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Neare K, Tummeleht L, Lassen B, Viltrop A. Coxiella burnetii Seroprevalence and Associated Risk Factors in Cattle, Sheep, and Goats in Estonia. Microorganisms 2023; 11:microorganisms11040819. [PMID: 37110243 PMCID: PMC10142450 DOI: 10.3390/microorganisms11040819] [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: 02/22/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023] Open
Abstract
Q fever, a disease caused by Coxiella burnetii (CB), is an emerging zoonotic health problem. The prevalence data from potential sources are valuable for assessing the risk to human and animal health. To estimate the prevalence of CB antibodies in Estonian ruminants, pooled milk and serum samples from cattle (Bos taurus) and pooled serum samples from sheep (Ovis aries) and goats (Capra hircus) were analyzed. Additionally, bulk tank milk samples (BTM; n = 72) were analyzed for the presence of CB DNA. Questionnaires and herd-level datasets were used to identify the risk factors for exposure using binary logistic regression analysis. The prevalence of CB-positive dairy cattle herds (27.16%) was significantly higher than that in beef cattle herds (6.67%) and sheep flocks (2.35%). No CB antibodies were detected in the goat flocks. CB DNA was found in 11.36% of the BTM samples. The odds of seropositivity were higher in dairy cattle herds, with an increasing number of cattle in the herd, and with location in southwestern, northeastern and northwestern Estonia. Dairy cattle herds had higher odds of testing positive for CB in BTM if the dairy cows were kept loose and lower odds if the herd was located in northwestern Estonia.
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Affiliation(s)
- Kädi Neare
- Chair of Veterinary Biomedicine and Food Hygiene, Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, 51006 Tartu, Estonia
| | - Lea Tummeleht
- Chair of Veterinary Biomedicine and Food Hygiene, Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, 51006 Tartu, Estonia
| | - Brian Lassen
- Research Group for Foodborne Pathogens and Epidemiology, National Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, Denmark
| | - Arvo Viltrop
- Chair of Veterinary Biomedicine and Food Hygiene, Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, 51006 Tartu, Estonia
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Hip periprosthetic joint infection due to Coxiella burnetii in an adult male. IDCases 2022; 31:e01661. [PMID: 36593892 PMCID: PMC9803808 DOI: 10.1016/j.idcr.2022.e01661] [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] [Received: 11/06/2022] [Revised: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Coxiella burnetii is an obligate intracellular Gram-negative bacterium. "Query fever" (Q fever) first described in 1939 is a disease caused by Coxiella burnetii. This bacterium infects animals including goats, sheep, and cattle, and has been recognized as a pathogen causing acute illness in humans. A patient living on a farm with a history of a right total hip arthroplasty presented with right hip pain. Arthrocentesis revealed a total nucleated count of 4288 (93% neutrophils), however his synovial fluid culture remained negative. His Q fever phase I IgG and phase II IgG were elevated at 1:4096 and 1:2048, respectively. He underwent incision and drainage with exchange of the femoral head and acetabular component, with retention of the femoral stem. PCR of tissue samples returned positive for Coxiella burnettii. He was diagnosed with a persistent localized prosthetic joint infection (PJI) of the right hip. Coxiella burnetii PJI is a rare but increasingly recognized form of persistent localized Q fever infection. Q fever should be considered in the differential diagnosis of culture-negative PJI, especially among patients with exposure to sheep, goats, or cattle. Initial screening for Coxiella burnetii includes serology, but tissue PCR and immunohistochemical staining may be obtained to confirm joint infection.
