Emergence of Coxiella burnetii in ruminants on Reunion Island? Prevalence and risk factors

Molecular detection of Coxiella burnetii infection (Q fever) in livestock in Makkah Province, Saudi Arabia

The study aims to investigate the prevalence of Q fever in livestock and ticks in Makkah Province, Saudi Arabia, by molecular methods. Using DNA obtained from (40) blood samples, (60) vaginal swabs and ticks (120) samples. Real-time PCR was used to detect the IS1111 insertion sequence of Coxiella burnetii in aborted animals. Among 40 blood samples only one sample of the camel was found to be infected with an overall prevalence of 2.5 %. The highest prevalence (10 %) was recorded in AL-Laith in one camel blood sample out of 10 samples examined. Of 60 vaginal swabs examined for C. burnetii DNA, four samples were found to be infected with an overall prevalence of 6.6 %. The highest prevalence (10 %) was recorded in Makkah in two camel vaginal swabs out of 20 samples, followed by Jeddah and AL-Laith with a prevalence of (5.6 %) by detection of one sample positive out of 18 samples on each of them, while vaginal swabs from AL-Kamil were negative. Three types of ticks were identified Hyalomma dromedarii, Hyalomma anatolicum, and Hyalomma excavatum. H. dromedarii tick is the most common in aborted camels with a prevalence (6.7 %) in Makkah followed by Jeddah (5 %). The findings of this study revealed that C. burnetii infection is prevalent in agricultural animals especially camels and ticks maintained at livestock farms in Makkah Province. However, these animals and ticks may pass on C. burnetii infections to nearby people and other animals in the study area.

Clinical and Epidemiological Aspects of Acute Q Fever in Reunion Island over Fourteen Years: A Retrospective Cohort Study

The clinical characteristics and epidemiology of Q fever in the Tropics are poorly described. We performed a retrospective cohort study of hospitalized cases between 2004 and 2017 in Reunion Island. Acute Q fever was defined in presence of a positive serology (phase II IgG ≥ 200 and phase II IgM ≥ 50), or a seroconversion (4-fold increase in phase II IgG between paired samples), or a positive PCR (blood or serum). Forty-two cases matched the diagnostic criteria. The most common clinical manifestations were fever (85.7%) and pulmonary symptoms (61.9%), including pneumonia (45.2%). Ninety percent of the patients were living in a farming area. Cumulative incidence was estimated at 9.3 per 100,000 inhabitants (95%CI: 6.4-12.1) with cases diagnosed yearly all throughout the study period except in 2006. Together with the seroprevalence figures, these data suggest that Q fever reaches low to moderate endemic levels on Reunion Island. As previously reported, pulmonary symptoms are in the foreground.

Prevalence and risk factors of Q fever (Coxiella burnetii) in cattle on farms of Limpopo province, South Africa

Q fever in animals and humans and its economic and public health significance has been widely reported worldwide but in South Africa. There are few studies on the prevalence of this zoonosis and its associated risk factors in South African livestock. Therefore, a cross-sectional study was conducted to determine the seroprevalence, molecular prevalence, and risk factors associated with C. burnetii in cattle on farms in South Africa's Limpopo province. Out of 383 cattle tested for antibodies, the overall seroprevalence was 24.28%. Herd size of >150 (OR: 9.88; 95%CI: 3.92-24.89; p < 0.01) remained associated with C. burnetii seropositivity in cattle. For PCR detection, targeting IS1111 fragment, cattle with no abortion history (OR: 0.37; 95%CI: 0.18-0.77; p < 0.01) and herd size of >150 (OR: 3.52; 95%CI: 1.34-9.24; p < 0.01) remained associated with C. burnetii positivity. The molecular prevalence in sheath scrapings and vaginal swabs by IS1111 PCR was 15.67%. Cohen's kappa agreement test revealed a fair agreement between the PCR and ELISA results (k = 0.40). Sequence analysis revealed that the amplicons had similarities to the C. burnetii transposase gene fragment, confirming the presence of the pathogen. The higher seroprevalence than molecular prevalence indicated a past C. burnetii infection, no bacterial shedding through vaginal mucus in cows, or preputial discharge in bulls. Similarly, the detection of C. burnetii by PCR in the absence of antibodies could be partly explained by recent infections in which antibodies have not yet been produced against the bacteria, or the level of these antibodies was below the detectability threshold. The presence of the pathogen in cattle and the evidence of exposure, as shown by both PCR and ELISA suggests an active circulation of the pathogen. This study demonstrated that C. burnetii is widespread in the study area and that a herd size of >150 is associated with C. burnetii seroprevalence and molecular prevalence.

