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A plasmid-encoded surface protein found in chronic-disease isolates of Coxiella burnetti.

The cbbE' gene codes for the E' protein of Coxiella burnetii and was detected in genomic DNA from all known human isolates of the biotzere strain but not in DNA from the other five strains of C. burnetti. The biotzere strain is strictly associated with chronic disease in humans. Extrinsic iodination of biotzere strain cells radiolabeled a 55-kDa protein which comigrated on sodium dodecyl sulfate-polyacrylamide gel electrophoresis with the E' protein synthesized in vitro from recombinants containing the cbbE' gene. The 125I-labeled 55-kDa protein was immunoprecipitated with polyclonal anti-E' antiserum, confirming its identity as E'. Predicted secondary structure of the E' polypeptide shows six regions of beta-sheet structure and an alpha-helix near the C terminus with adequate lengths to span a membrane. The predicted hydropathy profile of E' is similar to profiles of known outer membrane proteins and corroborates the biochemical data, indicating that the protein is located in the outer membrane of C. burnetii.

Amino Acid Sequence↗

Seroepidemiology of Rickettsia typhi, spotted fever group rickettsiae, and Coxiella burnetti infection in pregnant women from urban Tanzania.

Immunofluorescent antibody (IFA) testing was performed on sera drawn from 150 pregnant women in the port city of Dar es Salaam, Tanzania. Prevalence of antibodies to Rickettsia typhi was 28%, higher than in any of the 12 other African countries in which serosurveys using IFA testing have been performed. Seroprevalence of antibodies to spotted fever group rickettsiae antigens was 25.3%, comparable with that found in other sub-Saharan countries endemic for Amblyomma ticks. Only 4.7% of women were seropositive for Coxiella burnetii.

Adolescent↗

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.

Animals↗

Public health problem of zoonoses with emphasis on Q fever.

Zoonoses are animal and human diseases. Q fever is primarily a zoonosis-an animal disease that can be transmitted to humans under certain conditions. Recent epidemiological studies suggest that Q fever should be considered as a public health problem in many countries where it is present, but unrecognizable due to inadequate disease controls. Through specific serological diagnosis of clinically suspected human Q fever cases, we are trying to determine a level of general Coxiella burnetii (C. burnetii) exposition among populations in different regions of Bosnia and Herzegovina. This would be a contribution in controlling the present and the future disease outbreaks, as well as its prevention, which is one of the prime objectives of public health. During the period from January to June 2004, in the Laboratory of the Department for Microbiology in the Medical Faculty of the University of Sarajevo, of 58 tested sera from 48 clinically suspected individuals, we confirmed the presence of specific anti-C. burnetii antibodies in 30 sera (51.7%), from 25 seropositive individuals (52.0%), by means of indirect immunofluorescent antibody (IFA) testing. Urgent steps must be taken in public education to help decrease the risk of C. burnetii infection among at-risk populations in regions of Bosnia and Herzegovina.

Animal Diseases↗

Serological evidence of Rickettsia infections in forestry rangers in north-eastern Italy.

The prevalence of antibodies to Rickettsiae and other tick-borne microrganisms in the sera of 181 forestry rangers from Friuli-Venezia-Giulia, Italy, was examined. Seven (3.9%) sera were positive for Rickettsia conorii and Rickettsia helvetica, as single or dual infections; four of these sera had been found previously to be positive for Borrelia burgdorferi. Antibodies to Coxiella burnetii were detected in five (2.8%) sera, four of which were also positive for B. burgdorferi. These findings indicate that patients in this north-eastern Italian region with fever subsequent to tick-bite should be investigated for Rickettsia and Coxiella infections.

Animals↗

Seroepidemiology of rickettsial infections in Morocco.

The prevalence of antibodies reactive with Rickettsia conorii, Rickettsia typhi, Coxiella burnetii and Ehrlichia chaffeensis was investigated using indirect immunofluorescence (IFA) test on human sera obtained from 300 blood donors in Casablanca and 126 sera obtained from clinical laboratories in Fez. In sera from Casablanca, antibodies reactive at titers > or = 1:32 were found against R. conorii (7%), and R. typhi (1.7%), but not against E. chaffeensis. In the sera from Fez, antibodies were also detected against R. conorii (5.6%), R. typhi (4%), but not against E. chaffeensis. By Western immunoblotting, seroprevalence for R. conorii was in Casablanca and 4.8% in Fez. Antibodies reactive at titers > or = 1:50 against C. burnetii (phase II) were present in sera from Casablanca (1%) and Fez (18.3%).

Adolescent↗

Q fever outbreak in homeless shelter.

Urban outbreaks of Q fever have occurred after exposure to slaughterhouses or parturient cats. We detected an outbreak of Q fever in a homeless shelter in Marseilles. Investigations showed that the main factors exposing persons to Coxiella burnetii were an abandoned slaughterhouse, used for an annual Muslim sheep feast, and wind.

Adolescent↗

Guillain-Barré syndrome associated with acute Q fever.

