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PubMed1998

Survey of seroprevalence of Q fever in dogs in the southeast of France, French Guyana, Martinique, Senegal and the Ivory Coast.

A serological survey was carried out on 429 dogs belonging to the French military in France, French Guyana, Martinique, Senegal and the Ivory Coast. Serology against phase I and II antigens of Coxiella burnetii, the intracellular zoonotic bacterium was performed using indirect immunofluorescence techniques. Specific antibodies were found in dogs from France (9.8%), Senegal (11.6%), Ivory Coast (8.3%), French Guyana (5.2%) but not in those from Martinique. The seroprevalence among 77 dogs who had contact with sheep compared with 352 dogs who had had no contact, demonstrated a significantly higher seroprevalence in the former. Our results indicate that dogs, living close to sheep, may be infected by Coxiella burnetii and should be considered as possible sources of infection for humans.

Animals↗

PubMed2002

Comparative efficacy and immunogenicity of Q fever chloroform:methanol residue (CMR) and phase I cellular (Q-Vax) vaccines in cynomolgus monkeys challenged by aerosol.

Preliminary evidence gathered in rodents and livestock suggested that a phase I chloroform:methanol residue (CMR) extracted vaccine was safe and efficacious in protecting these animals from challenge with the obligate phagolysosomal pathogen (Coxiella burnetii). Prior to the initiation of phase II studies in human volunteers, we compared, in non-human primates (Macaca fascicularis), the efficacy of CMR vaccine with Q-Vax, a licensed cellular Australian Q fever vaccine that has been demonstrated to provide complete protection in human volunteers. Vaccine efficacy was assessed by evaluating thoracic radiographs and the presence of fever and bacteremia in monkeys challenged by aerosol with Coxiella burnetii. Changes in blood chemistries, hematology, behavior and pulmonary function were also examined. CMR, whether administered in single 30 or 100 microg doses or two 30 microg subcutaneous doses, gave equivalent protection in vaccine recipients as a single 30 microg dose of Q-Vax. In addition, vaccination resulted in significant, although temporary, increases in specific antibody titers against C. burnetii phases I and II antigens. The C. burnetii CMR vaccine may be an efficacious alternative to cellular Q fever vaccines in humans.

Administration, Inhalation↗

PubMed1992

[Q fever antibody titer--follow-up study in cattle with special reference to pregnancy].

In 290 Q fever positive cattle from three 2000 head dairy farms in the former district of Erfurt (Thüringen) the course of titers was examined serologically over several months by means of the complement fixation test (CFT). In 47.2% of the cows serologically observed for 2 up to 28 months complement fixing antibodies against Coxiella burnetii could be demonstrated til the end of the investigation period. Repeated tests during pregnancy showed increase of antibody titers in the first 4 months and after a short decrease again from the 5. til the 7. month. By observing the antibody titers during several pregnancies each time a new increase comparable to a booster immunisation could be found. This may explain the persistence of Q fever antibodies in cows for several years. The results of this investigation suggest that from a high antibody titer it can not be concluded an abortion in a positive cow being caused by a Coxiella burnetii infection.

Animals↗

PubMed1984

[Serological study of the presence of antibodies against Coxiella burnetti and Brucella abortus in veterinarians in the Netherlands].

Two hundred and twenty-two large animal practitioners in the Netherlands were studied serologically for the presence of antibodies to Coxiella burnetii (Q-fever) and Brucella abortus. Eighty-four percent showed antibodies to Coxiella burnetii, which were equally distributed over all age-groups. For blood donors the proportion in men was 31 per cent and 14 per cent in women, also equally distributed over all age-groups. In the case of Brucella abortus, the number of veterinarians showing antibodies in creased with age from 6 to 69 per cent. The conclusion that Q-fever is enzootic in the Netherlands would appear to be justified. This is contrary to the view that was previously accepted.

Adult↗

PubMed2006

Zoonotic infections among veterinarians in Turkey: Crimean-Congo hemorrhagic fever and beyond.

