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Changes in liver and L-cell plasma membranes during infection with Coxiella burnetii.

Changes in plasma membrane proteins of guinea pig liver and L-929 cells were studied during infection with Coxiella burnetii. Polypeptide species resolved by disc polyacrylamide gel electrophoresis with sodium dodecyl sulfate showed quantitative but no qualitative differences between uninfected and infected samples. When the O'Farrell technique of isoelectric focusing, followed by sodium dodecyl sulfate-slab gel polyacrylamide gel electrophoresis, was employed, additional polypeptides were resolved. Livers and L cells were labeled with [3H]-glucosamine. Infected livers incorporated less [3H]glucosamine in the membrane proteins than uninfected material, presumably indicating lower glycoprotein levels. Infected L-cell membranes incorporated greater amounts of [3H]glucosamine, and also were labeled to a greater extent than uninfected membranes, employing the [125I]lactoperoxidase technique. Uninfected L cells showed a greater agglutinability with concanavalin A than did infected cells. Infected livers had much greater levels of cyclic adenosine 3',5'-monophosphate. The data indicate changes in plasma membranes as a result of infection. Possible physiological consequences of membrane changes are discussed.

Adenosine Triphosphatases↗

Incidence of ovine abortion by Coxiella burnetii in northern Spain.

The infectious causes of ovine abortion occurring in 148 farms in northern Spain between 1999 and 2003 were investigated. Laboratory analysis included microbiological, serological, pathological and molecular techniques. Border disease was diagnosed in 16% of the flocks, toxoplasmosis in 15%, chlamydiosis in 12%, salmonellosis in 10%, Q fever in 3%, miscellaneous infections in 7% (Yersinia spp., Listeria spp., Brucella spp.), and inflammatory lesions compatible with an infectious cause were seen in 7% of the flock. In an additional 1% of the flocks non-infectious causes were identified, and a diagnosis was not reached in 38% of the flocks. When a PCR retrospective study was carried out to investigate the possible implication of Coxiella burnetii in the cases without diagnosis, including those with inflammatory lesions, the prevalence of this pathogen increased from 3% up to 9% of the flocks, revealing the importance of this zoonotic pathogen as a small-ruminant abortifacient agent. Placenta was the most commonly positive sample, but other fetal tissues were also of value for C. burnetii DNA detection. The present results update information about the situation of abortion in sheep farms in northern Spain, and highlight the relevance of molecular diagnostic tools in routine laboratory analysis of abortions by C. burnetii.

Abortion, Spontaneous↗

Antibiotic susceptibilities of two Coxiella burnetii isolates implicated in distinct clinical syndromes.

Antibiotic susceptibility testing of two isolates of the Q-fever agent, Coxiella burnetii, was performed with recently and persistently infected L929 fibroblast cells. The two genetically distinct isolates, Nine Mile and Priscilla, are implicated in two different clinical disease syndromes, acute and chronic Q fever, respectively. We compared the efficacies of rifampin, doxycycline, and five 4-quinolone compounds (ciprofloxacin, difloxacin, ofloxacin, norfloxacin, and pefloxacin) in reducing persistent C. burnetii infection of L929 fibroblasts. In persistently infected cells, the Priscilla isolate was less susceptible to all antibiotics tested when compared with the Nine Mile isolate. The most effective antibiotics against the Priscilla isolate were ofloxacin, pefloxacin, and ciprofloxacin (50% inhibitory concentrations of 0.5, 2.2, and 2.5 micrograms/ml, respectively). In persistently infected cells, the Nine Mile isolate was highly susceptible to all antibiotics tested except doxycycline. In contrast, the Priscilla and Nine Mile isolates in recently infected cells were somewhat susceptible to doxycycline; the Priscilla isolate was significantly more susceptible to ofloxacin and rifampin in recently infected host cells than in persistently infected cells. Persistently infected L929 cells were also treated with antibiotic combinations. Although ciprofloxacin and doxycycline had no synergistic effect on the Priscilla isolate, ciprofloxacin and rifampin acted synergistically. Collectively, these in vitro results are in accord with the fact that chronic Q fever in humans is generally not successfully managed with antibiotics. They also indicate that early diagnosis may be essential and that combination antibiotic therapy that includes quinolones may be effective in treating chronic Q fever.

