Fiebre Q: revisión histórica de casos humanos en Uruguay. Abordaje desde la complementariedad entre las ciencias médicas y veterinarias / Q fever: historical review of human cases in Uruguay. A complementary approach from the medical and veterinarian sciences / Febre Q: revisão histórica de casos humanos no Uruguai. Abordagem a partir da complementaridade entre as ciências médicas e veterinárias

Resumen: La fiebre Q es una zoonosis distribuida mundialmente, causada por Coxiella burnetii. Los bovinos, ovinos y caprinos son la fuente más frecuente de infección en humanos, en los que la enfermedad es de notificación obligatoria ante el Ministerio de Salud Pública. Revisamos las publicaciones que describen casos de fiebre Q en humanos en Uruguay, con foco en sus características epidemiológicas, y discutimos las pruebas diagnósticas disponibles localmente. Se incluyeron nueve trabajos publicados e información del registro de enfermedades profesionales. Colectivamente fueron analizadas 2.715 personas con sospecha de fiebre Q entre 1956-2019, siendo 959 (35,3%) seropositivas. Los diagnósticos se basaron en serología, clínica y/o antecedentes de exposición laboral. Epidemiológicamente, el ganado o material proveniente del mismo fueron considerados las fuentes más probables de exposición en la mayoría de los casos. Según el ámbito de ocurrencia, no sistemáticamente reportado, los casos se registraron principalmente por exposición a ovinos y bovinos en frigoríficos o en la cadena cárnica (positivos/evaluados: 863/1540; seropositivos sintomáticos: 585); y en menor medida a bovinos lecheros (sector lácteo (positivos/evaluados:20/58; seropositivos sintomáticos: 17) y laboratorio diagnóstico (positivos/evaluados:2/4; seropositivos sintomáticos: 1)), o rumiantes silvestres (seropositivos/evaluados:25/117; seropositivos sintomáticos: 17). Hipertermia, cefaleas y sudoración fueron reportados. La inhalatoria fue asumida como la vía de infección en todos los casos. Actualmente no están disponibles localmente pruebas de PCR para detección de C. burnetii en humanos, siendo una limitante en el diagnóstico, particularmente en etapas tempranas. La colaboración interdisciplinaria de profesionales de salud humana y animal es esencial en el abordaje de esta zoonosis.

Summary: Q fever is a globally distributed zoonosis caused by the bacteria Coxiella burnetii. Bovines, sheep and goats are the most frequent source of infection in humans, and it is mandatory for the latter to report the disease to the Ministry of Public Health. We reviewed the literature describing cases of Q fever in humans in Uruguay, focusing on epidemiological characteristics, and we discussed the diagnostic tests locally available. Nine published studies were included in the review, as well as the information in the professional diseases registry. 2.715 people with a suspicion of Q fever were collectively analyzed between 1956-2019, 959 (55.3%) of them being seropositive. Diagnosis were based on serology, clinical examination and/or a history of exposure while working. Epidemiologically, the cattle or material originating in it were considered as the most probable sources of exposure in most cases. Depending on the context cases arose, which were not systematically reported, they were mainly caused by exposure to sheep and cows in meat processing plants or in the meat chain (positive/evaluated: 863/1540; seropositive or symptomatic: 585); and to a lesser extent dairy cattle (milk sector (positive/evaluated: 20/58; symptomatic seropositive: 17) and diagnostic laboratory (positive/evaluated: 2/4; symptomatic seropositive: 1)) or wild ruminants (positive/evaluated: 25/117; symptomatic seropositive: 17). Hyperthermia, headaches and sweating were reported. In all cases inhalation was adopted as the source of infection. Today, there are no PCR tests to detect C. burnetii in humans available locally, what constitutes a limitation to diagnosis, in particular in early stages. Interdisciplinary collaboration between animal and human health professionals is key to approach this zoonosis.

Resumo: A febre Q é uma zoonose mundial causada por Coxiella burnetii. Bovinos, ovinos e caprinos são a fonte mais frequente de infecção em humanos, nos quais a doença é de notificação compulsória ao Ministério da Saúde Pública. Revisamos as publicações que descrevem casos de febre Q em humanos no Uruguai, enfocando em suas características epidemiológicas, e discutimos os testes diagnósticos disponíveis localmente. Foram incluídos nove trabalhos publicados e informações do registro de doenças ocupacionais. Foram analisadas 2.715 pessoas com suspeita de febre Q entre 1956-2019, das quais 959 (35,3%) eram soropositivas. Os diagnósticos foram baseados na sorologia, sintomas e/ou história de exposição ocupacional. Do ponto de vista epidemiológico, o gado ou material preveniente de gado foram considerados as fontes mais prováveis de exposição na maioria dos casos. De acordo com o lugar de ocorrência, não notificado sistematicamente, os casos foram registrados principalmente por exposição a ovinos e bovinos em matadouros ou na cadeia da carne (positivos/avaliados: 863/1540; soropositivos sintomáticos: 585); e em menor proporção gado leiteiro (setor leiteiro (positivo/avaliado: 20/58; soropositivo sintomático: 17) e laboratório de diagnóstico (positivo/avaliado: 2/4; soropositivo sintomático: 1)), ou ruminantes silvestres (soropositivo/avaliado: 25/117; soropositivos sintomáticos: 17). Hipertermia, dores de cabeça e sudorese foram relatados. A inalação foi assumida como via de infecção em todos os casos. Atualmente, os testes de PCR para detecção de C. burnetii em humanos não estão disponíveis localmente, sendo uma limitação no diagnóstico, principalmente em estágios iniciais. A colaboração interdisciplinar de profissionais de saúde humana e animal é essencial no enfrentamento dessa zoonose.

