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PubMed2006

Serotesting of human Q fever distribution in Bosnia and Herzegovina.

Q fever is a zoonotic disease with worldwide distribution. It occurs in different geographic regions and climate zones. From 1990 till the end of 1997, only three infected individuals were registered in Bosnia and Herzegovina, during the year 1991, with the incidence of 0.05% 000. From 1996 onward, there was a sudden aggravation of epizoological and epidemiological situation in particular regions of Bosnia and Herzegovina. We performed serotesting during the 4-year period from 2000 to 2003. We tested serum samples from 708 individuals from different regions of Bosnia and Herzegovina. Q fever was serologically diagnosed in 249 individuals. The overall seroprevalence was 35.2%. The acute disease form was confirmed in 79.9% of the whole seropositive sample. Most of the Q seropositive individuals were from Kakanj (17.3%), Mostar (15.3%), Sarajevo (12.5%), Bihać (9.6%), Zenica (9.2%), Gornji Vakuf (8.9%), Tesanj (4.4%), Visoko (2.8%), and Travnik (2.4%). The number and distribution of seropositive individuals suggests that Q fever is endemic in Bosnia and Herzegovina.

Bosnia and Herzegovina↗
PubMed1999

Hyperendemic focus of Q fever related to sheep and wind.

Q fever is a worldwide zoonosis which is caused by Coxiella burnetii and presents as both acute or chronic cases. The disease can be transmitted from animal reservoirs to humans by the inhalation of infected aerosols. The authors investigated the epidemiology of Q fever in the Bouches-du-Rhône district of southern France. The study area was centered around the small town of Martigues near the cities of Marseille and Aix-en-Provence, where the incidence of the disease seemed higher than in neighboring areas. Epidemiologic data included sheep breeding and wind. Between 1990 and 1995, Q fever was diagnosed in 289 patients, leading to an incidence rate of 35.4 per 100,000 in the study area (range: 6-132), compared with 6.6 in the area of Marseille, and 11.4 in the area of Aix-en-Provence. There was a graphical and statistical relation between the sheep densities, the incidence of the disease, and the strong, local wind known as the Mistral, which blows from the northwest. Although Coxiella burnetii transmission is multifactorial, we may speculate that the high endemicity in the study area is related to a contamination by aerosols because the Mistral blows through the local steppe where 70,000 sheep are bred. This public health problem requires further studies in order to confirm this hypothesis, and to identify more individual and preventable risk factors.

Adolescent↗
PubMed2004

Pulmonary manifestations of other agents: brucella, Q fever, tularemia and smallpox.

Brucella, Q fever, tularemia, and smallpox are all rare infections in the United States but are potential agents of biologic terrorism. The pulmonary manifestations of these infections range from uncommon (brucella and smallpox) to expected (Q fever and tularemia). and all have clinical and radiologic presentations that can be confused with other, more endemic,diseases. Once the release of these agents has been determined, the diagnosis of presenting patients will be straightforward. The onus is on the clinician,however, to be able to recognize the first few, unexpected cases, because early identification will be paramount in helping curb the effect of the outbreak.

Bioterrorism↗
PubMed2002

Changing clinical presentation of Q fever endocarditis.

Fifteen cases of Q fever endocarditis that occurred in 1999-2000 in southern France are described and compared with 15 cases from the same area reported in 1987. Significant decreases were found in the prevalences of heart failure, hepatomegaly, inflammatory syndrome, anemia, leukopenia, and abnormal liver function test results in patients who had Q fever endocarditis after 1997. This was probably the result of a reduction in the delay before diagnosis of the disease and of the use of novel, effective antibiotic regimens.

Adult↗
PubMed1996

Upregulation of tumor necrosis factor alpha and interleukin-1 beta in Q fever endocarditis.