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Hackert VH, Hoebe CJPA, Dukers-Muijrers N, Krafft T, Kauhl B, Henning K, Karges W, Sprague L, Neubauer H, Al Dahouk S. Q fever: Evidence of a massive yet undetected cross-border outbreak, with ongoing risk of extra mortality, in a Dutch-German border region. Transbound Emerg Dis 2020; 67:1660-1670. [PMID: 32027783 PMCID: PMC7383856 DOI: 10.1111/tbed.13505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 01/20/2020] [Accepted: 01/31/2020] [Indexed: 12/11/2022]
Abstract
Background Following outbreaks in other parts of the Netherlands, the Dutch border region of South Limburg experienced a large‐scale outbreak of human Q fever related to a single dairy goat farm in 2009, with surprisingly few cases reported from neighbouring German counties. Late chronic Q fever, with recent spikes of newly detected cases, is an ongoing public health concern in the Netherlands. We aimed to assess the scope and scale of any undetected cross‐border transmission to neighbouring German counties, where individuals unknowingly exposed may carry extra risk of overlooked diagnosis. Methods (A) Seroprevalence rates in the Dutch area were estimated fitting an exponential gradient to the geographical distribution of notified acute human Q fever cases, using seroprevalence in a sample of farm township inhabitants as baseline. (B) Seroprevalence rates in 122 neighbouring German postcode areas were estimated from a sample of blood donors living in these areas and attending the regional blood donation centre in January/February 2010 (n = 3,460). (C) Using multivariate linear regression, including goat and sheep densities, veterinary Q fever notifications and blood donor sampling densities as covariates, we assessed whether seroprevalence rates across the entire border region were associated with distance from the farm. Results (A) Seroprevalence in the outbreak farm's township was 16.1%. Overall seroprevalence in the Dutch area was 3.6%. (B) Overall seroprevalence in the German area was 0.9%. Estimated mean seroprevalence rates (per 100,000 population) declined with increasing distance from the outbreak farm (0–19 km = 2,302, 20–39 km = 1,122, 40–59 km = 432 and ≥60 km = 0). Decline was linear in multivariate regression using log‐transformed seroprevalence rates (0–19 km = 2.9 [95% confidence interval (CI) = 2.6 to 3.2], 20 to 39 km = 1.9 [95% CI = 1.0 to 2.8], 40–59 km = 0.6 [95% CI = −0.2 to 1.3] and ≥60 km = 0.0 [95% CI = −0.3 to 0.3]). Conclusions Our findings were suggestive of widespread cross‐border transmission, with thousands of undetected infections, arguing for intensified cross‐border collaboration and surveillance and screening of individuals susceptible to chronic Q fever in the affected area.
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Affiliation(s)
- Volker H Hackert
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, The Netherlands.,Department of Social Medicine and Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University/MUMC+, Maastricht, The Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, The Netherlands.,Department of Social Medicine and Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University/MUMC+, Maastricht, The Netherlands
| | - Nicole Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, The Netherlands.,Department of Social Medicine and Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University/MUMC+, Maastricht, The Netherlands
| | - Thomas Krafft
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Boris Kauhl
- Department III, Civil Engineering and Geoinformatics, Beuth University of Applied Sciences, Berlin, Germany
| | - Klaus Henning
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut (FLI), Federal Research Institute for Animal Health, Jena, Germany
| | - Wolfram Karges
- Department of Internal Medicine III, RWTH Aachen University Hospital, Aachen, Germany
| | - Lisa Sprague
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut (FLI), Federal Research Institute for Animal Health, Jena, Germany
| | - Heinrich Neubauer
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut (FLI), Federal Research Institute for Animal Health, Jena, Germany
| | - Sascha Al Dahouk
- Department of Internal Medicine III, RWTH Aachen University Hospital, Aachen, Germany.,Department of Biological Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany
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Coxiella burnetii Antibody Prevalence and Risk Factors of Infection in the Human Population of Estonia. Microorganisms 2019; 7:microorganisms7120629. [PMID: 31795442 PMCID: PMC6956122 DOI: 10.3390/microorganisms7120629] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/24/2019] [Accepted: 11/27/2019] [Indexed: 01/16/2023] Open
Abstract
Q fever is an emerging health problem in both humans and animals. To estimate the prevalence of Coxiella burnetii (C. burnetii) antibodies in the Estonian population, we analyzed plasma samples from 1000 individuals representing the general population and 556 individual serum samples from five population groups potentially at a higher risk (veterinary professionals, dairy cattle, beef cattle, and small ruminant stockbreeders and hunters). Additionally, 118 dairy cow bulk tank milk samples were analyzed to establish the infection status of the dairy cattle herds and the participating dairy cattle keepers. Questionnaires were used to find the potential risk factors of exposure. The effects of different variables were evaluated using binary logistic regression analysis and mixed-effects logistic analysis. The prevalence in veterinary professionals (9.62%; p = 0.003) and dairy cattle farmers (7.73%; p = 0.047) was significantly higher than in the general population (3.9%). Contact with production animals in veterinary practice and being a dairy stockbreeder in C. burnetii positive farms were risk factors for testing C. burnetii seropositive (p = 0.038 and p = 0.019, respectively). Results suggest that C. burnetii is present in Estonia and the increased risk of infection in humans is associated with farm animal contact.