First molecular detection of Coxiella burnetii in Brazilian artisanal cheese: a neglected food safety hazard in ready-to-eat raw-milk product

ABSTRACT Background: Global publications on Q fever have increased after the 2007 epidemic in the Netherlands. However, the epidemiology of Q fever/coxiellosis in Brazil is still poorly understood. Accordingly, there have been few studies investigating the presence of Coxiella burnetii in dairy products around the world, especially in Brazil, where consumption of fresh cheese made from raw-milk is very high. Objective: This study was a random survey to assess the prevalence of C. burnetii by PCR in traditional Minas artisanal cheese from the Serro microregion, Brazil, which is manufactured from bovine raw-milk. Methods: DNA extracted from 53 cheese samples were analyzed by nested PCR with C. burnetii-specific primers and the products confirmed by DNA sequencing. Results: Out of the 53 cheese samples five (9.43%) were C. burnetii DNA-positive, each coming from one of the respective randomly selected manufacturing agroindustries.Based on our results, it is estimated that 1.62 tons/day of ready-to-eat cheese made from raw-milk from a total of 16.2 tons produced daily in the study region are contaminated with C. burnetii. Conclusion: To our knowledge, this is the first report of highly heat-resistant zoonotic pathogen in raw-milk Brazilian artisanal cheese. This food safety hazard has been completely neglected in ready-to-eat raw-milk Brazilian artisanal cheese and could imply potential threats to consumers, since C. burnetii survives in artisanal cheese submitted to long ripening periods. Thus, this work established random and representative baseline prevalence of C. burnetii in this food product in Brazil. Further epidemiological studies, monitoring trends and setting control targets are warranted. Finally, these results point out the importance of including C. burnetii in animal and public health surveillance programs.

Causes of abortion in dairy cows in Uruguay / Causas de aborto em bovinos de leite no Uruguai

A case series study was conducted to determine the frequency of causes of abortion in dairy cattle in Uruguay. The sample size of 102 cases was composed of 53 fetuses, 35 fetuses with placentas, and 14 placentas without an associated fetus. All cases underwent gross and microscopic pathologic examinations as well as microbiological and serological testing. The etiology was determined in 54 (53%) of cases, 51 of which were caused by infectious agents. Within the observed 102 cases, 30 (29%) were caused by Neospora caninum, six (6%) by Coxiella burnetii and two (2%) by Campylobacter fetus subsp. venerealis. Bovine Parainfluenza-3 virus and Salmonella enterica serovar Newport caused one abortion each. Opportunistic bacteria (Escherichia coli, Streptococcus sp., Staphylococcus sp., Mannheimia sp., Trueperella pyogenes, and Providencia stuartii) were associated with 11 abortions. In two cases the fetal death was attributed to dystocia, and in one case the fetus had a congenital mesothelioma. Bovine viral diarrhea virus (BVDV) infection was identified in three fetuses; two of which were co-infected with and had typical lesions of N. caninum. No lesions were observed in the other fetus infected by BVDV. Leptospira interrogans was identified in one fetus without lesions. Despite the relatively low overall success rate in establishing an etiological diagnosis in cases of abortion in cattle, a systemic workup of bovine abortion is necessary to establish prevention and control strategies. This also facilitates monitoring and surveillance of reproductive diseases in dairy cattle, some of which represent a risk to public health.(AU)

Uma série de casos foi estudada para determinar a frequência de causas do aborto em bovinos leiteiros no Uruguai. A amostra, de 102 casos, foi composta por 53 fetos, 35 fetos com placentas e 14 placentas sem feto associado. Todos os casos foram submetidos a exames patológicos macroscópicos e microscópicos, além de testes microbiológicos e sorológicos. A etiologia foi determinada em 54 (53%) dos casos, 51 dos quais foram causados por agentes infecciosos. Nos 102 casos observados, 30 (29%) foram causados por Neospora caninum, seis (6%) por Coxiella burnetii e dois (2%) por Campylobacter fetus subsp. venerealis. O vírus da Parainfluenza-3 e Salmonella enterica serovar Newport causaram um aborto cada. Bactérias oportunistas (Escherichia coli, Streptococcus sp., Staphylococcus sp., Mannheimia sp., Trueperella pyogenes e Providencia stuartii) foram associadas a 11 abortos. Em dois casos, a morte fetal foi atribuída a distocia e, em um caso, o feto apresentava mesotelioma congênito. A infecção pelo vírus da diarreia viral bovina (BVDV) foi identificada em três fetos; dois dos quais foram co-infectados e apresentavam lesões típicas de N. caninum. Não foram observadas lesões no outro feto infectado pelo BVDV. Leptospira interrogans foi identificada em um feto sem lesões. Apesar da relativamente baixa taxa de sucesso no diagnóstico etiológico nos casos de aborto em bovinos, é necessário o diagnóstico sistemático dos abortos para estabelecer estratégias de prevenção e controle. Isso também facilita o monitoramento e a vigilância de doenças reprodutivas em bovinos leiteiros, algumas das quais representam um risco para a saúde pública.(AU)

Coxiella burnetii associated with BVDV (Bovine Viral Diarrhea Virus), BoHV (Bovine Herpesvirus), Leptospira spp, Neospora caninum, Toxoplasma gondii and Trypanosoma vivax in reproductive disorders in cattle / Coxiella burnetii associada ao BVDV (Vírus da Diarreia Viral Bovina), BoHV (Vírus do Herpes Bovino), Leptospira spp, Neospora caninum, Toxoplasma gondii e Trypanosoma vivax em distúrbios reprodutivos em bovinos

