Serological diagnosis and risk factors for Coxiella burnetii in goats and sheep in a semi-arid region of Northeastern Brazil

Coxiella burnetii seroprevalence in sheep herd from Paraguay: First evidence of bacterial circulation in the country

Coxiella burnetii is the agent of Q fever, a disease that poses risks to public health and damages livestock. We discovered the circulation of C. burnetii for the first time in Paraguay, based on the seropositivity of a flock of >300 sheep. The animals were tested by IFA for anti-C. burnetii antibodies and by SAM for anti-Leptospira spp. antibodies, an important differential diagnosis for reproductive disorders in sheep in Paraguay. C. burnetii seropositivity was determined in 45%, in contrast to Leptospira spp. which had no reactive samples. Cases of miscarriage and fetal resorption were associated with high seropositivity titers. This study suggests the circulation of a unique genotype in the country and an imminent risk to public health, since in addition to being highly transmissible and infectious to humans, Q fever is still not a cause for concern on the part of government and health agencies in the country.

Exposure of small ruminants and humans to Coxiella burnetii in the semi-arid region of Northeastern Brazil

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.

Molecular survey of hemoplasmas and Coxiella burnetii in vampire bats from northern Brazil

In addition to zoonotic viral pathogens, bats can also harbor bacterial pathogens, including hemoplasmas (hemotropic mycoplasmas) and Coxiella burnetii. The present study aimed to investigate, using molecular techniques, the presence of hemoplasmas and C. burnetii in spleen samples from vampire bats in northern Brazil. For this purpose, between 2017 and 2019, spleen samples were collected from Desmodus rotundus (n = 228) and Diaemus youngii (n = 1) captured in the states of Pará (n = 207), Amazonas (n = 1), Roraima (n = 18) and Amapá (n = 3). DNA samples extracted from the bat spleen and positive in PCR for the endogenous gapdh gene were subjected to conventional PCR assays for the 16S rRNA, 23S rRNA and RNAse P genes from hemoplasmas and to qPCR based on the IS1111 gene element for C. burnetii. All spleen samples from vampire bats were negative in the qPCR for C. burnetii. Hemoplasmas were detected in 10 % (23/229) of spleen samples using a PCR based on the 16S rRNA gene. Of these, 21.73 % (5/23) were positive for the 23S rRNA gene and none for the RNAseP gene. The seven hemoplasma 16S rRNA sequences obtained were closely related to sequences previously identified in vampire bats from Belize, Peru and Brazil. The 23S rRNA sequence obtained revealed genetic proximity to hemoplasmas from non-hematophagous bats from Brazil and Belize. The analysis revealed different circulating genotypes among Brazilian vampire bats, in addition to a trend towards genera-specific hemoplasma genotypes. The present study contributes to the knowledge of the wide diversity of hemoplasmas in vampire bats.

Overview of Q fever in Brazil: an underestimated zoonosis

This review aims to provide current information about Q fever, elucidating the etiological, epidemiological, pathogenic, clinical, diagnostic, therapeutic, and prophylactic aspects of the disease for the medical community. We discuss the main forms of presentation of the agent, its ability to persist in the body, the infinite possibilities of susceptible hosts, the main known forms of transmission, its importance in populations at occupational risk, and the role of arthropods in the natural history of the disease. Focusing on Brazil, we present the cases already described and studies developed since its first report, and how there is still much to unravel. We are aware of the possibilities of the persistence of the agent and the development of severe clinical pictures and the specific treatments currently instituted. We also wish to raise awareness about the future, the new genotypes that are emerging, the need to study the effects of vaccines, and the impact of Q fever on the population. Q fever is a poorly understood disease in Latin America, and recent studies, especially in Brazil, have revealed the importance of developing new studies.

Coxiella burnetii shedding and serological status in pregnant and postpartum ewes