Role of Goats in the Epidemiology of Coxiella burnetii

Since its first description in the late 1930s, Q fever has raised many questions. Coxiella burnetii, the causative agent, is a zoonotic pathogen affecting a wide range of hosts. This airborne organism leads to an obligate, intracellular lifecycle, during which it multiplies in the mononuclear cells of the immune system and in the trophoblasts of the placenta in pregnant females. Although some issues about C. burnetii and its pathogenesis in animals remain unclear, over the years, some experimental studies on Q fever have been conducted in goats given their excretion pattern. Goats play an important role in the epidemiology and economics of C. burnetii infections, also being the focus of several epidemiological studies. Additionally, variants of the agent implicated in human long-term disease have been found circulating in goats. The purpose of this review is to summarize the latest research on C. burnetii infection and the role played by goats in the transmission of the infection to humans.

First serological evidence of Q fever in large ruminants and its associated risk factors in Punjab, Pakistan

Coxiellosis, also known as Q fever, is a zoonotic disease caused by Coxiella burnetii, a gram-negative bacterium that exerts a significant deleterious impact on the productive and reproductive capabilities of livestock, severely effecting the economics of this sector. In this study, 448 sera samples from cattle (n = 224) and buffalo (n = 224) were collected from 112 farms in Pakistan and examined for antibodies against C. burnetii using an indirect ELISA. Ticks were also collected from these animals. Serological analysis revealed a 23.66% and 27.23% seroprevalence of Q fever in cattle and buffalo, respectively. Odds ratio (OR) analysis of the factors associated with C. burnetii seropositivity was performed, and a multivariable logistic model identified five main variables associated with the seropositivity for coxiellosis. These were: (i) the absence of acaricide use (OR 5.61; 95% CI 2.97-10.94); (ii) the presence of ticks (OR 3.23; 95% CI 1.87-5.69); (iii) the abortion history during the preceding year on the farm (OR 14.96; 95% CI 8.09-29.34); (iv) the presence of sheep and goats (OR 2.47; 95% CI 1.20-5.35); and (v) the absence of a separate parturition area (OR 3.17; 95% CI 1.76-5.86). This study provides new insights into the seroprevalence of Q fever in large ruminants across seven studied districts of Punjab, Pakistan, also providing baseline data to inform improved herd management and on-farm practices for the prevention and control of Q fever in large ruminants in the region. Results of this work suggest that further molecular investigation of coxiellosis is warranted to provide a more thorough evaluation of C. burnetii epidemiology in Pakistan.

The Prevalence of Coxiella burnetii in Hard Ticks in Europe and Their Role in Q Fever Transmission Revisited-A Systematic Review

The zoonosis Q fever is caused by the obligate intracellular bacterium Coxiella burnetii. Besides the main transmission route via inhalation of contaminated aerosols, ticks are discussed as vectors since the first isolation of the pathogen from a Dermacentor andersonii tick. The rare detection of C. burnetii in ticks and the difficult differentiation of C. burnetii from Coxiella-like endosymbionts (CLEs) are questioning the relevance of ticks in the epidemiology of Q fever. In this review, literature databases were systematically searched for recent prevalence studies concerning C. burnetii in ticks in Europe and experimental studies evaluating the vector competence of tick species. A total of 72 prevalence studies were included and evaluated regarding DNA detection methods and collection methods, country, and tested tick species. Specimens of more than 25 different tick species were collected in 23 European countries. Overall, an average prevalence of 4.8% was determined. However, in half of the studies, no Coxiella-DNA was detected. In Southern European countries, a significantly higher prevalence was observed, possibly related to the abundance of different tick species here, namely Hyalomma spp. and Rhipicephalus spp. In comparison, a similar proportion of studies used ticks sampled by flagging and dragging or tick collection from animals, under 30% of the total tick samples derived from the latter. There was no significant difference in the various target genes used for the molecular test. In most of the studies, no distinction was made between C. burnetii and CLEs. The application of specific detection methods and the confirmation of positive results are crucial to determine the role of ticks in Q fever transmission. Only two studies were available, which assessed the vector competence of ticks for C. burnetii in the last 20 years, demonstrating the need for further research.