Several bacterial and viral agents have been implicated in the pathogenesis of the Guillain-Barré syndrome, an acquired immune-mediated disorder. A case of Guillain-Barré syndrome associated with acute Q fever is described. Coxiella burnetii should therefore be added to the list of microorganisms capable of inducing the Guillain-Barré syndrome.

Adult↗

[Q fever in acute exacerbation of chronic lower respiratory tract infection].

We studied the effect of Q fever in acute exacerbation of chronic lower respiratory tract infection. The subjects consisted of 80 cases with acute exacerbation of chronic lower respiratory tract infection treated during the period from March 2002 till October 2004. Q fever was diagnosed using a PanBio Coxiella burnetii ELISA test kit. Two cases (2.5%) were positive for IgM in the acute stage, and were diagnosed as having acute infection by C. burnetii. They were elderly women with bronchiectasis, aged 76 and 82. They had no history of keeping cats or dogs, but the onset of acute exacerbation of chronic lower respiratory tract infection was June and March which is the breeding seasons for cats and dogs. Acute exacerbation of chronic lower respiratory tract infection were considerd to be a mixed infection with Pseudomonas aeruginosa (the 76-year-case) and Haemophilus influenzae (the 82-year-case). It is concluded that C. burnetii can induce exacerbation of chronic lower respiratory tract infection, their cases were considerd to be mixed infection with C. burnetii and other bacteria.

Acute Disease↗

Prevalence of antibodies to rickettsiae in the north-western part of Bosnia and Herzegovina.

The prevalence of rickettsial antibodies in north-western part of Bosnia and Herzegovina was studied. Among 231 sera tested by complement fixation (CF) positive were: 61.5% for Rickettsia typhi, 4.3% for R. prowazekii, 1.7% for R. conorii and 19.0% for Coxiella burnetii. Of 183 sera tested by indirect immunofluorescence assay (IFA) 37.7% reacted with R. typhi, 1.6% with R. conorii and 22.4% with C. burnetii. The results show that at least R. typhi and C. burnetii are highly endemic in this area.

Adolescent↗

An outbreak of sheep-associated Q fever in a rural community in Germany.

In spring 1996, an outbreak of Q fever occurred among residents of a rural town (population: 300) in Germany. A retrospective cohort study was conducted to ascertain the extent of the outbreak and to assess potential risk factors for illness. In July 1996, all residents > or =15 years received a self-administered questionnaire and were offered Coxiella burnetii antibody testing. Residents were considered to have probable Q fever if they had a positive result for IgM C. burnetii antibodies by ELISA or possible Q fever if they had fever > or =39 degrees C lasting >2 days and > or =3 symptoms (chills, sweats, severe headache, cough, aching muscles/joints, back pain, fatigue, or feeling ill) after 1 January 1996. Two hundred (84%) of the 239 residents aged > or =15 years either completed the questionnaire or submitted blood for antibody testing. Forty-five (23%) of these 200 met the probable or possible case definitions. Onsets of illness occurred in January-June 1996. Cases were geographically distributed throughout the town. Persons reporting contact with sheep (32% vs 18%, RR: 1.8, 95% CI: 1.1-2.9) and walking near a large sheep farm located next the town (34% vs 8%, RR: 4.5, 95% CI: 1.7-12.2) were more likely to have met the case definition than those without these exposures. Fifteen of 20 samples from the large sheep flock were positive for C. burnetii antibodies. The sheep had lambed outdoors in December 1995-January 1996 while the weather was extremely dry. The timing of the outbreak after lambing, the uniform distribution of cases throughout the town and the absence of risk factors among most case-persons suggest airborne transmission of C. burnetii from the large sheep farm.

Adolescent↗

Q fever seroprevalence and associated risk factors among students from the Veterinary School of Zaragoza, Spain.

Q fever is a zoonosis related to the existence of Coxiella burnetii infected animals. The authors studied the seroprevalence and risk factors associated to C. burnetii infection in veterinary students in Zaragoza (Spain). Sera were collected at the beginning and the end of the academic year (1994-1995) and were tested by Complement fixation test to detect antibodies against C. burnetii. 10.02 and 11.02% seroprevalences were observed at the beginning and the end of the study respectively. The cumulative incidence through the period of study was 0.0157. Risk factors associated to C. burnetii were multiple: students coursing the speciality in Food Inspection and Technology or the speciality of Animal Production; to practise with living animals in general and particularly with ruminants and to contact frequently with persons who worked with animals, particularly with veterinarians, farmers and animal traders. In parallel, the students coursing the first course showed a significant lower seroprevalence. Male students from the fifth course were significantly more seroprevalent than females, where sex was a protection factor. Concerning the clinical signs asked in the questionnaire, cardiovascular disturbances, flu and/or pneumonia, sweating, transient hyperthermia or spondylitis were associated factors. Conversely, a good response after treatment of symptoms was a protection factor. The only risk factor associated with incidence along the year of study was practising in farms. The authors recommend a revision of hygiene measures to control risk factors and the diagnostic of C. burnetii infection when populations at risk show the associated symptoms.