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Chenouard R, Hoppé E, Lemarié C, Talha A, Ducellier F, Ferchaud F, Kempf M, Edouard S, Abgueguen P, Rabier V, Pailhoriès H. A rare case of Prosthetic Joint Infection associated with Coxiella burnetii. Int J Infect Dis 2019; 87:166-169. [PMID: 31374343 DOI: 10.1016/j.ijid.2019.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/24/2019] [Accepted: 07/24/2019] [Indexed: 01/15/2023] Open
Abstract
We report here the case of a Prosthetic Joint Infection (PJI) associated with Coxiella burnetii in a 62-year-old man with a revised total hip arthroplasty. The diagnosis was performed first by 16S rDNA sequencing on hip fluid aspirate, and confirmed by specific qPCR. Q fever has been reported in few cases of Prosthetic Joint Infections, often associated with chronic evolution and iterative surgeries. This case report alerts about such an unexpected diagnosis in a patient with no known risk factors.
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Affiliation(s)
- Rachel Chenouard
- Laboratoire de Bactériologie, Institut de Biologie en Santé, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Emmanuel Hoppé
- Service de Rhumatologie, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Carole Lemarié
- Laboratoire de Bactériologie, Institut de Biologie en Santé, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Abdelhafid Talha
- Service de Chirurgie Osseuse, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Florian Ducellier
- Service de Chirurgie Osseuse, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - François Ferchaud
- Service de Chirurgie Osseuse, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Marie Kempf
- Laboratoire de Bactériologie, Institut de Biologie en Santé, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Sophie Edouard
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Pierre Abgueguen
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Valérie Rabier
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Hélène Pailhoriès
- Laboratoire de Bactériologie, Institut de Biologie en Santé, Centre Hospitalier Universitaire d'Angers, Angers, France.
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Nielsen S, Nørskov-Lauritsen N. Multispacer sequence typing of Coxiella burnetii DNA from removed prosthetic heart valve material discloses first human case of infective endocarditis caused by MST_18. Int J Infect Dis 2019; 79:139-141. [DOI: 10.1016/j.ijid.2018.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 11/25/2022] Open
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Khamesipour F, Dida GO, Anyona DN, Razavi SM, Rakhshandehroo E. Tick-borne zoonoses in the Order Rickettsiales and Legionellales in Iran: A systematic review. PLoS Negl Trop Dis 2018; 12:e0006722. [PMID: 30204754 PMCID: PMC6181433 DOI: 10.1371/journal.pntd.0006722] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 10/11/2018] [Accepted: 07/27/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Tick-borne zoonoses in the Order Rickettsiales and Legionellales cause infections that often manifest as undifferentiated fevers that are not easy to distinguish from other causes of acute febrile illnesses clinically. This is partly attributed to difficulty in laboratory confirmation since convalescent sera, specific diagnostic reagents, and the required expertise may not be readily available. As a result, a number of tick-borne zoonoses are underappreciated resulting in unnecessary morbidity, mortality and huge economic loses. In Iran, a significant proportion of human infectious diseases are tick-borne, with anecdotal evidence suggesting that tick-borne zoonoses are widespread but underreported in the country. Epidemiological review is therefore necessary to aid in the effective control and prevention of tick-borne zonooses in Iran. The aim of this review is to provide an in-depth and comprehensive overview of anaplasmosis, ehrlichiosis, spotted fever group rickettsioses and coxiellosis in Iran. