of America.,Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America.,Washington Animal Disease Diagnostic Laboratory, Washington State University, Pullman, Washington, United States of America
| | - J Bret Taylor
- USDA-ARS Range Sheep Production Efficiency Research, Dubois, Idaho, United States of America
| | - Donald P Knowles
- Department of Veterinary Microbiology & Pathology, Washington State University, Pullman, Washington, United States of America.,USDA-ARS Animal Disease Research, Pullman, Washington, United States of America.,Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
| | - Stephen N White
- Department of Veterinary Microbiology & Pathology, Washington State University, Pullman, Washington, United States of America.,USDA-ARS Animal Disease Research, Pullman, Washington, United States of America.,Center for Reproductive Biology, Washington State University, Pullman, Washington, United States of America
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29
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Muema J, Thumbi SM, Obonyo M, Wanyoike S, Nanyingi M, Osoro E, Bitek A, Karanja S. Seroprevalence and Factors Associated with Coxiella burnetii Infection in Small Ruminants in Baringo County, Kenya. Zoonoses Public Health 2017; 64:e31-e43. [PMID: 28117947 DOI: 10.1111/zph.12342] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Indexed: 01/06/2023]
Abstract
To improve estimates of C. burnetii epidemiology in Kenya, a survey was undertaken in small ruminants in Baringo County, where acute cases of Q fever in humans had been reported in 2014. From 140 household herds selected, 508 (60.5%) goats and 332 (39.5%) sheep were included and an indirect ELISA assay for C. burnetii IgG antibodies performed. In addition, epidemiological information at both herd and animal level was collected. Generalized mixed-effects multivariable logistic model using herd as the random effect was used to determine variables correlated to the outcome. Overall seroprevalence was 20.5% (95% CI: 17.8%, 23.3%). Goats had 26.0% (95% CI: 22.2%, 30.0%) compared to sheep 12.2% (95% CI: 8.7%, 16.0%). Nomadic pastoralism, goats and older animals (>1 year) were associated with greater risk of C. burnetii seropositivity (P = ≤0.05). Heterogeneity in C. burnetii seropositivity was observed across the sublocations (P = 0.028). Evidence of C. burnetii exposure in small ruminants revealed poses a potential risk of exposure to the people living in close proximity to the animals. We recommended integrated animal-human surveillance and socio-economic studies for C. burnetii, to aid our understanding of the risk of transmission between the animals and humans, and in the design of prevention and control strategies for the disease in the region.
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Affiliation(s)
- J Muema
- Field Epidemiology and Laboratory Training Program (FELTP), Nairobi, Kenya.,Zoonotic Disease Unit, Directorate of Veterinary Service, Nairobi, Kenya.,College of Health Sciences, Jomo Kenyatta University of Agriculture & Technology, Nairobi, Kenya
| | - S M Thumbi
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,Center for Global Health Research, Kenya Medical Research Institute, Kenya
| | - M Obonyo
- Field Epidemiology and Laboratory Training Program (FELTP), Nairobi, Kenya.,Zoonotic Disease Unit, Directorate of Veterinary Service, Nairobi, Kenya
| | - S Wanyoike
- Directorate of Veterinary Services, Nairobi, Kenya
| | - M Nanyingi
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Kenya.,Department of Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - E Osoro
- Zoonotic Disease Unit, Department of Preventive and Promotive Health Services, Ministry of Health, Nairobi, Kenya
| | - A Bitek
- Zoonotic Disease Unit, Directorate of Veterinary Service, Nairobi, Kenya
| | - S Karanja
- College of Health Sciences, Jomo Kenyatta University of Agriculture & Technology, Nairobi, Kenya
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30
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Tomizawa R, Sugiyama H, Sato R, Ohnishi M, Koizumi N. Male-specific pulmonary hemorrhage and cytokine gene expression in golden hamster in early-phase Leptospira interrogans serovar Hebdomadis infection. Microb Pathog 2017; 111:33-40. [PMID: 28811249 DOI: 10.1016/j.micpath.2017.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/11/2017] [Accepted: 08/11/2017] [Indexed: 01/19/2023]
Abstract
Leptospirosis causes severe clinical signs more frequently in men than in women, but the mechanism underlying the gender differences in leptospirosis remains unclear. In this study, petechial hemorrhage was observed in male but not in female hamster lung tissues infected with Leptospira interrogans serovar Hebdomadis at 120 h pi, demonstrating that male hamsters were more susceptible to the development of a severe disease upon Leptospira infection. No leptospiral DNA was detected in the lung tissues at 120 h pi when pulmonary hemorrhage was observed, indicating that pulmonary hemorrhage is attributable to the immune reactions of the host rather than from the direct effect of leptospires. The upregulation of nitric oxide synthase genes in the hamsters without pulmonary hemorrhage, inos and enos in female hamsters at 96 h pi and enos in male animals without hemorrhage at 120 h pi, may suggest that nitric oxide has a suppressive effect on leptospirosis-associated pulmonary hemorrhage.
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Affiliation(s)
- Rina Tomizawa
- Graduate School of Bio-Applications & Systems Engineering, Tokyo University of Agriculture and Technology, 2-24-16 Naka-cho, Koganei, Tokyo, 184-8588, Japan; Department of Bacteriology I, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo, 162-8640, Japan.
| | - Hiromu Sugiyama
- Department of Parasitology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo, 162-8640, Japan.
| | - Ryoichi Sato
- Graduate School of Bio-Applications & Systems Engineering, Tokyo University of Agriculture and Technology, 2-24-16 Naka-cho, Koganei, Tokyo, 184-8588, Japan.
| | - Makoto Ohnishi
- Department of Bacteriology I, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo, 162-8640, Japan.
| | - Nobuo Koizumi
- Department of Bacteriology I, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo, 162-8640, Japan.
