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PubMed1993

Q fever in children.

OBJECTIVE: To describe clinical profiles of Q fever in children. DESIGN: Retrospective study. SETTING: Tertiary teaching hospital. PARTICIPANTS: Thirteen children aged 2 to 14 years, with a mean +/- SD age of 9.6 +/- 3.6 years. SELECTION PROCEDURES: Review of the medical records of all children with Q fever admitted from 1986 to 1990. The diagnosis was made by detection of phase II antibodies to Coxiella burnetii by the complement fixation test. MEASUREMENTS/MAIN RESULTS: Clinical profiles consisted of a self-limited illness characterized by high fever (mean +/- SD, 39.9 degrees C +/- 0.66 degrees C) of 5 to 10 days' duration (mean +/- SD, 7.4 +/- 1.6 days), constitutional symptoms, and mild liver dysfunction. Eleven patients had gastrointestinal manifestations (vomiting and/or abdominal pain). Respiratory symptoms were not prominent. Most patients had normal or low white blood cell counts, and seven showed a relative increase of band forms. Their erythrocyte sedimentation rates ranged from 8 to 23 mm/h. All patients did well without specific therapy for C burnetii. CONCLUSION: In children with the symptoms described above, tests to detect antibodies to C burnetii should be performed.

Adolescent↗
PubMed1989

Clinical aspects and prevention of Q fever in animals.

The natural reservoir of Coxiella burnetii encompasses many free-living vertebrates but the major risk of human infection arises through contact with infected ruminant livestock and their contaminated products. The organism has a remarkable affinity for the ruminant placenta and mammary gland but the great majority of naturally-occurring infections are asymptomatic. However, the potential of C. burnetii to cause abortion has been demonstrated experimentally and observed in the field while more recent evidence has implied a contributory role in bovine infertility. Empirical vaccines incorporating inactivated whole cells of C. burnetii or derivatives have induced varying degrees of protection of cattle and sheep against both natural and experimental challenge but, in some cases, severe reactions have occurred at inoculation sites. Modifications in processes of antigen preparation seem to overcome this problem. Discrimination between antibodies resulting from natural infection and those induced by vaccination is possible using ELISAs with specificity for individual immunoglobulin isotypes.

Abortion, Septic↗
PubMed1991

Epidemiology of rickettsial diseases.

Rickettsial diseases have a diversity of epidemiologic characteristics reflective of the variety of ecologic situations in which the obligate intracellular bacteria are transmitted to humans. For the spotted fever group (SFG) rickettsiae, Rickettsia typhi, R. tsutsugamushi, Coxiella burnetii, and the human ehrlichial agent, humans are a dead-end host who plays no role in the maintenance of the organism in nature. All rickettsioses exist as zoonoses. Moreover, all rickettsiae are found in infected arthopods, which generally serve as the natural hosts and can transmit the infection to the next generation of ticks, mites, chiggers, or fleas. From our anthropocentric viewpoint, Q fever aerosol infection from parturient animals and Brill-Zinsser disease ignited epidemics of louse-borne epidemic typhus are exceptions. However, silent cycles of C. burnetii in ticks and R. prowazekii in the flying squirrel flea may have maintained these agents in transovarial or enzootic cycles for eons before humans and their domestic animals arrived on the scene. Thus, the epidemiology of rickettsial diseases must be recognized as an unfortunate aberration of the rickettsial economy. Several excellent reviews of rickettsial ecology contain a wealth of useful information.

Animals↗
PubMed1992

Q fever endocarditis: diagnostic approaches and monitoring of therapeutic effects.

The scope of current diagnostic methods for Q fever endocarditis includes serology, direct demonstration of Coxiella burnetii in the resected heart valve tissue, and animal inoculation studies. Illustrated by a clinical case report, the different methods are presented and discussed. Serology represents the primary method, using the techniques of complement fixation, indirect immunofluorescence, and enzyme-linked immunosorbent assay (ELISA). The latter two techniques allow the detection of immunoglobulins G, M, and A to the phase I and II antigens of C. burnetii. After cardiac surgery, we visualized C. burnetii on smears and specifically stained it on histologic sections of the resected heart valve by light and electron microscopic immunohistochemistry. In addition, seroconversion in animals after inoculation with valve specimens confirmed the presence of C. burnetii in the heart valve. The antibody titers determined by ELISA correlated well with the patient's clinical course during the treatment period. Therefore it is suggested that its usefulness for monitoring the efficacy of antimicrobial agents in patients with Q fever endocarditis should be further evaluated.

