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Alessiani A, Di Domenico M, Averaimo D, Pompilii C, Rulli M, Cocco A, Lomellini L, Coccaro A, Cantelmi MC, Merola C, Tieri EE, Romeo G, Secondini B, Marfoglia C, Di Teodoro G, Petrini A. Coxiella burnetii: A Brief Summary of the Last Five Years of Its Presence in the Abruzzo and Molise Regions in Italy. Animals (Basel) 2024; 14:2248. [PMID: 39123774 PMCID: PMC11310968 DOI: 10.3390/ani14152248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/23/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
Coxiella burnetii is the causative agent of Q fever. The main reservoirs for this bacterium, which can lead to human infection, in our region are typically cattle, goats, and sheep. In animals, C. burnetii infection is often detected due to reproductive problems. European Member States are required to report confirmed cases annually, but the lack of uniform reporting methods makes the data rather inconsistent. The Istituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise is involved in official controls to identify the causes of abortions, monitor suspected or positive herds, evaluate suspected infections in pets and humans, monitor the spread in wildlife, etc. In this paper, we summarize the presence of C. burnetii over the last five years (2019-2023). Additionally, a detailed overview of C. burnetii infection in wild and domestic animals is provided. Five hundred sixty animals-including cattle; goats; sheep; wild animals, such as deer, boars, wolves, roe deer, owls, and otters; buffalo; dogs; horses; cats; and a donkey-and six human samples were tested by real-time PCR on the transposase gene IS1111 to detect C. burnetii. The MST profile was identified in some of the samples. Outbreaks of C. burnetii occurred in four herds. In one of them, it was possible to follow the outbreak from inception to eradication by evaluating the effect of vaccination on real-time PCR Ct values. A total of 116 animals tested positive for C. burnetii, including 73 goats, 42 sheep, and one bovine. None of the other samples tested positive. The strains for which the ST was performed were identified as ST79, a strain that has been present in the area for more than ten years. The effect of vaccination on the reduction of positive samples and the variation of real-time PCR Ct values was evaluated in strict correlation.
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Affiliation(s)
- Alessandra Alessiani
- Istituto Zooprofilattico Sperimentale di Abruzzo e Molise “G. Caporale”, 64100 Teramo, Italy; (M.D.D.); (D.A.); (C.P.); (M.R.); (A.C.); (L.L.); (A.C.); (M.C.C.); (C.M.); (E.E.T.); (G.R.); (B.S.); (C.M.); (G.D.T.); (A.P.)
| | - Marco Di Domenico
- Istituto Zooprofilattico Sperimentale di Abruzzo e Molise “G. Caporale”, 64100 Teramo, Italy; (M.D.D.); (D.A.); (C.P.); (M.R.); (A.C.); (L.L.); (A.C.); (M.C.C.); (C.M.); (E.E.T.); (G.R.); (B.S.); (C.M.); (G.D.T.); (A.P.)
| | - Daniela Averaimo
- Istituto Zooprofilattico Sperimentale di Abruzzo e Molise “G. Caporale”, 64100 Teramo, Italy; (M.D.D.); (D.A.); (C.P.); (M.R.); (A.C.); (L.L.); (A.C.); (M.C.C.); (C.M.); (E.E.T.); (G.R.); (B.S.); (C.M.); (G.D.T.); (A.P.)
| | - Cinzia Pompilii
- Istituto Zooprofilattico Sperimentale di Abruzzo e Molise “G. Caporale”, 64100 Teramo, Italy; (M.D.D.); (D.A.); (C.P.); (M.R.); (A.C.); (L.L.); (A.C.); (M.C.C.); (C.M.); (E.E.T.); (G.R.); (B.S.); (C.M.); (G.D.T.); (A.P.)
| | - Marco Rulli
- Istituto Zooprofilattico Sperimentale di Abruzzo e Molise “G. Caporale”, 64100 Teramo, Italy; (M.D.D.); (D.A.); (C.P.); (M.R.); (A.C.); (L.L.); (A.C.); (M.C.C.); (C.M.); (E.E.T.); (G.R.); (B.S.); (C.M.); (G.D.T.); (A.P.)
| | - Antonio Cocco
- Istituto Zooprofilattico Sperimentale di Abruzzo e Molise “G. Caporale”, 64100 Teramo, Italy; (M.D.D.); (D.A.); (C.P.); (M.R.); (A.C.); (L.L.); (A.C.); (M.C.C.); (C.M.); (E.E.T.); (G.R.); (B.S.); (C.M.); (G.D.T.); (A.P.)