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31
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Characteristics of scrub typhus, murine typhus, and Q fever among elderly patients: Prolonged prothrombin time as a predictor for severity. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 52:54-61. [PMID: 28709838 DOI: 10.1016/j.jmii.2016.08.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 08/25/2016] [Accepted: 08/31/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND/PURPOSE The clinical manifestations of scrub typhus, murine typhus and acute Q fever in the elderly are not clear. METHODS We conducted a retrospective study to identify the characteristics of the elderly aged ≥65 years with a comparison group aged 18-64 years among patients with scrub typhus, murine typhus, or acute Q fever who were serologically confirmed at three hospitals in Taiwan during 2002-2011. RESULTS Among 441 cases, including 187 cases of scrub typhus, 166 acute Q fever, and 88 murine typhus, 68 (15.4%) cases were elderly patients. The elderly had a higher severe complication rate (10.3% vs. 3.5%, p = 0.022), but did not have a significantly higher mortality rate (1.47% vs. 0.54%, p = 0.396). Compared with those without severe complications, we found the elderly (p = 0.022), dyspnea (p = 0.006), less relative bradycardia (p = 0.004), less febrile illness (p = 0.004), prolonged prothrombin time (PT) (p = 0.002), higher levels of initial C-reactive protein (p = 0.039), blood leukocyte counts (p = 0.01), and lower platelet counts (p = 0.012) are significantly associated with severe complications. Only prolonged prothrombin time was associated with severe complications in multivariate analysis (p = 0.018, CI 95% 0.01-0.66). Among clinical symptoms and laboratory data, multivariate analysis revealed chills was less frequently occurred in the elderly (p = 0.012, 95% confidence interval [CI]: 1.33-9.99). CONCLUSION The elderly cases with scrub typhus, murine typhus, or acute Q fever would be more likely to have severe complications, for which prothrombin time prolongation is an important predictor for severe complications.
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32
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Han X, Hsu J, Miao Q, Zhou BT, Fan HW, Xiong XL, Wen BH, Wu L, Yan XW, Fang Q, Chen W. Retrospective Examination of Q Fever Endocarditis: An Underdiagnosed Disease in the Mainland of China. Chin Med J (Engl) 2017; 130:64-70. [PMID: 28051025 PMCID: PMC5221114 DOI: 10.4103/0366-6999.196566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: Q fever endocarditis, a chronic illness caused by Coxiella burnetii, can be fatal if misdiagnosed or left untreated. Despite a relatively high positive rate of Q fever serology in healthy individuals in the mainland of China, very few cases of Q fever endocarditis have been reported. This study summarized cases of Q fever endocarditis among blood culture negative endocarditis (BCNE) patients and discussed factors attributing to the low diagnostic rate. Methods: We identified confirmed cases of Q fever endocarditis among 637 consecutive patients with infective endocarditis (IE) in the Peking Union Medical College Hospital between 2006 and 2016. The clinical findings for each confirmed case were recorded. BCNE patients were also examined and each BCNE patient's Q fever risk factors were identified. The risk factors and presence of Q fever serologic testing between BCNE patients suspected and unsuspected of Q fever were compared using the Chi-squared or Chi-squared with Yates’ correction for continuity. Results: Among the IE patients examined, there were 147 BCNE patients, of whom only 11 patients (7.5%) were suspected of Q fever and undergone serological testing for C. burnetii. Six out of 11 suspected cases were diagnosed as Q fever endocarditis. For the remaining136 BCNE patients, none of them was suspected of Q fever nor underwent relevant testing. Risk factors for Q fever endocarditis were comparable between suspected and unsuspected patients, with the most common risk factors being valvulopathy in both groups. However, significantly more patients had consulted the Infectious Diseases Division and undergone comprehensive diagnostic tests in the suspected group than the unsuspected group (100% vs. 63%, P = 0.03). Conclusions: Q fever endocarditis is a serious yet treatable condition. Lacking awareness of the disease may prevent BCNE patients from being identified, despite having Q fever risk factors. Increasing awareness and guideline adherence are crucial in avoiding misdiagnosing and missed diagnosing of the disease.
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Affiliation(s)
- Xiao Han
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Jeffrey Hsu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Qi Miao
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Bao-Tong Zhou
- Department of Infection, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Hong-Wei Fan
- Department of Infection, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiao-Lu Xiong
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Bo-Hai Wen
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Lian Wu
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiao-Wei Yan
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Quan Fang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Wei Chen
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Faruque LI, Zaman RU, Gurley ES, Massung RF, Alamgir ASM, Galloway RL, Powers AM, Bai Y, Kosoy M, Nicholson WL, Rahman M, Luby SP. Prevalence and clinical presentation of Rickettsia, Coxiella, Leptospira, Bartonella and chikungunya virus infections among hospital-based febrile patients from December 2008 to November 2009 in Bangladesh. BMC Infect Dis 2017; 17:141. [PMID: 28193163 PMCID: PMC5307764 DOI: 10.1186/s12879-017-2239-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/02/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND We conducted a study to identify Rickettsia, Coxiella, Leptospira, Bartonella, and Chikungunya virus infections among febrile patients presenting at hospitals in Bangladesh. METHODS We collected blood samples from patients at six tertiary hospitals from December 2008 to November 2009 and performed laboratory tests at the United States Centers for Disease Control and Prevention (CDC). RESULTS Out of 720 enrolled patients, 263 (37%) were infected with Rickettsia; 132 patients had immunofluorescence antibody titer >64 against spotted fever, 63 patients against scrub typhus fever and 10 patients against typhus fever. Ten patients were identified with Coxiella. We isolated Leptospira from two patients and Bartonella from one patient. Ten patients had antibodies against Chikungunya virus. The proportion of patients who died was higher with rickettsial fever (5%) compared to those without a diagnosis of rickettsial infection (2%). None of the patients were initially diagnosed with rickettsial fever. CONCLUSIONS Rickettsial infections are frequent yet under-recognized cause of febrile illness in Bangladesh. Clinical guidelines should be revised so that local clinicians can diagnose rickettsial infections and provide appropriate drug treatment.