Endocarditis, Bacterial↗
PubMed1984

Computed tomographic brain scan findings in Q fever encephalitis.

Neurological involvement in Q Fever is unusual. We present a case of encephalitis due to Coxiella Burnetii with neuroradiologic findings on CT not described previously, consisting in areas of decreased absorption coefficient in the subcortical white matter of both hemispheres, predominantly in the right. Differential diagnosis must be established from viral encephalitis, of similar clinical presentation, which may show similar CT lesions to those in this case.

Cerebral Cortex↗
PubMedDate not supplied

Rapidly fatal Q-fever pneumonia in a patient with chronic granulomatous disease.

Acute Q-fever is a systemic illness which rarely has a fatal outcome. Fatal cases do occur with the chronic form of the disease and associated with endocarditis. This report presents the case of a fatal, acute Q-fever pneumonia in an 11-year-old patient with chronic granulomatous disease. Complement fixation antibody titer rose to 1:1,024 with positive IgM in immunofluorescence. Giemsa stained lung sections and indirect immunofluorescence demonstrated the microorganisms in the tissues. The Coxiella burnetii infection was probably contracted during a holiday trip to rural France. Despite the fact that the patient received a variety of antimicrobial agents with broad spectrum activity against bacteria and fungi, coverage for Q-fever, i.e. chloramphenicol or tetracyclines, was not included.

Anti-Bacterial Agents↗
PubMed1995

The seroprevalence of ten zoonoses in two villages of Crete, Greece.

The seroprevalence and incidence of 10 zoonoses due to Rickettsia typhi, R. conorii, Coxiella burnetii, Burcella sp., Borrelia sp., Toxoplasma sp., Leishmania sp., Entamoeba histolytica, Echinococcus granulosus and Fasciola hepatica were studied in an animal husbandry and a farming village in Crete, Greece. The serum conversion incidence of each infectious agent was determined by testing 2 blood samples, collected in 1985 and in 1987. The surveillance was conducted using detailed transparent maps of the 2 villages studied, on which epidemiological data were interrelated to the results obtained from the serological tests. Thus the importance and spread of each infection were visualized. C. burnetii, Toxoplasma sp., R. conorii, and E. granulosus, were the most common infectious agents encountered during this study.

Adult↗
PubMed1986

Rickettsial perimyocarditis--a follow-up study.

Sera and lymphocytes from a 37-year-old male patient with acute perimyocarditis during a Q-fever endemic were analyzed for antibody and cell-mediated immune reactions and followed up 28 months later. Circulating autoantibodies against myocardial tissue were assessed by indirect immunofluorescence. Cytolysis of vital contracting rat cardiocytes, by antimyolemmal antibodies and complement, and lymphocytotoxicity, with and without the patient's serum, were evaluated and compared with the results obtained in ten patients suffering from Q-fever without perimyocardial involvement and with 40 healthy subjects. Antimyolemmal antibodies (AMLA), a muscle-specific subtype of antisarcolemmal antibodies, were demonstrated by immunofluorescence in the one patient with Q-fever perimyocarditis in titers of up to 1:320 but not in the controls. AMLA induced cytolysis of myocytes in the presence of complement. Both AMLA and cytolytic serum activity could be absorbed in all sera of this patient by using Coxiella burnetii. Only marginal lymphocytotoxicity against heterologous cardiocytes was detected in the early phase and again during the follow-up 2 years later in the Q-fever myocarditis patient but not in any of the noncarditic Q-fever cases nor in controls. It is postulated that cross-reacting, complement-fixing, cytolytic autoantibodies against the cardiac myolemma are operative either as a cause of cardiac damage or a consequence, pointing to a secondary immunopathogenesis of chronic Q-fever perimyocarditis.

Adult↗
PubMedDate not supplied

Azithromycin: single 1.5 g dose in the treatment of patients with atypical pneumonia syndrome--a randomized study.

An open comparative study was undertaken in order to assess the efficacy and safety of a single dose of azithromycin in the treatment of community-acquired atypical pneumonia. A total of 100 adult patients with atypical pneumonia syndrome were randomized to receive 1.5 g of azithromycin as a single dose, or 500 mg once daily for 3 days. The presence of Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia psittaci, Coxiella burnetii, and Legionella pneumophila infection was diagnosed by serological tests. Control clinical examinations were performed 72 h, 10-12 days and 4 weeks after treatment initiation. Among 96 patients (48 in each group) who were evaluable for clinical efficacy M. pneumoniae infection was confirmed in 24, C. pneumoniae in nine, C. psittaci in five, C. burnetii in six, and L. pneumophila in five. Forty-seven patients (97.9%) in each group were cured. Side effects were observed in two patients in the single-dose group, and one patient in the 3-day group. In conclusion, a single 1.5 g dose of azithromycin may be an alternative to the standard 3-day azithromycin regimen in the treatment of outpatients with atypical pneumonia syndrome.