Abstract This is a cross-sectional study to assess the presence of antibodies in ruminants against selected pathogens associated with reproductive disorders in cattle in four Brazilian states, including the zoonotic agent Coxiella burnetii. The used tests were Virus Neutralization Assay for IBR and BVD, Microscopic Agglutination Test for Leptospira spp., Indirect Fluorescent Antibody Test (IFAT) for C. burnetii and Toxoplasma gondii, and Enzyme-Linked Immunosorbent Assay for Neospora caninum and Trypanosoma vivax. Seropositivity for C. burnetii was 13.7% with titers from 128 to 131,072; 57.8% for BoHV-1, with titers between 2 and 1,024; 47.1% for BVDV-1a, with titers from 10 to 5,120; 89.2% for N. caninum; 50% for T. vivax; and 52.0% for Leptospira spp., with titers between 100 to 800 (the following serovars were found: Tarassovi, Grippotyphosa, Canicola, Copenhageni, Wolffi, Hardjo, Pomona and Icterohaemorrhagiae); 19.6% for T. gondii with titer of 40. This is the first study that has identified C. burnetii in cattle associated with BoHV and BVDV, N. caninum, Leptospira spp., T. gondii and T. vivax. Thus, future studies should be conducted to investigate how widespread this pathogen is in Brazilian cattle herds.

Resumo Este é um estudo transversal para avaliar a presença de anticorpos em ruminantes contra patógenos selecionados e associados a distúrbios reprodutivos em bovinos de quatro estados brasileiros, incluindo o agente zoonótico Coxiella burnetii. Os testes utilizados foram Teste de Vírus-Neutralização para BoHV e BVDV, teste de Aglutinação Microscópica para Leptospira spp., Reação de Imunofluorescência Indireta for C. burnetii e Toxoplasma gondii, e Ensaio de Imunoabsorção Enzimática para Neospora caninum e Trypanosoma vivax. A soropositividade para C. burnetii foi de 13,7% com títulos de 128 a 131.072; 57,8% para BoHV-1, com títulos entre 2 a 1.024; 47,1% para BVDV-1a, com títulos de 10 a 5.120; 89,2% para N. caninum; 50% para T. vivax; e 52,0% para Leptospira spp., com títulos entre 100 a 800 (sorovares encontrados: Tarassovi, Grippotyphosa, Canicola, Copenhageni, Wolffi, Hardjo, Pomona e Icterohaemorrhagiae) 19,6% para T. gondii com título de 40. Este é o primeiro estudo que evidencia a participação de C. burnetii em bovinos associada ao Vírus da Rinotraqueíte bovina infecciosa e da diarreia viral bovina, N. caninum, Leptospira spp., T. gondii e T. vivax em bovinos. Desta forma, futuros estudos devem ser conduzidos a fim de investigar o quão disseminado se encontra este patógeno em rebanhos bovinos brasileiros.

“Hairiness” is a Facsimile of Reorganized Cytoskeletons: A Cytopathic Effect of Coxiella burnetii

In 1993, I reported that Coxiella burnetii transforms human B cells into hairy cells (cbHCs), the first hairy cell reported outside of hairy cell leukemia (HCL). Over last few decades, advances in molecular biology have provided evidence supporting that C. burnetii induces hairiness and inhibits the apoptosis of host cells. The present review summarizes new information in support of cbHC. C. burnetii was shown to induce reorganization of the cytoskeleton and to inhibit apoptosis in host cells. Peritoneal B1a cells were found to be permissive for virulent C. burnetii Nine Mile phase I (NMI) strains in mice. C. burnetii severely impaired E-cad expression in circulating cells of Q fever patients. B-cell non-Hodgkin lymphoma was linked to C. burnetii. Mutation of BRAF V600E was pronounced in HCL, but “hairiness” was not linked to the mutation. Risk factors shared among coxiellosis and HCL in humans and animals were reported in patients with Q-fever. Accordingly, I propose that C. burnetii induces reorganization of the cytoskeleton and inhibits apoptosis as cytopathic effects that are not target cell specific. The observed hairiness in cbHC appears to be a fixed image of dynamic nature, and hairy cells in HCL are distinct among lymphoid cells in circulation. As the cytoskeleton plays key roles in maintaining cell structural integrity in health and disease, the pathophysiology of similar cytopathic effects should be addressed in other diseases, such as myopathies, B-cell dyscrasias, and autoimmune syndromes.

Genotyping of Coxiella burnetii strains detected in cattle from a nationwide survey in Korea

A total of 123 Coxiella burnetii strains detected in cattle from a nationwide survey in Korea were classified into five genomic groups: I (0.8%), II (14.6%), III (12.2%), IV (66.7%), and V (5.7%). Acute Q-fever strains (Groups I, II, and III) comprised 27.6% and chronic strains (Groups IV and V) comprised 72.4%. At a dairy farm where both types were present, the detection rate was 6.7-times higher than that of another farm where only chronic strains were detected. Both acute and chronic Q-fever strains are widespread in Korea, and their presence could represent an active transmission to livestock and humans.

Molecular Detection of Coxiella burnetii in Cattle on Ulleung Island, Korea: A Population-based Study with Four Years of Follow Up

In a population-based study with 4 years of follow up, we evaluated the prevalence of Coxiella burnetii in cattle on Ulleung Island, Korea. In this study, the rates of C. burnetii infection in cattle on Ulleung Island were determined by PCR and were found to be 0.3–1.0% in the period 2011–2014. All 17 C. burnetii partial 16S rRNA gene sequences from PCR-positive cattle were identical and 2 geographic representatives were included in our analysis. The nucleotide sequences of the 2 samples showed high (98.4–100%) identity with C. burnetii sequences obtained from the GenBank. In this long-term tracking study, the number of cattle positive for C. burnetii on Ulleung Island was low. To prevent the transmission of C. burnetii on Ulleung Island, control strategy should include biosecurity improvement in surveillance, livestock management, administering suitable tests before purchasing animals to detect C. burnetii shedders, and restricting movements between herds.

