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de Souza EAR, Farias IF, Pesqueira TR, de Azevedo Serpa MC, Cunha TS, Moraes EA, Brandão PE, Labruna MB, Horta MC. Exposure of small ruminants and humans to Coxiella burnetii in the semi-arid region of Northeastern Brazil. Braz J Microbiol 2024; 55:1931-1939. [PMID: 38573541 PMCID: PMC11153395 DOI: 10.1007/s42770-024-01317-x] [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: 12/22/2023] [Accepted: 03/26/2024] [Indexed: 04/05/2024] Open
Abstract
Q fever is a zoonotic disease caused by the obligate intracellular pathogen Coxiella burnetii, for which domestic ruminants are the primary source of infection in humans. Herein, we investigated the presence of C. burnetii in humans, sheep, and goats in the semi-arid region of northeastern Brazil. The presence of anti-C. burnetii antibodies was surveyed using indirect immunofluorescence assay, and detection of C. burnetii DNA was performed by polymerase chain reaction (PCR). Anti-C. burnetii antibodies were detected in 60% of farms, 4.8% of goats, 1.5% of sheep, and 4.5% of human samples. PCR was positive in 18.9% of blood samples, 7.7% of milk samples, and 7.7% of vaginal mucus samples. A DNA sequence of a C. burnetii DNA sample extracted from the goat vaginal mucus showed 99.2-99.4% nucleotide identity with other strains previously reported in Brazil. These results indicate that C. burnetii is present in the surveyed area, where it poses a risk to both public and animal health. These findings indicate an urgent need for educative actions to protect population, as well as better training of veterinarians to detect and report Q fever.
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Affiliation(s)
- Eline Almeida Rodrigues de Souza
- Universidade Federal do Vale do São Francisco, Rodovia BR-407, KM 12 Lote 543 S/n Projeto de Irrigação Nilo Coelho, Petrolina, Pernambuco, 56300-000, Brazil.
- Universidade Federal Rural de Pernambuco, Recife, Pernambuco, Brazil.
| | - Ila Ferreira Farias
- Universidade Federal do Vale do São Francisco, Rodovia BR-407, KM 12 Lote 543 S/n Projeto de Irrigação Nilo Coelho, Petrolina, Pernambuco, 56300-000, Brazil
| | - Tainã Ramos Pesqueira
- Universidade Federal do Vale do São Francisco, Rodovia BR-407, KM 12 Lote 543 S/n Projeto de Irrigação Nilo Coelho, Petrolina, Pernambuco, 56300-000, Brazil
| | | | - Thaís Souza Cunha
- Universidade Federal do Vale do São Francisco, Rodovia BR-407, KM 12 Lote 543 S/n Projeto de Irrigação Nilo Coelho, Petrolina, Pernambuco, 56300-000, Brazil
| | - Elenice Andrade Moraes
- Universidade Federal do Vale do São Francisco, Rodovia BR-407, KM 12 Lote 543 S/n Projeto de Irrigação Nilo Coelho, Petrolina, Pernambuco, 56300-000, Brazil
| | - Paulo Eduardo Brandão
- Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcelo Bahia Labruna
- Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Mauricio Claudio Horta
- Universidade Federal do Vale do São Francisco, Rodovia BR-407, KM 12 Lote 543 S/n Projeto de Irrigação Nilo Coelho, Petrolina, Pernambuco, 56300-000, Brazil
- Universidade Federal Rural de Pernambuco, Recife, Pernambuco, Brazil
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Huber N, Gundling N, Thurow M, Ligges U, Hoedemaker M. Which Factors Influence the Consumption of Antibiotics in Q-Fever-Positive Dairy Farms in Northern Germany? Animals (Basel) 2024; 14:1375. [PMID: 38731379 PMCID: PMC11083311 DOI: 10.3390/ani14091375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/23/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
It was the aim of this study to examine whether the usage of the vaccine COXEVAC® (Ceva Santé Animale) could reduce the consumption of antibiotics in Q-fever-positive dairy farms. Additionally, the effects of other herd-level factors on the consumption of antibiotics were investigated. A total of 36 farms with vaccination and 13 farms without vaccination participated in this longitudinal cohort study. In all herds, Coxiella burnetii had been directly or indirectly diagnosed. To compare the treatment frequency of antibiotics between the vaccinated group and the non-vaccinated group, the consumption of antibiotics for each farm was collected using the veterinary documents about the application and delivery of antibiotics. To gather detailed information about herd data, nutrition, milking management, housing, and animal health, the farmers were interviewed with the help of a questionnaire. The results thereof suggest that there might be an association between the vaccination against Q fever and a reduced consumption of antibiotics. Neither herd size nor milk yield level influenced the consumption of antibiotics in the study herds. Type of flooring and udder-cluster disinfection while milking were associated with a lower and higher therapy frequency, respectively. Further studies are necessary to elucidate the cause-effect relationship between vaccination and the consumption of antibiotics.
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Affiliation(s)
- Niclas Huber
- Clinic for Cattle, University of Veterinary Medicine Hanover, Foundation, Bischofsholer Damm 15, 30173 Hannover, Germany
| | - Natascha Gundling
- Clinic for Cattle, University of Veterinary Medicine Hanover, Foundation, Bischofsholer Damm 15, 30173 Hannover, Germany
| | - Maria Thurow
- Department of Statistics, TU Dortmund University, 44221 Dortmund, Germany (U.L.)
- UA Ruhr, Research Center Trustworthy Data Science and Security, 44227 Dortmund, Germany
| | - Uwe Ligges
- Department of Statistics, TU Dortmund University, 44221 Dortmund, Germany (U.L.)