Anti-Bacterial Agents↗

Isolation of 16 strains of Coxiella burnetii from patients by using a sensitive centrifugation cell culture system and establishment of the strains in HEL cells.

Q fever, caused by Coxiella burnetii, may be acute or chronic. Only a few strains of C. burnetii have been isolated due to the difficulty and hazard of isolation. We report here the isolation using a centrifugation shell vial technique of 16 new strains from patients suffering chronic Q fever. Twenty-four samples were inoculated onto human embryonic lung (HEL) fibroblast cell monolayers growing in shell vials. C. burnetii was detected 6 days later by using immunofluorescence. Samples from valves (n = 10), arterial prostheses (n = 2), bone (n = 3), skin biopsy (n = 1), bone marrow (n = 1), and blood (n = 5) from 16 patients were successfully cultured. Two cerebrospinal fluid samples from two patients were negative. The strains were subcultured in HEL cells and are now established. The technique is sensitive and less hazardous than animal inoculation. We recommend the shell vial technique for isolation of C. burnetii.

Bacteriological Techniques↗

In vitro susceptibilities of Coxiella burnetii, Rickettsia rickettsii, and Rickettsia conorii to the fluoroquinolone sparfloxacin.

In vitro susceptibilities of Rickettsia rickettsii, Rickettsia conorii, and Coxiella burnetii to the new fluoroquinolone sparfloxacin (AT-4140; RP 64206) were determined. Plaque and dye uptake assays were used to measure the MICs against R. rickettsii and R. conorii. The susceptibilities of C. burnetii Nine Mile and Q 212 were determined in two acute-infection models and in two chronic-infection models. The MICs were 0.125 to 0.25 microgram/ml for R. rickettsii and 0.25 to 0.5 microgram/ml for R. conorii. Sparfloxacin (1 microgram/ml) cured cells recently infected with C. burnetii Nine Mile and Q 212 within 4 to 9 days and cured multiplying, persistently infected cells within 10 days. As previously described with other fluoroquinolones (D. Raoult, M. Drancourt, and G. Vestris, Antimicrob. Agents Chemother. 34:1512-1514, 1990), sparfloxacin failed to cure cells persistently infected with C. burnetii and blocked from dividing with cycloheximide. As determined by the dye uptake assay, no cellular toxicity was noted with sparfloxacin at up to 128 micrograms/ml. These results are consistent with those previously obtained with fluoroquinolones (D. Raoult, M. Yeaman, and O. Baca, Rev. Infect. Dis. 11[Suppl. 5]:S986, 1989), although sparfloxacin may be slightly more active.

4-Quinolones↗

Intracellular fate of phase I Coxiella burnetii in guniea pig peritoneal macrophages.

Cultivated guinea pig peritoneal macrophages were infected with radio-labeled phase I Coxiella burnetii in order to assess the intracellular distribution of ingested rickettsiae. Localization of organisms was determined by fractionation of macrophage homogenates by equilibrium density centrifugation on sucrose gradients. Macrophages isolated from either nonimmune or immune guinea pigs and infected with C burnetii opsonized with immune serum yielded equilibrium density distribution for rickettsiae similar to lysosomal enzymes, suggesting sequestration within macrophage lysosomes. To confirm these observations nonimmune or immune guinea pigs were injected with Triton WR-1339 prior to macrophage harvest to decrease the density of macrophage lysosomes. Triton-laden macrophages infected with opsonized rickettsiae resulted in equilibrium density distribution for lysosomal enzymes and organisms in less dense regions of the gradient. In contrast, when either nonimmune or immune macrophages were infected in the presence of normal guinea pig serum, the distribution of labeled rickettsiae in the gradient did not correspond with lysosomes. We conclude that in the absence of immune serum, ingested C burnetii are not sequestered within macrophage lysosomes. Phagolysomal fusion and subsequent degradation of rickettsiae within the lysosomes of the macrophages appear to occur only when C burnetii are opsonized with immune serum.

