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PubMed2002

Current laboratory diagnosis of Q fever.

Q fever is a worldwide zoonosis caused by the strictly intracellular bacterium Coxiella burnetii. Among symptomatic patients (one-half of patients remain asymptomatic), acute Q fever most frequently manifests as a self-limited febrile illness, pneumonia, or hepatitis. Endocarditis is the predominant form of chronic Q fever. All the classical techniques of bacteriology may be used for diagnosis of C burnetii infection. Nonetheless, because of the risk of contamination, isolation must be performed in biosafety level 3 laboratories. Moreover, to date no diagnostic tests for detection by polymerase chain reaction or specific antibodies for immunochemistry are available commercially. Hence, Q fever is diagnosed in most cases by serology. The most reliable technique appears to be micro-immunofluorescence, which exhibits both good sensitivity and specificity. A wider use of this serology in cases of blood culture-negative endocarditis, atypical pneumonia, unexplained fever, and hepatitis should lead to an increase of diagnosed cases.

Animals↗
PubMed1989

[The epidemiology of Q fever].

Q fever as one of infections with natural foci is characterized by epidemic outbreaks. Biologic plasticity and ecologic peculiarities of Coxiella determine its wide distribution and development of Q fever infections which are disseminated almost every-where. They occur in two, i. e. natural and agricultural types of foci. Present paper characterizes their structures, maintenance and peculiarities if their existence. It should be emphasized that single cases of disease as well as outbreaks of Q fever originate usually from agricultural foci, where the source of the infection are livestock, sheep and goats. Data are presented on the involvement of these animals into circulation of coxiellae in various countries of the world. It was shown that agricultural foci of Q fever depending upon close connection with domestic animals are determined in many aspects by basic factors of an epidemic process of the infection, i. e. seasonal occurrence, social conditions, professional relations, etc. which also enhance the course of the infection. Principles on prophylaxis complete the given paper.

Animals↗
PubMed2003

Comparison of PCR and serology assays for early diagnosis of acute Q fever.

Q fever is a potentially severe disease which can occur in large outbreaks of acute infections and is a possible bioterrorism agent. In order to lessen the delay in diagnosing acute Q fever, we compared LightCycler Nested PCR (LCN-PCR), a rapid nested PCR assay that uses serum sampled early during the disease as a specimen and the LightCycler as a thermal cycler, to serology by indirect immunofluorescence. We used the 20-copy htpAB-associated element as the DNA target. The detection sensitivity of this method was one Coxiella burnetii DNA copy. We applied this method to the first serum samples taken from 100 patients diagnosed in our laboratory as having acute Q fever on the basis of clinical manifestations and serology and to 80 controls. The LCN-PCR had a specificity of 100%. The sensitivity was 26% when no antibodies were detected but only 5% with seropositive patients (P < 10(-2)). The technique was most efficient in the first 2 weeks following the onset of symptoms (P = 0.02), when its sensitivity was 24% compared with 14% for serology. With combined use of LCN-PCR and serology within the first 2 weeks, the sensitivity was significantly increased over that with serology alone (P < 10(-2)). Thus, we propose a strategy for improving the early diagnosis of acute Q fever where LCN-PCR should be performed together with serology in the first 2 weeks of the disease but should be reserved for seronegative patients in the next 2 weeks and not used later than 4 weeks following onset, when serology is highly sensitive.

Adolescent↗
PubMed2005

Natural history and pathophysiology of Q fever.

Q fever is a zoonosis caused by Coxiella burnetii. Infection with C burnetii can be acute or chronic, and exhibits a wide spectrum of clinical manifestations. The extreme infectivity of the bacterium results in large outbreaks and makes it a potential bioweapon. In the past decade, the complete genome sequencing of C burnetii, the exploration of bacterial interactions with the host, and the description of the natural history of the disease in human beings and in experimental models have all added to our knowledge about this fascinating disease. Advances in understanding the pathophysiology and natural history of Q fever are reviewed.

Coxiella burnetii↗
PubMed2006

Q fever.

Q fever is a zoonosis with many manifestations. The most common clinical presentation is an influenza-like illness with varying degrees of pneumonia and hepatitis. Although acute disease is usually self-limiting, people do occasionally die from this condition. Endocarditis is the most frequent chronic presentation. Although Q fever is widespread, practitioner awareness and clinical manifestations vary from region to region. Geographically limited studies suggest that chronic fatigue syndrome and cardiovascular disease are long-term sequelae. An effective whole-cell vaccine is licensed in Australia. Live and acellular vaccines have also been studied, but are not currently licensed.

Adolescent↗
PubMed1983

Experimental model for dermal granulomatous hypersensitivity in Q fever.

Q fever has been associated with granulomatous changes in clinical biopsy material obtained from liver and bone marrow. Local reactions to skin testing have been described in previously sensitized humans, but histological studies of such reactions have not been reported. We note that delayed hypersensitivity reactions to whole-cell phase I Q fever vaccine in immunized guinea pigs have a time course of development of induration characteristic of granulomatous hypersensitivity. Histological examination of such skin reactions on day 9 after testing revealed epithelioid cell infiltration and the presence of large numbers of multinucleated giant cells. Prominent in the sections were fragments of disintegrating polymorphonuclear leukocytes having the appearance of leukocytoclasis. Electron microscopic studies confirmed the presence of epithelioid changes in cells of the mononuclear phagocyte series, as well as extensive collagen deposition. This animal system affords a readily reproducible model of dermal granulomatous hypersensitivity and an opportunity to analyze the immunological basis of this reaction.