The occurrence of Q fever endocarditis likely involves some alterations in the responses of monocytes, the in vivo targets of Coxiella burnetii. To test this hypothesis, the production of the inflammatory cytokines tumor necrosis factor alpha, interleukin-1 beta, and interleukin-6 was assessed in monocytes from patients with Q fever endocarditis. Spontaneous transcription and secretion of tumor necrosis factor and interleukin-1 were significantly higher in patient monocytes than in healthy controls. The interleukin-6 transcripts were also upregulated in patient cells. Moreover, in patients with recent endocarditis exhibiting high titers of immunoglobulin G directed to C. burnetii in phase I, monocytes released significantly higher levels of tumor necrosis factor and interleukin-1 than in patients with stabilized endocarditis. Immunoglobulin G titers and the overproduction of tumor necrosis factor and interleukin-1 were significantly correlated. Hence, the overproduction of inflammatory cytokines might be a marker of disease activity.

Adult↗
PubMed1977

[Radiograph and observation of the development of Q-fever pneumonia (author's transl)].

The radiograph in Q-fever pneumonia and the course of Q-fever was reported with the help of 12 clinically examined cases. Q-fever pneumonia is not to be diffrentiated from viral pneumonia or mycoplasmal pneumonia. A chronic course with residual infiltrates which lasts as long as two or three months is, however, more frequent in Q-fever pneumonia. According to our observations, a correlation seems to exist between the severity of the clinical symptoms, the extent of the pulmonary infiltrate and the level of the titer of the complement fixation.

Antibodies↗
PubMed2003

Q fever as a biological weapon.

Q fever is a bacterial zoonosis caused by Coxiella burnetii, a unique intracellular coccobacillus, adapted to live within the phagolysosomes of macrophages and monocytes. It is highly infectious, with as little as one organism needed to cause clinical infection, making it an attractive organism for use in biowarfare. Despite its high infectivity, it has low virulence, and most patients undergo only asymptomatic seroconversion. Acute clinical manifestations are a nonspecific febrile illness, pneumonia, hepatitis, and neurologic abnormalities ranging from headache to meningoencephalitis. Chronic Q fever can result in endocarditis, hepatitis, or a chronic fatigue syndrome. Diagnosis usually is made by serology because culture of the highly contagious organism is potentially hazardous. Tetracyclines are the antibiotics of choice. When individualized therapy is possible, a 14- to 21-day course of doxycycline usually is used. In a mass casualty situation, a 5- to 7-day course of doxycycline is recommended, both for therapy and prophylaxis. For chronic infections such as endocarditis, 18 months of doxycycline supplemented with hydroxychloroquine is currently the best therapy.

Anti-Infective Agents↗
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↗
PubMed1990

Vaccine prophylaxis of abattoir-associated Q fever: eight years' experience in Australian abattoirs.

During the period 1981-8 a clinical trial of a Q fever vaccine (Q-vax; Commonwealth Serum Laboratories, Melbourne) has been conducted in abattoir workers and other at-risk groups in South Australia. Volunteers in four abattoirs and visitors to the abattoirs were given one subcutaneous dose of 30 micrograms of a formalin-inactivated, highly-purified Coxiella burnetii cells, Henzerling strain, Phase 1 antigenic state, in a volume of 0.5 ml. During the period, over 4000 subjects have been vaccinated and the programme continues in the abattoirs and related groups. 'Common' reactions to the vaccine comprised tenderness and erythema, rarely oedema at the inoculation site and sometimes transient headache. Two more serious 'uncommon' reactions, immune abscess at the inoculation site, were observed in two subjects, and two others developed small subcutaneous lumps which gradually dispersed without intervention. Protective efficacy of the vaccine appeared to be absolute and to last for 5 years at least. Eight Q fever cases were observed in vaccinees, but all were in persons vaccinated during the incubation period of a natural attack of Q fever before vaccine-induced immunity had had time (greater than or equal to 13 days after vaccination) to develop. On the other hand, 97 Q fever cases were detected in persons working in, or visiting the same abattoir environments. Assays for antibody and cellular immunity showed an 80-82% seroconversion after vaccination, mostly IgM antibody to Phase 2 antigen, in the 3 months after vaccination. This fell to about 60%, mostly IgG antibody to Phase 1 antigen, after 20 months. On the other hand, 85-95% of vaccinees developed markers of cell mediated immunity as judged by lymphoproliferative responses with C. burnetii antigens; these rates remained elevated for at least 5 years. The Q fever vaccine, unlike other killed rickettsial vaccines, has the property of stimulating long-lasting T lymphocyte memory and this may account for its unusual protective efficacy as a killed vaccine.