OBJECTIVES: We aimed to determine the seroprevalence of Crimean-Congo hemorrhagic fever (CCHF) virus, Brucella spp, and Coxiella burnetii among veterinarians in a highly endemic and a non-endemic region for these infections in Turkey. METHODS: The antibody levels against these three infections were surveyed. Eighty-three veterinarians were included from two distinct geographic regions. RESULTS: CCHF IgG positivity (3% vs. 0%) and Brucella agglutination titer of > or =1/160 (33% vs. 5%) were more common in the endemic region, whereas the rates of Coxiella burnetii antibodies were similar (7% and 8%). A history of tick bite was significantly more common in the endemic region (35% vs. 12%, p=0.011). A multivariate analysis was performed among the veterinarians living in the endemic area, and percutaneous injuries were found to be associated with Brucella infection (OR 1.8, CI 1.09-3, p=0.022). CONCLUSIONS: Veterinarians should protect themselves against tick bites, and should use masks to prevent transmission by inhalation of zoonotic infections in endemic countries.

Adult↗

PubMed2004

Neurological complications of acute Q fever infection.

Coxiella burnetii the agent of Q fever produces a variety of clinical syndromes. Central nervous system (CNS) involvement is reported to be a rare feature of the disease usually presented as a severe headache and rarely as meningoencephalitis. We retrospectively studied the medical records of 49 patients with clinical signs of CNS involvement. Among 121 patients with acute Q fever infection 49 (40.5%) had some degree of neurological involvement, varying from a severe headache in the majority of the patients (40.5%) to confusion (4.1%) and meningitis (0.8%). The majority of these patients with CNS involvement (91%) had been admitted to the hospital as community acquired pneumonia. The clinical evidence of CNS involvement is not a rare feature of acute Q fever infection and Coxiella burnetii should be considered as a possible etiology of meningitis or meningoencephalitis in endemic areas.

Adolescent↗

PubMed1994

Q fever serology: cutoff determination for microimmunofluorescence.

Q fever, a worldwide zoonosis caused by Coxiella burnetii, lacks clinical specificity and may present as acute or chronic disease. Because of this polymorphism, serological confirmation is necessary to assess the diagnosis. Although microimmunofluorescence is our reference technique, the cutoff titers that are currently used to make a diagnosis of active or chronic Q fever were determined years ago with limited series of patients and sera. We determined the titers of immunoglobulin G (IgG), IgM, and IgA against both phases (I and II) of Coxiella burnetii. Rheumatoid factor was removed before testing IgM and IgA. We report here the various cutoff titers and the kinetics of antibody development from 2,218 first serum samples of patients, among whom 208 suffered from acute Q fever and 53 had chronic Q fever. In active Q fever, we have defined a low cutoff (phase II IgG titer < or = 100) below which the diagnosis cannot be made and would need further confirmation and confirmed a high cutoff (phase II IgG titer > or = 200 and phase II IgM titer > or = 50) over which the diagnosis can be made. For chronic Q fever diagnosis, phase I IgA titers are not contributive despite previous works claiming their usefulness; a phase I IgG titer of > or = 800 is highly predictive (98%) and sensitive (100%). We have also studied the possibility of rejecting or evoking the diagnosis of chronic Q fever by phase II IgG and IgA titers. This method is useful when phase I testing is not available, but the sensitivity remains low (57%).

Acute Disease↗

PubMed1996

Investigation of a Q-fever outbreak in northern Italy.