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, all relevant publications on tick-borne zoonoses in the Order Rickettsiales and Legionellales in Iran were searched using a number of search terms. The search was confined to authentic resources from repositories of popular data bases among them PubMed, Web of Science, Google Scholar, Science Direct, SpringerLink and SCOPUS. The search items included peer reviewed journals, books and book chapters published between 1996 and 2017. RESULTS A total of 1 205 scientific publications and reports were sourced, of which 63 met the search criteria and were reviewed. Of the 63 articles reviewed, 36 (57.1%) reported on coxiellosis, 15 (23.8%) on anaplasmosis, 11 (17.5%) on ehrlichiosis and 1(1.6%) on spotted fever group rickettsiae in a large scale study involving four countries, among them Iran. The existence of tick-borne pathogens in the Order Rickettsiales and Legionellales was confirmed by molecular, serological and microscopic techniques conducted on samples obtained from sheep, cattle, goats, camels, poultry, animal products (milk and eggs), dogs, ticks and even human subjects in different parts of the country; pointing to a countrywide distribution. DISCUSSION Based on the review, coxiellosis, anaplasmosis, ehrlichiosis, and SFG rickettsiae can be categorized as emerging tick-borne zoonotic diseases in Iran given the presence of their causiative agents (C. burnetii, A. phagocytophilum, A. marginale, A. bovis, A. ovis, A. central, E. canis, E. ewingii, E. chaffeensis and R. conorii) collectively reported in a variety of domestic animals, animal products, arthropods and human beings drawn from 22 provinces in Iran. CONCLUSION Given the asymptomatic nature of some of these zoonoses, there is a high likelihood of silent transmission to humans in many parts of the country, which should be considered a public health concern. Presently, information on the transmission intensity of tick-borne zoonoses caused by pathogens in the Order Rickettsiales and Legionellales to humans and its public health impact in Iran is scanty.
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Affiliation(s)
- Faham Khamesipour
- Cellular and Molecular Research Centre, Sabzevar University of Medical Sciences, Sabzevar, Iran
- Department of Pathobiology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Gabriel O. Dida
- School of Public Health and Community Development, Maseno University, Maseno, Kenya
- Department of Community and Public Health, Technical University of Kenya, Nairobi, Kenya
| | - Douglas N. Anyona
- School of Environment and Earth Sciences, Maseno University, Maseno, Kenya
| | - S. Mostafa Razavi
- Department of Pathobiology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Ehsan Rakhshandehroo
- Department of Pathobiology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
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Selim A, Yang E, Rousset E, Thiéry R, Sidi-Boumedine K. Characterization of Coxiella burnetii strains from ruminants in a Galleria mellonella host-based model. New Microbes New Infect 2018; 24:8-13. [PMID: 29922469 PMCID: PMC6004733 DOI: 10.1016/j.nmni.2018.02.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/01/2018] [Accepted: 02/06/2018] [Indexed: 11/25/2022] Open
Abstract
Coxiella burnetii is a small Gram-negative intracellular bacterium and is the causative agent of Q fever, which is a zoonotic disease with a worldwide distribution. Domesticated ruminants are the main reservoir of the disease, but the bacterium is able to infect a wide range of hosts, including humans, arthropods and invertebrates. Virulence studies of Coxiella strains usually require a suitable animal model. However, mammalian models are costly and are associated with many ethical constraints. An alternative infection model using Galleria mellonella has been used to study the virulence of several bacterial as well as fungal pathogens. Moreover, the G. mellonella larvae model has been used to identify virulence genes using phase II C. burnetii strain Nine Mile mutants. In our study we describe its use for the characterization of C. burnetii strains isolated from ruminants.