This study aimed to evaluate the occurence C. burnetii-DNA shedding by pregnant (vaginal mucus and feces) and postpartum (vaginal mucus, feces and milk) meat breed ewes from Saint Kitts. Additionally, antibodies anti-C. burnetii were detected in serum, and milk. Barbados Blackbelly ewes (n=187) were sampled using stratified convenience cross-sectional sampling. There were two animal groups: pregnant (n=96) and postpartum (n=91). Vaginal mucus (n=187), feces (n=177) and milk (n=83) samples were subjected to a TaqMan real time qPCR assay for C. burnetii based on the IS1111 multi copy element. IgG antibodies against C. burnetii were tested in blood serum (n=187) and milk (n=61) samples, via indirect ELISA. McNemar and Fischer exact tests were used to compare occurrence between routes and between groups, respectively. Overall, 86.6% of all the animals (162/187) were shedding C. burnetti DNA through at least one route (vaginal and/or fecal and/or milk). The DNA shedding occurrence via vaginal (73% vs 51%, p-value=0.003) and fecal routes (64% vs 47%, p-value=0.001) was higher in the pregnant compared to the postpartum animals. There was no prevalent shedding route among vaginal, fecal or milk in all ewes. Overall, 38% of the ewes were seropositive for C. burnetii IgG and a total of 19.7% of the tested postpartum ewes had IgG antibodies in milk. The vaginal and fecal DNA shedding were not associated with the blood serology, nor was milk DNA shedding related to the milk serology status, thus there was no association between C. burnetii seropositivity and bacterial DNA shedding. In short, high occurrence of C. burnetii DNA shedding was observed within ewes in St. Kitts, and represents the first detection of the Q fever agent within the Caribbean islands. Bacterial shedding was more prevalent in pregnant ewes, highlighting the importance of gestating animals as a source of C. burnetii.

Q fever and coxiellosis in Brazil: an underestimated disease? A brief review

Q fever, caused by the γ-proteobacterium Coxiella burnetii, is a zoonosis of great importance and global impact. This agent has high transmissibility and can spread over long distances via wind, in which a small number of aerosolized particles are needed to infect susceptible hosts. The clinical diagnosis of Q fever is difficult owing to the variety of clinical signs shared with other diseases. In Brazil, studies related to C. burnetii are constantly being conducted, and this review aims to increase the number of approaches already studied, leading to the following question: is Q fever an unknown, neglected disease, or does it have a focal occurrence in certain areas (exotic/rare) in the country?

Sero-Epidemiology of Coxiella burnetii Infection in Small Ruminants in the Eastern Region of Punjab, Pakistan

The aim of this study was to investigate the seroprevalence of Q fever in sheep and goats in Kasur, Okara, and Pakpattan in the Punjab of Pakistan. Q fever is a widely reported zoonotic disease caused by Coxiella (C.) burnetii. The main reservoirs are small ruminants that excrete the bacteria in birth by-products in high numbers. Thus, the bacteria can also be detected in the air and the dust of livestock farms. The infection is often asymptomatic in ruminants, but it can lead to reproductive disorders. This cross-sectional study found that a significant number (n = 43; 11.3%) of 300 randomly selected small ruminants of nine tehsils were seropositive using a commercially available ELISA. Seroprevalence was significantly higher in goats (17.1%) than in sheep (4.9%). Binary logistic regression analysis proved that species, age, and breed have a significant effect on the prevalence of Q fever. Tick infestation, contact with animal fomites, contact with other animals, production system, and health status of an animal had a significant impact on the prevalence of Q fever. These findings on Q fever in animals can be used to improve the visibility of this zoonotic disease. These findings will help local health authorities to focus on the origin of the problem and facilitate applying preventive measures to the affected livestock farms.

Seropositivity for Coxiella burnetii in suspected patients with dengue in São Paulo state, Brazil

Q fever and brucellosis are zoonoses that cause fever and other systemic clinical signs in humans; their occurrences are neglected and the differential diagnosis for some diseases is disregarded. This study aimed to investigate the seropositivity for Coxiella burnetii and Brucella spp. antibodies in patients suspected of dengue from 38 municipalities in the state of São Paulo, Brazil. The samples (n = 604) were obtained by convenience from the Adolfo Lutz Institute serum bank. Sera were subjected to an indirect immunofluorescence assay (IFA) using in-house and commercial diagnostic protocols to evaluate C. burnetii positivity. For Brucella spp., sera were subjected to rapid plate serum agglutination with buffered acidified antigen (AAT), slow tube serum agglutination (SAL), and 2-mercaptoethanol (2-ME) techniques. Associations and statistical inferences of the results were performed by logistic regression according to the clinical and demographic variables collected from the patients. Statistical analyses were performed using Statistical Analysis Software (SAS) and associations were considered when p value was <0.05. In all, 129 patients showed positive results for Q fever, indicating a seropositivity of 21.4% (95% CI 18.15–24.85). Patients with 14–20 days of symptoms had 2.12 (95% CI 1.34–3.35) times more chances of being seropositive for Q fever than patients with 7–13 days, and patients with 21–27 days of fever had 2.62 (95% CI 1.27–5.41) times more chances of being seropositive for Q fever than patients with 7–13 days. For the other variables analyzed, there were no significant associations between the groups. No positivity for brucellosis was observed. This is the most comprehensive study of people seropositive for Q fever in São Paulo state and provides additional data for the medical community in Brazil. It is suggested that Q fever may be an important differential diagnosis of febrile illnesses in the region, demanding the government’s attention and investment in health.