Coxiella burnetii e a febre Q no Brasil, uma questão de saúde pública / Coxiella burnetii and Q fever in Brazil: a public health issue

Resumo A Febre Q é uma zoonose de ampla distribuição mundial, apesar dos poucos relatos associados a sua ocorrência no Brasil. "Coxiella burnetii", agente etiológico da Febre Q, é um cocobacilo gram-negativo, parasita intracelular obrigatório da ordem Legionellales. O microrganismo geralmente está presente na urina e fezes de animais infectados, podendo ser encontrado em grande quantidade nos restos placentários de animais nascidos a termo ou produtos de aborto. A inalação de células bacterianas suspensas no ar ou aerossóis contaminados é a forma mais comum de entrar em contato com a bactéria. A febre Q é uma doença autolimitada e, geralmente, evolui de forma benigna. Nos casos onde a doença evolui de forma crônica, a endocardite é a manifestação mais frequente. O diagnóstico clínico é difícil, visto que os sintomas assemelham-se a várias outras doenças. Nos casos confirmados a antibioticoterapia é o tratamento indicado. Diante da sintomatologia pouco específica e dificuldade de diagnóstico, acredita-se que no Brasil a doença seja mais comum do que se pensa.

Abstract Q fever is a zoonosis that is broadly distributed worldwide, despite few reports associated with its occurrence in Brazil. Coxiella burnetii, namely the causative agent of Q fever is a gram-negative coccobacillus and an obligate intracellular bacterial parasite of the order of Legionellales. The microorganism is generally present in the urine and feces of infected animals and can be found in large quantities in placental membranes of at-term or aborted animals. The inhalation of particles suspended in the air or contaminated aerosols is the most common form of bacterial contact. Q Fever is a self-limited disease, and often progresses in a benign way. In cases where the disease progresses to the chronic form, endocarditis is the most prevalent manifestation. Clinical diagnosis is difficult since the symptoms are similar to many other diseases. In confirmed cases, antibiotic therapy is the treatment indicated. Given the lack of knowledge about the disease and the difficulty of diagnosis, it is believed that Q fever is more common than generally believed in Brazil.

Serological diagnosis and risk factors for Coxiella burnetii in goats and sheep in a semi-arid region of Northeastern Brazil / Diagnóstico sorológico e fatores de risco para Coxiella burnetii em caprinos e ovinos da região semiárida do nordeste do Brasil

Abstract Coxiella burnetii is a zoonotic agent transmitted mainly by small ruminants. In Brazil the disease has been classified as a notifiable disease since 2013, when human cases were reported. This study aimed to identify risk factors associated with the presence of anti- Coxiella burnetii antibodies in goats and sheep in a semiarid region of Northeastern Brazil. Sera of 412 goats and 403 sheep from municipality of Petrolina, Pernambuco, were examined by the Indirect Fluorescent Antibody Test (IFAT) against antigens of C. burnetii. Information about management variables (independent variables) that could be associated with the presence of the microorganism (dependent variables) were obtained from the supervisor of each farm. It was determined that 2.2% (9/412) of the goats and 2.1% (9/403) of the sheep had antibodies reactive to C. burnetii. The presence of anti-C. burnetii antibodies was associated with the dry area of the Sequeiro (a region in the northern part of the municipality of Petrolina) (P = 0.025), male sheep (P = 0.020), and intensive goat breeding (P = 0.005). This study therefore showed the presence of anti-C. burnetii antibodies in goat and sheep, confirming for the first time that this agent is likely circulating among goat herds in the Caatinga Biome, semi-arid of Brazil.

Resumo Coxiella burnetii é um agente zoonótico transmitido principalmente por pequenos ruminantes. No Brasil, a doença foi classificada como de notificação compulsória desde 2013, quando casos humanos foram relatados. O objetivo deste estudo foi identificar os fatores de risco associados à presença de anticorpos anti-Coxiella burnetii em caprinos e ovinos em uma região semiárida do Nordeste do Brasil. Este estudo envolveu um inquérito sorológico de 412 caprinos e 403 ovinos em fazendas do município de Petrolina, no estado de Pernambuco. Os soros foram examinados pela Reação de Imunofluorescência Indireta (RIFI) contra antígenos de C. burnetii . Informações sobre variáveis ​​de manejo (variáveis ​​independentes) que poderiam estar associadas à presença do microrganismo (variáveis ​​dependentes) foram obtidas do proprietário de cada fazenda. Foi determinado que 2,2% (9/412) dos caprinos e 2,1% (9/403) dos ovinos tinham anticorpos reativos a C. burnetii. A presença de anticorpos anti-C. burnetii foram associados com a área seca do Sequeiro (região no norte do município de Petrolina) (P = 0,025), ovinos machos (P = 0,020) e criação intensiva de caprinos (P = 0,005). Este estudo, portanto, observou a presença de anticorpos anti-C. burnetii em pequenos ruminantes, confirmando pela primeira vez que este agente pode estar circulando em rebanhos caprinos no bioma Caatinga, semiárido do Brasil.