Q fever seroprevalence in parturient women: the EQRUN cross-sectional study on Reunion Island

Background

Q fever (Coxiella burnetii infection) has been associated with adverse perinatal outcomes. After investigating the obstetrical importance of Q fever on Reunion island and demonstrating an association between incident Q fever and miscarriage, we conducted a cross-sectional serosurvey to assess the prevalence of Coxiella burnetii infection among parturient women.

Methods

Between January 9 and July 24, 2014, within the level-4 maternity of Saint Pierre hospital and the level-1 maternity of Le Tampon, we proposed to screen all parturient women for Coxiella burnetii serology. Seropositivity was defined using indirect immunofluorescence for a dilution of phase 2 IgG titre ≥1:64. Further dilutions were chosen to discriminate recent or active infections from past or prevalent infections (< 1:128) and classify these as either possible (1:128), or probable (≥1:256). Recurrent miscarriage, stillbirth, preterm birth, small-for-gestational as well as a composite outcome of these adverse pregnancy outcomes were compared according to seropositivity using bivariate analysis or propensity score matching of seropositive and seronegative women on confounding factors.

Results

Among 1112 parturient women screened for Q fever over this 7-month period, 203 (18.3%) were seropositive. Overall weighted seroprevalence was of 20.1% (95%CI, 17.7–22.5%). Weighted seroprevalence of probable infections was 4.7% (95%CI 3.4–5.9%), while > 90% of positive serologies corresponded to past infections or false positives. Seropositivity was associated with none of the abovementioned adverse perinatal outcomes, whether in unpaired or matched analyses on propensity score.

Conclusion

The magnitude and the pattern of seroprevalence suggest that Q fever is endemic on Reunion island. In this context, we found no significant contribution of prevalent Coxiella burnetii infection to adverse pregnancy outcomes. Although reassuring, these data put in our endemic context, with a previously demonstrated increased risk of incident Q fever associated miscarriage, encourage us to protect pregnant women against the risk of new infection, periconceptional or early in pregnancy.

Serological evidence of Coxiella burnetii infection in slaughtered sheep and goats at Kumasi Abattoir, Ghana

Q fever, caused by Coxiella burnetii, is an important zoonosis worldwide. Q fever is documented in many parts of the world; however, information on the disease in Ghana is scanty. This study was therefore conducted to provide evidence of exposure of sheep and goats slaughtered at the Kumasi Abattoir to Coxiella burnetii. A total of 350 serum samples collected from 175 sheep and 175 goats were analyzed for the presence of C. burnetii antibodies using a commercial ELISA kit (ID Vet). Results of the study established a seroprevalence of 28.57% in goats, 16.57% in sheep and an overall seroprevalence of 22.29% in sheep and goats; 20.57% for male sheep, 23.86% for female sheep, 26.44% for male goats and 30.68% for female goats. Results showed that goats are more at risk to the infection than sheep however sex is not a risk factor. This study confirms the existence of Q fever in sheep and goats in Ghana hence, the disease should be considered as a public health risk to workers at the abattoir and other stakeholders in the sheep and goat production chain.

Pregnancy outcomes of Q fever: prospective follow-up study on Reunion island

BACKGROUND

Q fever has been associated with perinatal complications. We conducted a prospective follow-up study to assess both the incidence of adverse pregnancy outcomes (APOs) associated with Coxiella burnetii infection and the contribution of Q fever to APOs.