| | - Martina Hoedemaker
- Clinic for Cattle, University of Veterinary Medicine Hanover, Foundation, Bischofsholer Damm 15, 30173 Hannover, Germany
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Moorthy GS, Rubach MP, Maze MJ, Refuerzo RP, Shirima GM, Lukambagire AS, Bodenham RF, Cash-Goldwasser S, Thomas KM, Sakasaka P, Mkenda N, Bowhay TR, Perniciaro JL, Nicholson WL, Kersh GJ, Kazwala RR, Mmbaga BT, Buza JJ, Maro VP, Haydon DT, Crump JA, Halliday JE. Prevalence and risk factors for Q fever, spotted fever group rickettsioses, and typhus group rickettsioses in a pastoralist community of northern Tanzania, 2016-2017. Trop Med Int Health 2024; 29:365-376. [PMID: 38480005 PMCID: PMC11073910 DOI: 10.1111/tmi.13980] [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] [Indexed: 04/11/2024]
Abstract
BACKGROUND In northern Tanzania, Q fever, spotted fever group (SFG) rickettsioses, and typhus group (TG) rickettsioses are common causes of febrile illness. We sought to describe the prevalence and risk factors for these zoonoses in a pastoralist community. METHODS Febrile patients ≥2 years old presenting to Endulen Hospital in the Ngorongoro Conservation Area were enrolled from August 2016 through October 2017. Acute and convalescent blood samples were collected, and a questionnaire was administered. Sera were tested by immunofluorescent antibody (IFA) IgG assays using Coxiella burnetii (Phase II), Rickettsia africae, and Rickettsia typhi antigens. Serologic evidence of exposure was defined by an IFA titre ≥1:64; probable cases by an acute IFA titre ≥1:128; and confirmed cases by a ≥4-fold rise in titre between samples. Risk factors for exposure and acute case status were evaluated. RESULTS Of 228 participants, 99 (43.4%) were male and the median (interquartile range) age was 27 (16-41) years. Among these, 117 (51.3%) had C. burnetii exposure, 74 (32.5%) had probable Q fever, 176 (77.2%) had SFG Rickettsia exposure, 134 (58.8%) had probable SFG rickettsioses, 11 (4.8%) had TG Rickettsia exposure, and 4 (1.8%) had probable TG rickettsioses. Of 146 participants with paired sera, 1 (0.5%) had confirmed Q fever, 8 (5.5%) had confirmed SFG rickettsioses, and none had confirmed TG rickettsioses. Livestock slaughter was associated with acute Q fever (adjusted odds ratio [OR] 2.54, 95% confidence interval [CI] 1.38-4.76) and sheep slaughter with SFG rickettsioses case (OR 4.63, 95% CI 1.08-23.50). DISCUSSION Acute Q fever and SFG rickettsioses were detected in participants with febrile illness. Exposures to C. burnetii and to SFG Rickettsia were highly prevalent, and interactions with livestock were associated with increased odds of illness with both pathogens. Further characterisation of the burden and risks for these diseases is warranted.
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Affiliation(s)
- Ganga S. Moorthy
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Matthew P. Rubach
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, United States of America
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
- Programme in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Michael J. Maze
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Regina P. Refuerzo
- School of Biodiversity, One Health and Veterinary Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Gabriel M. Shirima
- Nelson Mandela African Institution of Science and Technology, School of Life Sciences and Bioengineering, Arusha, Tanzania
| | - AbdulHamid S. Lukambagire
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- EcoHealth Alliance, New York, United States of America
| | | | - Shama Cash-Goldwasser
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Kate M. Thomas
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | - Nestory Mkenda
- Endulen Hospital, Endulen, Ngorongoro Conservation Area, Tanzania
| | - Thomas R. Bowhay
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Jamie L. Perniciaro
- Rickettsial Zoonoses Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - William L. Nicholson
- Rickettsial Zoonoses Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Gilbert J. Kersh
- Rickettsial Zoonoses Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rudovick R. Kazwala
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Joram J. Buza
- Nelson Mandela African Institution of Science and Technology, School of Life Sciences and Bioengineering, Arusha, Tanzania
| | - Venance P. Maro
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Daniel T. Haydon
- School of Biodiversity, One Health and Veterinary Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - John A. Crump
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, United States of America
- Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Jo E.B. Halliday
- School of Biodiversity, One Health and Veterinary Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Esmaeili S, Latifian M, Mahmoudi A, Ghasemi A, Mohammadi A, Mordadi A, Ziapour SP, Naddaf SR, Mostafavi E. Molecular investigation of Coxiella burnetii and Francisella tularensis infection in ticks in northern, western, and northwestern Iran. PLoS One 2023; 18:e0289567. [PMID: 37590254 PMCID: PMC10434890 DOI: 10.1371/journal.pone.0289567] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/20/2023] [Indexed: 08/19/2023] Open
Abstract
Tularemia and Q fever are endemic diseases in Iran; however, little information is available on the prevalence of the causative agents, Coxiella burnetii and Francisella tularensis, in Iranian ticks. This study investigated C. burnetii and F. tularensis among hard ticks in this country. We collected ticks from livestock and other mammals in Guilan, Mazandaran, Golestan (northern Iran), Kurdistan (western Iran), and West Azerbaijan (northwestern Iran) provinces. Genomic DNA from collected ticks was extracted and screened for C. burnetii and F. tularensis using Real-time PCR. A total of 4,197 ticks (belonging to 12 different species) were collected, and Ixodes ricinus (46.4%), Rhipicephalus turanicus (25%), and Rhipicephalus sanguineus sensu lato (19.1%) were the most collected species. Of 708 pooled tick samples, 11.3% and 7.20% were positive for C. burnetii and F. tularensis, respectively. The genus of Rhipicephalus had the highest (18.3%) C. burnetii infection among the collected tick pools (P<0.001). Furthermore, the most positive pools for F. tularensis belonged to Haemaphysalis spp. (44.4%). Kurdistan had the most significant percentage of C. burnetii-infected ticks (92.5%), and there was a meaningful relationship between the provinces and the infection (P< 0.001). The ticks from Golestan exhibited the highest F. tularensis infection rate (10. 9%), and the infection showed no significant relationship with the provinces (P = 0.19). Ticks collected from grasslands had a higher Coxiella burnetii infection rate than those collected from animals (39.4% vs. 7.9%; p<0.01). However, ticks collected from animal surfaces had a slightly higher rate of Francisella tularensis infection than those collected from grasslands (7.6% vs. 3.9%; p = 0.24). Here, we demonstrated the presence of both pathogens in the north (Guilan, Mazandaran, and Golestan provinces), the west (Kurdistan province), and the northwest (West Azerbaijan province) of Iran. The public health system should pay particular attention to tick bites in veterinary medicine and humans.