Coxiella burnetii infection in sheep and goats: a public risk health, Colombia / Infección por Coxiella burnetii en ovinos y caprinos: un riesgo en salud publica en Colombia

Objective. The aim of this study was to provide molecular evidence of C. burnetii in sheep and goats from some herds of Valledupar, Cesar, Colombia. Materials and methods. Fifteen herds of sheep and goats were chosen by convenience to investigate the infection by C. burnetii, during March and April of 2013. 328 female goats and 66 sheep from 15 herds were included in this study. Milk from ewes and vaginal mucus samples from goats were analyzed by Polymerase Chain Reaction for DNA detection of transposase gene (IS1111) of C. burnetii. Results. DNA of C. burnetii in 6% (4/66) of sheep's milk and 0.6% (2/328) vaginal mucus from goats was found. 13% (2/15) of the herds had at least one infected animal. Discussion. Our findings suggest the circulation of C. burnetii in sheep and goats from some herds of Valledupar, Colombia, and it highlights the possibility of occurrence of infections in humans and animals. Conclusions. The detection of C. burnetii in sheep milk could represent a public health risk factor for people who consuming raw milk, cheeses or people associated to agriculture and livestock handling. Further studies are necessary to evaluate other routes such as tick's bite, feces, milk from goats and vaginal mucus from sheep of this region of Colombia.

Objetivo. El objetivo de este estudio fue proporcionar evidencia molecular de infección por C. burnetii en ovinos y caprinos de algunos rebaños de Valledupar, Cesar, Colombia. Materiales y métodos. Quince rebaños de ovinos y caprinos fueron seleccionados a conveniencia para investigar la infección por C. burnetii, durante marzo y abril de 2013. En este estudio se incluyeron 328 caprinos y 66 ovinos de 15 rebaños. La leche procedente de ovinos y muestras de moco vaginal de caprinos fueron analizados mediante PCR (Reacción en Cadena de Polimerasa) para la detección de ADN del gen transposasa (IS1111) de C. burnetii. Resultados. Se encontró ADN de C. burnetii en 6% (4/66) de leche de oveja y 0,6% (2/328) de moco vaginal de cabras. El 13% (2/15) de los rebaños tenían al menos un animal infectado. Discusión. Nuestros hallazgos sugieren la circulación de C. burnetii en ovinos y caprinos de algunos rebaños de Valledupar, Colombia, y destaca la posibilidad de ocurrencia de infecciones en humanos y animales. Conclusiones. La detección de C. burnetii en la leche de oveja podría representar un factor de riesgo para la salud pública de las personas que consumen con frecuencia leche cruda, quesos o personas que trabajan en la agricultura y manipulación de ganado. Otros estudios son necesarios para evaluar otras rutas como la mordedura de la garrapata, las heces, la leche de las cabras y el moco vaginal de las ovejas de esta región de Colombia.

Serological evidence of exposure to some zoonotic microorganisms in cattle and humans with occupational exposure to livestock in Antioquia, Colombia / Evidencia serológica de exposición a algunos microorganismos zoonóticos en bovinos y humanos con exposición ocupacional a ganadería en Antioquia, Colombia / Evidências sorológicas de exposição a alguns microrganismos zoonóticos em bovinos e em humanos com exposição ocupacional ao gado na Antióquia, Colômbia

Bacteria belonging to Anaplasma, Ehrlichia, Rickettsia and Coxiella genera are considered emerging pathogens and livestock is one of the contexts where the transmission of these microorganisms can occur. The goal of this study was to determine serological evidence for the exposure to these bacteria in cattle and humans with occupational exposure to livestock in the subregions North and Magdalena Medio, Antioquia, Colombia, and to explore related factors. A cross-sectional study was conducted in 48 livestock farms distributed in six municipalities from both subregions: Belmira, Entrerríos and San Pedro de los Milagros (North), and Puerto Berrío, Puerto Nare and Puerto Triunfo (Magdalena Medio). Blood samples from 332 people and 384 bovines were evaluated by serology (IgM and IgG) screening for bacteria from the Anaplasma, Ehrlichia, Rickettsia, and Coxiella genera. Seropositivity in humans from both regions was 42.4% (95%CI: 31.2-55.1) for Anaplasma, 74.2% (95%CI: 66.0-84.4) for Ehrlichia, 72.5% (95%CI: 62.1-82.0) for Rickettsia, and 60.7% (95%CI: 59.7-69.1) for Coxiella burnetii. In cattle, seropositivity was 31.6% (95%CI: 19.9-44.2), 66.8% (95%CI: 55.2-78.1), 64.6% (95%CI: 53.8-74.5), and 61.6% (95%CI: 51.9-69.2), respectively. History of biting by ticks, milking, vaccination, having dogs and hens in the residence, as well as the consumption of raw milk derivatives were some factors associated with the infection by the bacteria studied. The results suggest a previous and recent exposure to these zoonotic bacteria genera in people with occupational exposure to livestock, as well as in cattle in the two studied subregions.

Las bacterias pertenecientes a los géneros Anaplasma, Ehrlichia, Rickettsia y Coxiella son consideradas patógenos emergentes y la ganadería es uno de los contextos donde se puede producir la transmisión de este tipo de microorganismos. El objetivo de este estudio fue determinar la evidencia serológica, debida a la exposición a estas bacterias en bovinos y humanos con exposición ocupacional a ganadería en las subregiones Norte y Magdalena Medio, Antioquia, Colombia, además de estudiar los factores relacionados. Se realizó un estudio transversal en 48 fincas ganaderas, distribuidas en seis municipios de ambas subregiones: Belmira, Entrerríos y San Pedro de los Milagros (Norte), y Puerto Berrío, Puerto Nare y Puerto Triunfo (Magdalena Medio). Las muestras de sangre de 332 personas y 384 bovinos fueron evaluadas mediante tamización serológica (IgM e IgG) para la detección de bacterias de los géneros Anaplasma, Ehrlichia, Rickettsia, y Coxiella. La seropositividad en humanos de ambas regiones fue 42,4% (IC95%: 31,2-55,1) en el caso de Anaplasma, un 74,2% (IC95%: 66,0-84,4) en Ehrlichia, un 72,5% (IC95%: 62,1-82,0) en Rickettsia, y un 60,7% (IC95%: 59,7-69,1) en Coxiella burnetii. En los bovinos, la seropositividad fue 31,6% (IC95%: 19,9-44,2), 66,8% (IC95%: 55,2-78,1), 64,6% (IC95%: 53,8-74,5), y 61,6% (IC95%: 51,9-69,2), respectivamente. El antecedente de haber sido mordido por garrapatas, ordeñar, vacunación, tener perros y gallinas en la residencia, así como el consumo de derivados de leche cruda fueron algunos de los factores asociados con la infección por las bacterias estudiadas. Los resultados sugieren la exposición previa y reciente a estas bacterias en personas con una exposición ocupacional a la ganadería, así como a los bovinos en las dos subregiones estudiadas.