Brazil is a tropical country with a warm climate and large animal herds that favor many zoonotic agents that circulate in the territory. Due to the high prevalence of some tropical diseases, such as dengue, malaria, and chikungunya, important zoonoses have been neglected during the clinical evaluation of patients, resulting in misdiagnosis. Examples include Q fever and brucellosis, zoonoses that occur in animals in Brazil and are easily transmitted to humans through contaminated air and food products. There is not much data on these diseases in humans in the country representing their actual health situation. The current knowledge is supported by a few serological surveys developed by research groups and case reports. In this study, sera from patients with fever of unknown origin were positive for Q fever and brucellosis. The authors found that, contrary to brucellosis, Q fever has affected many people in São Paulo, the most populous state in the country. In addition, other findings regarding patient profile and disease behavior have been established. This research highlights the need for surveillance and control of Q fever in humans and animals to prevent acute cases and treat chronic patients.

Identification of Immunogenic Linear B-Cell Epitopes in C. burnetii Outer Membrane Proteins Using Immunoinformatics Approaches Reveals Potential Targets of Persistent Infections

Coxiella burnetii is a global, highly infectious intracellular bacterium, able to infect a wide range of hosts and to persist for months in the environment. It is the etiological agent of Q fever—a zoonosis of global priority. Currently, there are no national surveillance data on C. burnetii’s seroprevalence for any South American country, reinforcing the necessity of developing novel and inexpensive serological tools to monitor the prevalence of infections among humans and animals—especially cattle, goats, and sheep. In this study, we used immunoinformatics and computational biology tools to predict specific linear B-cell epitopes in three C. burnetii outer membrane proteins: OMP-H (CBU_0612), Com-1 (CBU_1910), and OMP-P1 (CBU_0311). Furthermore, predicted epitopes were tested by ELISA, as synthetic peptides, against samples of patients reactive to C. burnetii in indirect immunofluorescence assay, in order to evaluate their natural immunogenicity. In this way, two linear B-cell epitopes were identified in each studied protein (OMP-H_(51–59), OMP-H_(91–106), Com-1_(57–76), Com-1_(191–206), OMP-P1_(197–209), and OMP-P1_(215–227)); all of them were confirmed as naturally immunogenic by the presence of specific antibodies in 77% of studied patients against at least one of the identified epitopes. Remarkably, a higher frequency of endocarditis cases was observed among patients who presented an intense humoral response to OMP-H and Com-1 epitopes. These data confirm that immunoinformatics applied to the identification of specific B-cell epitopes can be an effective strategy to improve and accelerate the development of surveillance tools against neglected diseases.

Tick-borne pathogens in dogs, wild small mammals and their ectoparasites in the semi-arid Caatinga biome, northeastern Brazil

Caatinga is a biome exclusive to the semiarid zone of Brazil, where studies on ticks and tick-borne diseases are scarce. Herein, we investigated the occurrence of Rickettsia, Ehrlichia, and Coxiella in wild mammals, domestic dogs and their ectoparasites using molecular and serological techniques. During 2014-2016, blood samples and ectoparasites were collected from 70 small mammals (51 rodents, 18 marsupials, 1 wild canid) and 147 domestic dogs in three areas of the Caatinga. Through serological analyses of domestic dogs of the three areas, 8 to 11 % were seropositive for Rickettsia rickettsii, 9 to 37 % for Rickettsia amblyommatis, 61 to 75 % for Ehrlichia canis, and 0-5% for Coxiella burnetii. All wild mammals were seronegative for Rickettsia spp. and C. burnetii, except for one rodent (Wiedomys pyrrhorhinos) and one marsupial (Didelphis albiventris) that were seroreactive to C. burnetii, one wild canid (Cerdocyon thous) for R. amblyommatis, and two Rattus rattus for Rickettsia spp. Through PCR targeting DNA of Rickettsia, Ehrlichia or Coxiella, all blood samples were negative, except for the presence of Ehrlichia canis DNA in 8.8 % of the domestic dogs, and a recently reported novel agent, Ehrlichia sp. strain Natal, in one marsupial (Gracilinanus agilis). A total of 222 ticks, 84 fleas, and six lice were collected. Ticks were mostly Rhipicephalus sanguineus sensu lato, some Ixodes loricatus, Ornithodoros rietcorreai, Haemaphysalis sp., and Amblyomma spp.; fleas were Ctenocephalides felis felis, Pulex sp. and Polygenis (Polygenis) bohlsi jordani; and lice were Polyplax sp. and Gyropus sp. Through molecular detection of microorganisms, 9% of C. felis felis contained Rickettsia felis, 20 % of A. auricularium contained R. amblyommatis and 13 % of A. parvum contained 'Candidatus Rickettsia andeanae', whereas Ehrlichia canis DNA was detected in at least 6% of the R. sanguineus s.l. from one area. We report a variety of ectoparasites infesting small mammals and domestic dogs in the Caatinga biome, where these ectoparasites probably act as vectors of rickettsiae, ehrlichial agents (E. canis and Ehrlichia sp. strain Natal) and C. burnetii. Our results highlight to the potential risks of human infection by these tick-borne agents in the Caatinga biome.