| | - Laura Lomellini
- Istituto Zooprofilattico Sperimentale di Abruzzo e Molise “G. Caporale”, 64100 Teramo, Italy; (M.D.D.); (D.A.); (C.P.); (M.R.); (A.C.); (L.L.); (A.C.); (M.C.C.); (C.M.); (E.E.T.); (G.R.); (B.S.); (C.M.); (G.D.T.); (A.P.)
| | - Antonio Coccaro
- Istituto Zooprofilattico Sperimentale di Abruzzo e Molise “G. Caporale”, 64100 Teramo, Italy; (M.D.D.); (D.A.); (C.P.); (M.R.); (A.C.); (L.L.); (A.C.); (M.C.C.); (C.M.); (E.E.T.); (G.R.); (B.S.); (C.M.); (G.D.T.); (A.P.)
| | - Maria Chiara Cantelmi
- Istituto Zooprofilattico Sperimentale di Abruzzo e Molise “G. Caporale”, 64100 Teramo, Italy; (M.D.D.); (D.A.); (C.P.); (M.R.); (A.C.); (L.L.); (A.C.); (M.C.C.); (C.M.); (E.E.T.); (G.R.); (B.S.); (C.M.); (G.D.T.); (A.P.)
- Department of Bioscience and Technology for Food and Environment, University of Teramo, 64100 Teramo, Italy
| | - Carmine Merola
- Istituto Zooprofilattico Sperimentale di Abruzzo e Molise “G. Caporale”, 64100 Teramo, Italy; (M.D.D.); (D.A.); (C.P.); (M.R.); (A.C.); (L.L.); (A.C.); (M.C.C.); (C.M.); (E.E.T.); (G.R.); (B.S.); (C.M.); (G.D.T.); (A.P.)
- Department of Bioscience and Technology for Food and Environment, University of Teramo, 64100 Teramo, Italy
| | - Elga Ersilia Tieri
- Istituto Zooprofilattico Sperimentale di Abruzzo e Molise “G. Caporale”, 64100 Teramo, Italy; (M.D.D.); (D.A.); (C.P.); (M.R.); (A.C.); (L.L.); (A.C.); (M.C.C.); (C.M.); (E.E.T.); (G.R.); (B.S.); (C.M.); (G.D.T.); (A.P.)
| | - Gianfranco Romeo
- Istituto Zooprofilattico Sperimentale di Abruzzo e Molise “G. Caporale”, 64100 Teramo, Italy; (M.D.D.); (D.A.); (C.P.); (M.R.); (A.C.); (L.L.); (A.C.); (M.C.C.); (C.M.); (E.E.T.); (G.R.); (B.S.); (C.M.); (G.D.T.); (A.P.)
| | - Barbara Secondini
- Istituto Zooprofilattico Sperimentale di Abruzzo e Molise “G. Caporale”, 64100 Teramo, Italy; (M.D.D.); (D.A.); (C.P.); (M.R.); (A.C.); (L.L.); (A.C.); (M.C.C.); (C.M.); (E.E.T.); (G.R.); (B.S.); (C.M.); (G.D.T.); (A.P.)
| | - Cristina Marfoglia
- Istituto Zooprofilattico Sperimentale di Abruzzo e Molise “G. Caporale”, 64100 Teramo, Italy; (M.D.D.); (D.A.); (C.P.); (M.R.); (A.C.); (L.L.); (A.C.); (M.C.C.); (C.M.); (E.E.T.); (G.R.); (B.S.); (C.M.); (G.D.T.); (A.P.)
| | - Giovanni Di Teodoro
- Istituto Zooprofilattico Sperimentale di Abruzzo e Molise “G. Caporale”, 64100 Teramo, Italy; (M.D.D.); (D.A.); (C.P.); (M.R.); (A.C.); (L.L.); (A.C.); (M.C.C.); (C.M.); (E.E.T.); (G.R.); (B.S.); (C.M.); (G.D.T.); (A.P.)
| | - Antonio Petrini
- Istituto Zooprofilattico Sperimentale di Abruzzo e Molise “G. Caporale”, 64100 Teramo, Italy; (M.D.D.); (D.A.); (C.P.); (M.R.); (A.C.); (L.L.); (A.C.); (M.C.C.); (C.M.); (E.E.T.); (G.R.); (B.S.); (C.M.); (G.D.T.); (A.P.)