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Affiliation(s)
- A Selim
- French Agency for Food, Environmental and Occupational Health Safety (ANSES), Sophia Antipolis Laboratory, Animal Q Fever Unit, Sophia Antipolis, France.,Animal Medicine Department, Faculty of Veterinary Medicine, Banha University, Banha, Egypt
| | - E Yang
- French Agency for Food, Environmental and Occupational Health Safety (ANSES), Sophia Antipolis Laboratory, Animal Q Fever Unit, Sophia Antipolis, France
| | - E Rousset
- French Agency for Food, Environmental and Occupational Health Safety (ANSES), Sophia Antipolis Laboratory, Animal Q Fever Unit, Sophia Antipolis, France
| | - R Thiéry
- French Agency for Food, Environmental and Occupational Health Safety (ANSES), Sophia Antipolis Laboratory, Animal Q Fever Unit, Sophia Antipolis, France
| | - K Sidi-Boumedine
- French Agency for Food, Environmental and Occupational Health Safety (ANSES), Sophia Antipolis Laboratory, Animal Q Fever Unit, Sophia Antipolis, France
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Esmaeili S, Golzar F, Ayubi E, Naghili B, Mostafavi E. Acute Q fever in febrile patients in northwestern of Iran. PLoS Negl Trop Dis 2017; 11:e0005535. [PMID: 28394892 PMCID: PMC5398717 DOI: 10.1371/journal.pntd.0005535] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/20/2017] [Accepted: 03/28/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Q fever is an endemic disease in different parts of Iran. This study aimed to investigate the prevalence of acute Q fever disease among at-risk individuals in northwestern Iran. METHODOLOGY An etiological study was carried out in 2013 in Tabriz County. A total of 116 individuals who were in contact with livestock and had a nonspecific febrile illness were enrolled in the study. IgG phase II antibodies against Coxiella burnetii were detected using ELISA. PRINCIPAL FINDINGS The prevalence of acute Q fever was 13.8% (95% confidence interval [CI]: 8.0, 21.0%). Headache (87.5%) and fatigue and weakness (81.3%) were the dominant clinical characteristics among patients whit acute Q fever. Acute lower respiratory tract infection and chills were poorly associated with acute Q fever. Furthermore, 32% (95% CI: 24, 41%) of participants had a history of previous exposure to Q fever agent (past infection). Consumption of unpasteurized dairy products was a weak risk factor for previous exposure to C. burnetii. CONCLUSION This study identified patients with acute Q fever in northwestern of Iran. The evidence from this study and previous studies conducted in different regions of Iran support this fact that Q fever is one of the important endemic zoonotic diseases in Iran and needs due attention by clinical physicians and health care system.