Animals↗

Serological cross-reactions between Bartonella quintana, Bartonella henselae, and Coxiella burnetii.

The clinical manifestations of Q fever and bartonelloses can be confused, especially in cases of infectious endocarditis. Differential diagnosis of the diseases is important because the treatments required for Q fever and bartonelloses are different. Laboratory confirmation of a suspected case of either Q fever or bartonelloses is most commonly made by antibody estimation with an indirect immunofluorescence assay. With an indirect immunofluorescence assay, 258 serum samples from patients with Q fever were tested against Bartonella henselae and Bartonella quintana antigens, and 77 serum samples from patients with infection by Bartonella sp. were tested against Coxiella burnetii antigen. Cross-reactivity was observed: more than 50% of the chronic Q fever patients tested had antibodies which reacted against B. henselae antigen to a significant level. This cross-reaction was confirmed by a cross-adsorption study and protein immunoblotting. However, because the levels of specific antibody titers in cases of Bartonella endocarditis are typically extremely high, low-level cross-reaction between C. burnetii antibodies and B. henselae antigen in cases of Q fever endocarditis should not lead to misdiagnosis, provided serology testing for both agents is performed.

Angiomatosis, Bacillary↗

[A seroprevalence study of Coxiella burnetii in Antalya, Diyarbakir and Samsun provinces].

The aim of this study was to demonstrate the presence of Q fever infection in three selected provinces, located in South Anatolia, Southeast Anatolia and Black Sea regions of Turkey. Specimens of 339 healthy subjects (114 from Antalya, 116 from Diyarbakir, and 109 from Samsun) were randomly selected from serum samples that are stored in National Serum Bank, Refik Saydam National Hygiene Center, and tested for the presence of IgG antibodies against Coxiella burnetii phase II antigen by using indirect immunofluorescent antibody (IFA) test with a commercial kit (Vircell, SL Granada, Spain). IgG antibodies were accepted positive in case of > or = 1:64 titers, and negative in case of < 1:64 titer, according to the test guidelines. IgG seropositivity rates were found 13.2% (n: 15), 6% (n: 7) and 1.8% (n: 2), in Antalya, Diyarbakir and Samsun provinces, respectively, with an overall rate of 7.1% (n: 24). By logistic regression analysis on the positive IgG antibodies, no significant differences were shown in terms of age, gender and residence in all the three selected provinces, but seropositivity rate was significantly higher in Antalya (OR=8.21, %95 GA=1.82-36.96). The study results showed that Q fever exists in Turkey, and it is necessary to take control measures against this disease.

Adolescent↗

[Coxiella burnetii: what is the reality?].