Adult↗
PubMed2006

Ticks (Ixodidae) from passerine birds in the Carpathian region.

Birds have been found to be a reservoir host of borrelia. In order to assess the situation in Slovakia ticks were collected from a total of 3057 mist-netted, ringed and released passerine birds in two locations at 500 m (in 2001) and 1000 m (in 2003) above sea level in the Bukovské Vrchy Hills, part of the Carpathian region in the north-east of Slovakia. A total of 75 birds of 16 species were infested with subadult ticks of Ixodes ricinus species (prevalence of parasitization 5%). Sixty-two larvae from 31 birds of 9 species and 80 nymphs from 52 birds of 15 species were found. The highest intensity of parasitization was observed on blackbirds Turdus merula, song thrushes T. philomelos and dunnocks Prunella modularis. Six Ixodes ricinus adult ticks were found on humans working with birds, and one I. ricinus female tick on their dog. In ticks, the presence of Rickettsia sp., Coxiella burnetii, Borrelia burgdorferi sensu lato and members of the Anaplasmataceae and Piroplasmidae, were investigated by polymerase chain reaction, followed by sequence analysis. Rickettsia sp. was found in 1 nymph from the European robin Erithacus rubecula, in 3 adult ticks (1 male, 2 females) from humans and in the tick from the dog. The closely related Ehrlichia- like species "Schotti variant" was detected in 1 nymph from the song thrush. Borrelia afzelii was identified in 1 male and B. garinii in 1 female tick collected on humans. Ixodes ricinus was found to be the vector of a wide spectrum of tick-borne pathogens in a mountainous area of the Carpathians. Because of the low yield of ticks and pathogens the importance of birds as reservoir hosts is still poorly understood.

Animals↗
PubMed2000

Primary aortoduodenal fistula and Q fever: an underrecognized association?

We report a rare case of primary aortoduodenal fistula (ADF) secondary to a Coxiella burnetii (Q fever) infection in a patient with an abdominal aortic aneurysm. A review of the available literature on the vascular complications of Q fever is presented. Q fever should be suspected in vascular patients with close animal contact when a standard infectious work-up is unrevealing. Diagnostic steps and management strategies for primary ADF are also briefly reviewed.

Aged↗
PubMed1998

Etiology of respiratory tract infection in adults in a general practice setting.

A prospective study was conducted over a 3-month winter period in three general practice clinics in an urban population in southern Israel to identify the etiological agents of respiratory tract infections (RTI) in adults. RTI was defined as an acute febrile illness with cough, coryza, sore throat or hoarseness. Serum samples were taken from all patients in both the acute and convalescent phases of their illness. Tests were conducted for detection of 17 microorganisms known to cause RTI, including serological tests for 16 known pathogens. An etiological diagnosis was established in 80 (66%) of the 122 patients who participated in the study. The distribution of the etiological agents was as follows: influenza B virus in 27 (22%) patients. Chlamydia pneumoniae in 22 (18%), Legionella spp. in 15 (12%), Mycoplasma pneumoniae in 13 (11%), influenza A virus in 11 (9%), Bordetella pertussis in 9 (7%), adenovirus in 4, Epstein Barr virus in 4, Haemophilus influenzae in 3, beta-hemolytic streptococci in 3, Streptococcus pneumoniae in 2, respiratory syncytial virus in 2, parainfluenza 1 virus in 2 and parainfluenza 2 virus in 1. No patients were found to be infected with Coxiella burnetii, Moraxella catarrhalis or parainfluenza 3 virus. More than one pathogen was identified in 27 (34%) patients in whom an etiological diagnosis was established. It is concluded that RTI is caused by a broad spectrum of etiological agents, a considerable number of patients having evidence of infection with more than one pathogen. The therapeutic significance of these findings should be elucidated in further studies.

Adult↗
PubMed1999

Prospective study of community-acquired pneumonia of bacterial etiology in adults.