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Bauer BU, Knittler MR, Andrack J, Berens C, Campe A, Christiansen B, Fasemore AM, Fischer SF, Ganter M, Körner S, Makert GR, Matthiesen S, Mertens-Scholz K, Rinkel S, Runge M, Schulze-Luehrmann J, Ulbert S, Winter F, Frangoulidis D, Lührmann A. Interdisciplinary studies on Coxiella burnetii: From molecular to cellular, to host, to one health research. Int J Med Microbiol 2023; 313:151590. [PMID: 38056089 DOI: 10.1016/j.ijmm.2023.151590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/19/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023] Open
Abstract
The Q-GAPS (Q fever GermAn interdisciplinary Program for reSearch) consortium was launched in 2017 as a German consortium of more than 20 scientists with exceptional expertise, competence, and substantial knowledge in the field of the Q fever pathogen Coxiella (C.) burnetii. C. burnetii exemplifies as a zoonotic pathogen the challenges of zoonotic disease control and prophylaxis in human, animal, and environmental settings in a One Health approach. An interdisciplinary approach to studying the pathogen is essential to address unresolved questions about the epidemiology, immunology, pathogenesis, surveillance, and control of C. burnetii. In more than five years, Q-GAPS has provided new insights into pathogenicity and interaction with host defense mechanisms. The consortium has also investigated vaccine efficacy and application in animal reservoirs and identified expanded phenotypic and genotypic characteristics of C. burnetii and their epidemiological significance. In addition, conceptual principles for controlling, surveilling, and preventing zoonotic Q fever infections were developed and prepared for specific target groups. All findings have been continuously integrated into a Web-based, interactive, freely accessible knowledge and information platform (www.q-gaps.de), which also contains Q fever guidelines to support public health institutions in controlling and preventing Q fever. In this review, we will summarize our results and show an example of how an interdisciplinary consortium provides knowledge and better tools to control a zoonotic pathogen at the national level.
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Affiliation(s)
- Benjamin U Bauer
- Clinic for Swine and Small Ruminants, Forensic Medicine and Ambulatory Service, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Michael R Knittler
- Friedrich-Loeffler-Institut, Institute of Immunology, Greifswald - Insel Riems, Germany
| | - Jennifer Andrack
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses, Jena, Germany
| | - Christian Berens
- Friedrich-Loeffler-Institut, Institute of Molecular Pathogenesis, Jena, Germany
| | - Amely Campe
- Department of Biometry, Epidemiology and Information Processing, (IBEI), WHO Collaborating Centre for Research and Training for Health at the Human-Animal-Environment Interface, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Bahne Christiansen
- Friedrich-Loeffler-Institut, Institute of Immunology, Greifswald - Insel Riems, Germany
| | - Akinyemi M Fasemore
- Bundeswehr Institute of Microbiology, Munich, Germany; University of Würzburg, Würzburg, Germany; ZB MED - Information Centre for Life Science, Cologne, Germany
| | - Silke F Fischer
- Landesgesundheitsamt Baden-Württemberg, Ministerium für Soziales, Gesundheit und Integration, Stuttgart, Germany
| | - Martin Ganter
- Clinic for Swine and Small Ruminants, Forensic Medicine and Ambulatory Service, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Sophia Körner
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses, Jena, Germany; Fraunhofer Institute for Cell Therapy and Immunology IZI, 04103 Leipzig, Germany
| | - Gustavo R Makert
- Fraunhofer Institute for Cell Therapy and Immunology IZI, 04103 Leipzig, Germany
| | - Svea Matthiesen
- Friedrich-Loeffler-Institut, Institute of Immunology, Greifswald - Insel Riems, Germany
| | - Katja Mertens-Scholz
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses, Jena, Germany
| | - Sven Rinkel
- Institut für Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Martin Runge
- Lower Saxony State Office for Consumer Protection and Food Safety (LAVES), Food and Veterinary Institute Braunschweig/Hannover, Hannover, Germany
| | - Jan Schulze-Luehrmann
- Institut für Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Sebastian Ulbert
- Fraunhofer Institute for Cell Therapy and Immunology IZI, 04103 Leipzig, Germany
| | - Fenja Winter
- Department of Biometry, Epidemiology and Information Processing, (IBEI), WHO Collaborating Centre for Research and Training for Health at the Human-Animal-Environment Interface, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Dimitrios Frangoulidis
- Bundeswehr Institute of Microbiology, Munich, Germany; Bundeswehr Medical Service Headquarters VI-2, Medical Intelligence & Information, Munich, Germany
| | - Anja Lührmann
- Institut für Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany.