Abattoirs↗
PubMed2002

Q fever--still a query and underestimated infectious disease.

Coxiella burnetii (C.b.) is a strictly intracellular, Gram-negative bacterium. It causes Q fever in humans and animals worldwide. The animal Q fever is sometimes designated "coxiellosis". This infection has many different reservoirs including arthropods, birds and mammals. Domestic animals and pets, are the most frequent source of human infections. Q fever may appear basically in two forms, acute and chronic (persistent). The latter form of Q fever in animals is characteristic by shedding C.b. into the environment during parturition or abortion. Human Q fever results usually from inhalation of contaminated aerosols originating mostly from tissue and body fluids of infected animals. Q fever may appear in humans either in an acute form accompanied mainly by fever (pneumonia, flu-like disease, hepatitis) or in a chronic form (mainly endocarditis). Diagnosis of Q fever is based on isolation of the agent in cell culture, its direct detection, namely by PCR, and serology. Detection of high phase II antibodies titers 1-3 weeks after the onset of symptoms and identification of IgM antibodies are indicative to acute infection. High phase I IgG antibody titers >800 as revealed by microimmunofluorescence offer evidence of chronic C.b. infection. For acute Q fever, a two-weeks-treatment with doxycycline is recommended as the first-line therapy. In the case of Q fever endocarditis a long-term combined antibiotic therapy is necessary to prevent relapses. Application of Q fever vaccines containing or prepared from phase I C.b. corpuscles should be considered at least for professionally exposed groups of the population. Infections caused by C.b. are spread worldwide and may pose serious and often underestimated health problems in human but also in veterinary medicine. Though during the last decades substantial progress in investigation of C.b. has been achieved and many data concerning this pathogen has been accumulated, some questions, namely those related to the pathogenesis of the disease, remain open.

Acute Disease↗
PubMedDate not supplied

[Q-fever in the Zadar region].

The occurrence of Q fever in a population of Zadar region (2787 km2) which has five microregions (Zadar, Benkovac, Biograd, Obrovac and Pag microregion) is presented. In 1986, nine cases of Q fever were reported. Five patients were detected in Zadar community, one in Pag microregion and 3 in Biograd community and microregion, respectively. In 1989, two cases in Zadar and, in 1988 and 1991, one case in each year from the territory of Zadar were found. A total of 13 cases of Q fever were treated and reported. The personnel of the Zadar Veterinary Stations were not able to provide information since blood samples from the suspected animals were not taken. The agent was therefore not isolated. It is known that there were more serologically proven cases of Q fever, but they were not registered by the Epidemiologic Service of the Zadar Department for Health Protection. Clinical manifestation in a form of pulmonary affection is a very significant data in this zoonosis and it is therefore most commonly detected at the hospital departments for lung diseases, what was one of the reasons for undertaking this study.

Adult↗
PubMed1985

[Clinical aspects observed during an epidemic of 415 cases of Q fever].

The clinical findings during a major epidemic of Q-fever which affected 415 people in the Val de Bagnes (Valais, Switzerland) in the autumn of 1983 are reported. Q-fever symptoms were evident in 191 cases but inconspicuous or absent in 224 cases. The symptoms most frequently reported were prolonged high fever, headaches, severe exhaustion, loss of appetite, cough and myalgia. Amongst disorders which accompany acute Q-fever, pneumonia and granulomatous hepatitis are very frequent, while myopericarditis and glomerulonephritis are less frequently observed. Endocarditis, a later complication of Q-fever, is a severe illness which more frequently affects patients with underlying valvular lesions. New serological techniques now permit more rapid and more accurate diagnosis of both acute and chronic Q-fever.

Adolescent↗
PubMed2005

Role of goats in epizootiology and epidemiology of Q fever.