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Affiliation(s)
- Saber Esmaeili
- Research Centre for Emerging and Reemerging Infectious Diseases, National Reference Laboratory for Plague, Tularemia and Q Fever, Pasteur Institute of Iran, Akanlu, Kabudar-Ahang, Hamadan, Iran
- Department of Epidemiology and Biostatistics, Pasteur Institute of Iran, Tehran, Iran
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Farhad Golzar
- Institute of Natural and Mathematical Science, Massey University, Auckland, New Zealand
| | - Erfan Ayubi
- Research Centre for Emerging and Reemerging Infectious Diseases, National Reference Laboratory for Plague, Tularemia and Q Fever, Pasteur Institute of Iran, Akanlu, Kabudar-Ahang, Hamadan, Iran
- Department of Epidemiology and Biostatistics, School of Public Health and Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Behrooz Naghili
- Research Center of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Tabriz university of Medical Science, Tabriz, Iran
| | - Ehsan Mostafavi
- Research Centre for Emerging and Reemerging Infectious Diseases, National Reference Laboratory for Plague, Tularemia and Q Fever, Pasteur Institute of Iran, Akanlu, Kabudar-Ahang, Hamadan, Iran
- Department of Epidemiology and Biostatistics, Pasteur Institute of Iran, Tehran, Iran
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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: 528] [Impact Index Per Article: 75.4] [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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11
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Nielsen SY, Mølbak K, Henriksen TB, Krogfelt KA, Larsen CS, Villumsen S. Adverse pregnancy outcomes and Coxiella burnetii antibodies in pregnant women, Denmark. Emerg Infect Dis 2015; 20:925-31. [PMID: 24856281 PMCID: PMC4036770 DOI: 10.3201/eid2006.130584] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Q fever may be associated with complications, but overall risk is low. A high risk for obstetric complications has been reported among women infected with Coxiella burnetii, the causative agent of Q fever, but recent studies have failed to confirm these findings. We reviewed national data collected in Denmark during 2007–2011 and found 19 pregnancies in 12 women during which the mother had a positive or equivocal test for antibodies to C. burnetii (IgM phase I and II titers >64, IgG phase I and II titers >128). Of these 12 women, 4 experienced obstetric complications (miscarriage, preterm delivery, infant small for gestational age, oligohydramnion, fetal growth restriction, or perinatal death); these complications occurred in 9 pregnancies (47% of the 19 total pregnancies identified). Our findings suggest an association between Q fever and adverse pregnancy outcomes, but complications were identified in only 9 pregnancies during the study’s 5-year period, indicating that the overall risk is low.
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NIELSEN SY, HENRIKSEN TB, HJØLLUND NH, MØLBAK K, ANDERSEN AMN. Risk of adverse pregnancy outcome in women exposed to livestock: a study within the Danish National Birth Cohort. Epidemiol Infect 2014; 142:1545-53. [PMID: 24054461 PMCID: PMC9151197 DOI: 10.1017/s0950268813002203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 08/16/2013] [Accepted: 08/17/2013] [Indexed: 11/19/2022] Open
Abstract
Maternal infection in pregnancy is a known risk factor for adverse pregnancy outcome, and a number of zoonotic pathogens may constitute a risk to pregnant women and their fetuses. With animal contact as a proxy for the risk of zoonotic infection, this study aimed to evaluate pregnancy outcome in women with self-reported occupational or domestic contact with livestock compared to pregnant women without such contact. The Danish National Birth Cohort collected information on pregnancy outcome from 100 418 pregnant women (1996-2002) from which three study populations with occupational and/or domestic exposure to livestock and a reference group of women with no animal contact was sampled. Outcome measures were miscarriage, very preterm birth (before gestational week 32), preterm birth (before 37 gestational weeks), small for gestational age (SGA), and perinatal death. Adverse reproductive outcomes were assessed in four different exposure groups of women with occupational or domestic exposure to livestock with no association found between exposure to livestock and miscarriage, preterm birth, SGA or perinatal death. These findings should diminish general occupational health concerns for pregnant women with exposures to a range of different farm animals.
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Affiliation(s)
- S. Y. NIELSEN
- Department of Occupational Medicine, Regional Hospital West Jutland, Herning, Denmark
- Perinatal Epidemiology Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - T. B. HENRIKSEN
- Department of Occupational Medicine, Regional Hospital West Jutland, Herning, Denmark
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - N. H. HJØLLUND
- Perinatal Epidemiology Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - K. MØLBAK
- Department of Infectious Disease Epidemiology, Statens Serum Institute, Copenhagen, Denmark
| | - A. M. N. ANDERSEN
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Epidemiological characteristics of serologically confirmed q Fever cases in South Korea, 2006-2011. Osong Public Health Res Perspect 2013; 4:34-8. [PMID: 24159527 PMCID: PMC3747682 DOI: 10.1016/j.phrp.2012.12.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 12/19/2012] [Accepted: 12/21/2012] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Q fever has been reported worldwide; however, there was almost no official report of Q fever in Korea. In this study, we describe the current status of human Q fever occurrence in Korea. METHODS Demographic data of Q fever patients were collected from the National Notifiable Diseases Surveillance System from 2006 to 2011. Case investigation reports from regional public health departments were used for additional information, like risk factors and clinical manifestation, of the patients since 2008. RESULTS There were 65 serologically confirmed cases during the study period. The annual notification rate of Q fever was 0.22 cases per million persons. The majority of cases were men (87.7%), adults (98.5%), and urban inhabitants (67.7%). Relevant exposures to risk factors were identified in 45.7% of patients. The most common symptoms of acute Q fever were fever (89.3%), myalgia (67.9%) and asthenia (53.6%). Two cases with endocarditis were identified in chronic Q fever. CONCLUSION This study suggests that Q fever has a low endemicity in Korea. However, management and research at national level is required for prevention of a future epidemic.