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Affiliation(s)
- Saber Esmaeili
- National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, KabudarAhang, Hamadan, Iran
- Department of Epidemiology and Biostatics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
| | - Mina Latifian
- National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, KabudarAhang, Hamadan, Iran
- Department of Epidemiology and Biostatics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
| | - Ahmad Mahmoudi
- Department of Biology, Faculty of Science, Urmia University, Urmia, Iran
| | - Ahmad Ghasemi
- National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, KabudarAhang, Hamadan, Iran
- Department of Microbiology, Research Center of Reference Health Laboratories, Ministry of Health and Medical Education, Tehran, Iran
| | - Ali Mohammadi
- Department of Epidemiology and Biostatics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
- Department of Medical Entomology and Vector Control, School of Public Health and National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Mordadi
- Department of Epidemiology and Biostatics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
| | - Seyyed Payman Ziapour
- Department of Parasitology, Zoonoses, Research Center, Pasteur Institute of Iran, Amol, Mazandaran, Iran
| | | | - Ehsan Mostafavi
- National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, KabudarAhang, Hamadan, Iran
- Department of Epidemiology and Biostatics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
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Brus IM, Spronk I, Haagsma JA, Erasmus V, de Groot A, Olde Loohuis AGM, Bronner MB, Polinder S. Prerequisites, barriers and opportunities in care for Q-fever patients: a Delphi study among healthcare workers. BMC Health Serv Res 2023; 23:319. [PMID: 37004033 PMCID: PMC10064509 DOI: 10.1186/s12913-023-09269-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 03/10/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Q-fever is a zoonotic disease that can lead to illness, disability and death. This study aimed to provide insight into the perspectives of healthcare workers (HCWs) on prerequisites, barriers and opportunities in care for Q-fever patients. METHODS A two-round online Delphi study was conducted among 94 Dutch HCWs involved in care for Q-fever patients. The questionnaires contained questions on prerequisites for high quality, barriers and facilitators in care, knowledge of Q-fever, and optimization of care. For multiple choice, ranking and Likert scale questions, frequencies were reported, while for rating and numerical questions, the median and interquartile range (IQR) were reported. RESULTS The panel rated the care for Q-fever patients at a median score of 6/10 (IQR = 2). Sufficient knowledge of Q-fever among HCWs (36%), financial compensation of care (30%) and recognition of the disease by HCWs (26%) were considered the most important prerequisites for high quality care. A lack of knowledge was identified as the most important barrier (76%) and continuing medical education as the primary method for improving HCWs' knowledge (76%). HCWs rated their own knowledge at a median score of 8/10 (IQR = 1) and the general knowledge of other HCWs at a 5/10 (IQR = 2). According to HCWs, a median of eight healthcare providers (IQR = 4) should be involved in the care for Q-fever fatigue syndrome (QFS) and a median of seven (IQR = 5) in chronic Q-fever care. CONCLUSIONS Ten years after the Dutch Q-fever epidemic, HCWs indicate that the long-term care for Q-fever patients leaves much room for improvement. Facilitation of reported prerequisites for high quality care, improved knowledge among HCWs, clearly defined roles and responsibilities, and guidance on how to support patients could possibly improve quality of care. These prerequisites may also improve care for patients with persisting symptoms due to other infectious diseases, such as COVID-19.
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Affiliation(s)
- Iris M Brus
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000CA, Rotterdam, the Netherlands.
| | - Inge Spronk
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000CA, Rotterdam, the Netherlands
| | - Juanita A Haagsma
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000CA, Rotterdam, the Netherlands
| | - Vicki Erasmus
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000CA, Rotterdam, the Netherlands
| | | | | | - Madelon B Bronner
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000CA, Rotterdam, the Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000CA, Rotterdam, the Netherlands
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Tomljenovic M, Lakošeljac D, Knežević L, Bubonja-Šonje M, Abram M, Špičić S, Zdelar-Tuk M, Duvnjak S, Reil I, Valjin O, Kramarić M, Miškić T, Janković IL, Rončević D. Coxiella burnetii (Q-fever) outbreak associated with non-occupational exposure in a semi-urban area of western Croatia in 2022. Zoonoses Public Health 2022; 70:285-293. [PMID: 36582027 DOI: 10.1111/zph.13022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022]
Abstract
In March 2022, an outbreak of Q fever (Coxiella burnetii) with non-occupational exposure was confirmed in a semi-urban area in Čavle, Croatia. Veterinary and human epidemiological investigations were conducted to identify the source of the outbreak and to implement appropriate control measures. Three farms were settled next to each other near the homes of the first human cases at the end of the street. The closest farm was less than 500 meters away. These farms contained 161 adult sheep and goats. Among the animal samples analysed, all 16 goats (100%) and 24/50 sheep (48%) tested positive for C. burnetii IgM/IgG antibodies, phase I and II. One out of five sheeps' vaginal swabs were C. burnetti DNA positive. Human testing revealed 20 confirmed and three probable cases (9/23 pneumonia, 2/23 hepatitis, 21/23 fever), with three hospitalizations, and one death. Twenty-seven cases were discarded following negative laboratory results. The epidemiological investigation revealed airborne transmission as the most likely route of transmission. Multiple logistic regression analyses were used to evaluate risk factors for Q fever infection. Persons who were near the farms (≤750 m) (OR 4.5; 95% CI = 1.1-18.3) and lived in the nearest street to the farms had the highest risk of contracting Q fever (OR 3.7; 95% CI = 1.1-13.6). Decreased rainfall compared to monthly averages was recorded in the months prior to the outbreak with several days of strong wind in January preceding the outbreak. This was the largest Q fever outbreak in the county in the last 16 years, which was unexpected due to its location and non-occupational exposure. To stop the outbreak, numerous intensive biosecurity measures were implemented. The outbreak highlights the importance of urban development strategies to limit the number of animal housing near residential areas while providing regular biosecurity measures to prevent infections in livestock.
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Affiliation(s)
- Morana Tomljenovic
- Department of Social Medicine and Epidemiology, Faculty of Medicine, Rijeka, Croatia.,Department of Epidemiology, Teaching Institute of Public Health of the Primorje-Gorski Kotar County, Rijeka, Croatia
| | - Danijela Lakošeljac
- Department of Epidemiology, Teaching Institute of Public Health of the Primorje-Gorski Kotar County, Rijeka, Croatia.,Department of Public Health, Faculty of Health Studies, University of Rijeka, Rijeka, Croatia
| | - Lucija Knežević
- Department of Epidemiology, Teaching Institute of Public Health of the Primorje-Gorski Kotar County, Rijeka, Croatia
| | - Marina Bubonja-Šonje
- Department of Clinical Microbiology, Clinical Hospital Centre Rijeka, Rijeka, Croatia.,Department of Microbiology and Parasitology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Maja Abram
- Department of Clinical Microbiology, Clinical Hospital Centre Rijeka, Rijeka, Croatia.,Department of Microbiology and Parasitology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Silvio Špičić
- Department of Bacteriology and Parasitology, Croatian Veterinary Institute, Zagreb, Croatia
| | - Maja Zdelar-Tuk
- Department of Bacteriology and Parasitology, Croatian Veterinary Institute, Zagreb, Croatia
| | - Sanja Duvnjak
- Department of Bacteriology and Parasitology, Croatian Veterinary Institute, Zagreb, Croatia
| | - Irena Reil
- Department of Bacteriology and Parasitology, Croatian Veterinary Institute, Zagreb, Croatia
| | - Orea Valjin
- State Inspectorate of Republic of Croatia, Regional office Rijeka, Rijeka, Croatia
| | - Melanija Kramarić
- State Inspectorate of Republic of Croatia, Regional office Rijeka, Rijeka, Croatia
| | - Tihana Miškić
- Ministry of Agriculture, Veterinary and Food Safety Directorate, Zagreb, Croatia
| | | | - Dobrica Rončević
- Department of Epidemiology, Teaching Institute of Public Health of the Primorje-Gorski Kotar County, Rijeka, Croatia.,Department of Public Health, Faculty of Health Studies, University of Rijeka, Rijeka, Croatia
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Profiling Risk Factors for Household and Community Spatiotemporal Clusters of Q Fever Notifications in Queensland between 2002 and 2017. Pathogens 2022; 11:pathogens11080830. [PMID: 35894053 PMCID: PMC9332293 DOI: 10.3390/pathogens11080830] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/07/2022] [Accepted: 07/20/2022] [Indexed: 02/05/2023] Open
Abstract
Q fever, caused by the bacterium Coxiella burnetii, is an important zoonotic disease worldwide. Australia has one of the highest reported incidences and seroprevalence of Q fever, and communities in the state of Queensland are at highest risk of exposure. Despite Australia’s Q fever vaccination programs, the number of reported Q fever cases has remained stable for the last few years. The extent to which Q fever notifications cluster in circumscribed communities is not well understood. This study aimed to retrospectively explore and identify the spatiotemporal variation in Q fever household and community clusters in Queensland reported during 2002 to 2017, and quantify potential within cluster drivers. We used Q fever notification data held in the Queensland Notifiable Conditions System to explore the geographical clustering patterns of Q fever incidence, and identified and estimated community Q fever spatiotemporal clusters using SatScan, Boston, MA, USA. The association between Q fever household and community clusters, and demographic and socioeconomic characteristics was explored using the chi-squared statistical test and logistic regression analysis. From the total 2175 Q fever notifications included in our analysis, we found 356 Q fever hotspots at a mesh-block level. We identified that 8.2% of Q fever notifications belonged to a spatiotemporal cluster. Within the spatiotemporal Q fever clusters, we found 44 (61%) representing household clusters and 20 (27.8%) were statistically significant with an average cluster size of 3 km radius. Our multivariable model shows statistical differences between cases belonging to clusters in comparison with cases outside clusters based on the type of reported exposure. In conclusion, our results demonstrate that clusters of Q fever notifications are temporally stable and geographically circumscribed, indicating a persistent common exposure. Furthermore, within individuals in household and community clusters, abattoir exposure (a traditional occupational exposure) was rarely reported by individuals.