Numerous data show that the epizootics of Q fever in goats can be particularly related to cases of this disease in humans. The aim of the study was to examine 98 goat serum samples from the farm where abortions, early parturition and parturition of weak goatlings were noted. The microaglutination method was used in this study. Serum dilution 1:8 was defined as a positive titre. The study revealed that 79.6% of serum samples were positive and numerous high titres suggested an acute form of infection. It could be supposed that Q fever was the reason of abortions in the herd. The results obtained point to the necessity of examinations for Q fever in goats, because of the possibility of infection in people who have a contact with these animals. Goats seem to be the animal species especially sensitive to C. burnetii infection. Q fever should be taken into consideration in the differential diagnosis of the goat diseases, when abortions occur.

Animals↗
PubMed1994

Chronic Q fever in hemodialysis patients.

We describe two cases of chronic Q fever in hemodialysis patients (HD). In the first case, we discovered chronic Q fever when looking for the cause of an unexplained fever. In the second case, Q fever was diagnosed in a patient who complained of an unexplained shoulder arthritis. To our knowledge these are the first reported cases of chronic Q fever in HD.

Adult↗
PubMed1982

Q fever in maritime Canada.

Only nine cases of Q fever were recorded in Canada in the 20 years prior to 1978. In the 18 months from August 1979 to January 1981 the disease was diagnosed serologically in six patients from the Maritime provinces. All were epidemiologically unrelated and none had been exposed to animals. Five had pneumonia and one had chronic Q fever with probable prosthetic valve endocarditis. Three of the five pneumonia patients presented with signs and symptoms of an acute lower respiratory tract infection and were indistinguishable clinically from other patients with atypical pneumonias. The other two with pneumonia presented with nonresolving pulmonary infiltrates and complained of decreased energy. Four of the five pneumonia patients responded well to treatment with erythromycin; the fifth required two courses of tetracycline. The patient with chronic Q fever had a large amount of cryoglobulins in his serum and evidence of immune complex disease. These cases indicate that Q fever should be considered as a possible cause of atypical pneumonia in Canada.

Adult↗
PubMed1990

A randomized, controlled, double-blind, cross-over, clinical trial of Q fever vaccine in selected Queensland abattoirs.

A limited, randomized, blind, placebo-controlled trial of Q fever and influenza vaccines has been conducted in three Queensland abattoirs on a sequential analysis design. Ninety-eight subjects were given Q fever vaccine and 102 influenza vaccine. Q fever cases were observed in unvaccinated workers in all three abattoirs during the period of observation. A total of seven Q fever cases in one group, one more than the number required to achieve statistical significance between the two vaccine groups, was reached after 15 months with the cases coming from two of the abattoirs. These Q fever cases were in the group which had been given influenza vaccine and none in that given Q fever vaccine. Symptomless seroconversion rates of 24% were found in the remaining influenza virus vaccinees, and those without immunity were given Q fever vaccine.

Abattoirs↗
PubMed1985

Subclinical chronic Q fever.

Seven patients are described in whom chronic Q fever was detected by serology (Coxiella burneti phase I antibody titre greater than 1:200) during routine screening at admission for cardiac catheterisation. None had clinical evidence of endocarditis, hepatitis or other foci of infection. Three of the patients were kept under observation without antibiotic treatment for periods of six, 18 and 20 months. In two patients of this group, cardiac tissue was obtained at operation and in one patient seroconversion following guinea-pig inoculation indicated the presence of Coxiella burneti infection. Four patients were given antibiotic treatment when Q fever was confirmed by serology. Courses of antibiotic treatment with a combination of two drugs were maintained for four to six years and in three of these patients phase I antibody titres fell to very low levels with no appearance of overt infection. The fourth patient died after resection of an aortic aneurysm, seven months after starting antibiotic treatment. Cases reported in the literature indicate that while endocarditis is the most common manifestation of chronic Q fever, the infection can persist at other sites. Of the seven cases of subclinical chronic Q fever reported here, the infection was localised in only one. Patients with this subclinical form of infection pose the therapeutic dilemma of whether or not they should receive antibiotic treatment.

Adult↗
PubMed1997

Q fever tricuspid valve endocarditis.

Q fever is a zoonosis caused by Coxiella burnetii. The most frequent clinical expression of the chronic form is a bacterial culture negative aortic or mitral endocarditis. A case of tricuspid valve endocarditis due to C burnetii is described, with a favourable outcome after treatment with doxycycline and hydroxychloroquine.

Anti-Bacterial Agents↗