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Affiliation(s)
- Labib Imran Faruque
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rashid Uz Zaman
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Emily S. Gurley
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - A. S. M. Alamgir
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | | | - Ann M. Powers
- Centers for Disease Control and Prevention (CDC), Atlanta, GA USA
| | - Ying Bai
- Centers for Disease Control and Prevention (CDC), Atlanta, GA USA
| | - Michael Kosoy
- Centers for Disease Control and Prevention (CDC), Atlanta, GA USA
| | | | - Mahmudur Rahman
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Stephen P. Luby
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Eldin C, Mélenotte C, Mediannikov O, Ghigo E, Million M, Edouard S, Mege JL, Maurin M, Raoult D. From Q Fever to Coxiella burnetii Infection: a Paradigm Change. Clin Microbiol Rev 2017; 30:115-190. [PMID: 27856520 PMCID: PMC5217791 DOI: 10.1128/cmr.00045-16] [Citation(s) in RCA: 550] [Impact Index Per Article: 78.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Coxiella burnetii is the agent of Q fever, or "query fever," a zoonosis first described in Australia in 1937. Since this first description, knowledge about this pathogen and its associated infections has increased dramatically. We review here all the progress made over the last 20 years on this topic. C. burnetii is classically a strict intracellular, Gram-negative bacterium. However, a major step in the characterization of this pathogen was achieved by the establishment of its axenic culture. C. burnetii infects a wide range of animals, from arthropods to humans. The genetic determinants of virulence are now better known, thanks to the achievement of determining the genome sequences of several strains of this species and comparative genomic analyses. Q fever can be found worldwide, but the epidemiological features of this disease vary according to the geographic area considered, including situations where it is endemic or hyperendemic, and the occurrence of large epidemic outbreaks. In recent years, a major breakthrough in the understanding of the natural history of human infection with C. burnetii was the breaking of the old dichotomy between "acute" and "chronic" Q fever. The clinical presentation of C. burnetii infection depends on both the virulence of the infecting C. burnetii strain and specific risks factors in the infected patient. Moreover, no persistent infection can exist without a focus of infection. This paradigm change should allow better diagnosis and management of primary infection and long-term complications in patients with C. burnetii infection.
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Affiliation(s)
- Carole Eldin
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Cléa Mélenotte
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Oleg Mediannikov
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Eric Ghigo
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Matthieu Million
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Sophie Edouard
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Jean-Louis Mege
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
| | - Max Maurin
- Institut de Biologie et de Pathologie, CHU de Grenoble, Grenoble, France
| | - Didier Raoult
- URMITE, UMR CNRS 7278, IRD 198, INSERM U1095, Faculté de Médecine, Marseille, France
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BRANDWAGT DAH, HERREMANS T, SCHNEEBERGER PM, HACKERT VH, HOEBE CJPA, PAGET J, VAN DER HOEK W. Waning population immunity prior to a large Q fever epidemic in the south of The Netherlands. Epidemiol Infect 2016; 144:2866-72. [PMID: 27075042 PMCID: PMC9150411 DOI: 10.1017/s0950268816000741] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 02/11/2016] [Accepted: 03/22/2016] [Indexed: 11/07/2022] Open
Abstract
Historical survey data suggest that the seroprevalence of antibodies against Coxiella burnetii in the general population of The Netherlands decreased from more than 40% in 1983 to 2·4% in 2007, just before the start of the large 2007-2010 Q fever epidemic. To assess whether the sharp decline in seroprevalence was real, we performed a cross-sectional study using historical samples. We tested samples using a contemporary commercial indirect immunofluorescence assay. In plasma samples from the south of The Netherlands from 1987, we found an age- and sex-standardized seroprevalence of 14·4% (95% confidence interval 11·2-18·3). This was significantly lower than a 1983 estimate from the same area (62·5%), but significantly higher than 2008 (1·0%) and 2010 (2·3%) estimates from the same area. The study suggests that there was a steady and sharp decline in Q fever seroprevalence in the south of The Netherlands from 1987 to 2008. We assume that seroprevalence has decreased in other parts of The Netherlands as well and seroprevalence surveys in other European countries have shown a similar declining trend. Waning population immunity in The Netherlands may have contributed to the scale of the 2007-2010 Q fever epidemic. For a better understanding of the infection dynamics of Q fever, we advocate an international comparative study of the seroprevalence of C. burnetii.