As bactérias dos gêneros Anaplasma, Ehrlichia, Rickettsia e Coxiella são considerados patógenos emergentes, e a transmissão desses microrganismos pode ocorrer no contexto da pecuária. O estudo teve como objetivos determinar as evidências sorológicas de exposição a essas bactérias em bovinos e em humanos com exposição ocupacional ao gado nas sub-regiões Norte e Magdalena Médio, Antióquia, Colômbia, e explorar fatores associados. Foi realizado um estudo transversal em 48 fazendas de gado bovino distribuídas em seis municípios nas duas sub-regiões: Belmira, Entrerríos e San Pedro de los Milagros (Norte) e Puerto Berrío, Puerto Nare e Puerto Triunfo (Magdalena Médio). Amostras de sangue de 332 humanos e 384 bovinos foram analisadas com sorologia (IgM e IgG) para bactérias dos gêneros Anaplasma, Ehrlichia, Rickettsia e Coxiella. Os níveis de sorologia positiva em humanos das duas regiões foram de 42,4% (IC95%: 31,2-55,1) para Anaplasma, 74,2% (IC95%: 66,0-84,4) para Ehrlichia, 72,5% (IC95%: 62,1-82,0) para Rickettsia e 60,7% (IC95%: 59,7-69,1) para Coxiella burnetii. Nos bovinos, os níveis foram 31,6% (IC95%: 19,9-44,2), 66,8% (IC95%: 55,2-78,1), 64,6% (IC95%: 53,8-74,5) e 61,6% (IC95%: 51,9-69,2), respectivamente. Os fatores associados às bactérias estudadas foram: história de picada de carrapato, ordenha, vacinação, presença de cães e galinhas no domicílio e consumo de laticínios feitos com leite cru, entre outros. Os resultados sugerem exposição prévia e recente a esses gêneros bacterianos zoonóticos em pessoas com contato ocupacional com gado, assim como nos próprios animais, nas duas sub-regiões estudadas.

Resumen de evidencia para políticas: estrategias para el control de la fiebre Q / Evidence briefs for policy: Q fever control strategies

ANTECEDENTES Y OBJETIVO El 15 de julio de 2017 aparece el primer caso de un brote con características de evento inusitado en un trabajador de una lechería en la provincia de Osorno, región de Los Lagos, Chile. A fines del mes de octubre ya se habían notificado 56 casos y se logra obtener las primeras confirmaciones de serología positiva para fiebre Q. El 2 de noviembre se declara alerta sanitaria por enfermedad zoonótica. En consecuencia, el Ministerio de Salud de Chile solicita este resumen de políticas basado en evidencia, con el objetivo de estudiar estrategias terapéuticas para el control de la fiebre Q, así ayudando a la toma de decisiones. METODOLOGÍA Para identificar la evidencia científica disponible sobre las opciones para abordar el problema se realizó una búsqueda amplia en la base de datos Epistemonikos, mediante una estrategia de búsqueda. RESULTADOS Se trabaja con 1 revisión sistemática Vacunación en Humanos contra Fiebre Q -La vacunación en humanos contra fiebre Q podría disminuir el desarrollo de fiebre Q (certeza de evidencia baja). Vacunación en Animales contra Fiebre Q -El riesgo de diseminación podría disminuir con el uso de vacunación tanto en cabras como en ovejas, versus su no uso. -El riesgo de diseminación probablemente disminuye en leche, fluido vaginal y fecas con el uso de vacunación en animales versus su no uso. Medidas ambientales y medidas de protección para trabajadores -La búsqueda de evidencia no identificó estudios que comparasen el impacto de medidas ergonómicas sobre el desarrollo de fiebre Q. -Esto debiese considerarse como una brecha de evidencia, que pudiera ser abordada por futuras investigaciones Control de hemoderivados -La búsqueda de evidencia no identificó estudios que comparasen el impacto del control de hemoderivados sobre el desarrollo de fiebre Q. -No hay evidencia comparativa entre las diferentes estrategias de control de hemoderivados. Control de plagas -La búsqueda de evidencia encontró una revisión sistemática, la cual evalúa el efecto de un programa en EEUU llevado a cabo entre los años 1997 y 2004. -No está claro si el control de plagas impacta el desarrollo de la enfermedad (certeza de evidencia muy baja).

