Q fever in France.

In France Q fever is a notifiable disease, but information could only be obtained from fragmental inquiries. Routine serologic examination of 75 901 sera during the years 1982-85 showed 430 Q fever positive sera (mean rate 0.57%). Our laboratory could confirm 135 cases of clinical Q fever. In the region of Dijon, 4.4% of the country population was seropositive, but among breeders 25% were positive. 36 persons (8%) among 245 employees of the departmental veterinary services were seropositive, some with very high titers, but without obvious clinical symptoms. It seems that infection by Coxiella burnetii is still largely underestimated.

Chronic Q fever.

From 1982 to 1986, sera from 36 patients suspected for chronic Q fever were submitted to serologic examination. By serology combined with clinical information, endocarditis was diagnosed in 17 cases, granulomatous hepatitis in 9 cases. 10 cases were dubious. High anti-phase I IgG titers and presence of specific IgM, particularly in cases of liver involvement, were demonstrated by the indirect immunofluorescence test (IFAT). IgA was present in all cases of endocarditis, but not in hepatitis patients. Distinction between subacute and chronic Q fever is difficult. It is advisable that every patient with subacute or chronic Q fever should be examined clinically and serologically for several years.

[Q fever infectious endocarditis. 3 cases]. / L'endocardite infectieuse de la fièvre Q. Trois cas.

An acute infectious disease with predominant pulmonary symptoms, Q fever, may become chronic as hepatitis or, more frequently, endocarditis. We report 3 cases of Q fever endocarditis. In 2 of these patients endocarditis developed on cardiac valve prosthesis. The 3 patients have been under doxycycline for more than a year, and their condition is satisfactory. A review of the literature provides additional data on the epidemiological, aetiological, clinical, biological and therapeutic aspects of this rare type of endocarditis. It is recommended to look for chronic Q fever in all cases of endocarditis with negative blood cultures.

[Present status of rickettsiosis]. / Actualité des rickettsioses.

Actual knowledges of the biology of rickettsia, their pathogenicity and the diagnostic are briefly exposed. The description of sero-epidemic surveys in Bolivia, Botswana, Ethiopia, Greece and France shows that fifty years after the death of Charles Nicolle, rickettsial diseases are still a major health problem in numerous countries.

Immunoenzymatic test for Q-fever.

An immunoenzymatic test using as antigen purified suspensions of Coxiella burnetti coated by methylglyoxal on microtiter plates was developed. Multiple testing of the same sera gave similar results: two dilutions of serum (1:400 and 1:1600) were used in routine tests. Good agreement between the immunoenzymatic and the indirect immunofluorescent antibody tests was obtained for 41 of 50 sera examined. Five sera negative by the immunofluorescent antibody test were positive by the immunoenzymatic test; this result may be due to the higher sensitivity of the latter test. On the other hand, three sera with higher titers by the indirect immunofluorescent antibody test showed a rather feeble positivity by the immunoenzymatic test. This is probably due to the different specificity of the reacting antibodies in the two methods. The indirect immunofluorescent antibody test permits better distinction of the very high titers (greater than 1:5120) than the immunoenzymatic test. The immunoenzymatic test seems to be the method of choice for seroepidemiology surveys of Q-fever; however, its use for clinical serodiagnosis needs further confirmation.

Immunofluorescence serology. A tool for prognosis of Q-fever.

The indirect immunofluorescence antibody test is currently the method of choice for Q-fever laboratory diagnosis. It permits the detection of IgG-, IgM-, and IgA-specific antibodies against the two phases of Coxiella burnetii. Sera from 20 cases of C. burnetii infection have been examined. Only total IgG against phase II were detected in cryptic infections. In acute Q-fever cases, the appearance of total IgG antibodies against phase I was a sign of aggravation, while IgM titers remained low. In subacute cases of Q-fever, anti-phase-I IgG titers were equal to or higher than anti-phase-II titers, and IgM against both phases were produced over a long time. Particularly high IgM titers were found in cases of granulomatous hepatitis. IgA antibodies against phase I were found in cases of Q-fever endocarditis, although the two cases that died had few or no IgA antibodies, despite very high IgG and IgM titers.

Respiratory disease (rhinotracheitis) in turkeys in Brittany, France, 1981-1982. II. Laboratory findings.

After discovering that numerous turkey flocks experiencing rhinotracheitis in Brittany, France, had antibodies against chlamydia, laboratory studies were conducted to determine whether chlamydia and/or viruses would explain the respiratory disease observed. Although both lentogenic paramyxoviruses of type 1 (Newcastle disease virus) and Chlamydia psittaci were isolated, it was concluded, based on epidemiologic and other laboratory findings, that C. psittaci was the primary cause of the disease.

[Current data on rickettsial diseases in Tunisia]. / Données actuelles sur les rickettsioses en Tunisie.

The indirect immunofluorescent technic, recommended by WHO, allows us to consider again, the problem of rickettsial diseases in Tunisia. This pathology, always actual, presents, also in epidemiological as in clinical aspect, a predominance for Mediterranean spotted fever by R. conori. Murin typhus by R. mooseri is still remained, but its incidence seems to be slight. The frequency of Q Fever must to be determined.

[Rickettsioses. A disease of tourism]. / Les rickettsioses. Une morbidité du tourisme.

Clinical diagnosis of rickettsial diseases, which are acute infections of variable severity, cannot be done without knowledge of the epidemiologic background. It must be confirmed subsequently by indirect immunofluorescence, which is the choice serologic test. Among the 225 cases of rickettsial disease confirmed between 1980 and 1982, 118 cases of mediterranean spotted fever were acquired in the south of France during the summer. The other cases of spotted fever and all the cases of murine, louse-borne and scrub typhus occurred in tourists who had recently come back from countries where rickettsial morbidity still persists.

[Results of attempted isolation of Chlamydia trachomatis in 2,000 specimens (author's transl)]. / Résultats de 2,000 essais d'isolement de Chlamydia trachomatis.

Chlamydia trachomatis was isolated in cultured L cell lines. 29.5% of 1115 specimens from the male urethra were positive; specimens included 13 samples of semen, with 7 positive results. 39.9% of 771 specimens from the female genital tract were positive. In this group, 46 samples (with 17 positive results) were either biopsy specimens from the Fallopian tubes or their adhesions, or samples from culdocentesis. The remaining samples came from cervical swabs. The difference in the prevalence of positive results between male and female patients is statistically significant and may result from a better sampling technique in women. Isolation of chlamydia in pelvic specimens and in 19 out of 49 pharyngeal samples from neonates illustrates the main complications of chlamydial infection: sterility may result from salpingitis and neonatal pneumonia from contamination during birth. Among 57 specimens from the conjunctiva, 26 were positive. Isolation of chlamydia is the best diagnostic procedure in chlamydial infection: the serotypes of isolated strains should be determined.

[Newer diagnostic procedures for chlamydial diseases (author's transl)]. / Les nouveaux diagnostics de chlamydioses.

Chlamydiales are bacteries showing a growth cycle unique among procaryotes. The two species Chlamydia trachomatis and Chlamydia psittaci are genetically very distant and their pathogenicity for man is very distinct. Human chlamydia infections by Chlamydia trachomatis are diseases chiefly sexually transmitted and their epidemiological importance is growing. The relationship between chlamydial infections, Reiter disease, and cat scratch disease are discussed. The various laboratory diagnostic procedures are reported, including the techniques and their indications; the method of choice is in the majority of cases the isolation of Chlamydia on cell culture.