METHODS

Between May 1 and October 31, 2013, within the regional perinatal health care centre of Saint Pierre, Reunion island, we investigated unexplained miscarriages, stillbirths, preterm births or small-for-gestational age children. Seropositivity for C. burnetii antibodies was defined using indirect immunofluorescence for a phase 2 IgG titre ≥1:64. Acute Q fever was defined for a high phase 2 IgG titre ≥1:256 (compatible with recent or active infection) or the detection of C. burnetii genome in miscarriage products and placentas. Incidence rate ratios (IRR) for Q fever related APOs (taken as a composite outcome or individually) were assessed using Poisson regression models for dichotomous outcomes controlling major confounders.

RESULTS

Over a 6-month period, 179 pregnant women suspected or diagnosed with an APO were investigated for Q fever, of whom 118 met the definition for an APO. Of these, 19 were seropositive and 10 presented a profile indicative of an acute infection. For three women with an acute Q fever, the chronology between the onset of infection, the APO (2 miscarriages, 1 preterm birth) and the seroconversion suggested causality in the pathogenesis. The cumulative incidence of Q fever related APOs was estimated between 2.2‰ and 5.2‰, whether causality was required or not. Both C. burnetii exposure and acute Q fever were independently associated with APOs (IRR 1.55, 95% CI 1.31-1.84; IRR 1.47, 95% CI 1.15-1.89, respectively).

CONCLUSIONS

In the endemic context of Reunion island, acute Q fever may lead to APOs. To limit the burden of Q fever on reproduction, pregnant women should be kept away from farms and avoid direct contact with ruminants.

Seroprevalence of Coxiella burnetii (Q fever) Exposure in Humans on Reunion Island

After the documentation of sporadic cases of Q fever endocarditis, we conducted a serosurvey to assess Coxiella burnetii exposure on Reunion Island. Two hundred forty-one stored frozen human sera were analyzed using an immunofluorescence assay. The weighted seroprevalence of Q fever was of 6.81% (95% confidence interval, 4.02%–9.59%). Despite the absence of infection in youths <20 years of age, exposure was not driven by age or by gender. There was a spatial disparity in exposure across the island, with higher prevalence being reported in regions where ruminant farms are present. The seroprevalence pattern suggests that Q fever is endemic on Reunion Island.

Prevalence of Coxiella burnetii in cattle and buffalo populations in Punjab, India

Q fever is an important zoonosis of animal and public health significance but there is very limited information about its prevalence in the Punjab state of India. The current study was designed to estimate Q fever prevalence in cattle and buffalo populations of the state. We randomly selected 22 villages, one from each of the 22 districts of Punjab. Households in these villages were randomly selected using village voter lists to ensure representative sample collection. Blood, vaginal swab and milk samples were collected from the animals in these enrolled households. Serum samples were screened using Coxiella burnetii specific IgG ELISA whereas milk and genital swab samples were subjected to a Trans-PCR assay. The agreement (Cohan's Kappa) between shedding of C. burnetii in milk and genital secretions and between ELISA and Trans-PCR was estimated. The selected PCR products were sequenced, and phylogenetic analyses were performed. We collected 610 blood samples, 610 genital swabs and 361 milk samples from 610 bovines (378 cattle and 232 buffaloes) in 179 households. Considering all tests in parallel and after adjusting for clustering, we estimated an overall individual animal prevalence of Q fever of 7.0% (95% CI: 4.7, 9.4). There was a low agreement between shedding of C. burnetii in milk and genital secretion (kappa: 14.3%; 95% CI: 5.6, 22.9) and between ELISA and Trans-PCR (10.3%; 95% CI: 3.2, 17.4%). Phylogenetic analysis confirmed all samples to be of C. burnetii. The results suggest that the disease is present in the state and further epidemiological information should be collected to determine its zoonotic potential and its impact on animal and public health in Punjab, India.

A systematic knowledge synthesis on the spatial dimensions of Q fever epidemics

From 2007 through 2010, the Netherlands experienced the largest Q fever epidemic ever reported. This study integrates the outcomes of a multidisciplinary research programme on spatial airborne transmission of Coxiella burnetii and reflects these outcomes in relation to other scientific Q fever studies worldwide. We have identified lessons learned and remaining knowledge gaps. This synthesis was structured according to the four steps of quantitative microbial risk assessment (QMRA): (a) Rapid source identification was improved by newly developed techniques using mathematical disease modelling; (b) source characterization efforts improved knowledge but did not provide accurate C. burnetii emission patterns; (c) ambient air sampling, dispersion and spatial modelling promoted exposure assessment; and (d) risk characterization was enabled by applying refined dose–response analyses. The results may support proper and timely risk assessment and risk management during future outbreaks, provided that accurate and structured data are available and exchanged readily between responsible actors.