OBJECTIVES: A study was conducted to evaluate the extent of a Q-fever epidemic through active case finding in the area of Vicenza (north-eastern Italy), and to identify risk factors for Q-fever in this outbreak. METHODS: 1) Descriptive epidemiology; 2) Seroepidemiological survey; 3) Case-control study. 1) Epidemic curve and maps with the location of cases. Identification of the road followed by the flocks of sheep. 2) Cross-sectional study on humans and flocks of sheep tested for anti-Coxiella burnetii antibodies. 3) Cases were defined by the presence of fever > 38 degrees C plus serological confirmation. Controls were 94 apparently healthy individuals attending outpatient facilities for control visits or certification, group-matched by geographical area, age and gender. A standardized questionnaire was administered by trained interviewers. Odds ratio and 95% confidence intervals (CI) were used to evaluate risk factors for Q-fever. RESULTS: A total 58 cases were identified in a 5-month period. Male to female ratio was 2.8:1; mean age was 42 years (range: 20-65 years). Twenty-eight patients (48%) were hospitalized. Fever was accompanied by asthenia (81%), headache (76%), chills (72%), and myalgia and arthralgia (53%); cough was present in 47% of patients. Rx abnormalities were found in 81% of the patients undergoing chest X-ray. Among 111 apparently healthy family members who underwent serological testing, four (3.6%) had antibodies to Coxiella burnetii. Three flocks which passed through the outbreak area between late May and early June were shown to be infected, with prevalence of antibodies ranging between 45 and 53%. The case-control study showed a significant association with exposure to flocks of sheep (Odds ratio = 6.1; 95% CI 2.5, 16.3). Other potential risk factors were not more commonly reported by cases with respect to controls. CONCLUSIONS: Indirect exposure to flocks of sheep was a determinant of this outbreak of Q-fever. This finding suggests that transmission occurred through inhalation of contaminated airborne particles. The importance of control measures should be stressed in areas traversed by flocks of sheep.

Adult↗

PubMed1995

The risk of acquiring Q fever on farms: a seroepidemiological study.

OBJECTIVES: To determine the occupational risk of Q fever. DESIGN: Cohort study. SETTING: Community: five English local authority districts. SUBJECTS AND METHODS: Prevalence and incidence of immunoglobulin G (IgG) specific antibody to Coxiella burnetii phase II antigen was measured in a representative (study) cohort of farm workers in the United Kingdom, and detailed exposure data were collected. Also seroprevalence of Q fever in a (control) cohort of police and emergency service personnel was measured. RESULTS: Prevalence was significantly (P < 0.01) higher in the study cohort (105/385 v 43/395). During the first 12 month period after enrollment no seroconversions were found (upper 95% confidence limit: 1318/100,000/year). During the second 12 month period after enrollment two seroconversions were found, equalling an incidence of 813/100,000/year (95% confidence interval (95% CI) 98-2937/100,000/year). No association was found between seroprevalence and age. In the study cohort, extent of total contact with farm animals seemed more important than exposure to any specific animal: full time employees were more than four times more likely to be antibody positive than part time employees (P < 0.05). Exposure to cattle, but not sheep, goats, cats, raw milk, and hay (all reported sources of Q fever) was associated with being positive to Coxiella burnetii IgG by univariate analysis but this association was not independent of total farm animal contact. CONCLUSIONS: The risk of Q fever on livestock farms is related to contact with the farm environment rather than any specific animal exposure. The absence of an increasing prevalence with age suggests that exposure may occur as clusters in space and time (outbreaks).

Adolescent↗

PubMed2005

Use of shell-vial cell culture assay for isolation of bacteria from clinical specimens: 13 years of experience.

The shell-vial culture assay is performed routinely in our laboratory. Recently we revisited our experience of using the shell-vial culture assay for the isolation of microorganisms from various clinical samples. Over a 13-year period, we have isolated 580 bacterial strains (5%) from 11,083 clinical samples tested. Over the same period, 285 isolates of rickettsiae, bartonellae, or Coxiella burnetii were cultured from a total of 7,102 samples tested. These isolates include 55 Rickettsia sp. isolates, 95 Coxiella burnetii isolates, and 135 Bartonella sp. isolates. Based on our experience with the growth of fastidious microorganisms, we have used a centrifugation shell-vial technique called JNSP, for "je ne sais pas" ("I don't know [what I am growing]") for the isolation of other microorganisms. A total of 173 isolates were cultured from the 3,861 clinical samples tested using the JNSP method. Of these, 40 isolates had not been grown before on usual axenic medium. These include 2 Staphylococcus aureus isolates, 7 isolates of Streptococcus sp. and related genera, 6 Mycobacterium sp. isolates, 1 Nocardia asteroides isolate, 1 Actinomyces sp. isolate, 1 Brucella melitensis isolate, 2 Francisella tularensis isolates, 1 Mycoplasma pneumoniae isolate, and 1 Legionella pneumophila isolate. Using this protocol, we have also cultured intracellular bacteria such as Chlamydia trachomatis and we have performed the first culture and establishment of Trophyrema whipplei. Applied in our laboratory, the shell-vial culture generally exhibits a low rate of success. However, in some cases, this technique allowed microbial diagnosis when classical agar procedure and PCR were negative.