After the Second World War, in Italy Q Fever or Coxiellosis has been shown a significant relevance, a recrudescence with an epidemic state for over ten years. Later, the infectious disease occurred as endemic since the 80s, the outbreaks were just isolated. Workflows analysis of some authors has demonstrated the spread out of the infection throughout Italian herds with a prevalence ranging from 1.2 per cent to 10 per cent. Our survey carried out throughout Campania area in cattle has shown a real positivity over 14 per cent performing the IFAT for the detection of IgG antibodies for Coxiella burnetii. Therefore, it has been so important to stress the influence of cattle farming management in stables as a real risk of Coxiellosis. For example, the Relative Risk (RR) has been registrated about 6.84 (2.18<RR<21.4) in comparison with some herds permanently housed than those kept unhoused and about 8.4 (1.8<RR<38.6) in housed herds and those permanently kept at pasture. Therefore, we have detected a seroprevalence of Q Fever about 11.8 per cent within sheep and about 6.3 per cent within goats. The investigations have focused buffaloes too, tested by several authors, especially from India, but in Italy, only Galiero has recorded significant results: the overall seroprevalence (1.2 per cent) was observed within 1012 buffaloes. Other studies have demonstrated that dogs may transmit Q Fever to humans by infected birth fluids and membranes and by urine. Because of this observation, addressed some of our search projects to assess possible relation among other pathogens, such as Leishmania infantum, Rickettsia conori and Ehrlichia canis. The results have confirmed the presence of C. burnetii (seroprevalence about 7 per cent) within tested dogs in southern Italy. There was no direct estimated relationship between C. burnetii and E. canis and R. conori, instead of significant relation has been shown for L. infantum. The investigation focused on the direct interaction between seropositivity and the age of ruminants. For example, the highest prevalence has been observed in cows and sheep ranging from 3-5 years in which the infection risk was higher than in younger herds. In accordance with the workflows serological analysis, C. burnetii is widespread in Italy among housed ruminants. PCR assay was, therefore performed to test cows with clinical signs of abortion and neonatal mortality. All the survey involved 305 animals (267 foeti and 38 stillborn) with 77 positive herds showing DNA of C. burnetii. To detect C. burnetii pathogen in milk samples, two methods have been combined: the immunomagnetic separation (IMS) and PCR assay, obtaining an increasing of sensitivity (10(-17)) more than only PCR technique (10(-8)). The overall analysis of serological and biomolecular results has demonstrated that C. burnetii is really widespread and may have detrimental effects on farm management system.

Abortion, Veterinary↗

[A case of Coxiella burnetii pneumonia in an adult].

A 49-year-old man visited our hospital complaining of a continuous high-grade fever and cough which had appeared during his stay in Indonesia. He was admitted on the same day because his laboratory data showed marked inflammatory changes and his chest radiograph revealed an infiltrative shadow in the right upper lung field. Initial treatment with beta-lactams was not effective and both his symptoms and his chest radiograph worsened. However, treatment with erythromycin clearly had an effect. Then, we carried out several tests for detection of atypical pathogens including Mycoplasma and Chlamydia. Finally, the case was diagnosed as one of Coxiella burnetii pneumonia because the DNA of C. burnetii was detected from his sera and seroconversion of C. burnetii--specific antibody was observed among paired serum samples. C. burnetii is one of the most commonly recognized pathogens among community-acquired pneumonias in Western countries, but in Japan, reports of community-acquired C. burnetii pneumonia have been rare. This difference may be due to the features of Q fever, in which there are large differences in frequency and form from country to country and among areas of the same country. Surveillance of C. burnetii pneumonia in Japan and different area will be required.

Anti-Bacterial Agents↗

Protective immunity against Q fever induced with a recombinant P1 antigen fused with HspB of Coxiella burnetii.

The gene fragments encoding outer membrane protein 1 (P1) and heat-shock protein B (HspB) amplified from genomic DNA of Coxiella burnetii Xinqiao by PCR were inserted into prokaryotic expression vector pQE30 to construct recombinant expression plasmids pQE30/p1 and pQE30/hspB, respectively. The p1 fragment from pQE30/p1 was ligated with hspB of pQE30/hspB to construct pQE30/p1-hspB. Recombinant proteins, P1, HspB, and P1-HspB, were expressed in Escherichia coli cells transformed with pQE30/p1, pQE30/hspB, and pQE30/p1-hspB, respectively. The purified recombinant proteins and whole-cell antigen (WCA) of C. burnetii were used to immunize BALB/c mice. The antibody detection, T-cell proliferation assay, and cytokine detection demonstrated that the animals immunized with P1-HspB or WCA exhibited stronger humoral and cellular immune responses compared with animals immunized with P1 or HspB individually. Seven days after challenge of 10-fold 50% infection dose of C. burnetii, mice were euthanized and their spleens were collected. The splenic weights of mice immunized with P1-HspB or WCA were significantly lighter than that of mice immunized with P1 or HspB. By real-time PCR assay, the coxiella loads of spleens of mice immunized with P1-HspB or WCA were also significantly lower than that of mice immunized with P1 or HspB. The data from this study indicate that fusion antigen P1-HspB is a good immunogen for eliciting immunoresponses against C. burnetii, and it may be a more suitable candidate for preparing subunit vaccine against Q fever.