Adult↗

A microbial strategy to multiply in macrophages: the pregnant pause.

Humans live in harmony with much of the microbial world, thanks to a sophisticated immune system. As the first line of defense, macrophages engulf, digest, and display foreign material, then recruit specialists to eliminate potential threats. Yet infiltrators exist: certain fungi, viruses, parasites, and bacteria thrive within sentinel macrophages. By scrutinizing the life styles of these shrewd microbes, we can deduce how macrophages routinely mount an effective immune response. The bimorphic life cycles of three pathogens have dramatic consequences for phagosome traffic. In the transmissible state, Leishmania spp., Coxiella burnetii, and Legionella pneumophila block phagosome maturation; after a pregnant pause, replicative forms emerge and thrive in lysosomes.

Actins↗

The phagosomal transporter A couples threonine acquisition to differentiation and replication of Legionella pneumophila in macrophages.

Differentiation in response to environmental cues is integral to the success of many intracellular pathogens. By characterizing a Legionella pneumophila mutant defective for differentiation in broth and replication in macrophages, we identified a subfamily of major facilitator superfamily transporters, here named Pht (phagosomal transporter), that also is conserved in two other vacuolar pathogens, Coxiella burnetii and Francisella tularensis. Biolog phenotype microarray analysis indicated that PhtA transports threonine, an essential amino acid. Either excess threonine or threonine peptides bypass phtA function. In minimal medium, phtA mutants do not replicate; in rich broth, the bacteria prematurely differentiate to the transmissive phase, as judged by the kinetics of flaA-gfp expression, heat resistance, and sodium sensitivity. PhtA is dispensable for transmissive L. pneumophila to establish and persist within a replication vacuole but is essential for their differentiation to the replicative phase, based on phenotypic and RT-PCR analysis. Accordingly, we propose that the Pht transporter family equips transmissive L. pneumophila, C. burnetii, and F. tularensis to assess their phagosomal nutrient supply before committing to reenter the cell cycle.

Amino Acid Transport Systems↗

Clinical presentation of acute Q fever in lanzarote (Canary Islands): a 2-year prospective study.

The clinical manifestations of acute Q fever may differ markedly from country to country. In this regard, fever and hepatitis seem to be the dominant clinical features of acute Coxiella burnetii infection in Lanzarote, Canary Islands. A possible interaction between environmental factors and some strains of C. burnetii could explain the different clinical presentations of acute Q fever.

Acute Disease↗

[Bone marrow granulomatosis in Q-fever].

BACKGROUND: Petersdorf and Beeson defined Fever of Unknown Origin (FUO) as an illness characterized by rectal temperature exceeding 38.3 degrees C on at least 3 occasions, evolving during at least 3 weeks, with no diagnosis reached after 1 week of in-patient investigation. A quarter of FUO cases is caused by infectious diseases, most often hidden abscesses, subacute endocarditis and tuberculosis. CASE REPORT: In a 29-year-old patient with undulating fever of 3 months duration solely the demonstration of bone marrow fibrin ring granulomas led to the diagnosis of protracted Q-fever. The diagnosis later has been proved by elevated Coxiella burnetii antibody titers. CONCLUSION: The case report underlines the diagnostic value of bone marrow biopsy in the evaluation of fever of unknown origin.

Adult↗

Pneumonia and carcinoma of the lung.

In a prospective study of 1269 patients with community-acquired pneumonia, 25 (1.97%) were found to have carcinoma of the lung. In 23 cases, the diagnosis was confirmed histologically. For nine of the 23 patients, this episode of pneumonia was the initial manifestation of carcinoma of the lung. The diagnosis of carcinoma was first suggested by the radiologist as the result of a chest radiograph in five of the nine cases. One patient with bronchoalveolar cell carcinoma presented with rapidly progressive diffuse airspace disease. The diagnosis in this case was made by means of open lung biopsy. Two of the 25 patients (8%) had pneumonia caused by Coxiella burnetii, a rate that was 2.4 times higher than that for the other patients with pneumonia. We conclude that pneumonia is uncommonly the presenting manifestation of carcinoma of the lung but is usually evident before the patient leaves hospital. The rate of pneumonia caused by C. burnetii among patients with carcinoma of the lung seems to be higher than that among patients who have pneumonia without carcinoma of the lung.

Adult↗

Acute and chronic Q fever in patients with cancer.

Q fever is caused by Coxiella burnetii, a strictly intracellular bacterium that lives within the phagolysosome of infected cells. We report here five cases of Q fever in patients with cancer. Three of them had a solid tumor, one had a B cell lymphoma, and one had chronic myeloid leukemia. One patient had acute Q fever, and the four others had chronic Q fever endocarditis. Two patients with endocarditis had no previous history of valvulopathy. C. burnetii was isolated from the valves of two patients. One of the patients with endocarditis died. Patients with cancer who have unexplained fever and live in areas in which C. burnetii is endemic should undergo serological testing for infection with this microorganism.

Acute Disease↗