Q fever (coxiellosis): epidemiology and pathogenesis

Q fever is a widespread zoonosis caused by the Gram-negative bacterium Coxiella burnetii. Aborting domestic ruminants are the main sources of human infection but the reservoir of infection is extremely wide. In humans, Q fever may occur as acute pneumonia, hepatitis or flu-like illness or may take a severe chronic form, characterized by endocarditis, chronic hepatitis and chronic fatigue syndrome. In animals, the main clinical manifestation is late abortion. Infection with C. burnetii can be diagnosed using cultural, serological and genetic methods but because the organism is potentially dangerous and requires specialized skills only specialist laboratories are capable of undertaking diagnostic tests. This paper provides a brief overview of the epidemiology and pathogenesis of Q fever (coxiellosis).     

Q fever - a review

Q or “query” fever is a zoonosis caused by the organism Coxiella burnetii. Cattle, sheep and goats are the most common reservoirs of this organism. The placenta of infected animals contains high numbers (up to 10⁹/g) of C. burnetii. Aerosols occur at the time of parturition and man becomes infected following inhalation of the microorganism. The spectrum of illness in man is wide and consists of acute and chronic forms. Acute Q fever is most often a self-limited flu-like illness but may include pneumonia, hepatitis, or meningoencephalitis. Chronic Q fever almost always means endocarditis and rarely osteomyelitis. Chronic Q fever is not known to occur in animals other than man. An increased abortion and stillbirth rate are seen in infected domestic ungulates.

Four provinces (Nova Scotia, New Brunswick, Ontario and Alberta) reported cases of Q fever in 1989.

A vaccine for Q fever has recently been licensed in Australia.

     

Q fever in Japan: an update review

As neglected zoonosis for many years, Q fever is now ubiquitous in Japan. Similarly to elsewhere in the world, domestic animals are considered to be important reservoirs of the causal agent, Coxiella burnetii, a resistant intracellular bacterium. Infected animals shed bacteria in milk, feces, urine, vaginal mucous and birth products. Inhalation of bacteria present in the environment is the main route of animal and human infection. Shedding of C. burnetii in milk by domestic ruminants has a very limited impact as raw milk is seldom ingested by the Japanese population. The clinical expression of Q fever in Japan is similar to its clinical expression elsewhere. However clinical cases in children are more frequently reported in this country. Moreover, C. burnetii is specified as one of the causative organisms of atypical pneumonia in the Japanese Respiratory Society Guideline for the management of community-acquired pneumonia. In Japan, C. burnetii isolates are associated with acute illness and are mainly of moderate to low virulence. Cats are considered a significant source of C. burnetii responsible for human outbreaks in association with the presence of infected parturient cats. Since its recognition as a reportable disease in 1999, 7-46 clinical cases of Q fever have been reported by year. The epidemiology of Q fever in Japan remains to be elucidated and the exact modes of transmission are still unproven. Important further research is necessary to improve knowledge of the disease itself, the endogenous hosts and reservoirs, and the epidemiological cycle of coxiellosis in Japan.     

Q fever in Greece: Findings of a 13 years surveillance study

Q fever is an endemic disease in different parts of Greece. The current study aimed to investigate the prevalence of acute Q fever disease in Greece through the operation of the national reference centre for Q fever.A total of 5397 sera were received from febrile patients under the suspicion of Q fever infection during a 13 years period (2001–20013). A questionnaire was filled in by the clinicians containing certain clinical/epidemiological/demographic information.The diagnosis was based both on IFA (IgG and IgM phase II antibodies against Coxiella burnetii) and on molecular means.A total of 685 (12.7 %) samples were initially tested positive for acute Q fever. The mean (±SD) age of patients was 55.3 years (±18.7). Out of the 489 convalescent samples, 134 (27.4 %) samples indicated a minimum of a four-fold seroconversion and were considered as laboratory confirmed cases of acute Q fever. Pneumonia was the most frequently encountered clinical symptom with presence in 6.8 % of all positive samples. Forty six (46) patients were laboratory confirmed as chronic Q fever cases.Climate seemed to influence the distribution of Q fever cases throughout the years. The findings of the current study comply with past studies carried out elsewhere that had demonstrated a clear relation of the disease with temperature, south winds, etc.This study represents the first large scale attempt to gather a long period information on Q fever infection in Greece. The findings of the current study support the fact that Q fever is an important endemic zoonotic disease in Greece and needs increased awareness by clinical physicians and health care system.     

Is Q fever an emerging or re-emerging zoonosis?

