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Background. Community-acquired pneumonia (CAP) is the major manifestation of Q fever, an emerging disease in French Guiana. Consequently, the empirical antibiotherapy used for the treatment of CAP combines doxycycline and the recommended amoxicillin. Our objectives were to estimate the prevalence of Q fever pneumonia and to build a prediction rule to identify patients with Q fever pneumonia for empirical antibiotic guidance. Methods. A retrospective case-control study was conducted on inpatients admitted with CAP in the Department of Infectious Diseases of Cayenne Hospital from 2004 to 2007. Serodiagnosis for Coxiella burnetii was performed for all patients. Risk factor analysis was performed using multivariate logistic regression, and a prognostic score was computed using bootstrap procedures. The score performance characteristics were used to choose the best prediction rule to identify patients with Q fever pneumonia. Results. One hundred thirty-one patients with CAP were included and the Q fever pneumonia prevalence was 24.4% (95% confidence interval [CI], 17.1-31.9). In multivariate analysis, male sex, middle age (age, 30-60 years), headache, leukocyte count <10 × 10 9 /L and C-reactive protein level >185 mg/L were independently associated with Q fever pneumonia. Patients with a predictive score ≤3 had a low risk of Q fever pneumonia with a negative predictive value of 0.97 (95% CI, 90-1) and a sensitivity of 0.97 (95% CI, .89-1). Conclusions. The prediction rule described here accurately identifies patients with low risk of Q fever pneumonia and may help physicians to make more rational decisions about the empirical use of antibiotherapy. Further prospective studies should be performed to validate this score.

Q fever in dairy cattle herds occurs mainly after inhalation of contaminated aerosols generated from excreta by shedder animals. Propagation of Coxiella burnetii, the cause of the disease between ruminant herds could result from transmission between neighbouring herds and/or the introduction of infected shedder animals in healthy herds. The objective of this study were (i) to describe the spatial distribution C. burnetii-infected dairy cattle herds in two different regions: the Finistère District in France (2,829 herds) and the island of Gotland in Sweden (119 herds) and (ii) to quantify and compare the relative contributions of C. burnetii transmission related to neighbourhood and to animal movements on the risk for a herd to be infected. An enzyme--linked immunosorbent assay was used for testing bulk tank milk in May 2012 and June 2011, respectively. Only one geographical cluster of positive herds was identified in north-western Finistère. Logistic regression was used to assess the association of risk for a herd to test positively with local cattle density (the total number of cattle located in a 5 km radius circle) and the in-degree (ID) parameter, a measure of the number of herds from which each herd had received animals directly within the last 2 years. The risk for a herd to test positively was higher for herds with a higher local cattle density [odds ratio (OR) = 2.3, 95% confidence interval (CI) = 1.6-3.2, for herds with a local density between 100 and 120 compared to herds with a local density 60]. The risk was also higher for herds with higher IDs (OR = 2.3, 95% CI = 1.6-3.2, for herds with ID 3 compared to herds that did not introduce animals). The proportion of cases attributable to infections in the neighbourhood in high-density areas was twice the proportion attributable to animal movements, suggesting that wind plays a main role in the transmission.

Information on zoonotic diseases in humans and livestock are limited in pastoral/agro-pastoral communities in Ethiopia. A multi-stage cross sectional cluster design study was implemented with the aim to establish the seroprevalence of zoonotic diseases including brucellosis, Q-fever and Rift Valley fever (RVF) in humans and livestock in Adadle Woreda of the Somali Region, Ethiopia. Blood samples were collected from humans and livestock and tested by relevant serological tests. For brucellosis, Rose Bengal test (RBT) and indirect ELISA was used for screening and confirmatory diagnosis respectively. Indirect and competitive ELISA were also used for Q-fever and RVF respectively. The individual seropositivity of Q-fever in livestock was 9.6% (95% CI 5.9–15.1) in cattle, 55.7% (95% CI 46.0–65.0) in camels, 48.8% (95% CI 42.5–55.0) in goats, and 28.9% (95% CI 25.0–33.2) in sheep. In humans, seropositivity of Q-fever was 27.0% (95% CI 20.4–34.0), with prevalence in males of 28.9% vs 24.2% in females (OR = 1.3; 95% CI 0.6–2.5). Camel seropositivity of Q-fever was significantly associated with age (OR = 8.1; 95% CI 2.8–23.7). The individual apparent seroprevalence of RVF was 13.2% (95% CI 8.7–18.8) in humans, 17.9% (95% CI 11.0–27.8) in cattle, 42.6% (95% CI 34.8–50.7) in camels, 6.3% (95% CI 3.3–11.6) in goats and 7.4% (95% CI 4.7–11.5) in sheep. Camels had the highest seropositivity of both Q-fever and RVF. Only a weak correlation was observed between human and livestock seropositivity for both Q-fever and RVF. Only cattle and camels were seropositive for brucellosis by iELISA. The individual seroprevalence of brucellosis was 2.8(0.9–6.4) in humans, 1.5% (95% CI 0.2–5.2) in cattle and 0.6% (95% CI 0.0–3.2) in camels. This study showed the importance of zoonoses in Somali Region and is the first published study to describe RVF exposure in humans and livestock in the country. Even though human exposure to RVF virus was reported, public health sector of Somali Region has not given attention to such zoonoses. Collaboration between public and animal health sectors for further investigation on these zoonoses using the One Health concept is indispensable.