Animals↗
PubMed1993

Q fever.

Q fever is an acute febrile illness first described in 1935 and now seen in many parts of the world. Human infection follows exposure to animals, especially domestic livestock. Recent outbreaks in metropolitan areas have implicated cats as the carrier of disease to humans. The etiologic agent, Coxiella burnetti, belongs to the family Rickettsiaceae, although it has distinct genetic characteristics and modes of transmission. Most recent attention has been focused on a number of large outbreaks of Q fever associated with medical research involving pregnant sheep. Although most infections are self-limited, some patients require prolonged treatment. Recent vaccines have had encouraging success in the prevention of disease in individuals at high risk of exposure.

Acute Disease↗
PubMed1998

Increases in the levels of Coxiella burnetii-specific immunoglobulin G1 and G3 antibodies in acute Q fever and chronic Q fever.

A detailed analysis of the humoral response to Coxiella burnetii may provide insight into the pathogenesis of Q fever, a zoonosis caused by C. burnetii. The subclasses of C. burnetii-specific antibodies were determined by immunofluorescence in 20 patients with acute Q fever and 20 patients with chronic Q fever. Although immunoglobulin G1 (IgG1) and IgG3 antibodies were found in acute and chronic Q fever, neither IgG2 nor IgG4 was detected. The detection of IgG1 and IgG3 antibodies was not due to an increase of the IgG1 and IgG3 subclasses. Moreover, IgG1 and IgG3 antibodies were not correlated, suggesting that they may play different roles in Q fever.

Acute Disease↗
PubMed1980

Q fever.

Q fever is endemic throughout much of Australia and is most frequently seen in abattoir workers, farmers and veterinarians. Initially, there is a febrile, influenza-like illness. The infection is usually self-limited within several weeks, but rarely patients may develop infective endocarditis or hepatitis. The diagnosis is usually confirmed by finding risings titres of antibodies specific for C. burneti. The infection is not very responsive to treatment, but if tetracycline is administered early, the duration of fever is shortened.

Abattoirs↗
PubMed2007

Psoas abscess: An unusual manifestation of Q fever.

Q fever may lead to serious complications in chronically infected patients. We report two cases of psoas abscess due to Coxiella burnetii associated with lumbar osteomyelitis secondary to an aortic aneurysmal infection. Diagnosis was based on serology, and PCR detected C. burnetii DNA in an abscess sample.

Journal Article↗
PubMed2004

Bichat guidelines for the clinical management of Q fever and bioterrorism-related Q fever.

Q fever is a zoonotic disease caused by Coxiella burnetii. Its interest as a potential biological weapon stems from the fact that an aerosol of very few organisms could infect humans. Another route of transmission of C. burnetii could be through adding it to the food supply. Nevertheless, C. burnetii is considered to be one of the less suitable candidate agents for use in a bioterrorist attack; the incubation is long, many infections are inapparent and the mortality is low. In the case of an intentional release of C. burnetii by a terrorist, clinical presentation would be similar to naturally occurring disease. It may be asymptomatic, acute, normally accompanied by pneumonia or hepatitis, or chronic, usually manifested as endocarditis. Most cases of acute Q fever are asymptomatic and resolve spontaneously without specific treatment. Nevertheless, treatment can shorten the duration of illness and decrease the risk of complications such as endocarditis. Post-exposure prophylaxis is recommended after the exposure in the case of a bioterrorist attack.

Bioterrorism↗
PubMed2003

Dysregulation of cytokines in acute Q fever: role of interleukin-10 and tumor necrosis factor in chronic evolution of Q fever.

Q fever manifests as primary infection or acute Q fever and may become chronic in patients with underlying valvulopathy. Because Coxiella burnetii infection depends on host response, we measured tumor necrosis factor (TNF), interleukin (IL)-6, IL-12, and IL-10 in patients with different clinical presentations of acute Q fever. Compared with control subjects, patients with uncomplicated acute Q fever exhibited increased release of the 4 cytokines. Their amounts were higher in patients with hepatitis than in patients with fever or pneumonia. In patients with valvulopathy, who exhibited the highest risk of chronic evolution, the amounts of TNF and IL-10 were higher than in patients without valvulopathy. TNF production was specifically enhanced in patients who developed Q fever endocarditis. These results show that acute Q fever is associated with cytokine overproduction. Persistent TNF amounts were associated with the occurrence of endocarditis in patients with valvulopathy, and that may be a marker of chronic evolution of Q fever.

Adolescent↗
PubMed1985

Cellular immunity in Q fever: specific lymphocyte unresponsiveness in Q fever endocarditis.

Human infection with the rickettsia Coxiella burnetii presents as acute influenza-like primary Q fever, subacute granulomatous hepatitis, or chronic endocarditis with hepatitis. To investigate whether persistent infection is associated with a possible immunologic defect, we tested lymphocyte proliferation specific for Coxiella in vitro in peripheral blood mononuclear cells from patients and controls. All four patients with endocarditis had profound lymphocyte unresponsiveness to Coxiella antigens with normal proliferation to control antigens. Hepatitis and primary Q fever were associated with vigorous responses in vitro to Coxiella antigens. Suppression of lymphocyte unresponsiveness was in part mediated by an antigen-nonspecific, glass-adherent cell. We hypothesize that specific T cell unresponsiveness is an important factor in persistent infection with C. burnetii and offer in vitro lymphocyte stimulation as a more specific diagnostic test to distinguish cases of endocarditis among those with chronic hepatitis due to Q fever.

Adult↗