Epidemiology of Q fever in Iran: A systematic review and meta-analysis for estimating serological and molecular prevalence

Background:

Q fever is endemic in Iran, thus, we conducted a systematic review and meta-analysis on epidemiology of Coxiella burnetii among humans and animals in Iran.

Materials and Methods:

A systematic search was performed to identify all articles reporting C. burnetii prevalence in Iranian humans or animals, published from January 2000 to January 2015. Data from articles were extracted, and a pooled estimate of prevalence with corresponding 95% confidence interval (CI) was calculated using random effect method.

Results:

In this review, 27 papers were identified. The pooled seroprevalence of Q fever in animals was 27% (CI 95%: 23%–32%). The prevalence was 33% (CI 95%: 22%–45%) in goats, 27% (CI 95%: 21%–32%) in sheep, and 17% (CI 95%: 5%–28%) in cattle. The bacterial DNA was detected in 5% (95% CI: 3%–9%) of milk samples, and it was higher in cattle (10%; 95% CI: 6%–16%) than sheep (2%; 95% CI: 0–7%) and goats (4%; 95% CI: 0–12%).

Conclusion:

C. burnetii DNA or its antibody has been frequently detected among ruminants. Since these animals can transmit the infection to humans, Q fever could be a potential health problem in Iran.

Are brucellosis, Q fever and melioidosis potential causes of febrile illness in Madagascar?

Brucellosis, Q fever and melioidosis are zoonoses, which can lead to pyrexia. These diseases are often under-ascertained and underreported because of their unspecific clinical signs and symptoms, insufficient awareness by physicians and public health officers and limited diagnostic capabilities, especially in low-resource countries. Therefore, the presence of Brucella spp., Coxiella burnetii and Burkholderia pseudomallei was investigated in Malagasy patients exhibiting febrile illness. In addition, we analyzed zebu cattle and their ticks as potential reservoirs for Brucella and C. burnetii, respectively. Specific quantitative real-time PCR assays (qPCRs) were performed on 1020 blood samples drawn from febrile patients. In total, 15 samples (1.5%) were Brucella-positive, mainly originating from patients without travel history, while DNA from C. burnetii and Bu. pseudomallei was not detected. Anti-C. burnetii antibodies were found in four out of 201 zebu serum samples (2%), whereas anti-Brucella antibodies could not be detected. Brucella DNA was detected in a single zebu sample. Three out of 330 ticks analyzed (1%) were positively tested for C. burnetii DNA but with high Ct values in the qPCR assay. Our data suggest that zebus as well as Amblyomma and Boophilus ticks have to be considered as a natural reservoir or vector for C. burnetii, but the risk of cattle-to-human transmission is low. Since bovine brucellosis does not seem to contribute to human infections in Madagascar, other transmission routes have to be assumed.

Coxiella burnetii (Q fever) Infection in Farmed Ruminants in Three Northeastern Provinces and Inner Mongolia Autonomous Region, China

Coxiella burnetii is the pathogenic agent of Q fever, a zoonosis that occurs worldwide. In China, the organism infects people and a wide range of wild and farmed animals. However, little is known about C. burnetii infection in farmed ruminants in northeastern China, and there appears to have been no previous study on sika deer. The present study was conducted to determine the seroprevalence of C. burnetii in farmed ruminants in this region of China. A total of 3147 domestic ruminants (784 sheep, 1016 cattle, and 1347 sika deer) were randomly collected for this study. An indirect enzyme-linked immunosorbent assay kit was used to detect the antibodies to C. burnetii. The results showed an overall seroprevalence of 16.7% in domestic ruminants (24.9%, 13.5%, and 12.3% in cattle, sheep, and sika deer, respectively). This is the first report of C. burnetii seroprevalence in sika deer in China. Protective and hygiene measures should be applied in farm management to reduce the risk of exposure of C. burnetii to humans.