Q fever is a zoonotic disease considered as emerging or re-emerging in many countries. It is caused by Coxiella burnetii, a bacterium developing spore-like forms that are highly resistant to the environment. The most common animal reservoirs are livestock and the main source of infection is by inhalation of contaminated aerosols. Although the culture process for Coxiella is laborious, advances on the knowledge of the life cycle of the bacterium have been made. New tools have been developed to (i) improve the diagnosis of Q fever in humans and animals, and especially animal shedders, (ii) perform epidemiological studies, and (iii) prevent the disease through the use of vaccines. This review summarizes the state of the knowledge on the bacteriology and clinical manifestations of Q fever as well as its diagnosis, epidemiology, treatment and prevention in order to understand what factors are responsible for its emergence or re-emergence.     

Epidemiology and clinical features of human infection with Coxiella burnetii in Denmark during 2006-07

Query (Q) fever was virtually unknown in Denmark in 2005, when, after the introduction of new sensitive diagnostic methods for Coxiella burnetii, an increasing number of positive cattle created concern among people with frequent exposure. This led to a dramatic rise in examinations for Q fever among humans in the following 2 years. The aim of our study was to assess indication for testing and symptoms in individuals with serological signs of infection with C. burnetii. We performed a case-review study of seropositives among all humans tested for Q fever in 2006-07 in Denmark. Seropositive cases were categorized with acute infection: 4-fold increase in immunoglobulin G (IgG) phase II or concomitant IgM phase II ≥ 1 : 256 and IgG phase II ≥ 1 : 1024; and previous infection: IgG phase II ≥ 1 : 1024. A borderline result was defined as: IgG phase II = 1 : 512. Physicians completed a questionnaire retrospectively. Of the 1613 people tested, 177 (11%) were seropositive [37 (2%) acute infection, 140 (9%) previous infection], 180 had a borderline result. Among 127 seropositives responders, 31% were tested due to symptoms compatible with Q fever after a possible exposure to C. burnetii, 64% were asymptomatic and were tested following relevant exposure only; 64% were males, 43% farmers, 39% veterinarians, 84% had been exposed to cattle. The most frequently reported symptoms were asthenia (25%), myalgia (21%), fever (17%) and headache (13%). About two-thirds of seropositives reported asymptomatic infections, and were tested for Q fever because of concern for occupational exposure to cattle. One-third of the seropositives reported symptoms consistent with Q fever, the majority being mild. Our study provided important evidence that increased requests for Q fever testing in 2006-07 arose from heightened public awareness of the disease, and not from an outbreak of clinical disease. Nonetheless, Q fever should be considered endemic in Denmark.     

猪丹毒

猪丹毒又称“红热病” “打火印”或“钻石皮肤病”,是一种急性的、热性的传染病,引起该病的病原为红斑丹毒丝菌,可以通过伤口感染人,也是一种人兽共患病。患病猪的临床表现形式大致可分为3种类型,即急性、亚急性和慢性型。急性型病例主要的表现为出现明显的败血症症状。亚急性型病例则是在四肢、胸腹部、背部等皮肤处出现红色菱形、方形或圆形疹块。慢性型则多以出现关节炎和心内膜炎引起的关节肿胀、运动障碍和心跳加速、呼吸急促为主的临床表现;有时还可见皮肤坏死。红斑丹毒丝菌的最易感动物是猪,没有品种和年龄差异。使用疫苗是最佳的预防手段,治疗方面除使用抗生素外还可以选择中药方剂进行治疗。     

Q热血清学检测方法的研究进展

Q热是由贝氏柯克斯体(Coxiella burnetii)引起的急性自然疫源性传染病。本病呈世界性流行,人类和动物普遍易感,已经成为当前分布最广的人兽共患病之一。文章综述了Q热的病原学、流行病学以及血清学检测方法的研究进展,为Q热的进一步研究与防控提供科学依据。     

Q fever epidemic in Cayenne,French Guiana,epidemiologically linked to three-toed sloth