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Yde Nielsen S, Mølbak K, Nybo Andersen AM, Brink Henriksen T, Kantsø B, Krogfelt KA, Hjøllund NH. Prevalence of Coxiella burnetii in women exposed to livestock animals, Denmark, 1996 to 2002. Euro Surveill 2013; 18. [PMID: 23870098 DOI: 10.2807/1560-7917.es2013.18.28.20528] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- S Yde Nielsen
- Perinatal Epidemiology Research Unit, Aarhus University Hospital, Skejby, Aarhus, Denmark
- Department of Occupational Medicine, Regional Hospital West Jutland, Herning, Denmark
| | - K Mølbak
- Department of Infectious Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - A M Nybo Andersen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - T Brink Henriksen
- Perinatal Epidemiology Research Unit and Department of Pediatrics, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - B Kantsø
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | - K A Krogfelt
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | - N H Hjøllund
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Occupational Medicine, Regional Hospital West Jutland, Herning, Denmark
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Saegerman C, Speybroeck N, Dal Pozzo F, Czaplicki G. Clinical Indicators of Exposure toCoxiella burnetiiin Dairy Herds. Transbound Emerg Dis 2013; 62:46-54. [DOI: 10.1111/tbed.12070] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Indexed: 11/29/2022]
Affiliation(s)
- C. Saegerman
- Department of Infectious and Parasitic Diseases; Faculty of Veterinary Medicine; Research Unit in Epidemiology and Risk analysis applied to Veterinary Sciences (UREAR-ULg); University of Liege; Liege Belgium
| | - N. Speybroeck
- Institute of Health and Society (IRSS); Université catholique de Louvain; Bruxelles Belgium
| | - F. Dal Pozzo
- Department of Infectious and Parasitic Diseases; Faculty of Veterinary Medicine; Research Unit in Epidemiology and Risk analysis applied to Veterinary Sciences (UREAR-ULg); University of Liege; Liege Belgium
| | - G. Czaplicki
- Association Régionale de Santé et d'Identification Animales (ARSIA); Loncin Belgium
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Nielsen SY, Andersen AMN, Mølbak K, Hjøllund NH, Kantsø B, Krogfelt KA, Henriksen TB. No excess risk of adverse pregnancy outcomes among women with serological markers of previous infection with Coxiella burnetii: evidence from the Danish National Birth Cohort. BMC Infect Dis 2013; 13:87. [PMID: 23413787 PMCID: PMC3585700 DOI: 10.1186/1471-2334-13-87] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 02/14/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Q fever caused by Coxiella burnetii is transmitted to humans by inhalation of aerosols from animal birth products. Q fever in pregnancy is suspected to be a potential cause of fetal and maternal morbidity and fetal mortality but the pathogenesis is poorly understood, and even in Q fever endemic areas, the magnitude of a potential association is not established.We aimed to examine if presence of antibodies to C. burnetii during pregnancy or seroconversion were associated with adverse pregnancy outcomes. METHODS The Danish National Birth Cohort collected blood samples and interview data from 100,418 pregnant women (1996-2002). We sampled 397 pregnant women with occupational or domestic exposure to cattle or sheep and a random sample of 459 women with no animal exposure. Outcome measures were spontaneous abortion, preterm birth, birth weight and Small for Gestational Age (SGA).Blood samples collected in pregnancy were screened for antibodies against C. burnetii by enzyme-linked immunosorbent assay (ELISA). Samples positive for IgG or IgM antibodies in the ELISA were confirmed by immunofluorescence antibody test (IFA). RESULTS Among the 856 women, 169 (19.7%) women