Animals↗

[Coxiella burnetii endocarditis. A report of the first case diagnosed in Mexico].

The first case of Q fever endocarditis that has been diagnosed in Mexico is presented. A 10-year-old girl with discrete subaortic stenosis (SAS) and patent ductus arteriosus (PDA) was seen in December of 1996 with fever, hepatomegaly and splenomegaly. She presented also anemia, leukopenia, hypergammaglobulinemia, positive rheumatoid factor, cryoglobulinemia, antinuclear and anticytoplasmic antibodies (anti-RNA-proteins and anti-DNA). An aortic valve vegetation was seen by echocardiogram. Blood-cultures were negative. Antibody test for Coxiella burnetii was positive. Treatment with doxicyclin was initiated as soon the diagnosis was done. PDA was closed, SAS was liberated and two aortic vegetations were resected. Endocarditis in Q fever occurs when there is predisposing heart disease and/or immunodeficiency. Effective therapy has not yet been established. The diagnosis of Q fever endocarditis is difficult; it should be considered, in case of clinical suspicion of endocarditis with negative blood-cultures.

Antibodies, Bacterial↗

Differentiation of Coxiella burnetii isolates by analysis of restriction-endonuclease-digested DNA separated by SDS-PAGE.

Thirty-two isolates of Coxiella burnetii collected from various hosts ranging from arthropods to man were compared by restriction endonuclease (RE) digestion patterns of chromosomal DNA using SDS-PAGE. SDS-PAGE provided better DNA fragment separation than agarose gel electrophoresis and enabled the differentiation of these isolates into six distinct groups on the basis of DNA restriction fingerprints. Two groups of chronic disease isolates could be distinguished, each having unique RE digestion patterns of chromosomal DNA. Three similar but distinct RE digestion patterns were seen among the group of acute disease isolates. Three additional isolates included in this study exhibited a unique RE digestion pattern and also had a unique plasmid type, designated QpDG. DNA-DNA hybridization on selected isolates quantified the relatedness between several groups and supported the classification of these groups as distinct strains.

Animals↗

Experimental double infection with Coxiella burnetii and tick-borne encephalitis virus in Dermacentor reticulatus ticks.

Experimental parenteral inoculation of Dermacentor reticulatus ticks with the rickettsia Coxiella burnetii (C.b.) and tick-borne encephalitis (TBE) virus resulted in a generalized rickettsial and viral infection, irrespective of whether the agents were given simultaneously or by a 7 days interval apart. Both agents multiplied intensively in ticks, C.b. being detectable predominantly in cytoplasmic vacuoles and TBE virus mostly in the endoplasmic reticulum.

Animals↗

Agglutinins to Coxiella burnetii and Brucella spp, with particular reference to Brucella canis, in wild animals of southern Texas.

The prevalence of agglutinins to Coxiella burnetii and Brucella spp, particularly Brucella canis, was determined in 269 wild animals (14 species) in southern Texas. Serologic evidence of coxiellosis and brucellosis, including B canis infection, was shown for coyotes, raccoons, opossums, badgers, jackrabbits, and feral hogs. Using the microagglutination test, the seroprevalence of C burnetii, phases I and II (titer greater than or equal to 4) was 4.1 and 27.9%, respectively. For brucella agglutinins, prevalence rates were 7.1, 8.9, and 6.7%, as determined by the brucellosis card test, the rapid slide agglutination test, and the salt 2-mercaptoethanol tube agglutination (titer greater than or equal to 50) test, respectively.