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Affiliation(s)
- D. A. H. BRANDWAGT
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands
- Municipal Health Service (GGD) region Utrecht, Zeist, The Netherlands
| | - T. HERREMANS
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - P. M. SCHNEEBERGER
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, ’s-Hertogenbosch, The Netherlands
| | - V. H. HACKERT
- South Limburg Public Health Service, Geleen, The Netherlands
- Maastricht University Medical Centre, School of Public Health and Primary Care, Maastricht, The Netherlands
| | - C. J. P. A. HOEBE
- South Limburg Public Health Service, Geleen, The Netherlands
- Maastricht University Medical Centre, School of Public Health and Primary Care, Maastricht, The Netherlands
| | - J. PAGET
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - W. VAN DER HOEK
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands
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Febrile patients admitted to remote hospitals in Northeastern Kenya: seroprevalence, risk factors and a clinical prediction tool for Q-Fever. BMC Infect Dis 2016; 16:244. [PMID: 27260261 PMCID: PMC4891891 DOI: 10.1186/s12879-016-1569-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 05/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Q fever in Kenya is poorly reported and its surveillance is highly neglected. Standard empiric treatment for febrile patients admitted to hospitals is antimalarials or penicillin-based antibiotics, which have no activity against Coxiella burnetii. This study aimed to assess the seroprevalence and the predisposing risk factors for Q fever infection in febrile patients from a pastoralist population, and derive a model for clinical prediction of febrile patients with acute Q fever. METHODS Epidemiological and clinical data were obtained from 1067 patients from Northeastern Kenya and their sera tested for IgG antibodies against Coxiella burnetii antigens by enzyme-linked-immunosorbent assay (ELISA), indirect immunofluorescence assay (IFA) and quantitative real-time PCR (qPCR). Logit models were built for risk factor analysis, and diagnostic prediction score generated and validated in two separate cohorts of patients. RESULTS Overall 204 (19.1 %, 95 % CI: 16.8-21.6) sera were positive for IgG antibodies against phase I and/or phase II antigens or Coxiella burnetii IS1111 by qPCR. Acute Q fever was established in 173 (16.2 %, 95 % CI: 14.1-18.7) patients. Q fever was not suspected by the treating clinicians in any of those patients, instead working diagnosis was fever of unknown origin or common tropical fevers. Exposure to cattle (adjusted odds ratio [aOR]: 2.09, 95 % CI: 1.73-5.98), goats (aOR: 3.74, 95 % CI: 2.52-9.40), and animal slaughter (aOR: 1.78, 95 % CI: 1.09-2.91) were significant risk factors. Consumption of unpasteurized cattle milk (aOR: 2.49, 95 % CI: 1.48-4.21) and locally fermented milk products (aOR: 1.66, 95 % CI: 1.19-4.37) were dietary factors associated with seropositivity. Based on regression coefficients, we calculated a diagnostic score with a sensitivity 93.1 % and specificity 76.1 % at cut off value of 2.90: fever >14 days (+3.6), abdominal pain (+0.8), respiratory tract infection (+1.0) and diarrhoea (-1.1). CONCLUSION Q fever is common in febrile Kenyan patients but underappreciated as a cause of community-acquired febrile illness. The utility of Q fever score and screening patients for the risky social-economic and dietary practices can provide a valuable tool to clinicians in identifying patients to strongly consider for detailed Q fever investigation and follow up on admission, and making therapeutic decisions.
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Roles of Toll-Like Receptor 2 (TLR2), TLR4, and MyD88 during Pulmonary Coxiella burnetii Infection. Infect Immun 2016; 84:940-949. [PMID: 26787722 DOI: 10.1128/iai.00898-15] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 01/14/2016] [Indexed: 01/15/2023] Open
Abstract
Coxiella burnetii, the causative agent of Q fever, is an obligate intracellular, primarily pulmonary, bacterial pathogen. Although much is known about adaptive immune responses against this bacterium, our understanding of innate immune responses against C. burnetii is not well defined, particularly within the target tissue for infection, the lung. Previous studies examined the roles of the innate immune system receptors Toll-like receptor 2 (TLR2) and TLR4 in peripheral infection models and described minimal phenotypes in specific gene deletion animals compared to those of their wild-type controls (S. Meghari et al., Ann N Y Acad Sci 1063:161-166, 2005,http://dx.doi.org/10.1196/annals.1355.025; A. Honstettre et al., J Immunol 172:3695-3703, 2004,http://dx.doi.org/10.4049/jimmunol.172.6.3695) . Here, we assessed the roles for TLR2, TLR4, and MyD88 in pulmonary C. burnetii infection and compared responses to those that occurred in TLR2- and TLR4-deficient animals following peripheral infection. As observed previously, neither TLR2 nor TLR4 was needed for limiting bacterial growth after peripheral infection. In contrast, TLR2 and, to a lesser extent, TLR4 limited growth (or dissemination) of the bacterium in the lung and spleen after pulmonary infection. TLR2, TLR4, and MyD88 were not required for the general inflammatory response in the lungs after pulmonary infection. However, MyD88 signaling was important for infection-induced morbidity. Finally, TLR2 expression on hematopoietic cells was most important for limiting bacterial growth in the lung. These results expand on our knowledge of the roles for TLR2 and TLR4 in C. burnetii infection and suggest various roles for these receptors that are dictated by the site of infection.
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Malov VA, Ponomarev SV, Тarasevich IV, Kubensky EN, Gorobchenko AN, Pantyukhina AN, Nemilostiva EA, Bogdanova MV, Makhmutov YI. [Description of a case of severe Q fever]. TERAPEVT ARKH 2016; 87:84-91. [PMID: 26821422 DOI: 10.17116/terarkh2015871184-91] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The paper considers a rare clinical case of severe Q fever in a young man with no compromised premorbid background. It describes and analyzes clinical manifestations and laboratory findings with consideration for the current data available in the literature. The issues of the differential diagnosis, laboratory diagnosis, and treatment of Q fever are discussed.