A Q fever epidemic occurred in 2013 in a small military residential area in Cayenne, French Guiana. A retrospective cohort study was conducted to identify Q fever risk factors. Confirmed acute Q fever case was defined as positive serology (IgM ≥ 50 and phase II IgG ≥ 200) and/or positive qPCR on serum or blood. In addition, wild mammals were captured at the study site and tested by serology and real-time PCR performed on blood, vaginal swabs and ticks. The attack rate was 20 percent (11/54). All the cases were symptomatic with fever >38.5 °C and community-acquired pneumonia for four cases. Log binomial multivariate models identified two independent risk factors associated with Q fever: to clean the house (RRa = 7.5 CI95% [1.03–55.3]) and to carry a three-toed sloth in arms (RRa = 2.6 CI95% [1.1–5.8]). Eighteen marsupial individuals were captured, all PCRs were negative but 17% (3/18) had a positive serology. Another study conducted after the epidemic found only one (1/4) three-tooth sloth (Bradypus tridactylus) with feces highly infectious for C. burnetii MST17. The same strain C. burnetii genotype 17 has been laboratory- confirmed in this mammal and in human cases. These results support the implication of three-toed-sloth in this epidemic. Human contamination mainly occurs through inhalation of infectious aerosols as suggested by high relative risk associated with house cleaning activities and pulmonary forms of the disease, and through direct contact with three- toed-sloth. Positive serological results among marsupials confirm wildlife exposure and suggest a more complex sylvatic transmission cycle among wild mammals.     

Q fever osteomyelitis: a case report and literature review

Q fever is a worldwide zoonosis caused by Coxiella burnetii. The clinical manifestations of Q fever include endocarditis, pneumonitis and hepatitis. Disease awareness and evolving diagnostic tests have enabled the recognition of unusual manifestations of Q fever. We report a case of Q fever osteomyelitis. A 51-year-old patient was admitted to hospital because of fever, leg weakness, and asthenia. His past medical history included surgery and a bone graft for the treatment of a giant cell tumor on the distal part of the femur. Blood and bone biopsy cultures were negative. Bone histological examination was consistent with a sub-acute or chronic inflammatory reaction that involved foci of epithelioid and gigantocellular infiltrates and necrosis. Serology testing revealed high antibody titers to C. burnetii antigens (phase I: IgG 3200; IgA 200; phase II: IgG 6400; IgA 400), which is indicative of chronic Q fever. The specific Polymerase Chain Reaction (PCR) of the abscess sample from the femoral region was positive for C. burnetii. The patient was treated for chronic Q fever with doxycycline and hydroxychloroquine for 18 months and recovered gradually without recurrence of pain or functional impairment. Q fever osteomyelitis is a rare and most likely underestimated disease. Epithelioid and gigantocellular granulomatous osteomyelitis in the context of culture-negative bone specimens should raise suspicion of Q fever. Serological tests, specific PCR and cell culture can provide evidence of a C. burnetii infection. Although bone diffusion may be a concern, the currently recommended treatment for Q fever was effective in this case.     

Seroepidemiologic survey for Coxiella burnetii among hospitalized US troops deployed to Iraq

Q fever is a zoonotic illness which frequently has a non-specific clinical presentation. Cases among deployed US military personnel have been reported in increasing numbers indicating an emerging at-risk occupational group. Banked serum specimens were utilized to estimate seroprevalence and risk factors among military personnel deployed to Iraq. Coxiella burnetii antibody testing was performed and epidemiologic data were analysed from 909 servicemembers. The overall number who seroconverted to Q fever was 88 (10%). The most common ICD-9 code assigned to Q fever cases was fever not otherwise specified (NOS) (45%). A combat occupational specialty was a risk factor for Q fever seroconversion (OR = 1.8, 95% CI: 1.1-2.8) as well as receiving a primary diagnosis of fever NOS (OR = 2.6, 95% CI: 1.6-4.1). These findings indicate that Q fever is a significant infectious disease threat to military personnel deployed to Iraq. A heightened awareness among physicians is necessary to ensure prompt diagnosis and treatment.     

Akabane and bovine ephemeral fever virus infections.

Akabane and bovine ephemeral fever viruses are exotic to the American continent. Both viruses are spread by insect vectors, and each causes disease of varying severity in food-producing animals. However, there are few other similarities between the agents and the diseases that they cause. They do not share the same insect vectors, the mammalian host range is different, and the clinical manifestations of virus infection vary markedly. Akabane virus is a cause of severe congenital defects, but adult animals show no signs of infection. In contrast, bovine ephemeral fever virus causes a febrile illness affecting mainly mature animals. If introduced to North America, it is probable that there would be significant economic losses, at least until endemic virus transmission patterns were established. Subsequently, it is likely that there would be patterns of alternate disease outbreaks followed by interepidemic periods in which there is a minor clinical effect.     