Animals↗

PubMed1982

Q-fever endocarditis in England and Wales, 1975-81.

Endocarditis was recorded in 92 (11%) of 839 confirmed Q-fever infections reported for the Communicable Disease Report by laboratories between 1975 and 1981; Q-fever endocarditis accounted for approximately 3% of all cases of endocarditis reported. Two-thirds of the 92 reports were of men, and in both men and women endocarditis affected mainly young and middle-aged adults. Only one-third of Q-fever endocarditis patients were noted to have an underlying heart-valve lesion. There were also 30 reports of chronic Q-fever infection, and in 10 the primary clinical feature was liver disease. The laboratory data do not support the view that Q-fever endocarditis is a rare compilation of Coxiella burnetii infection, and the condition may be considerably underdiagnosed. Joint veterinary and medical investigations should be undertaken to establish the natural history of Coxiella burnetii infection in the U.K. in order to formulate policies for prevention of acute and chronic infection.

Adult↗

PubMed2003

Rickettsial, ehrlichial and Bartonella infections of the myocardium and pericardium.

Myocarditis and pericarditis are uncommon complications of human rickettsial, ehrlichial and Bartonella infections. Myocardial inflammation usually occurs in the setting of acute disseminated infection. Organisms associated with myocarditis include: Rickettsia rickettsii, R. conorii, Orientia tsutsugamushi, Coxiella burnetii, Anaplasma phagocytophila (the causative agent of Human Granulocytic Ehrlichiosis) and Bartonella henselae. Pericarditis has been described in the setting of R. conorii and Coxiella burnetii infections. This article reviews the epidemiology, pathologic characteristics, clinical manifestations, diagnosis and treatment of myocarditis and pericarditis caused by these organisms.

Animals↗

PubMed1996

Diagnosis of acute respiratory tract infections: serology and new methods.

No test is available that can identify all potential pathogens in acute respiratory tract infections. Each diagnostic test is associated with limitations with respect to sensitivity and/or specificity and/or speed, and thus a combination of tests has to be used. Even so, no etiologic agent is found in 30--60% of cases. The following methods are recommended for use in the routine laboratory for the diagnosis of infections: (1) Legionella --- direct immunofluorescence test, culture, serology and antigen detection (available only in specialized laboratories); (2) Chlamydia pneumoniae --- micro-immunofluorescence test, complement fixation, but not direct antigen detection by immunofluorescence; (3) Mycoplasma pneumoniae - complement fixation and/or particle agglutination or other evaluated methods; (4) Coxiella burnetii --- immunofluorescence test (IgG and IgM) and complement fixation; (5) viruses --- complement fixation or other similar test (ELISAs often lack adequate evaluation). Culture for Chlamydia, Mycoplasma pneumoniae, Coxiella burnetii and viruses should only be performed by very experienced laboratories. Most procedures deliver results only retrospectively or too late. The most promising diagnostic tools for the future are nucleic acid amplification techniques (NAT) or PCR, which could solve many of the problems connected with conventional techniques, but there are enormous contamination problems. Further research and worldwide aid in the development of standardized NAT, especially by industrial companies, is urgently encouraged to improve the laboratory diagnosis of these pneumonias.

Journal Article↗

PubMed2005

[New etiologies responsible for infective endocarditis with negative blood cultures].