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Wang T, Wang C, Li C, Song L. The intricate dance: host autophagy and Coxiella burnetii infection. Front Microbiol 2023; 14:1281303. [PMID: 37808314 PMCID: PMC10556474 DOI: 10.3389/fmicb.2023.1281303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
Q fever is a zoonotic disease caused by Coxiella burnetii, an obligatory intracellular bacterial pathogen. Like other intracellular pathogens, C. burnetii is able to survive and reproduce within host cells by manipulating host cellular processes. In particular, the relationship between C. burnetii infection and host autophagy, a cellular process involved in degradation and recycling, is of great interest due to its intricate nature. Studies have shown that autophagy can recognize and target intracellular pathogens such as Legionella and Salmonella for degradation, limiting their replication and promoting bacterial clearance. However, C. burnetii can actively manipulate the autophagic pathway to create an intracellular niche, known as the Coxiella-containing vacuole (CCV), where it can multiply and evade host immune responses. C. burnetii promotes the fusion of CCVs with lysosomes through mechanisms involving virulence factors such as Cig57 and CvpF. This review summarizes the latest findings on the dynamic interaction between host autophagy and C. burnetii infection, highlighting the complex strategies employed by both the bacterium and the host. A better understanding of these mechanisms could provide important insights into the development of novel therapeutic interventions and vaccine strategies against C. burnetii infections.
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Affiliation(s)
- Tingting Wang
- Department of Infectious Diseases, First Hospital of Zibo City, Zibo, China
| | - Chao Wang
- Department of Traditional Chinese Medicine, First Hospital of Zibo City, Zibo, China
| | - Chang Li
- Department of VIP Unit, China-Japan Union Hospital, Changchun, China
| | - Lei Song
- Department of Respiratory Medicine, Center for Pathogen Biology and Infectious Diseases, The First Hospital of Jilin University, Changchun, China
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Robi DT, Demissie W, Temteme S. Coxiellosis in Livestock: Epidemiology, Public Health Significance, and Prevalence of Coxiella burnetii Infection in Ethiopia. VETERINARY MEDICINE (AUCKLAND, N.Z.) 2023; 14:145-158. [PMID: 37614223 PMCID: PMC10443632 DOI: 10.2147/vmrr.s418346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
Coxiellosis is a zoonotic disease that is prevalent globally and can pose significant challenges, especially in less developed countries like Ethiopia. Coxiella burnetii is responsible for causing an infection called Q fever in humans and coxiellosis in ruminants. Pneumonia and endocarditis are the only signs that characterize the acute and chronic forms of Q fever, respectively. Ruminants exhibit symptoms such as abortion during the later stages of pregnancy, impaired fertility, perinatal death, premature delivery, and reduced birth weight. C. burnetii infection typically spreads among healthy cattle via tick bites and exposure to infected cattle or their bodily secretions. The primary source of human infection is through the ingestion of contaminated milk and milk products, but transmission through aerosols and dust generated during livestock operations is also common. Cattle, sheep, camels and goats are the primary sources of human infection, and the bacterium can be found in various bodily fluids of infected animals. Several factors, including host characteristics, environmental conditions, and management practices, can potentially affect the occurrence of C. burnetii infection in livestock, such as cattle, camels, sheep, and goats. Coxiellosis is prevalent in Ethiopia's pastoral and mixed cattle management systems, as individuals frequently interact with cattle and are therefore more prone to exposure to the C. burnetii bacterium. Vaccination and biosecurity measures are effective techniques for managing C. burnetii infection. Therefore, it is crucial to implement appropriate mitigation strategies, raise awareness about the spread of C. burnetii infection, and conduct further studies on C. burnetii infection in high-risk groups.