The aim of this study was to prospectively analyze the bacterial etiology of community-acquired pneumonia in adults in Spain. From May 1994 to February 1996, 392 episodes of CAP diagnosed in the emergency department of a 600-bed university hospital were studied. An etiological diagnosis based on noninvasive microbiological investigations was achieved in 228 cases (58%); 173 of these diagnoses were definitive and 55 probable. Streptococcus pneumoniae, which caused 23.9% of the episodes, was the predominant pathogen observed, followed by Chlamydia pneumoniae (13.5%) and Legionella pneumophila (12.5%). Other less frequent pathogens found were Haemophilus influenzae (2.3%), Pseudomonas aeruginosa (1.5%), Mycoplasma pneumoniae (1.3%), Coxiella burnetii (1%), Moraxella catarrhalis (2 cases), Nocardia spp. (2 cases), and Staphylococcus aureus (2 cases). Streptococcus pneumoniae was significantly more frequent in patients with underlying disease and/or age > or =60 years (28% vs. 13%, P = 0.002), while Legionella pneumophila was more frequent in patients below 60 years of age and without underlying disease (20% vs. 9%, P = 0.006). Likewise, Streptococcus pneumoniae and Legionella pneumophila were the most frequent etiologies in patients requiring admission to the intensive care unit, occurring in 29% and 26.3% of the patients, respectively. In addition to Streptococcus pneumoniae, other microorganisms such as Chlamydia pneumoniae and Legionella spp. should be seriously considered in adults with community-acquired pneumonia when initiating empiric treatment or ordering rapid diagnostic tests.

Adolescent↗
PubMed2007

Rickettsial pathogens in the tropical rat mite Ornithonyssus bacoti (Acari: Macronyssidae) from Egyptian rats (Rattus spp.).

We collected and tested 616 tropical rat mites (Ornithonyssus bacoti (Hirst)) from rats (Rattus norvegicus (Berkenhout) and R. rattus (Linnaeus)) throughout 14 governorates in Egypt and tested DNA extracts from pools of these mites for Bartonella spp., Coxiella burnetii, and Rickettsia spp. by PCR amplification and sequencing. Three different mite-associated bacterial agents, including one Bartonella and two Rickettsia spp., were detected in eight pools of mites. Further research could demonstrate the vector potential of mites and pathogenicity of these agents to humans or animals.

Animals↗
PubMed2005

A pedagogical farm as a source of Q fever in a French city.

Q fever is a worldwide zoonosis caused by Coxiella burnetii and presents as both acute or chronic cases. The disease can be transmitted from animal reservoirs to humans by inhalation of infected aerosols. A previous study had revealed a hyperendemic focus in South France. A case-control study was carried-out in this area from 1996 to 1999. Besides the role of wind, this study stressed out the exposure to a pedagogical farm as an independent risk factor (4.7% of cases - 0 controls): Exposure to sheep and new-born animals (OR: 3.07 and 4.01 respectively) were not significant after omission of people exposed to the pedagogical farm. Such farms are visited by people who would not have any other contact with farm animals. These farms require a drastic hygiene and control. Q fever, as a public health problem, still requires further studies to identify and confirm individual behavioral risk factors.

Adolescent↗
PubMed2004

A prediction model for community-acquired Chlamydia pneumoniae pneumonia in hospitalized patients.

BACKGROUND: The objective of the study was to identify factors that help to predict community-acquired Chlamydia pneumoniae pneumonia in hospitalized patients. PATIENTS AND METHODS: Clinical data of 83 patients with serologically confirmed C. pneumoniae pneumonia were compared with the data obtained from 72 patients with bacterial pneumonia. The criteria of bacterial pneumonia included positive blood and/or sputum cultures and negative serology for Mycoplasma pneumoniae, Chlamydia psittaci, Chlamydia pneumoniae and Coxiella burnetii. The data collected included demographics, chronic diseases, pre- and post-hospitalization course of pneumonia, clinical data on admission and laboratory findings. Descriptive statistical analysis, involving numerous variables, was followed by univariate and multivariate logistic regression analysis. RESULTS: Two different situations, one including demographic data and information on the pre-hospitalization course of pneumonia, and another based on clinical information on admission and on laboratory results, were modeled using multivariate logistic regression. Several variables selected from these two models were incorporated into the third model, and the following four variables were found to have the highest predictive value of C. pneumoniae pneumonia: nursing home residence (odds ratio [OD] 3.73, 95% confidence interval [CI] 1.39-10.06), low c-reactive protein (CRP) levels (OD 5.99, 95% CI 1.82-19.67), nonproductive cough (OD 0.32, 95% CI 0.14-0.73), and a normal urinalysis (OD 0.38, 95% CI 0.17-0.83). CONCLUSION: Our findings seem to allow for a more reliable differentiation between C. pneumoniae pneumonia and other bacterial pneumonias, but further investigations will be needed to validate the proposed model.

Adolescent↗