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8
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Mahmoud A, Abid F, Khairallah M, Affes S, Mbarek S, Amor HIH, Khalifa ABH, Mesaoud R, Khairallah M. Acute multifocal retinitis in a patient with Q fever (Coxiella Burnetii infection) with endocarditis. J Ophthalmic Inflamm Infect 2022; 12:19. [PMID: 35723746 PMCID: PMC9209575 DOI: 10.1186/s12348-022-00295-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/30/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To report acute multifocal retinitis in association with serologically-proven Coxiella (C) Burnetii infection (Q fever) with endocarditis. MATERIAL AND METHODS A single case report documented with multimodal imaging. RESULTS A 67-year-old cattle breeder presented with a 2-week history of persistent fever, headache, and floaters in both eyes. On examination, his best-corrected visual acuity was 20/20, and there was 1+ vitreous cells in both eyes. Bilateral fundus examination showed multiple small superficial white retinal lesions scattered in the posterior pole and midperiphery associated with a few retinal hemorrhages. These retinal lesions did not stain on fluorescein angiography (FA) and showed focal hyperreflectivity and thickening primarily involving the inner retinal layers on optical coherence tomography (OCT). There also was a band-like hyper-reflective area in the middle retina consistent with paramacular acute middle maculopathy. Transthoracic echocardiogram (TTE) showed a mobile echodensity on the anterior aortic leaflet consistent with a diagnosis of endocarditis. Elisa assays performed on paired serum samples collected 2 weeks apart showed increase in antibodies against C burnetii from 60 IU/ml to 255 IU/ml. The patient was treated with doxycycline 100 mg twice a day for 18 months, with subsequent resolution of the endocarditis. Sequential ocular examinations showed gradual resolution of all acute retinal findings without visible scars. CONCLUSION Acute Q fever, caused by C burnetii infection, should be considered in the differential diagnosis of acute multifocal retinitis. A systematic cardiac assessment with echocardiography is essential for early diagnosis of associated endocarditis and for prompt administration of appropriate antibiotic treatment to improve clinical outcomes.
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Affiliation(s)
- Anis Mahmoud
- Department of Ophthalmology, Tahar Sfar University Hospital, Mahdia, Tunisia
| | - Fatma Abid
- Department of Ophthalmology, Tahar Sfar University Hospital, Mahdia, Tunisia
| | - Molka Khairallah
- Department of Ophthalmology, Tahar Sfar University Hospital, Mahdia, Tunisia
| | - Sofien Affes
- Department of Ophthalmology, Tahar Sfar University Hospital, Mahdia, Tunisia
| | - Sameh Mbarek
- Department of Ophthalmology, Tahar Sfar University Hospital, Mahdia, Tunisia
| | | | | | - Riadh Mesaoud
- Department of Ophthalmology, Tahar Sfar University Hospital, Mahdia, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
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9
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Winter F, Campe A. Q fever expertise among human and veterinary health professionals in Germany - A stakeholder analysis of knowledge gaps. PLoS One 2022; 17:e0264629. [PMID: 35239742 PMCID: PMC8893703 DOI: 10.1371/journal.pone.0264629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 02/14/2022] [Indexed: 12/01/2022] Open
Abstract
Q fever is a zoonosis caused by Coxiella burnetii. In Germany, the common sources of human infections include small ruminants that excrete the pathogen. Q fever in humans can be asymptomatic or nonspecific. However, severe disease progression is also possible, which can lead to death. Q fever in small ruminants is usually asymptomatic, although reproductive disorders may occur. To protect humans from Q fever, it is important that human and veterinary health professionals (practitioners/health authority employees) have comprehensive knowledge of the diagnosis, control and prevention of Q fever, and its zoonotic potential. To ensure and enhance this understanding, this stakeholder analysis assessed Q fever expertise in human and veterinary health professionals in Germany and investigated how these knowledge gaps can best be resolved. For this purpose, an online survey and two focus group discussions were conducted with 836 and 18 participants, respectively. Knowledge gaps are due to a lack of awareness of Q fever, especially among human health practitioners. Moreover, colleagues who have heard about Q fever still lack the necessary cross-species knowledge to successfully diagnose, control and prevent this zoonosis. Additionally, differences exist between stakeholders regarding their work context and the region in which they work. In this study, stakeholders in southwestern Germany had slightly better Q fever knowledge than their colleagues in northeastern Germany. In addition, information sources aimed at resolving knowledge gaps involve direct conversations between the stakeholders, as well as reading materials and seminars. Each of these information sources should focus on interdisciplinary resources to strengthen the cooperation between human and veterinary health professionals and to raise awareness of the strengths of each stakeholder group. These results have already been implemented by the Q-GAPS project, with goals of raising awareness of Q fever and filling knowledge gaps.