Acute Q fever is classically described as a mild illness. We report 9 patients with acute Q fever in Queensland, Australia, who required intensive care unit support to survive. Clinicians should consider an acute Q fever diagnosis and its empirical treatment in critically ill persons in the appropriate clinical context.

Q fever is a highly infectious disease with a worldwide distribution. Its causative agent, the intracellular bacterium Coxiella burnetii, infects a variety of vertebrate species, including humans. Its evolutionary origin remains almost entirely unknown and uncertainty persists regarding the identity and lifestyle of its ancestors. A few tick species were recently found to harbor maternally-inherited Coxiella-like organisms engaged in symbiotic interactions, but their relationships to the Q fever pathogen remain unclear. Here, we extensively sampled ticks, identifying new and atypical Coxiella strains from 40 of 58 examined species, and used this data to infer the evolutionary processes leading to the emergence of C. burnetii. Phylogenetic analyses of multi-locus typing and whole-genome sequencing data revealed that Coxiella-like organisms represent an ancient and monophyletic group allied to ticks. Remarkably, all known C. burnetii strains originate within this group and are the descendants of a Coxiella-like progenitor hosted by ticks. Using both colony-reared and field-collected gravid females, we further establish the presence of highly efficient maternal transmission of these Coxiella-like organisms in four examined tick species, a pattern coherent with an endosymbiotic lifestyle. Our laboratory culture assays also showed that these Coxiella-like organisms were not amenable to culture in the vertebrate cell environment, suggesting different metabolic requirements compared to C. burnetii. Altogether, this corpus of data demonstrates that C. burnetii recently evolved from an inherited symbiont of ticks which succeeded in infecting vertebrate cells, likely by the acquisition of novel virulence factors.

Background Q fever is a zoonotic disease caused by Coxiella burnetii . This bacterium survives harsh conditions and attaches to dust, suggesting environmental dispersal is a risk factor for outbreaks. Spatial epidemiology studies collating evidence on Q fever geographical contamination gradients are needed, as human cases without occupational exposure are increasing worldwide. Methods We used a systematic literature search to assess the role of distance from ruminant holdings as a risk factor for human Q fever outbreaks. We also collated evidence for other putative drivers of C. burnetii geographical dispersal. Results In all documented outbreaks, infective sheep or goats, not cattle, was the likely source. Evidence suggests a prominent role of airborne dispersal; Coxiella burnetii travels up to 18 km on gale force winds. In rural areas, highest infection risk occurs within 5 km of sources. Urban outbreaks generally occur over smaller distances, though evidence on attack rate gradients is limited. Wind speed / direction, spreading of animal products, and stocking density may all contribute to C. burnetii environmental gradients. Conclusions Q fever environmental gradients depend on urbanization level, ruminant species, stocking density and wind speed. While more research is needed, evidence suggests that residential exclusion zones around holdings may be inadequate to contain this zoonotic disease, and should be species-specific.