were IFA positive; 147 (87%) of these had occupational or domestic contact with livestock (IFA cutoff > =1:128).Two abortions were IFA positive vs. 6 IFA negative (OR: 1.5; 95%CI: 0.3-7.6). Three preterm births were IFA positive vs. 38 IFA negative (OR: 0.4; 95% CI: 0.1-1.1). There was a significant difference in birth weight of 168 g (95% CI: 70-267 g) with IFA positive being heavier, and the risk of being SGA was not increased in the newborns of IFA positive women (OR: 0.4; 95%CI: 0.8-1.0).Most seropositive women were IgG positive indicating previous exposure. Seroconversion during pregnancy was found in 10 women; they all delivered live babies at term, but two were SGA. CONCLUSION We found no increased risk of adverse pregnancy outcome in women with verified exposure to C. burnetii.To our knowledge, this is the first population-based seroepidemiologic study evaluating pregnancy outcome in women with serologically verified exposure to C. burnetii against a comparable reference group of seronegative women.
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Affiliation(s)
- Stine Yde Nielsen
- Department of Occupational Medicine, Regional Hospital West Jutland, Gl, Landevej 61, Herning 7400, Denmark.
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Nielsen SY, Hjøllund NH, Andersen AMN, Henriksen TB, Kantsø B, Krogfelt KA, Mølbak K. Presence of antibodies against Coxiella burnetii and risk of spontaneous abortion: a nested case-control study. PLoS One 2012; 7:e31909. [PMID: 22363769 PMCID: PMC3283715 DOI: 10.1371/journal.pone.0031909] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 01/16/2012] [Indexed: 12/25/2022] Open
Abstract
Background and Aims Q fever is a bacterial zoonosis caused by infection with Coxiella burnetii. It is well established that Q fever causes fetal loss in small ruminants. The suspicion has been raised that pregnant women may also experience adverse pregnancy outcome when the infection is acquired or reactivated during pregnancy. The purpose of this study was to assess the potential association between serologic markers of infection with C.burnetii and spontaneous abortion. Methods A nested case-control study within the Danish National Birth Cohort, a cohort of 100,418 pregnancies recruited from 1996–2002. Women were recruited in first trimester of pregnancy and followed prospectively. Median gestational age at enrolment was 8 weeks (25 and 75 percentiles: 7 weeks; 10 weeks). During pregnancy, a blood sample was collected at gestational week 6–12 and stored in a bio bank. For this study, a case sample of 218 pregnancies was drawn randomly among the pregnancies in the cohort which ended with a miscarriage before 22 gestational weeks, and a reference group of 482 pregnancies was selected in a random fashion among all pregnancies in the cohort. From these pregnancies, serum samples were screened for antibodies against C. burnetii in a commercial enzyme-linked immunosorbent assay (ELISA). Samples that proved IgG or IgM antibody positive were subsequently confirmatory tested by an immunofluorescence (IFA) test. Results Among cases, 11 (5%) were C. burnetii positive in ELISA of which one was confirmed in the IFA assay compared to 29 (6%) ELISA positive and 3 IFA confirmed in the random sample. Conclusions We found no evidence of a higher prevalence of C.burnetii antibodies in serum samples from women who later miscarried and the present study does not indicate a major association between Q fever infection and spontaneous abortion in humans. Very early first trimester abortions were, however, not included in the study.
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Affiliation(s)
- Stine Yde Nielsen
- Department of Occupational Medicine, Regional Hospital West Jutland, Herning, Denmark.
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