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Affiliation(s)
- Fenja Winter
- Department of Biometry, Epidemiology and Information Processing, WHO Collaborating Centre for Research and Training for Health in the Human-Animal-Environment Interface, University for Veterinary Medicine Hanover, Hanover, Germany
| | - Amely Campe
- Department of Biometry, Epidemiology and Information Processing, WHO Collaborating Centre for Research and Training for Health in the Human-Animal-Environment Interface, University for Veterinary Medicine Hanover, Hanover, Germany
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10
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Vaca DJ, Dobler G, Fischer SF, Keller C, Konrad M, von Loewenich FD, Orenga S, Sapre SU, van Belkum A, Kempf VAJ. Contemporary diagnostics for medically relevant fastidious microorganisms belonging to the genera Anaplasma, Bartonella, Coxiella, Orientia, and Rickettsia. FEMS Microbiol Rev 2022; 46:6530194. [PMID: 35175353 PMCID: PMC9300619 DOI: 10.1093/femsre/fuac013] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/07/2022] [Accepted: 02/15/2022] [Indexed: 12/02/2022] Open
Abstract
Many of the human infectious pathogens—especially the zoonotic or vector-borne bacteria—are fastidious organisms that are difficult to cultivate because of their strong adaption to the infected host culminating in their near-complete physiological dependence on this environment. These bacterial species exhibit reduced multiplication rates once they are removed from their optimal ecological niche. This fact complicates the laboratory diagnosis of the disease and hinders the detection and further characterization of the underlying organisms, e.g. at the level of their resistance to antibiotics due to their slow growth. Here, we describe the current state of microbiological diagnostics for five genera of human pathogens with a fastidious laboratory lifestyle. For Anaplasma spp., Bartonella spp., Coxiella burnetii, Orientia spp. and Rickettsia spp., we will summarize the existing diagnostic protocols, the specific limitations for implementation of novel diagnostic approaches and the need for further optimization or expansion of the diagnostic armamentarium. We will reflect upon the diagnostic opportunities provided by new technologies including mass spectrometry and next-generation nucleic acid sequencing. Finally, we will review the (im)possibilities of rapidly developing new in vitro diagnostic tools for diseases of which the causative agents are fastidiously growing and therefore hard to detect.
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Affiliation(s)
- Diana J Vaca
- Institute of Medical Microbiology and Infection Control, Goethe University of Frankfurt, Germany
| | - Gerhard Dobler
- Department of Virology and Rickettsiology, Bundeswehr Institute of Microbiology, Germany
| | - Silke F Fischer
- National Consulting Laboratory for Coxiella burnetii, State Health Office Baden-Württemberg, Germany
| | | | - Maik Konrad
- National Consulting Laboratory for Coxiella burnetii, State Health Office Baden-Württemberg, Germany
| | | | | | | | | | - Volkhard A J Kempf
- Institute of Medical Microbiology and Infection Control, Goethe University of Frankfurt, Germany
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11
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Héloïse VN, Marcella M, Marielle M, Evelyne M, Sophie L, Doina G, El Mehdi C, Philippe C. A zoonotic cause of blood culture-negative infective endocarditis in Belgium: Case report and review of the literature on Q fever. IDCases 2022; 29:e01595. [PMID: 36032176 PMCID: PMC9399264 DOI: 10.1016/j.idcr.2022.e01595] [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] [Received: 11/11/2021] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
Q fever is a worldwide zoonotic infection caused by Coxiella burnetii. In Belgium, the disease must be notified, and the incidence is low. Human contamination is mostly due to sheep and goats. Herein, we report a case of chronic Q fever presenting as a prolonged fever in a patient with a history of valve prosthesis. Blood culture-negative endocarditis was diagnosed through an assessment including echocardiography and systematic serological testing. Despite the absence of travel abroad or obvious contact with domestic or wildlife animals, C. burnetii phase I and phase II IgG antibody titers were > 1:8192, and polymerase chain reaction performed on blood was positive for C. burnetii. Genotypic single nucleotide polymorphism (SNP) analysis of the pathogen strain identified a SNP-type 1 genomic group, which is associated with small ruminants in Belgium. The epidemiological investigation did not confirm the presence of positive C. burnetii cattle or sheep herds in the vicinity of the patient’s workplace and home, nor in the pest animals surrounding the workplace. Patients with risk factors for chronic Q fever should be tested for C. burnetii infection in case of prolonged fever of unknown origin, osteomyelitis, abscess or blood culture-negative endocarditis, even in the absence of direct exposure to animals.
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Affiliation(s)
- Van Noten Héloïse
- Infectious Diseases Department, CHU-Brugmann, Brussels, Belgium
- Correspondence to: CHU Brugmann Victor Horta, Département de cardiologie, Place Arthur Van Gehuchten 4, 1020 Brussels, Belgium.
| | - Mori Marcella
- National Reference Center for Coxiella burnetii and Bartonella, Zoonoses of Animals Unit, Sciensano, Brussels, Belgium
| | | | | | - Leemans Sophie
- Infectious Diseases Department, CHU-Brugmann, Brussels, Belgium
| | - Gvinda Doina
- Cardiology Department, CHU-Brugmann, Brussels, Belgium
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12
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Hasselbach L, Dübbers M. [Pneumonia, endocarditis of two valves and pulmonary artery embolism in a 26-year-old male patient]. Internist (Berl) 2021; 63:443-447. [PMID: 34939162 PMCID: PMC8956517 DOI: 10.1007/s00108-021-01228-1] [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: 11/24/2021] [Indexed: 12/02/2022]
Abstract
Ein 26-jähriger Patient zeigte eine linksseitige Pneumonie, eine Zweiklappenendokarditis und eine Lungenarterienembolie. Im Jahr 2004 war er bei angeborener Aortenklappenstenose mittels Ross-Operation versorgt worden. Es zeigte sich ein Anstieg der Titer für Coxiella burnetii, den Erreger des Q‑Fiebers. Unter antibiotischer Therapie mit Levofloxacin und Doxycyclin kam es zu einer Besserung der Symptomatik und einem Rückgang der Entzündungsparameter. Die Therapie der Endokarditis war erfolgreich.
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Affiliation(s)
- Lisa Hasselbach
- Universitätsklinik für Innere Medizin, Klinikum Oldenburg AöR, Rahel-Straus-Str. 10, 26133, Oldenburg, Deutschland.
| | - Maximilian Dübbers
- Universitätsklinik für Innere Medizin, Klinikum Oldenburg AöR, Rahel-Straus-Str. 10, 26133, Oldenburg, Deutschland
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13
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Uribe Pulido N, Escorcia García C, Cabrera Orrego R, Gutiérrez LA, Agudelo CA. Acute Q Fever With Dermatologic Manifestations, Molecular Diagnosis, and No Seroconversion. Open Forum Infect Dis 2021; 8:ofab458. [PMID: 34692888 PMCID: PMC8530256 DOI: 10.1093/ofid/ofab458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/06/2021] [Indexed: 11/14/2022] Open
Abstract
We herein described a case of acute infection by Coxiella burnetii (acute Q fever) that started with a short incubation period and showed prominent dermatological manifestations and unusual serological behavior. The infection was confirmed by molecular detection through real-time polymerase chain reaction using genomic DNA collected from peripheral blood.