Long-term fatigue with detrimental effects on daily functioning often occurs following acute Q-fever. Following the 2007-2010 Q-fever outbreak in the Netherlands with over 4000 notified cases, the emphasis on long-term consequences of Q-fever increased. The aim of this study was to provide an overview of all relevant available literature, and to identify knowledge gaps regarding the definition, diagnosis, background, description, aetiology, prevention, therapy, and prognosis, of fatigue following acute Q-fever. A systematic review was conducted through searching Pubmed, Embase, and PsycInfo for relevant literature up to 26th May 2015. References of included articles were hand searched for additional documents, and included articles were quality assessed. Fifty-seven articles were included and four documents classified as grey literature. The quality of most studies was low. The studies suggest that although most patients recover from fatigue within 6-12 months after acute Q-fever, approximately 20% remain chronically fatigued. Several names are used indicating fatigue following acute Q-fever, of which Q-fever fatigue syndrome (QFS) is most customary. Although QFS is described to occur frequently in many countries, a uniform definition is lacking. The studies report major health and work-related consequences, and is frequently accompanied by nonspecific complaints. There is no consensus with regard to aetiology, prevention, treatment, and prognosis. Long-term fatigue following acute Q-fever, generally referred to as QFS, has major health-related consequences. However, information on aetiology, prevention, treatment, and prognosis of QFS is underrepresented in the international literature. In order to facilitate comparison of findings, and as platform for future studies, a uniform definition and diagnostic work-up and uniform measurement tools for QFS are proposed.

Coxiella burnetii is the causative agent of Q fever which is a highly infectious zoonotic disease. C. burnetii has become one of the most important causes of abortion in livestock, which can lead to widespread abortions in these animals. There are very limited studies on the prevalence of C. burnetii infection in cases of animal abortion in Iran. The aim of this study was to investigate the occurrence of C. burnetii in ruminant abortion samples in Iran. Abortion samples from cattle, sheep and goats were collected from different parts of Iran and were tested using Real-time PCR targeting the IS1111 element of C. burnetii. In this study, 36 samples (24.7%) of the 146 collected samples were positive for C. burnetii. The prevalence of C. burnetii was 21.3% (20 of 94 samples) in sheep samples. Also, 10 of 46 cattle samples (21.7%) were positive. All six goat abortion samples were positive for C. burnetii. The findings of the study demonstrate that C. burnetii plays an important role in domestic ruminant abortions in Iran, suggesting that more attention should be paid to the role of C. burnetii in domestic animal abortions by veterinary organizations. The risk of transmitting the infection to humans due to abortion of animals should also be considered.

Bacterial zoonoses are diseases caused by bacterial pathogens that can be naturally transmitted between humans and vertebrate animals. They are important causes of non-malarial fevers in Kenya, yet their epidemiology remains unclear. We investigated brucellosis, Q-fever and leptospirosis in the venous blood of 216 malaria-negative febrile patients recruited in two health centres (98 from Ijara and 118 from Sangailu health centres) in Garissa County in north-eastern Kenya. We determined exposure to the three zoonoses using serological (Rose Bengal test for Brucella spp., ELISA for C. burnetti and microscopic agglutination test for Leptospira spp.) and real-time PCR testing and identified risk factors for exposure. We also used non-targeted metagenomic sequencing on nine selected patients to assess the presence of other possible bacterial causes of non-malarial fevers. Considerable PCR positivity was found for Brucella (19.4%, 95% confidence intervals [CI] 14.2–25.5) and Leptospira spp. (1.7%, 95% CI 0.4–4.9), and high endpoint titres were observed against leptospiral serovar Grippotyphosa from the serological testing. Patients aged 5–17 years old had 4.02 (95% CI 1.18–13.70, p -value = 0.03) and 2.42 (95% CI 1.09–5.34, p -value = 0.03) times higher odds of infection with Brucella spp. and Coxiella burnetii than those of ages 35–80. Additionally, patients who sourced water from dams/springs, and other sources (protected wells, boreholes, bottled water, and water pans) had 2.39 (95% CI 1.22–4.68, p -value = 0.01) and 2.24 (1.15–4.35, p -value = 0.02) times higher odds of exposure to C. burnetii than those who used unprotected wells. Streptococcus and Moraxella spp. were determined using metagenomic sequencing. Brucellosis, leptospirosis, Streptococcus and Moraxella infections are potentially important causes of non-malarial fevers in Garissa. This knowledge can guide routine diagnosis, thus helping lower the disease burden and ensure better health outcomes, especially in younger populations.

Optimal management of the birthing parent with Q fever in pregnancy and of the infant has not been established. Coxiella burnetii expresses a tropism for the placenta; resulting infection can potentially lead to spontaneous abortion and fetal demise. Although evidence around preventing transmission and infection in the peripartum and postpartum period is lacking, reports of healthy babies born to mothers with acute or chronic Q fever in pregnancy are increasing. Historically, many clinicians have recommended against breastfeeding in this setting because of a theoretical risk for bacterial transmission through breastmilk. We discuss 2 women in Australia who had Q fever in pregnancy, focusing on the peripartum period and infant management. Breastfeeding was encouraged in both cases. Both infants were born healthy and at term and have demonstrated no serologic or clinical evidence of Q fever infection in the first year of life.