The prevalence of infective endocarditis with negative blood cultures varies in the different series from 5 to 25%. There are certain explanations of negative blood culture endocarditis: previous incorrect antibiotic therapy before obtaining blood samples (antibiotic treatment inhibits the growth of germs, and therefore bacteremia, without sterilizing the vegetations); infective endocarditis due to fastidious microorganism, that is of difficult cultivation and identification; infective endocarditis due to cell-dependent organism (e.g. Coxiella burnetii); infective endocarditis due to fungi; non-infectious involvement of the endocardium (at times with vegetations) during the course of certain disease. We underline three etiologies (Coxiella burnetii, Bartonella species and Whipple's disease bacterium) because their study have constituted the stimulus for the introduction into clinical evaluation of patients with suspected infective endocarditis of different diagnostic approaches, based on a correct sequential application of blood cultures, serodiagnosis and molecular microbiology.

Bartonella Infections↗

PubMed2003

Molecular evidence of Coxiella-like microorganism harbored by Haemaphysalis concinnae ticks in the Russian Far East.

Twenty female imago of Haemaphysalis concinnae ticks collected from wild vegetation in May of 2001 in the Obor region near Khabarovsk in the Russian Far East were studied. DNA was extracted with commercially available kits following manufacturer's instructions. We used broad range primers SFG3 and SFG6 proposed for amplification of 16S ribosomal RNA gene's portion of spotted fever group Rickettsia. Initial amplification resulted in positive results in all 20 ticks. Direct sequencing of five randomly chosen amplicons showed that obtained sequences belong to a new species. Closest homology was found in Coxiella burnetii 16S rDNA. Using the obtained sequence as a basis, we designed internal primers highly specific for that sequence. Then we confirmed our results by nested PCR amplification with newly designed primers Cox1 and Cox2-all 20 samples also were positive. Having combined these primers with universal eubacterial primers fD1 and rP2 we retrieved a 1,043 bp portion of the 16S rRNA gene. Consecutive homology search demonstrated that the closest sequence similarity belongs to new Coxiella sp. recently found in Rhipicephalus sanguineus ticks (95.2% of homology) and Coxiella burnetii (94% of homology). So, our results suggest that a novel Coxiella-like microorganism, provisionally called here "Cenerentola," is harbored by Haemaphysalis concinnae ticks in the Russian Far East.

Animals↗

PubMed1986

Q fever pneumonia associated with exposure to wild rabbits.

4 patients with atypical pneumonia and a history of exposure to wild rabbits were found to have antibodies to Coxiella burnetii but not to the other organisms also commonly associated with atypical pneumonia. 10 (45%) of 22 snowshoe hares caught in the area where 1 of the patients snared his rabbits had antibodies to Coxiella burnetii. Q fever ought to be included in the differential diagnosis of pneumonia acquired following exposure to wild rabbits.

Animal Population Groups↗

PubMed1996

[Infectious endocarditis caused by Q fever].

A case of aortic valve endocarditis caused by Coxiella burnetii and operated on with success is reported. The patient is doing well at 18 months follow up. Diagnosis of Q-fever endocarditis was made by high antibodies against phase I Coxiella burnetii antigens titration and by demonstration of aortic valvular vegetations by bidimensional echocardiography. Our patient suffered emergency aortic valve substitution due to acute hemodynamic failure and started a long-term treatment with doxycycline and rifampicin. Some interesting aspects about the diagnosis and treatment of this patient are reviewed because long-term follow-up and serological controls are still rare in the literature.

Anti-Bacterial Agents↗

PubMed1991

The seroprevalence of coxiellosis (Q fever) in Ontario sheep flocks.

A serological survey for Coxiella burnetii was undertaken on a randomly selected population of 103 Ontario sheep flocks. Twenty-two flocks had at least one positive ewe; seven flocks had two or more reactors. The positive flocks were geographically clustered northwest of Guelph. Crutch-clipping of the ewe's wool prior to lambing, and total confinement housing at lambing in winter and spring seemed to lower the probability of seroreactivity of the flock (p less than 0.05). The study suggests that sheep are not a major reservoir for Coxiella burnetii in Ontario.

Analysis of Variance↗