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Affiliation(s)
| | | | - Ruth Cabrera Orrego
- Grupo Biología de Sistemas, Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Lina Andrea Gutiérrez
- Grupo Biología de Sistemas, Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Carlos Andrés Agudelo
- Clínica Universitaria Bolivariana, Medellín, Colombia
- Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
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14
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Rabaza A, Giannitti F, Fraga M, Macías-Rioseco M, Corbellini LG, Riet-Correa F, Hirigoyen D, Turner KME, Eisler MC. Serological Evidence of Human Infection with Coxiella burnetii after Occupational Exposure to Aborting Cattle. Vet Sci 2021; 8:196. [PMID: 34564590 PMCID: PMC8473284 DOI: 10.3390/vetsci8090196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/30/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022] Open
Abstract
Cattle are broadly deemed a source of Coxiella burnetii; however, evidence reinforcing their role in human infection is scarce. Most published human Q fever outbreaks relate to exposure to small ruminants, notably goats. Anti-phase II C. burnetii IgG and IgM were measured by indirect fluorescent antibody tests in 27 farm and veterinary diagnostic laboratory workers to ascertain whether occupational exposure to cattle aborting due to C. burnetii was the probable source of exposure. Four serological profiles were identified on the basis of anti-phase II IgG and IgM titres. Profile 1, characterised by high IgM levels and concurrent, lower IgG titres (3/27; 11.1%); Profile 2, with both isotypes with IgG titres higher than IgM (2/27; 7.4%); Profile 3 with only IgG phase II (5/27; 18.5%); and Profile 4, in which neither IgM nor IgG were detected (17/27; 63.0%). Profiles 1 and 2 are suggestive of recent C. burnetii exposure, most likely 2.5-4.5 months before testing and, hence, during the window of exposure to the bovine abortions. Profile 3 suggested C. burnetii exposure that most likely predated the window of exposure to aborting cattle, while Profile 4 represented seronegative individuals and, hence, likely uninfected. This study formally linked human Q fever to exposure to C. burnetii infected cattle as a specific occupational hazard for farm and laboratory workers handling bovine aborted material.
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Affiliation(s)
- Ana Rabaza
- Instituto Nacional de Investigación Agropecuaria, Plataforma de Investigación en Salud Animal, Estación Experimental La Estanzuela, Colonia 70000, Uruguay; (A.R.); (F.G.); (M.F.); (M.M.-R.); (L.G.C.); (F.R.-C.); (D.H.)
- Bristol Veterinary School, University of Bristol, Langford House, Langford, Bristol BS40 5DU, UK;
| | - Federico Giannitti
- Instituto Nacional de Investigación Agropecuaria, Plataforma de Investigación en Salud Animal, Estación Experimental La Estanzuela, Colonia 70000, Uruguay; (A.R.); (F.G.); (M.F.); (M.M.-R.); (L.G.C.); (F.R.-C.); (D.H.)
| | - Martín Fraga
- Instituto Nacional de Investigación Agropecuaria, Plataforma de Investigación en Salud Animal, Estación Experimental La Estanzuela, Colonia 70000, Uruguay; (A.R.); (F.G.); (M.F.); (M.M.-R.); (L.G.C.); (F.R.-C.); (D.H.)
| | - Melissa Macías-Rioseco
- Instituto Nacional de Investigación Agropecuaria, Plataforma de Investigación en Salud Animal, Estación Experimental La Estanzuela, Colonia 70000, Uruguay; (A.R.); (F.G.); (M.F.); (M.M.-R.); (L.G.C.); (F.R.-C.); (D.H.)
- California Animal Health & Food Safety Laboratory System, University of California-Davis, Tulare, CA 95616, USA
| | - Luis G. Corbellini
- Instituto Nacional de Investigación Agropecuaria, Plataforma de Investigación en Salud Animal, Estación Experimental La Estanzuela, Colonia 70000, Uruguay; (A.R.); (F.G.); (M.F.); (M.M.-R.); (L.G.C.); (F.R.-C.); (D.H.)
| | - Franklin Riet-Correa
- Instituto Nacional de Investigación Agropecuaria, Plataforma de Investigación en Salud Animal, Estación Experimental La Estanzuela, Colonia 70000, Uruguay; (A.R.); (F.G.); (M.F.); (M.M.-R.); (L.G.C.); (F.R.-C.); (D.H.)
- Programa de Pós Graduação em Ciência Animal nos Trópicos, Faculdade de Veterinária, Universidade Federal da Bahia, Ondina, Salvador 40170-290, Brazil
| | - Darío Hirigoyen
- Instituto Nacional de Investigación Agropecuaria, Plataforma de Investigación en Salud Animal, Estación Experimental La Estanzuela, Colonia 70000, Uruguay; (A.R.); (F.G.); (M.F.); (M.M.-R.); (L.G.C.); (F.R.-C.); (D.H.)
| | - Katy M. E. Turner
- Bristol Veterinary School, University of Bristol, Langford House, Langford, Bristol BS40 5DU, UK;
| | - Mark C. Eisler
- Bristol Veterinary School, University of Bristol, Langford House, Langford, Bristol BS40 5DU, UK;
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15
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Huang M, Ma J, Jiao J, Li C, Chen L, Zhu Z, Ruan F, Xing L, Zheng X, Fu M, Ma B, Gan C, Mao Y, Zhang C, Sun P, Liu X, Lin Z, Chen L, Lu Z, Zhou D, Wen B, Chen W, Xiong X, Xia J. The epidemic of Q fever in 2018 to 2019 in Zhuhai city of China determined by metagenomic next-generation sequencing. PLoS Negl Trop Dis 2021; 15:e0009520. [PMID: 34264939 PMCID: PMC8282036 DOI: 10.1371/journal.pntd.0009520] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 05/30/2021] [Indexed: 12/24/2022] Open
Abstract
Q fever is a worldwide zoonosis caused by Coxiella burnetii (Cb). From January 2018 to November 2019, plasma samples from 2,382 patients with acute fever of unknown cause at a hospital in Zhuhai city of China were tested using metagenomic next-generation sequencing (mNGS). Of those tested, 138 patients (5.8%) were diagnosed with Q fever based on the presence of Cb genomic DNA detected by mNGS. Among these, 78 cases (56.5%) presented from Nov 2018 to Mar 2019, suggesting an outbreak of Q fever. 55 cases with detailed clinical information that occurred during the outbreak period were used for further analysis. The vast majority of plasma samples from those Cb-mNGS-positive patients were positive in a Cb-specific quantitative polymerase chain reaction (n = 38) and/or indirect immunofluorescence assay (n = 26). Mobile phone tracing data was used to define the area of infection during the outbreak. This suggested the probable infection source was Cb-infected goats and cattle at the only official authorized slaughterhouse in Zhuhai city. Phylogenic analysis based on genomic sequences indicated Cb strains identified in the patients, goat and cattle were formed a single branch, most closely related to the genomic group of Cb dominated by strains isolated from goats. Our study demonstrates Q fever was epidemic in 2018–2019 in Zhuhai city, and this is the first confirmed epidemic of Q fever in a contemporary city in China. Generally, the clinical diagnosis of acute Q fever, which is caused by Coxiella burnetii, is based on serologic methods that detect the presence antibodies produced by the body to fight the infection. However, the lag time between becoming infected and production of antibodies limits early diagnosis using this method. Here, we confirmed an epidemic of human Q fever in Zhuhai, a contemporary city in China, using clinical metagenomic next-generation sequencing (mNGS) and cell phone location data. Our results indicate that Cb-infected goats and cattle at the only official authorized slaughterhouse in Zhuhai were the likely infection source for the Q fever epidemic. More importantly, we demonstrate that mNGS is a useful tool for rapid and effective public health responses to acute bacterial infections.