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Affiliation(s)
- V A Malov
- Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - S V Ponomarev
- Acad. N.N. Burdenko Main Military Clinical Hospital, Ministry of Defense of the Russian Federation, Moscow, Russia
| | - I V Тarasevich
- N.F Gamaleya Federal Research Center for Epidemiology and Microbiology, Ministry of Health of Russia, Moscow, Russia
| | - E N Kubensky
- Acad. N.N. Burdenko Main Military Clinical Hospital, Ministry of Defense of the Russian Federation, Moscow, Russia
| | - A N Gorobchenko
- Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - A N Pantyukhina
- N.F Gamaleya Federal Research Center for Epidemiology and Microbiology, Ministry of Health of Russia, Moscow, Russia
| | - E A Nemilostiva
- Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - M V Bogdanova
- Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - Ya I Makhmutov
- Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
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Hackert VH, Dukers-Muijrers NHTM, van Loo IHM, Wegdam-Blans M, Somers C, Hoebe CJPA. Coxiella burnetii Infection Is Lower in Children than in Adults After Community Exposure: Overlooked Cause of Infrequent Q Fever Reporting in the Young. Pediatr Infect Dis J 2015; 34:1283-8. [PMID: 26252570 DOI: 10.1097/inf.0000000000000871] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Q fever is rarely reported in children/adolescents. Although lower reporting rates are commonly attributed to milder disease and subsequent underdiagnosis in infected children/adolescents, pertinent evidence is scarce. We present data from a large, well-defined single-point source outbreak of Q fever to fill this gap. METHODS We compared (A) Q fever testing and notification rates in children/adolescents who were 0-19 years of age with those in adults 20+ years of age in October 2009; (B) serological attack rates of acute Q fever in children/adolescents with the rates in adults after on-source exposure on the outbreak farm's premises; (C) incidence of Q fever infection in children/adolescents with that in adults after off-source exposure in the municipality located closest to the farm. RESULTS (A) Children/adolescents represented 19.3% (59,404 of 307,348) of the study area population, 12.1% (149 of 1217) of all subjects tested in October 2009 and 4.3% (11 of 253) of notified laboratory-confirmed community cases. (B) Serological attack rate of acute Q fever in children with on-source exposure was 71% (12 of 17), similar to adults [68% (40 of 59)]. (C) Incidence of infection in children/adolescents after community (off-source) exposure was 4.5% (13 of 287) versus 11.0% (12 of 109) in adults (adjusted odds ratio: 0.36; 95% confidence interval: 0.16-0.84; P = 0.02). No children/adolescents reported clinical symptoms. Proportion of notified infections was significantly lower in children/adolescents (2.5%) than in adults (10.4%; risk ratio: 0.26; 95% confidence interval: 0.08-0.80, P = 0.02). CONCLUSION Notified Q fever was less frequent in children/adolescents than in adults. Although underrecognition contributed to this phenomenon, lower rates of infection in children after community exposure played an unexpected major role. On-source (presumed high-dose) exposure, by contrast, was associated with high serological and clinical attack rates not only in adults but also in children/adolescents. Our findings allow for improved age-specific clinical and public health risk assessment in Q fever outbreaks.
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Affiliation(s)
- Volker H Hackert
- From the *Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Geleen, The Netherlands; †Department of Medical Microbiology, School of Public Health and Primary Care, Maastricht University Medical Center, Maastricht, The Netherlands; and ‡Department of Medical Microbiology, Laboratory for Pathology and Medical Microbiology (PAMM), Veldhoven, The Netherlands
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Q fever and pregnancy: experience from the Limoges Regional University Hospital. Arch Gynecol Obstet 2015; 294:233-8. [PMID: 26559421 DOI: 10.1007/s00404-015-3958-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Q fever is an ubiquitous zoonosis caused by Coxiella burnetii. Its tropism for the uterus is a potential source of obstetric complications. MATERIALS AND METHODS We describe the obstetric consequences of Q fever diagnosed during pregnancy from a series of cases. When an antenatal diagnosis was made, antibiotic therapy with roxithromycin (Rulid(®)) was started until delivery. RESULTS Between 2007 and 2012, 30 patients were treated for Q fever diagnosed during pregnancy, i.e. 1.9 cases per 1000 people. The most common reasons for performing serology was intrauterine growth retardation, preterm labor and oligoamnios. Q fever was diagnosed as acute and chronic in 26 and 4 cases, respectively. Progression to chronic disease occurred in 8 % of acute forms of the diseases. The prevalence of obstetric complications was 66 %, including 10 % foetal deaths, 31 % preterm delivery and 27 % low birthweight <10th percentile. The obstetric complication rate amongst the 22 patients treated with ante partum macrolides was 60, 30 % of which involved prematurity and 33 % involved low growth. No cases of foetal death were found on treatment and no congenital malformation and placental or neonatal injury was found. No case of disease reactivation was diagnosed in the eight patients who became pregnant again. CONCLUSION Q fever during pregnancy is responsible for severe obstetric complications. It must be diagnosed early and its clinical forms known in order to start appropriate antibiotic therapy.
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Abstract
Q fever is a zoonosis of worldwide distribution with the exception of New Zealand. It is caused by an intracellular bacterium, Coxiella burnetii. The disease often goes underdiagnosed because the main manifestation of its acute form is a general self-limiting flu-like syndrome. The Dutch epidemics renewed attention to this disease, which was less considered before. This review summarizes the description of C. burnetii (taxonomy, intracellular cycle, and genome) and Q fever disease (description, diagnosis, epidemiology, and pathogenesis). Finally, vaccination in humans and animals is also considered.
