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Buijs SB, Hermans MHA, Agni N, de Vries MC, Hoepelman AIM, Oosterheert JJ, Wever PC. Pitfalls of molecular diagnostic testing for Coxiella burnetii DNA on throat swabs. J Microbiol Methods 2019; 162:16-20. [PMID: 31100316 DOI: 10.1016/j.mimet.2019.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/13/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Coxiella burnetii, the causative pathogen of Q fever, is regularly detected in throat swabs from patients without serological evidence of Q fever infection. C. burnetii is also frequently found in bulk tank milk from dairy cows. We evaluated the false positivity rate of polymerase chain reaction (PCR) for C. burnetii DNA on throat swabs and investigated whether recent consumption of C. burnetii DNA-positive cow milk could contribute to this phenomenon. METHODS C. burnetii PCR was performed on throat swabs obtained from patients in whom a throat swab was ordered for other diagnostic purposes; patients with community-acquired pneumonia (CAP); and healthy volunteers after consumption of commercial C. burnetii-containing cow milk products. RESULTS C. burnetii DNA was found in 5.0% of throat swabs ordered for other diagnostic purposes and in 15.3% of throat swabs from CAP patients without serological evidence of Q fever pneumonia. The positive and negative predictive value of C. burnetii PCR on throat swabs for Q fever pneumonia were 66.7% (95% CI, 38.0-88.2) and 48.9% (95% CI, 41.3-54.6), respectively. After consumption of commercial C. burnetii-containing cow milk products, C. burnetii DNA could be detected in throat swabs for as long as 30 min after ingestion. CONCLUSION C. burnetii PCR on throat swabs is of low diagnostic value for Q fever pneumonia and was false positive in 15.3% of CAP patients without Q fever pneumonia. Recent consumption of C. burnetii-containing products can influence the outcome of C. burnetii PCR on throat swabs. Therefore, diagnosis of C. burnetii infection should be made in combination with serology or PCR performed on blood.
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Affiliation(s)
- Sheila B Buijs
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Mirjam H A Hermans
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, Henri Dunantlaan 1, 5223 GZ 's-Hertogenbosch, the Netherlands
| | - Nabila Agni
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, Henri Dunantlaan 1, 5223 GZ 's-Hertogenbosch, the Netherlands
| | - Maaike C de Vries
- Centre for Infectious Diseases Control, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, the Netherlands
| | - Andy I M Hoepelman
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Jan Jelrik Oosterheert
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Peter C Wever
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, Henri Dunantlaan 1, 5223 GZ 's-Hertogenbosch, the Netherlands
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Angelakis E, Mediannikov O, Socolovschi C, Mouffok N, Bassene H, Tall A, Niangaly H, Doumbo O, Znazen A, Sarih M, Sokhna C, Raoult D. Coxiella burnetii-positive PCR in febrile patients in rural and urban Africa. Int J Infect Dis 2014; 28:107-10. [PMID: 25245003 DOI: 10.1016/j.ijid.2014.05.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 05/27/2014] [Accepted: 05/30/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES Q fever has been reported throughout the African continent. The objective of this study was to detect the presence of Coxiella burnetii in febrile patients from Africa. METHODS Blood samples from febrile and non-febrile patients from six African countries and from France were investigated retrospectively for Q fever infection by molecular assays targeting the IS1111 and IS30A spacers. RESULTS We tested 1888 febrile patients from Senegal, Mali, Tunisia, Algeria, Gabon, and Morocco and found one male adult patient (0.3%) infected with C. burnetii in Algeria and six positive patients (0.5%) in Senegal. For one patient from Senegal we determined that the infection was caused by C. burnetii genotype 35. In Senegal, more patients were infected with C. burnetii in Keur Momar Sarr (p=0.002) than in the other locations. Blood samples taken from 500 (51% males) non-febrile people from Senegal and France were all negative. CONCLUSIONS The installation of point-of-care laboratories in rural Africa can be a very effective tool for studying the epidemiology of many infectious diseases.
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Affiliation(s)
| | - Oleg Mediannikov
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Campus Commun UCAD-IRD of Hann, BP 1386, CP 18524, Dakar, Senegal
| | | | - Nadjet Mouffok
- Service des Maladies Infectieuses, Centre Hospitalo-Universitaire d'Oran, Oran, Algeria
| | - Hubert Bassene
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Campus Commun UCAD-IRD of Hann, BP 1386, CP 18524, Dakar, Senegal
| | - Adama Tall
- Institut Pasteur de Dakar, Dakar, Senegal
| | - Hamidou Niangaly
- Malaria Research and Training Centre, Faculty of Medicine, University of Sciences Techniques and Technology, Bamako, Bamako, Mali
| | - Ogobara Doumbo
- Malaria Research and Training Centre, Faculty of Medicine, University of Sciences Techniques and Technology, Bamako, Bamako, Mali
| | - Abir Znazen
- Laboratory of Microbiology and Laboratory of Research 'MPH', Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Mhammed Sarih
- Laboratoire des Maladies Vectorielles, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Cheikh Sokhna
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Campus Commun UCAD-IRD of Hann, BP 1386, CP 18524, Dakar, Senegal
| | - Didier Raoult
- URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Campus Commun UCAD-IRD of Hann, BP 1386, CP 18524, Dakar, Senegal
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Abstract
Osteoarticular infection is an uncommon presentation of Q fever. Positron emission tomography (PET) scanning is a valuable tool for the diagnosis of Coxiella burnetii graft prosthesis infection and endocarditis. Our objective was to test a series of culture-negative osteoarticular samples using molecular assays for Coxiella burnetii. We tested for C. burnetii by molecular assays targeting the IS1111 and the IS30A spacer regions, using culture-negative osteoarticular samples obtained in our laboratory between January 2011 and December 2012. We examine a total of 1,410 osteoarticular samples, and we observed two cases of arthritis and subacromial bursitis caused by C. burnetii. The infections were localized using PET scanning, and the diagnosis was confirmed through serology. For one, a C. burnetii strain with a multispacer sequence type 8 genotype was isolated from synovial fluid culture. Q fever articular infections could be undiagnosed because of the long evolution of articular attack, and patients with high antibody titers against C. burnetii should be tested using PET scanning to localize the site of infection.
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