An historical view of the experimental leptospiral infection in ruminants

The first experimental infections with Leptospira in ruminants were conducted in the 1950s, primarily assessed the pathogenesis caused by serovar Pomona in cows. Throughout the decades, experimental infections have also demonstrated the clinical aspects of the infection by other strains, mainly Hardjo. Despite the important outcomes observed in experimental infections in ruminants, there is still a large discrepancy regarding the ideal dose, route, strain, model species or animal age that should be used to reproduce the acute and chronic leptospirosis in ruminants. In this context, the present study aimed to review the historical processes involved on the experimental leptospiral infection in ruminants. The inclusion criteria were papers that clearly described inoculation route, strain, dose, clinical signs and animal age. Overall, 37 experiments were noted. The most frequently reported clinical signs were fever, prostration, hematuria and death, with the majority of them occurring in young animals infected by incidental strains. Regarding reproductive problems, they occurred in the majority of the experiments and were also more related to incidental strains. In this context, abortions, retained placenta and weak fetuses were the most frequent symptoms. Noteworthy that although the mechanisms of the clinical acute disease either systemic or reproductive, is reasonably well understood, the physiopathology involved on reproductive problems due to the silent chronic infection is less discussed and remains to be elucidated. In this context, it is evident the need for studies focused on the genital infection and reproductive aspects of leptospiral infection in ruminants.     

Seroepidemiological study on Coxiella burnetii and associated risk factors in ruminants at Kurdistan Province,west of Iran

Q fever is zoonotic disease caused by Coxiella burnetii. Ruminants are the main reservoir of this pathogen, which is often asymptomatic but lead to abortion. This study aims to survey the seroprevalence and risk factors of this zoonose among ruminants in Kurdistan province, the west of Iran. 480 blood samples were collected from ruminants including sheep, goats and cows, each 160 samples, in the age groups of <1, ≥1−3, >3−5 year with and without the history of abortion in two groups border and non-border cities in Kurdistan province. Serums were tested by use of indirect ELISA to determine specific antibodies against C. burnetii. The results indicate the seroprevalence of 46.6 % for Q fever. Seroprevalence in sheep, goats and cows were 28.58 % (n = 64), 45.53 % (n = 102) and 25.89 % (n = 58), respectively. Seroprevalence is significantly higher in animals with abortion than in those without such history (P < 0.05). The seroprevalence in the border cities has been significantly higher than other geographical areas (P < 0.05). Seroprevalence had no significant correlation with animal age (P> 0.05). This study is the first seroepidemiological study done on Q fever in ruminants of Kurdistan province, Iran. The results indicate the high seroprevalence of Coxiella burnetii in the area under the study. Therefore, doing an epidemiologically study aimed at isolating C. brunetii in the human population of Kurdistan province is recommended, so that the epidemiological aspect of this pathogen in the people of Kurdistan province be clarified and subsequently disease control and prevention programs be applied.     

Leptospirosis in the western Indian Ocean islands: what is known so far?

In the past decade, leptospirosis has emerged as a major zoonosis with a worldwide distribution. The disease is caused by bacteria of the genus Leptospira. The western Indian Ocean includes more than one hundred tropical or subequatorial islands where leptospirosis constitutes a major public health problem. The clinical signs of the human disease are generally similar to an influenza-like syndrome, but acute forms of the disease are reported and mortality remains significant in this region. In animals, clinical forms are mainly asymptomatic but leptospirosis reduces the fertility of livestock, resulting in economic losses. The data available about human and animal leptospirosis in the western Indian Ocean islands are diverse: human leptospirosis has been extensively studied in Reunion Island, Mayotte, and the Seychelles, whereas the human clinical disease has never been described in Madagascar, Comoros, Mauritius, or Rodrigues, mainly because of the deficiency in appropriate medical and diagnostic structures. The rat is recognized as the major reservoir host for the bacteria on all islands, but recent data from Reunion Island indicates that almost all mammals can be a source of contamination. The incidence of leptospirosis in humans is highly seasonal, and linked to the rainy season, which is favorable for the environmental maintenance and transmission of the bacteria. The epidemiology of leptospirosis is fully island-dependent, related to the number of mammalian species, the origins of the introduced mammalian species, the relationships between humans and fauna, and environmental as well as cultural and socio-economic factors.     

Role of goats in epizootiology and epidemiology of Q fever

Numerous data show that the epizootics of Q fever in goats can be particularly related to cases of this disease in humans. The aim of the study was to examine 98 goat serum samples from the farm where abortions, early parturition and parturition of weak goatlings were noted. The microaglutination method was used in this study. Serum dilution 1:8 was defined as a positive titre. The study revealed that 79.6% of serum samples were positive and numerous high titres suggested an acute form of infection. It could be supposed that Q fever was the reason of abortions in the herd. The results obtained point to the necessity of examinations for Q fever in goats, because of the possibility of infection in people who have a contact with these animals. Goats seem to be the animal species especially sensitive to C. burnetii infection. Q fever should be taken into consideration in the differential diagnosis of the goat diseases, when abortions occur.     