Evidence of exposure to Coxiella burnetii in neotropical free-living cervids in South America

Coxiella burnetii (order Legionellales, family Coxiellaceae), the etiological agent of Q fever, is a pleomorphic, obligate Gram-negative intracellular bacillococcus that can infect humans and animals. Among the mammals hosting this agent, both domestic and wild ruminants are of particular economic and public health importance. Ticks and other hematophagous arthropods or aerosols are incriminated in the transmission between reservoirs and susceptible hosts. This study used serological and molecular methods to investigate the C. burnetii occurrence in blood samples from free-living deer (143 Blastocerus dichotomus, 27 Mazama gouazoubira, 4 M. bororo, 3 M. americana, and 11 Ozotocerus bezoarticus) sampled in Mato-Grosso do Sul, São Paulo, Goiás and Paraná states in Brazil. The DNA extracted from the blood samples of 188 cervids was submitted to nested (n) PCR for C. burnetii based on the IS1111 repetitive insertion element of the heat shock protein (htpAB) gene. Additionally, 169 serum samples were submitted to Indirect Immunofluorescence Assay (IFAT) to detect Ig antibodies to C. burnetii. The nPCR results indicated that all blood samples were negative, evidencing the absence of circulating C. burnetii DNA in cervids from the studied regions or, alternatively, the C. burnetii DNA concentration in the deer blood samples was below the threshold of the used PCR technique. On the other hand, 5.32% (9/169) of deer were seropositive for C. burnetii by IFAT, with titers ranging from 256 and 16,384. In conclusion, the present work showed the first evidence of exposure of free-living deer to C. burnetii in Brazil.

Coxiella burnetii associated with BVDV (Bovine Viral Diarrhea Virus), BoHV (Bovine Herpesvirus), Leptospira spp., Neospora caninum, Toxoplasma gondii and Trypanosoma vivax in reproductive disorders in cattle

This is a cross-sectional study to assess the presence of antibodies in ruminants against selected pathogens associated with reproductive disorders in cattle in four Brazilian states, including the zoonotic agent Coxiella burnetii. The used tests were Virus Neutralization Assay for IBR and BVD, Microscopic Agglutination Test for Leptospira spp., Indirect Fluorescent Antibody Test (IFAT) for C. burnetii and Toxoplasma gondii, and Enzyme-Linked Immunosorbent Assay for Neospora caninum and Trypanosoma vivax. Seropositivity for C. burnetii was 13.7% with titers from 128 to 131,072; 57.8% for BoHV-1, with titers between 2 and 1,024; 47.1% for BVDV-1a, with titers from 10 to 5,120; 89.2% for N. caninum; 50% for T. vivax; and 52.0% for Leptospira spp., with titers between 100 to 800 (the following serovars were found: Tarassovi, Grippotyphosa, Canicola, Copenhageni, Wolffi, Hardjo, Pomona and Icterohaemorrhagiae); 19.6% for T. gondii with titer of 40. This is the first study that has identified C. burnetii in cattle associated with BoHV and BVDV, N. caninum, Leptospira spp., T. gondii and T. vivax. Thus, future studies should be conducted to investigate how widespread this pathogen is in Brazilian cattle herds.

Real-time quantitative PCR-based detection of Coxiella burnetii in unpasteurized cow's milk sold for human consumption

Coxiella burnetii is a zoonotic pathogen with a worldwide distribution that is responsible for Q fever in humans. It is a highly infectious bacterium that can be transmitted from cattle to humans through the consumption of unpasteurized milk. We report the molecular identification of C. burnetii in raw cow's milk being sold directly for human consumption in Brazil without official inspection or pasteurization. One hundred and twelve samples of raw milk were analysed by real-time quantitative PCR (qPCR), and C. burnetii was detected in 3.57% (4/112) of the samples at a concentration ranging from 125 to 404 bacteria per millilitre. The identification of this zoonotic pathogen in raw milk sold directly for human consumption is a public health concern since C. burnetii can be transmitted through the oral route. This result indicates that health education and other preventive measures should be officially implemented in Brazil to prevent the spread of infection. To our knowledge, this is the first qPCR-based detection of C. burnetii in raw milk samples from cows sold in Brazil that do not undergo official inspection or pasteurization.