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Affiliation(s)
- Mingxing Huang
- Department of Infectious Diseases, the Fifth Affiliated Hospital of Sun Yat-Sen University (SYSU), Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
- Department of Microbiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | | | - Jun Jiao
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, 20# Dong-Da-Jie Street, Fengtai, Beijing, China
| | - Chunna Li
- Department of Infectious Diseases, the Fifth Affiliated Hospital of Sun Yat-Sen University (SYSU), Zhuhai, China
| | - Luan Chen
- BGI PathoGenesis Pharmaceutical Technology, BGI-Shenzhen, Shenzhen, China
| | - Zhongyi Zhu
- BGI PathoGenesis Pharmaceutical Technology, BGI-Shenzhen, Shenzhen, China
| | - Feng Ruan
- Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Li Xing
- BGI PathoGenesis Pharmaceutical Technology, BGI-Shenzhen, Shenzhen, China
| | - Xinchun Zheng
- Department of Infectious Diseases, the Fifth Affiliated Hospital of Sun Yat-Sen University (SYSU), Zhuhai, China
| | - Mengjiao Fu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, 20# Dong-Da-Jie Street, Fengtai, Beijing, China
| | - Binyin Ma
- BGI PathoGenesis Pharmaceutical Technology, BGI-Shenzhen, Shenzhen, China
| | - Chongjie Gan
- Department of Infectious Diseases, the Fifth Affiliated Hospital of Sun Yat-Sen University (SYSU), Zhuhai, China
| | - Yuanchen Mao
- BGI PathoGenesis Pharmaceutical Technology, BGI-Shenzhen, Shenzhen, China
| | - Chongnan Zhang
- Department of Infectious Diseases, the Fifth Affiliated Hospital of Sun Yat-Sen University (SYSU), Zhuhai, China
| | - Ping Sun
- Department of Infectious Diseases, the Fifth Affiliated Hospital of Sun Yat-Sen University (SYSU), Zhuhai, China
| | - Xi Liu
- Department of Infectious Diseases, the Fifth Affiliated Hospital of Sun Yat-Sen University (SYSU), Zhuhai, China
| | - Ziliang Lin
- Department of Infectious Diseases, the Fifth Affiliated Hospital of Sun Yat-Sen University (SYSU), Zhuhai, China
| | - Lu Chen
- BGI PathoGenesis Pharmaceutical Technology, BGI-Shenzhen, Shenzhen, China
| | - Zhiyu Lu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, 20# Dong-Da-Jie Street, Fengtai, Beijing, China
| | - Dongsheng Zhou
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, 20# Dong-Da-Jie Street, Fengtai, Beijing, China
| | - Bohai Wen
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, 20# Dong-Da-Jie Street, Fengtai, Beijing, China
| | - Weijun Chen
- BGI PathoGenesis Pharmaceutical Technology, BGI-Shenzhen, Shenzhen, China
- BGI Education Center, University of Chinese Academy of Sciences, Shenzhen, China
- * E-mail: (WJC); (XLX); (JXY)
| | - Xiaolu Xiong
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, 20# Dong-Da-Jie Street, Fengtai, Beijing, China
- * E-mail: (WJC); (XLX); (JXY)
| | - Jinyu Xia
- Department of Infectious Diseases, the Fifth Affiliated Hospital of Sun Yat-Sen University (SYSU), Zhuhai, China
- * E-mail: (WJC); (XLX); (JXY)
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16
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Winter F, Schoneberg C, Wolf A, Bauer BU, Prüfer TL, Fischer SF, Gerdes U, Runge M, Ganter M, Campe A. Concept of an Active Surveillance System for Q Fever in German Small Ruminants-Conflicts Between Best Practices and Feasibility. Front Vet Sci 2021; 8:623786. [PMID: 33644150 PMCID: PMC7902497 DOI: 10.3389/fvets.2021.623786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/04/2021] [Indexed: 11/16/2022] Open
Abstract
Q fever is a zoonotic disease caused by the bacterium Coxiella burnetii. Inhalation of contaminated dust particles or aerosols originating from animals (esp. small ruminants) is the main source of human infection. Hence, an active early warning system for Q fever in German small ruminant livestock was conceptualized to prevent human infections. First, we describe the best practice for establishing this system before evaluating its feasibility, as the combination of both evokes conflicts. Vaginal swabs from all husbandry systems with a focus on reproductive females should pooled and investigated by PCR to detect C. burnetii-shedding animals. Multistage risk-based sampling shall be carried out at the flock level and within-flock level. At the flock level, all flocks that are at risk to transmit the pathogen to the public must be sampled. At the within-flock level, all primi- and multiparous females after lambing must be tested in order to increase the probability of identifying a positive herd. Sampling should be performed during the main lambing period and before migration in residential areas. Furthermore, individual animals should be tested before migration or exhibition to ensure a negative status. If a flock tests positive in at least one individual sample, then flock-specific preventive measures should be implemented. This approach implies huge financial costs (sample testing, action/control measures). Hence, taking the step to develop more feasible and affordable preventive measures, e.g., vaccinating small ruminant flocks, should replace testing wherever justifiable.