Detection and risk factors of Coxiella burnetii infection in dairy cattle based on bulk tank milk samples in center of Iran

Infection with Coxiella burnetii has a worldwide distribution in ruminants and is associated with abortions and reproductive problems in this group of animals. This study aimed to determine the prevalence of C. burnetii DNA in bulk tank milk (BTM) of dairy cattle herds and to identify the risk factors of infection. This cross-sectional study was conducted in spring 2015. A total of 163 BTM samples from 74 commercial and 89 traditional dairy cattle herds in Isfahan, Iran was tested for the IS1111 transposon of C. burnetii by real-time polymerase chain reaction (PCR). A checklist containing general information of the herds was filled for each farm. Data were analyzed using univariate tests (chi square and t-tests) and multivariable binary logistic regression analysis. Bacterial DNA was detected in 8.6% of the samples (95% CI: 4.2- 12.9). In univariate analysis, the prevalence rate was higher in traditional herds than in commercial herds (n=12; 13.5% vs. n=2; 2.7%; P=0.01). The prevalence rate was inversely associated with the size and infection control score of the herd. In multivariable binary logistic regression, however, only herd size was found to be related with the infection rate, i.e. herds with ≥80 cattle were less likely to be infected (OR: 0.07; 95% CI: 0.01- 0.77; P=0.03). The only identified risk factor for this infection was the herd size. In fact, smaller herds (size <80) were more likely to be infected.

The Importance of Ticks in Q Fever Transmission: What Has (and Has Not) Been Demonstrated?

Q fever is a widespread zoonotic disease caused by Coxiella burnetii, a ubiquitous intracellular bacterium infecting humans and a variety of animals. Transmission is primarily but not exclusively airborne, and ticks are usually thought to act as vectors. We argue that, although ticks may readily transmit C. burnetii in experimental systems, they only occasionally transmit the pathogen in the field. Furthermore, we underscore that many Coxiella-like bacteria are widespread in ticks and may have been misidentified as C. burnetii. Our recommendation is to improve the methods currently used to detect and characterize C. burnetii, and we propose that further knowledge of Coxiella-like bacteria will yield new insights into Q fever evolutionary ecology and C. burnetii virulence factors.

First molecular evidence of Coxiella burnetii infecting ticks in Cuba

Coxiella burnetii is the causative agent of Q fever. In order to explore the occurrence of C. burnetii in ticks, samples were collected from horses, dogs and humans living in a Cuban occidental community. The species most commonly recovered were Amblyomma mixtum (67%), Rhipicephalus sanguineus s.l. (27%) and Dermacentor nitens (6%). Specific IS1111 PCR and amplicon sequencing allowed the identification of C. burnetii DNA in A. mixtum collected from a domestic horse. These findings, for first time in Cuba, indicate the need for an in-depth assessment of the C. burnetii occurrence in hosts and humans at risk of infection.

First serologic survey of Q fever in free-range yaks in China

The objective of the present investigation was to determine the seroprevalence of Coxiella burnetii infection in free-range yaks in China. A total of 552 serum samples were collected from yaks in Gansu province, northwest China between April 2013 and January 2014, and antibodies against C. burnetii were evaluated using enzyme-linked immunosorbent assay (ELISA). Overall, 13.59% (75/552, 95% CI: 10.73-16.45) of the examined animals were positive for C. burnetii antibodies. There was no significant difference in C. burnetii seroprevalence between female yaks (13.78%, 95% CI: 10.36-17.19) and male yaks (13.13%, 95% CI: 7.89-18.36) (P>0.05). Coxiella burnetii seroprevalence in yaks in different age groups ranged from 10.88% to 15.26%, but the difference was not statistically significant (P>0.05). Coxiella burnetii seroprevalence in yaks sampled in different seasons ranged from 12.06% (autumn) to 18.33% (summer), but the difference was not statistically significant (P>0.05). This is the first report of C. burnetii seroprevalence in free-range yaks in China, indicating the need for measures to be taken to control C. burnetii infection in free-range yaks in China.