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Affiliation(s)
- Samira Boarbi
- Centre d'étude et de recherches vétérinaires et agrochimiques (CERVA), Direction opérationnelle des maladies bactériennes, Zoonoses bactériennes des animaux de rente, Groeselenberg 99, 1180 Bruxelles, Belgique.,Centre d'étude et de recherches vétérinaires et agrochimiques (CERVA), Direction opérationnelle des maladies bactériennes, Zoonoses bactériennes des animaux de rente, Groeselenberg 99, 1180 Bruxelles, Belgique
| | - David Fretin
- Centre d'étude et de recherches vétérinaires et agrochimiques (CERVA), Direction opérationnelle des maladies bactériennes, Zoonoses bactériennes des animaux de rente, Groeselenberg 99, 1180 Bruxelles, Belgique.,Centre d'étude et de recherches vétérinaires et agrochimiques (CERVA), Direction opérationnelle des maladies bactériennes, Zoonoses bactériennes des animaux de rente, Groeselenberg 99, 1180 Bruxelles, Belgique
| | - Marcella Mori
- Centre d'étude et de recherches vétérinaires et agrochimiques (CERVA), Direction opérationnelle des maladies bactériennes, Zoonoses bactériennes des animaux de rente, Groeselenberg 99, 1180 Bruxelles, Belgique.,Centre d'étude et de recherches vétérinaires et agrochimiques (CERVA), Direction opérationnelle des maladies bactériennes, Zoonoses bactériennes des animaux de rente, Groeselenberg 99, 1180 Bruxelles, Belgique
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Chang K, Lee NY, Ko WC, Tsai JJ, Lin WR, Chen TC, Lu PL, Chen YH. Identification of factors for physicians to facilitate early differential diagnosis of scrub typhus, murine typhus, and Q fever from dengue fever in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 50:104-111. [PMID: 25648664 DOI: 10.1016/j.jmii.2014.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 09/30/2014] [Accepted: 12/09/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Dengue fever, rickettsial diseases, and Q fever are acute febrile illnesses with similar manifestations in tropical areas. Early differential diagnosis of scrub typhus, murine typhus, and Q fever from dengue fever may be made by understanding the distinguishing clinical characteristics and the significance of demographic and weather factors. METHODS We conducted a retrospective study to identify clinical, demographic, and meteorological characteristics of 454 dengue fever, 178 scrub typhus, 143 Q fever, and 81 murine typhus cases in three Taiwan hospitals. RESULTS Case numbers of murine typhus and Q fever correlated significantly with temperature and rainfall; the scrub typhus case number was only significantly related with temperature. Neither temperature nor rainfall correlated with the case number of dengue fever. The rarity of dengue fever cases from January to June in Taiwan may be a helpful clue for diagnosis in the area. A male predominance was observed, as the male-to-female rate was 2.1 for murine typhus and 7.4 for Q fever. Multivariate analysis revealed the following six important factors for differentiating the rickettsial diseases and Q fever group from the dengue fever group: fever ≥8 days, alanine aminotransferase > aspartate aminotransferase, platelets >63,000/mL, C-reactive protein >31.9 mg/L, absence of bone pain, and absence of a bleeding syndrome. CONCLUSION Understanding the rarity of dengue in the first half of a year in Taiwan and the six differentiating factors may help facilitate the early differential diagnosis of rickettsial diseases and Q fever from dengue fever, permitting early antibiotic treatment.
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Affiliation(s)
- Ko Chang
- Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Nan-Yao Lee
- Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; Center of Infection Control, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan; Center of Infection Control, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan
| | - Jih-Jin Tsai
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Tropical Medicine Research Center, College of Medicine, Kaohsiung Medical University, Taiwan
| | - Wei-Ru Lin
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Tun-Chieh Chen
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Liang Lu
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Yen-Hsu Chen
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Tropical Medicine Research Center, College of Medicine, Kaohsiung Medical University, Taiwan; Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Dahlgren FS, McQuiston JH, Massung RF, Anderson AD. Q fever in the United States: summary of case reports from two national surveillance systems, 2000-2012. Am J Trop Med Hyg 2014; 92:247-55. [PMID: 25404080 DOI: 10.4269/ajtmh.14-0503] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Q fever is a worldwide zoonosis historically associated with exposure to infected livestock. This study summarizes cases of Q fever, a notifiable disease in the United States, reported to the Centers for Disease Control and Prevention through two national surveillance systems with onset during 2000-2012. The overall incidence rate during this time was 0.38 cases per million persons per year. The reported case fatality rate was 2.0%, and the reported hospitalization rate was 62%. Most cases (61%) did not report exposure to cattle, goats, or sheep, suggesting that clinicians should consider Q fever even in the absence of livestock exposure. The prevalence of drinking raw milk among reported cases of Q fever (8.4%) was more than twice the national prevalence for the practice. Passive surveillance systems for Q fever are likely impacted by underreporting and underdiagnosis because of the nonspecific presentation of Q fever.