Clinical and epidemiological use of nested PCR targeting the repetitive element IS1111 associated with the transposase gene from Coxiella burnetii

ABSTRACT Q fever is a worldwide zoonosis caused by Coxiella burnetii—a small obligate intracellular Gram-negative bacterium found in a variety of animals. It is transmitted to humans by inhalation of contaminated aerosols from urine, feces, milk, amniotic fluid, placenta, abortion products, wool, and rarely by ingestion of raw milk from infected animals. Nested PCR can improve the sensitivity and specificity of testing while offering a suitable amplicon size for sequencing. Serial dilutions were performed tenfold to test the limit of detection, and the result was 10× detection of C. burnetti DNA with internal nested PCR primers relative to trans-PCR. Different biological samples were tested and identified only in nested PCR. This demonstrates the efficiency and effectiveness of the primers. Of the 19 samples, which amplify the partial sequence of C. burnetii, 12 were positive by conventional PCR and nested PCR. Seven samples—five spleen tissue samples from rodents and two tick samples—were only positive in nested PCR. With these new internal primers for trans-PCR, we demonstrate that our nested PCR assay for C. burnetii can achieve better results than conventional PCR.

Serologic Survey and Risk Factors for Coxiella burnetii Infection among Dairy Cattle Farmers in Korea

BACKGROUND: The zoonotic disease Q fever is caused by Coxiella burnetii and usually affects high-risk human populations. We conducted a serological survey of dairy cattle farmers in Korea to determine seroreactivity and identify risk factors for C. burnetii infection. METHODS: This cross-sectional study included 1,824 of 7,219 dairy cattle farms (25.3%) in the study region. The selected dairy cattle farmers visited the nearest public health centers or branches with completed questionnaires. Serum samples from the farmers were tested using an indirect immunofluorescence assay to detect phase II C. burnetii immunoglobulin (Ig) G or M antibodies. RESULTS: A total of 1,222 dairy cattle farmers from 784 dairy cattle farms (43.0%) participated in this study, and 11.0% (134/1,222) exhibited seroreactivity, defined as a phase II antigen IgG or IgM titer ≥ 1:16. In the multivariate analysis, male sex, residence in Gyeonggi Province, a larger herd size, and ocular/oral contact with birth products during calf delivery were significantly associated with a higher risk of C. burnetii infection. Furthermore, the risk was significantly lower among farmers who always wore protective gloves while cleaning cattle excretion, compared to those who sometimes or rarely wore protective gloves. CONCLUSION: Dairy cattle farmers should exercise caution by avoiding ocular/oral contact with birth products during calf delivery and by using protective equipment (including gloves).

Seroprevalence of Coxiella burnetii infection in cattle on Ulleung Island, Korea / 대한수의학회지

We assessed the seroprevalence of Coxiella burnetii (C. burnetii) in cattle on Ulleung Island, Korea in a population-based follow up study for 4 years and determined the spatial distribution and risk factors associated with C. burnetii. The seroprevalence of C. burnetii was determined to be 1.4–2.0% during 2011–2014. Overall, nine cattle from three farms that tested seropositive showed C. burnetii antibody seroconversions between 2011 and 2014. The number of seropositive cattle was low, suggesting that movement of and contact between animals was possible risk factors for the transmission of C. burnetii.

Epidemiology, Microbiological and Clinical Features, Treatment, and Outcomes of Infective Endocarditis in Crete, Greece / 감염과화학요법

BACKGROUND: This study aimed to evaluate the epidemiology, clinical and microbiological features, treatment, and outcomes of infective endocarditis (IE) on the island of Crete, a region with high levels of antimicrobial resistance. MATERIALS AND METHODS: Medical records of all hospitalized patients diagnosed with IE at the University Hospital of Heraklion, Crete, Greece, from 1995 to 2015, were retrospectively reviewed. Patients who met the modified Duke's criteria for definite or possible IE were included. RESULTS: A total of 82 IE patients (median age 67 [range 21–86] years) were included. Most patients suffered from left-sided IE (94%), while most cases of infection occurred in native valves (53.6%). Systemic inflammatory response syndrome criteria were lacking in almost half of the patient population. The leading causative microorganism was Staphylococcus aureus, isolated in 24 cases (29%), followed by Streptococcus spp. in 15 (18%) and Enterococcus spp. in 12 (14.5%). A number of rare and difficult to treat microorganisms had been identified, such as Gemella morbillorum in four cases (4.5%), Streptococcus lugdunensis in two (2.5%) and Streptococcus pneumoniae in one (1%). One patient was serologically positive for Coxiella burnetii (1%). All patients received empirical antimicrobial treatment, proven appropriate in 39 blood culture-positive patients (56.5%). Thirteen (16%) patients were classified as culture negative. Seven patients (8.5%) were surgically treated. In-hospital death occurred in 9 patients (11%). CONCLUSION: Changes in IE profile requires continuous epidemiological updates. Staphylococcus and Streptococcus spp. remain the most common etiologic agents. However, the presence of uncommon and/or difficult to treat pathogens raise concerns on the appropriate prophylaxis as well as empirical treatment.

Epidemiology, Microbiological and Clinical Features, Treatment, and Outcomes of Infective Endocarditis in Crete, Greece / 감염과화학요법

BACKGROUND: This study aimed to evaluate the epidemiology, clinical and microbiological features, treatment, and outcomes of infective endocarditis (IE) on the island of Crete, a region with high levels of antimicrobial resistance. MATERIALS AND METHODS: Medical records of all hospitalized patients diagnosed with IE at the University Hospital of Heraklion, Crete, Greece, from 1995 to 2015, were retrospectively reviewed. Patients who met the modified Duke's criteria for definite or possible IE were included. RESULTS: A total of 82 IE patients (median age 67 [range 21–86] years) were included. Most patients suffered from left-sided IE (94%), while most cases of infection occurred in native valves (53.6%). Systemic inflammatory response syndrome criteria were lacking in almost half of the patient population. The leading causative microorganism was Staphylococcus aureus, isolated in 24 cases (29%), followed by Streptococcus spp. in 15 (18%) and Enterococcus spp. in 12 (14.5%). A number of rare and difficult to treat microorganisms had been identified, such as Gemella morbillorum in four cases (4.5%), Streptococcus lugdunensis in two (2.5%) and Streptococcus pneumoniae in one (1%). One patient was serologically positive for Coxiella burnetii (1%). All patients received empirical antimicrobial treatment, proven appropriate in 39 blood culture-positive patients (56.5%). Thirteen (16%) patients were classified as culture negative. Seven patients (8.5%) were surgically treated. In-hospital death occurred in 9 patients (11%). CONCLUSION: Changes in IE profile requires continuous epidemiological updates. Staphylococcus and Streptococcus spp. remain the most common etiologic agents. However, the presence of uncommon and/or difficult to treat pathogens raise concerns on the appropriate prophylaxis as well as empirical treatment.