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Affiliation(s)
- Fenja Winter
- Department of Biometry, Epidemiology and Information Processing, WHO Collaborating Centre for Research and Training for Health at the Human-Animal-Environment Interface, University of Veterinary Medicine Hannover Foundation, Hanover, Germany
| | - Clara Schoneberg
- Department of Biometry, Epidemiology and Information Processing, WHO Collaborating Centre for Research and Training for Health at the Human-Animal-Environment Interface, University of Veterinary Medicine Hannover Foundation, Hanover, Germany
| | - Annika Wolf
- Clinic for Swine, Small Ruminants and Forensic Medicine, University of Veterinary Medicine Hannover Foundation, Hanover, Germany
| | - Benjamin U. Bauer
- Clinic for Swine, Small Ruminants and Forensic Medicine, University of Veterinary Medicine Hannover Foundation, Hanover, Germany
| | - T. Louise Prüfer
- Lower Saxony State Office for Consumer Protection and Food Safety – Food and Veterinary Institute Braunschweig/Hannover, Hanover, Germany
| | - Silke F. Fischer
- National Consulting Laboratory for Coxiella burnetii, State Health Office Baden-Württemberg, Stuttgart, Germany
| | - Ursula Gerdes
- Animal Disease Fund of Lower Saxony, Public Law Institution, Hanover, Germany
| | - Martin Runge
- Lower Saxony State Office for Consumer Protection and Food Safety – Food and Veterinary Institute Braunschweig/Hannover, Hanover, Germany
| | - Martin Ganter
- Clinic for Swine, Small Ruminants and Forensic Medicine, University of Veterinary Medicine Hannover Foundation, Hanover, Germany
| | - Amely Campe
- Department of Biometry, Epidemiology and Information Processing, WHO Collaborating Centre for Research and Training for Health at the Human-Animal-Environment Interface, University of Veterinary Medicine Hannover Foundation, Hanover, Germany
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17
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Bronner MB, Haagsma JA, Dontje ML, Barmentloo L, Kouwenberg RMCEJ, Olde Loohuis AGM, de Groot A, Erasmus V, Polinder S. Long-term impact of a Q-fever outbreak: An evaluation of health symptoms, health-related quality of life, participation and health care satisfaction after ten years. J Psychosom Res 2020; 139:110258. [PMID: 33069049 PMCID: PMC7508008 DOI: 10.1016/j.jpsychores.2020.110258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/19/2020] [Accepted: 09/19/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess health symptoms, health-related quality of life, participation, and health care satisfaction in Q-fever patients up to 10 years after infection. METHODS Cross-sectional questionnaire survey in the Netherlands. Data on health symptoms, fatigue (CIS), health-related quality of life (EQ-5D), social/work participation, health care providers and health care satisfaction were collected in patients with chronic Q-fever (CQ), Q-fever fatigue syndrome (QFS), and patients who experience QFS-like disease without a post-infection diagnosis (QLD). RESULTS A vast majority of the 478 Q-fever patients (response rate 54.3%) face several health problems 10 years after infection. Fatigue was the most prevalent symptom in all groups (91.2%). The median EQ-5D index value differed significantly between the three diagnostic groups (CQ: 0.67; QFS: 0.55; QLD:0.70; p < 0.001). Approximately 50% of all patients had serious problems with work and physical activities, and more than 25% experienced difficulties with leisure time, household and social contacts. Also, more than one third stopped working permanently. Furthermore, GP's, internists, and physical therapists were the most often consulted health care providers. Patients gave low ratings for the overall quality of care for Q-fever, with 75% scoring a 5.0 or lower on a 10-point scale. CONCLUSION Long-term health consequences are considerable for Q-fever patients, especially for those with QFS. The majority of the patients was unsatisfied with the quality of care for Q-fever. Awareness of the long-term impact of zoonotic diseases like Q-fever is needed to offer optimal health care for these patients.
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Affiliation(s)
- Madelon B Bronner
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Juanita A Haagsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Manon L Dontje
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Lotte Barmentloo
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | | | | | - Annemieke de Groot
- Q-support, Goudsbloemvallei 1, 5237 MH 's-Hertogenbosch, the Netherlands.
| | - Vicki Erasmus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
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Prevalence of Coxiella burnetii in German sheep flocks and evaluation of a novel approach to detect an infection via preputial swabs at herd-level. Epidemiol Infect 2020; 148:e75. [PMID: 32172709 PMCID: PMC7118722 DOI: 10.1017/s0950268820000679] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A prevalence study was conducted on German sheep flocks including goats if they cohabitated with sheep. In addition, a novel approach was applied to identify an infection at the herd-level before lambing season with preputial swabs, suspecting venereal transmission and ensuing colonisation of preputial mucosa with Coxiella (C.) burnetii. Blood samples and genital swabs were collected from breeding males and females after the mating season and were analysed by enzyme-linked immunosorbent assay (ELISA) and quantitative polymerase chain reaction (qPCR) respectively. In total, 3367 animals were sampled across 71 flocks. The true herd-level prevalence adjusted for misclassification probabilities of the applied diagnostic tests using the Rogan-Gladen estimator for the prevalence estimate and a formula by Lang and Reiczigel (2014) for the confidence limits, ranged between 31.3% and 33% (95% confidence interval [95% CI] 17.3–45.5) detected by the ELISA and/or qPCR. Overall 26–36.6% (95% CI 13–56.8) were detected by ELISA, 13.9% (95% CI 4.5–23.2) by the qPCR and 7.9–11.2% (95% CI 0.08–22.3) by both tests simultaneously. The range of results is due to data obtained from literature with different specifications for test quality for ELISA. Among eight farms with females shedding C. burnetii, three farms (37.5%) could also be identified by preputial swabs from breeding sires. This indicates less reliability of preputial swabs if used as a single diagnostic tool to detect C. burnetii infection at the herd-level.
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Nader J, Kugener H, Remadi JP. Cardiac device Q fever endocarditis - A delayed diagnosis. Int J Infect Dis 2019; 92:69-70. [PMID: 31862342 DOI: 10.1016/j.ijid.2019.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- J Nader
- Cardiac Surgery Unit, Amiens Academic Hospital, France
| | | | - Jean-Paul Remadi
- Cardiac Surgery Unit, Amiens Academic Hospital, France; Cardiology Unit, Europe Clinic, Amiens, France.
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Genetic evidence of Coxiella burnetii infection in acute febrile illnesses in Iran. PLoS Negl Trop Dis 2019; 13:e0007181. [PMID: 30742631 PMCID: PMC6386404 DOI: 10.1371/journal.pntd.0007181] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 02/22/2019] [Accepted: 01/23/2019] [Indexed: 01/03/2023] Open
Abstract
Mounting evidence suggests that Q-fever is more prevalent in Iran than originally believed. However, in most parts of the country, clinicians do not pay enough attention to Q fever in their differential diagnosis. The aim of this study was to investigate the prevalence of Coxiella burnetii in suspected cases of acute Q fever in north-western Iran using molecular techniques. Febrile patients were enrolled in the study and investigated for C. burnetii infection. Sera samples were tested using real-time PCR for detection of IS1111 gene, and positive samples were confirmed with nested PCR. Nine patients (4.2%) out of 216 suspected cases were positive for C. burnetii. Weakness and fatigue, headache, and lethargy were the most prevalent clinical symptoms in acute Q fever patients. According to the results of this study and other reports of human cases in Iran, the diagnosis system of Q fever in Iran should be urgently revamped. Q fever is a zoonotic infectious disease caused by Coxiella burnetii. Domestic ruminants are the most common source of human infection. Main route of transmission to humans is inhalation of infected aerosols and dust with C. burnetii. Acute Q fever is usually presented as a non-specific febrile and self-limiting influenza-like illness, but in severe acute cases, may manifest as atypical pneumonia or hepatitis. In Iran, Q fever is an endemic disease with high seroprevalence among humans and domestic animals. However, human Q fever cases remain undiagnosed in most regions of Iran, especially because most clinicians fail to spot this disease in their differential diagnosis. The aim of this study was to investigate the prevalence of acute Q fever in suspected cases (216 suspected cases) using molecular techniques. Nine acute Q fever patients were diagnosed by Real-time PCR and Nested PCR. Weakness and fatigue, headache, and lethargy were the most prevalent clinical symptoms in positive cases. Human Q fever cases described in this, and previous studies, indicate the need to implement diagnostic techniques for this disease across the country.
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