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Affiliation(s)
- F Scott Dahlgren
- Rickettsial Zoonoses Branch, Division of Vector-borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer H McQuiston
- Rickettsial Zoonoses Branch, Division of Vector-borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert F Massung
- Rickettsial Zoonoses Branch, Division of Vector-borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alicia D Anderson
- Rickettsial Zoonoses Branch, Division of Vector-borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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González-Del Vecchio M, Vena A, Valerio M, Marin M, Verde E, Muñóz P, Bouza E. Coxiella burnetii infection in hemodialysis and other vascular grafts. Medicine (Baltimore) 2014; 93:364-371. [PMID: 25500706 PMCID: PMC4602435 DOI: 10.1097/md.0000000000000218] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Prosthetic arteriovenous (AV) graft infection is the principal cause of morbidity related to chronic hemodialysis AV graft fistula. Coxiella burnetii is a known pathogen that causes fever, pneumonia, and intravascular infections with the limitation of negative cultures. Herein, we report the first case of a patient who presented to the emergency department of our hospital with a prosthetic hemodialysis AV graft infection due to Coxiella burnetii. We also performed a literature search with PubMed to identify studies reporting cases of Coxiella burnetii vascular graft infection. Overall, we reviewed 15 cases of vascular graft infection, including ours. We found a high prevalence of male patients (87%); mean age ± standard deviation (SD) of the entire population was 60.4 ± 9.6 years. The dacron infrarenal aortic and the aortobifemoral bypass were the most common involved grafts. The early diagnosis of infection due to Coxiella burnetii was done by serology or with polymerase chain reaction (PCR), in 12 and 3 cases, respectively. All patients underwent partial or complete resection of the infected grafts; the most common antibiotic treatment for this entity was doxycycline and hydroxycloroquine.Although this is a relatively rare disease, Coxiella burnetii should be included in the differential diagnosis of all patients who present with infection of an endovascular graft of any nature with an inconclusive etiologic diagnosis.
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Affiliation(s)
- Marcela González-Del Vecchio
- Department of Clinical Microbiology and Infectious Diseases (MGDV, AV, MV, MM, PM, EB), Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón; Department of Nephrology (EV), Hospital General Universitario Gregorio Marañón, Madrid; and Facultad de Medicina (MM, PM, EB), Universidad Complutense de Madrid (UCM), Spain
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Espejo E, Gil-Díaz A, Oteo JA, Castillo-Rueda R, García-Alvarez L, Santana-Báez S, Bella F. Clinical presentation of acute Q fever in Spain: seasonal and geographical differences. Int J Infect Dis 2014; 26:162-4. [DOI: 10.1016/j.ijid.2014.06.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/27/2014] [Accepted: 06/14/2014] [Indexed: 01/17/2023] Open
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Ammatuna E, Iannitto E, Tick LW, Arents NLA, Kuijper PH, Nijziel MR. Two cases of q-Fever in hairy cell leukemia. Case Rep Hematol 2014; 2014:863932. [PMID: 25180111 PMCID: PMC4144079 DOI: 10.1155/2014/863932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 07/25/2014] [Indexed: 11/28/2022] Open
Abstract
Hairy cell leukemia (HCL) is a rare B-cell lymphoproliferative disorder accounting for about 2% of all leukemias. The clinical course is indolent, however HCL patients are particularly susceptible to infections. Here we report two cases of Q-fever as first manifestation of disease in two patients affected by HCL. Both patients described in this report showed an unusually sluggish clinical response to the antibiotic treatment with ciprofloxacin probably because of the marked immunodeficiency. However, treatment of HCL with cladribine administered soon after the resolution of QF pneumonitis was uneventful and led to a complete remission in both cases. Most probably the association of Coxiella burnetii (CB) infection and HCL that we observed in two patients is due to chance. However, a hairy cell resembling transformation of freshly isolated human peripheral blood lymphocytes upon CB has been showed. We think that the possibility of CB infection in febrile HCL patient should be always taken in mind, especially in endemic areas. In addition the potential for such infections to become chronic in HCL patients should not be overlooked and the reporting of further cases should be encouraged.
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Affiliation(s)
- Emanuele Ammatuna
- Department of Hematology, Erasmus University Medical Centre, Daniel den Hoed, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands
| | - Emilio Iannitto
- Department of Oncology, Haematology Unit, University of Palermo School of Medicine, Palermo, Italy
| | - Lidwine W. Tick
- Department of Internal Medicine, Maxima Medical Centre, The Netherlands
| | | | - Philip H. Kuijper
- Department of Clinical Chemistry, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Marten R. Nijziel
- Department of Internal Medicine, Maxima Medical Centre, The Netherlands
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Lai CH, Chang LL, Lin JN, Chen WF, Wei YF, Chiu CT, Wu JT, Hsu CK, Chen JY, Lee HS, Lin HH, Chen YH. Clinical characteristics of Q fever and etiology of community-acquired pneumonia in a tropical region of southern Taiwan: a prospective observational study. PLoS One 2014; 9:e102808. [PMID: 25033402 PMCID: PMC4102556 DOI: 10.1371/journal.pone.0102808] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 06/24/2014] [Indexed: 12/11/2022] Open
Abstract
Background The clinical characteristics of Q fever are poorly identified in the tropics. Fever with pneumonia or hepatitis are the dominant presentations of acute Q fever, which exhibits geographic variability. In southern Taiwan, which is located in a tropical region, the role of Q fever in community-acquired pneumonia (CAP) has never been investigated. Methodology/Principal Findings During the study period, May 2012 to April 2013, 166 cases of adult CAP and 15 cases of acute Q fever were prospectively investigated. Cultures of clinical specimens, urine antigen tests for Streptococcus pneumoniae and Legionella pneumophila, and paired serologic assessments for Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Q fever (Coxiella burnetii) were used for identifying pathogens associated with CAP. From April 2004 to April 2013 (the pre-study period), 122 cases of acute Q fever were also included retrospectively for analysis. The geographic distribution of Q fever and CAP cases was similar. Q fever cases were identified in warmer seasons and younger ages than CAP. Based on multivariate analysis, male gender, chills, thrombocytopenia, and elevated liver enzymes were independent characteristics associated with Q fever. In patients with Q fever, 95% and 13.5% of cases presented with hepatitis and pneumonia, respectively. Twelve (7.2%) cases of CAP were seropositive for C. burnetii antibodies, but none of them had acute Q fever. Among CAP cases, 22.9% had a CURB-65 score ≧2, and 45.8% had identifiable pathogens. Haemophilus parainfluenzae (14.5%), S. pneumoniae (6.6%), Pseudomonas aeruginosa (4.8%), and Klebsiella pneumoniae (3.0%) were the most common pathogens identified by cultures or urine antigen tests. Moreover, M. pneumoniae, C. pneumoniae, and co-infection with 2 pathogens accounted for 9.0%, 7.8%, and 1.8%, respectively. Conclusions In southern Taiwan, Q fever is an endemic disease with hepatitis as the major presentation and is not a common etiology of CAP.