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Affiliation(s)
- Dereje Tulu Robi
- Ethiopian Institute of Agricultural Research, Tepi Agricultural Research Center, Tepi, Ethiopia
| | - Wondimagegn Demissie
- Jimma University College of Agriculture and Veterinary Medicine School of Veterinary Medicine, Jimma, Ethiopia
| | - Shiferaw Temteme
- Ethiopian Institute of Agricultural Research, Tepi Agricultural Research Center, Tepi, Ethiopia
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Omar Osman I, Mezouar S, Brahim-Belhaouari D, Mege JL, Devaux CA. Modulation of the E-cadherin in human cells infected in vitro with Coxiella burnetii. PLoS One 2023; 18:e0285577. [PMID: 37285354 PMCID: PMC10246793 DOI: 10.1371/journal.pone.0285577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/25/2023] [Indexed: 06/09/2023] Open
Abstract
High concentration of soluble E-cadherin (E-cad) was previously found in sera from Q fever patients. Here, BeWo cells which express a high concentration of E-cad were used as an in vitro model to investigate the expression and function of E-cad in response to infection by Coxiella burnetii, the etiological agent of Q fever. Infection of BeWo cells with C. burnetii leads to a decrease in the number of BeWo cells expressing E-cad at their membrane. A shedding of soluble E-cad was associated with the post-infection decrease of membrane-bound E-cad. The modulation of E-cad expression requires bacterial viability and was not found with heat-inactivated C. burnetii. Moreover, the intracytoplasmic cell concentration of β-catenin (β-cat), a ligand of E-cad, was reduced after bacterial infection, suggesting that the bacterium induces modulation of the E-cad/β-cat signaling pathway and CDH1 and CTNNB1 genes transcription. Finally, several genes operating the canonical Wnt-Frizzled/β-cat pathway were overexpressed in cells infected with C. burnetii. This was particularly evident with the highly virulent strain of C. burnetii, Guiana. Our data demonstrate that infection of BeWo cells by live C. burnetii modulates the E-cad/β-cat signaling pathway.
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Affiliation(s)
- Ikram Omar Osman
- Aix-Marseille Univ, IRD, APHM, MEPHI, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
| | - Soraya Mezouar
- Aix-Marseille Univ, IRD, APHM, MEPHI, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
| | - Djamal Brahim-Belhaouari
- Aix-Marseille Univ, IRD, APHM, MEPHI, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
| | - Jean-Louis Mege
- Aix-Marseille Univ, IRD, APHM, MEPHI, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
| | - Christian Albert Devaux
- Aix-Marseille Univ, IRD, APHM, MEPHI, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
- CNRS, Marseille, France
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Huang W, Hu S, Zhu Y, Liu S, Zhou X, Fang Y, Lu Y, Wang R. Metagenomic surveillance and comparative genomic analysis of Chlamydia psittaci in patients with pneumonia. Front Microbiol 2023; 14:1157888. [PMID: 37323913 PMCID: PMC10265514 DOI: 10.3389/fmicb.2023.1157888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/12/2023] [Indexed: 06/17/2023] Open
Abstract
Chlamydia psittaci, a strictly intracellular bacterium, is an underestimated etiologic agent leading to infections in a broad range of animals and mild illness or pneumonia in humans. In this study, the metagenomes of bronchoalveolar lavage fluids from the patients with pneumonia were sequenced and highly abundant C. psittaci was found. The target-enriched metagenomic reads were recruited to reconstruct draft genomes with more than 99% completeness. Two C. psittaci strains from novel sequence types were detected and these were closely related to the animal-borne isolates derived from the lineages of ST43 and ST28, indicating the zoonotic transmissions of C. psittaci would benefit its prevalence worldwide. Comparative genomic analysis combined with public isolate genomes revealed that the pan-genome of C. psittaci possessed a more stable gene repertoire than those of other extracellular bacteria, with ~90% of the genes per genome being conserved core genes. Furthermore, the evidence for significantly positive selection was identified in 20 virulence-associated gene products, particularly bacterial membrane-embedded proteins and type three secretion machines, which may play important roles in the pathogen-host interactions. This survey uncovered novel strains of C. psittaci causing pneumonia and the evolutionary analysis characterized prominent gene candidates involved in bacterial adaptation to immune pressures. The metagenomic approach is of significance to the surveillance of difficult-to-culture intracellular pathogens and the research into molecular epidemiology and evolutionary biology of C. psittaci.
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Affiliation(s)
- Weifeng Huang
- Department of Intensive Care Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuqin Hu
- Department of Critical Care Medicine, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
| | - Yongzhe Zhu
- Department of Microbiology, Navy Medical University, Shanghai, China
| | - Shijia Liu
- Department of Pulmonary Disease, PLA 905 Hospital, Shanghai, China
| | - Xingya Zhou
- Genoxor Medical Science and Technology Inc., Shanghai, China
| | - Yuan Fang
- Genoxor Medical Science and Technology Inc., Shanghai, China
| | - Yihan Lu
- Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Shanghai, China
- Shanghai Institute of Infectious Disease and Biosecurity, Shanghai, China
| | - Ruilan Wang
- Department of Critical Care Medicine, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
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