Investigação sorológica de Rickettsia rickettsii e Coxiella burnetii em caprinos e ovinos no entorno do Parque Nacional da Serra das Confusões, Piauí / Infection survey of Rickettsia rickettsii and Coxiella burnetii in sheep and goats from National Park of Serra das Confusões, Piauí

As doenças causadas por bactérias dos gêneros Rickettsia e Coxiella possuem como vetores artrópodes hematófagos, na sua maioria carrapatos, que atuam diretamente na transmissão de patógenos responsáveis por enfermidades de grande impacto na medicina veterinária e humana. O presente estudo objetivou realizar uma investigação sorológica de Rickettsia rickettsii e Coxiella burnetii em caprinos e ovinos criados no entorno do Parque Nacional da Serra das Confusões (PNSC), localizado no estado do Piauí, região nordeste do Brasil. Amostras de soro de 202 caprinos e 153 ovinos foram testadas pela Reação de Imunofluorescência Indireta (RIFI) para detecção de anticorpos anti-R. rickettsii e anti-C. burnetii, sendo consideradas positivas quando apresentaram títulos ≥ 64. Carrapatos em fase de parasitismo foram coletados e identificados. Todas as amostras de caprinos e ovinos foram soronegativas para antígenos de R. rickettsii. Foi verificado soropositividade em 2% (3/153) das amostras de ovinos para C. burnetii, com títulos variando de 64 a 4.096. As amostras de caprinos não foram reagentes ao referido antígeno. Não foi observado parasitismo em caprinos por carrapatos. No total, foram coletados 56 carrapatos parasitando 15 ovinos (9,8%), todos identificados como Rhipicephalus microplus. O estudo demonstrou a ausência de anticorpos anti-R. rickettsii nas amostras de caprinos e ovinos, ausência de anticorpos anti-C. burnetii em caprinos; e possibilitou o primeiro relato da ocorrência sorológica de C. burnetii em ovinos nesta região do Brasil.(AU)

The diseases caused by bacteria from the genera Rickettsia and Coxiella have hematophagous arthropods as vectors, mostly by ticks, which act directly on the transmission of pathogens that are responsible for diseases with major impact on veterinary and human medicine. The present study aimed to survey the infection of Rickettsia rickettsii and Coxiella burnetii in sheep and goats surrounding in the National Park of Serra das Confusões (NPSC), located in the state of Piauí, Northeast of Brazil. Serum samples from 202 goats and 153 sheep were tested by Indirect Immunofluorescence Assay (IFA) for the detection of antibodies against R. rickettsii and C. burnetii. The samples were considered positive when they showed titers ≥ 64. Ticks in parasitic stage were collected and identified. All samples from sheep and goats were seronegative for R. rickettsii. Seropositivity was verified in 2% (3/153) of the samples of sheep for C. burnetii, with titers ranging from 64 to 4096. The serum samples obtained from goats were seronegative to the above antigens. In total, 56 ticks were collected from 15 sheep (9.8%) all identified as Rhipicephalus microplus. The study demonstrated absence of infection by R. rickettsii in samples of sheep and goats, absence of infection of C. burnetii in goats; and the first report of serological occurrence of C. burnetii in sheep in this region of Brazil.(AU)

Seroreactivity to Q Fever Among Slaughterhouse Workers in South Korea / 예방의학회지

OBJECTIVES: Q fever is a zoonotic disease that occurs worldwide; however, little is known about its prevalence in South Korea. We attempted to determine the prevalence of Q fever seroreactivity among Korean slaughterhouse workers and the risk factors for seroreactivity according to the type of work. METHODS: The study was conducted among 1503 workers at a total of 73 slaughterhouses and 62 residual-product disposal plants. During the study period, sites were visited and surveys were administered to employees involved in slaughterhouse work, and serological tests were performed on blood samples by indirect immunofluorescence assays. Serological samples were grouped by job classification into those of slaughter workers, residual-product handlers, inspectors and inspection assistants, and grading testers and testing assistants. Employee risk factors were analyzed according to the type of work. RESULTS: Out of 1481 study subjects who provided a blood sample, 151 (10.2%) showed reactive antibodies. When these results were analyzed in accordance with the type of work, the result of slaughter workers (11.3%) was similar to the result of residual-product handlers (11.4%), and the result of inspectors and assistants (5.3%) was similar to the result of grading testers and assistants (5.4%). Among those who answered in the affirmative to the survey question, “Has there been frequent contact between cattle blood and your mouth while working?” the proportions were 13.4 and 4.6%, respectively, and this was identified as a risk factor that significantly varied between job categories among slaughterhouse workers. CONCLUSIONS: This study found a Q fever seroreactivity rate of 10.2% for slaughterhouse workers, who are known to be a high-risk population. Contact with cattle blood around the mouth while working was the differential risk factor between job categories among slaughterhouse workers.