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Affiliation(s)
- Chung-Hsu Lai
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan
- Division of Infection Control Laboratory, E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan
| | - Lin-Li Chang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Faculty of Medicine, Department of Microbiology, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Jiun-Nong Lin
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan
| | - Wei-Fang Chen
- Division of Infection Control Laboratory, E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan
| | - Yu-Feng Wei
- Division of Pulmonary Medicine, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan
| | - Chien-Tung Chiu
- Division of Pulmonary Medicine, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan
| | - Jiun-Ting Wu
- Division of Pulmonary Medicine, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan
| | - Chi-Kuei Hsu
- Division of Pulmonary Medicine, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan
| | - Jung-Yueh Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan
| | - Ho-Sheng Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan
| | - Hsi-Hsun Lin
- Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung City, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan
| | - Yen-Hsu Chen
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- * E-mail:
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Kunchev M, Alexandrov E, Kamarinchev B, Marinov K, Gergova I, Mekouchinov K. Effective Lux (Light Upon eXtension) Primer System for Early and Rapid Detection ofCoxiella burnetii. BIOTECHNOL BIOTEC EQ 2014. [DOI: 10.1080/13102818.2007.10817470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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50
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Wielders CCH, Wuister AMH, de Visser VL, de Jager-Leclercq MG, Groot CAR, Dijkstra F, van Gageldonk-Lafeber AB, van Leuken JPG, Wever PC, van der Hoek W, Schneeberger PM. Characteristics of hospitalized acute Q fever patients during a large epidemic, The Netherlands. PLoS One 2014; 9:e91764. [PMID: 24614585 PMCID: PMC3948881 DOI: 10.1371/journal.pone.0091764] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 02/13/2014] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND From 2007 to 2009, The Netherlands experienced a major Q fever epidemic, with higher hospitalization rates than the 2-5% reported in the literature for acute Q fever pneumonia and hepatitis. We describe epidemiological and clinical features of hospitalized acute Q fever patients and compared patients presenting with Q fever pneumonia with patients admitted for other forms of community-acquired pneumonia (CAP). We also examined whether proximity to infected ruminant farms was a risk factor for hospitalization. METHODS A retrospective cohort study was conducted for all patients diagnosed and hospitalized with acute Q fever between 2007 and 2009 in one general hospital situated in the high incidence area in the south of The Netherlands. Pneumonia severity scores (PSI and CURB-65) of acute Q fever pneumonia patients (defined as infiltrate on a chest x-ray) were compared with data from CAP patients. Hepatitis was defined as a >twofold the reference value for alanine aminotransferase and for bilirubin. RESULTS Among the 183 hospitalized acute Q fever patients, 86.0% had pneumonia. Elevated liver enzymes (alanine aminotransferase) were found in 32.3% of patients, although hepatitis was not observed in any of them. The most frequent clinical signs upon presentation were fever, cough and dyspnoea. The median duration of admission was five days. Acute Q fever pneumonia patients were younger, had less co-morbidity, and lower PSI and CURB-65 scores than other CAP patients. Anecdotal information from attending physicians suggests that some patients were admitted because of severe subjective dyspnoea, which was not included in the scoring systems. Proximity to an infected ruminant farm was not associated with hospitalization. CONCLUSION Hospitalized Dutch acute Q fever patients mostly presented with fever and pneumonia. Patients with acute Q fever pneumonia were hospitalized despite low PSI and CURB-65 scores, presumably because subjective dyspnoea was not included in the scoring systems.
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Affiliation(s)
- Cornelia C. H. Wielders
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, ’s-Hertogenbosch, the Netherlands
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- * E-mail:
| | - Annemarie M. H. Wuister
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Department of Internal Medicine, Bernhoven Hospital, Uden, the Netherlands
| | - Veerle L. de Visser
- Department of Pulmonary Diseases, Jeroen Bosch Hospital, ’s-Hertogenbosch, the Netherlands
| | | | | | - Frederika Dijkstra
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Arianne B. van Gageldonk-Lafeber
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Jeroen P. G. van Leuken
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Institute for Risk Assessment Sciences, Faculty of Veterinary Sciences, Utrecht University, Utrecht, the Netherlands
| | - Peter C. Wever
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, ’s-Hertogenbosch, the Netherlands
| | - Wim van der Hoek
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Peter M. Schneeberger
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, ’s-Hertogenbosch, the Netherlands
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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