Agglutinins↗

Suitability of various Coxiella burnetii antigen preparations for detection of serum antibodies by various tests.

Comparison of four serological tests (complement fixation (CF) test, microagglutination (MA) test, microimmunofluorescence (MIF) test, and enzyme-linked immunosorbent assay (ELISA)) for detection of post-infection antibody response in human and animal sera revealed a low sensitivity of the CF test with acute Q fever human, goat and sheep sera but not with chronic Q fever human sera and sera of aborting cows. The remaining three tests gave similar results with human (both acute and chronic) and cow sera, but the ELISA was more sensitive than the MA and MIF tests with goat and sheep sera. A treatment of phase I Coxiella burnetii (C.b.) cells with chloroform-methanol, potassium periodate and trichloroacetic acid (TCA), and mild acidic hydrolysis did not result in increase of the sensitivity of the tests when compared with the natural phase I and phase II C.b. cells, respectively. The suitability of various C.b. antigen preparations for the abovementioned serological tests with various sera is discussed.

Acute Disease↗

Differential effects of cyclophosphamide on Coxiella burnetii infection in mice.

Treatment of mice with a single dose (200 mg/kg body weight) of cyclophosphamide (CPA) 3 days before intraperitoneal (i. p.) administration of Coxiella burnetii did not substantially affect either the yield of C. burnetii from mouse spleen or the splenomegaly induced by the infection. Administration of the same CPA dose 2 days after i. p. infection resulted in an increased yield of C. burnetii from the spleen and in a reduction of the spleen size as compared to CPA-untreated and CPA-pretreated infected mice. The yields of C. burnetii from the blood and peritoneum were similarly affected. The reduction of splenomegaly was accompanied by a marked decrease in the number of spleen lymphocytes especially in white pulp. Agglutinating antibody response to C. burnetii antigens was inhibited regardless whether CPA was given before of after infection. Whereas delayed hypersensitivity reaction to phase I soluble C. burnetii antigen was not influenced significantly by CPA pretreatment, it was markedly inhibited in mice treated with CPA after C. burnetii administration. The results stress the importance of cell-mediated immunity in C. burnetii infection.

Animals↗

Diagnostic evaluation of 2', 5'-oligoadenylate synthetase activities and antibodies against Epstein-Barr virus and Coxiella burnetii in patients with chronic fatigue syndrome in Japan.

To investigate the association of viral infections with chronic fatigue syndrome (CFS), we assayed 2', 5'-oligoadenylate synthetase (2-5AS) activities in peripheral blood mononuclear cells from CFS patients in Japan. These patients were diagnosed in two hospitals, H1 and H2, located in different areas of the country. The activities were detected in 19 (86%) and 7 (32%) of each of the 22 patients in H1 and H2, respectively, while they were detected in only four (11%) out of the 38 healthy controls. IFN-alpha was similarly detected in a few CFS patients and healthy controls. We also assayed the antibody titers against Epstein-Barr virus (EBV) and Coxiella burnetii in these patients. The EBV anti-EA-IgG antibodies were detected in two (9%) and seven (32%) of each of the 22 patients in H1 and H2, respectively. Anti-C. burnetii IgG antibodies were detected in six (27%) out of 22 patients in H1 but not in 22 patients in H2, while they were detected in one (11%) of the nine healthy controls. Some CFS patients may be associated with EBV or C. burnetii infection. There were some statistical correlations between the 2-5AS activities and antibody titers of EA-IgG (P < 0.05, Student's t-test) but not to the antibody titers of C. burnetii. The up-regulation of 2-5AS activities suggests immunological dysfunctions with some virus infections in the CFS patients. Our results indicate that 2-5AS activities are useful for a diagnostic marker of CFS and for exploring the complicated pathogenesis of CFS.

2',5'-Oligoadenylate Synthetase↗