Monocytic ehrlichiosis in dogs

Ehrlichiosis is the multiorgan infectious disease caused by small, intracellular rickettsias from the genus Ehrlichia. These microorganisms are known as an etiologic factor of infections world wide in humans and in different species of animals. Dog ehrlichiosis can be caused by several species of Ehrlichia attacking different groups of blood cells, but most often an infection by Ehrlichia canis is diagnosed with special relation to monocytes. A vector for E. canis are Rhipicephalus sanguineus and Ixodes ricinus, commonly occurring in Poland. Disease caused by E. canis is known as Canine Monocytic Ehrlichiosis (CME). The disease most often has an asymptomatic course which can, in favourable circumstances, run into acute or chronic forms. The acute form of CME proceeds usually with fever, apathy, weakness and accompanying respiratory symptoms, lameness and disturbances in blood coagulation. In laboratory examinations thrombocytopenia, anemia and leucopenia are ascertained. The chronic form of CME proceeds among gentle, unspecific symptoms which may last even 5 years. The CME diagnosis is difficult and often demands parallel different diagnostic methods. A medicines of choice in the ehrlichiosis treatment are antibiotics from the group of tetracyclines, given at least for 28 days. They are largely efficient during treatment of the acute CME, causing the quick improvement. Instead, in the case of chronic form, answer for treatment can be weak, and cases of resistance to antibiotics ave known.     

Asymptomatic leptospiral infection is associated with canine chronic kidney disease

Canine leptospirosis is characterized by an acute or chronic disease. Some dogs may act as asymptomatic carriers, keeping the agent in the renal tubules and eliminating it in the urine for an extended period. Chronic kidney disease (CKD) is multifactorial and pathophysiology has been widely discussed. The aim of the study was to investigate whether the occurrence of CKD may possibly be associated with asymptomatic leptospiral infection in dogs in endemic regions. Serology and urine PCR were performed in 16 dogs with CKD and 48 healthy dogs from an endemic area. Dogs with CKD were more frequently shedders (75%) than non-CKD animals (20.8%). Therefore, our results demonstrate that asymptomatic leptospiral infection is associated with canine chronic kidney disease and that differential diagnosis is important for dogs from endemic areas presenting CKD. The early detection of shedders, besides the obvious impact on Public health may also help to improve the animal health and avoid the development of CKD.     

Risk factors for bacterial zoonotic pathogens in acutely febrile patients in Mpumalanga Province,South Africa

Endemic zoonoses, such as Q fever and spotted fever group (SFG) rickettsiosis, are prevalent in South Africa, yet often undiagnosed. In this study, we reviewed the demographics and animal exposure history of patients presenting with acute febrile illness to community health clinics in Mpumalanga Province to identify trends and risk factors associated with exposure to Coxiella burnetii, the causative agent of Q fever, and infection by SFG Rickettsia spp. Clinical and serological data and questionnaires elucidating exposure to animals and their products were obtained from 141 acutely febrile patients between 2012 and 2016. Exposure or infection status to C. burnetii and SFG Rickettsia spp. was determined by presence of IgG or IgM antibodies. Logistic regression models were built for risk factor analysis. Clinical presentation of patients infected by SFG rickettsiosis was described. There were 37/139 (27%) patients with a positive C. burnetii serology, indicative of Q fever exposure. Patients who had reported attending cattle inspection facilities (“dip tanks”) were 9.39 times more likely to be exposed to Q fever (95% CI: 2.9–30.4). Exposure risk also increased with age (OR: 1.03, 95% CI: 1.002–1.06). Twenty‐one per cent of febrile patients (24/118) had evidence of acute infection by SFG Rickettsia spp. Similarly, attending cattle inspection facilities was the most significant risk factor (OR: 8.48, 95% CI: 1.58–45.60). Seropositivity of females showed a significant OR of 8.0 when compared to males (95% CI: 1.49–43.0), and consumption of livestock was associated with a decreased risk (OR: 0.02, 95% CI: 0.001–0.54). A trend between domestic cat contact and SFG rickettsiosis was also noted, albeit borderline non‐significant. In this endemic region of South Africa, an understanding of risk factors for zoonotic pathogens, including exposure to domestic animals, can help clinic staff with diagnosis and appropriate therapeutic management of acutely febrile patients as well as identify target areas for education and prevention strategies.     

郏县红牛结节性皮肤病的治疗办法

郏县红牛结节病是牛养殖业中的常见疾病,是由病毒引起郏县红牛的一种急性、亚急性或慢性、传染病。该病的临床特征是病牛发热、消瘦,淋巴结肿大,皮肤、水肿、局部形成坚硬的结节或溃疡为主要特征。