Seroprevalence of Q fever in a district located in the west Black Sea region of Turkey

Molecular detection of Coxiella burnetii in tick and blood samples from small ruminants in northwest of Iran

This survey sought to molecularly detect Coxiella burnetii in Argasidae and Ixodidae ticks attached to small ruminants in the region of West Azerbaijan (Northwest of Iran) and blood samples collected from the same animals. 451 tick samples and 927 blood samples were obtained from sheep (n = 536) and goats (n = 391) and tested by nested PCR for detection of C. burnetii insertion sequence IS1111 or icd gene sequence. The collected ticks were morphologically classified as Rhipicephalus sanguineus, Rhipicephalus turanicus, Hyalomma asiaticum, Hyalomma anatolicum, or Argas reflexus. 14% of ticks (65 in total 43 for IS1111 and 22 for icd gene) tested positive for C. burnetii, none of which were from the Argas genus. Among the 927 blood samples, 218 (23.5%) tested positive for C. burnetii. The positive result from analysis targeting the genes IS1111 and icd were 131 and 87 respectively. As Q fever is a tickborne zoonosis and endemic to Iran, such information is critical for creating effective, coordinated, and strategic tick and pathogen control programs to prevent disease outbreak in domestic animals and humans.

The epidemiological survey of Coxiella burnetii in small ruminants and their ticks in western Iran

Background

Q fever is one of the most important zoonotic diseases caused by Coxiella burnetii. Although Q fever is an endemic disease in Iran, epidemiological data on C. burnetii infection are not yet complete in reservoirs and vectors in some parts of Iran. This survey investigated C. burnetii infection in small ruminants (sheep and goat blood samples) and their ticks in western Iran (Kurdistan province) in 2020. The presence of C. burnetii DNA was identified in these samples by targeting the IS1111 gene using the quantitative PCR (qPCR) method.

Results

Out of 250 blood samples (232 sheep and 18 goats), C. burnetii was detected in two samples (0.8%) belonging to the sheep (0.9%). In addition, 34 of 244 collected ticks (13.9%) from infested animals (244) were positive for C. burnetii infection. The highest prevalence of infection was found in Dermacentor marginatus (18.3%) and Haemaphysalis concinna (12.5%).

Conclusions

The present study showed that ticks could have a possible role in the epidemiology of Q fever in Iran.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12917-022-03396-0.

… İlindeki Q ateşi olgularının retrospektif olarak değerlendirilmesi

Amaç: Q ateşi, özellikle risk grubundaki bireylerde akut ve kronik formda görülebilen, özgül olmayan semptomları nedeniyle tanısı atlanabilen, zoonotik bir hastalıktır. Önceleri sıklıkla yanlış tanı alan bu hastalık olguları, ülkemizden de son yıllarda bildirilmeye başlamıştır. Bu çalışmada Q ateşi olgularının klinik ve laboratuvar parametrelerini retrospektif olarak değerlendirmeyi ve Q ateşi farkındalığını arttırmayı amaçladık. Gereç ve Yöntem: Retrospektif gözlemsel çalışmamızda, 1 Ocak 2018–1 Mart 2021 tarihleri arasında hastanemizde takip ve tedavi edilen, 18 yaş üstü, kesin tanı almış, Q ateşi olguları değerlendirildi. Hastalara ait yaş, cinsiyet, meslek, ikamet edilen yer gibi demografik veriler, kene teması öyküleri, hastalığın geliştiği zaman dilimi (yıl, mevsim, ay), eşlik eden komorbiditeler, semptomlar, fizik muayene ve laboratuvar bulguları, tedaviler, hastaların iyileşme ve mortalite durumları irdelendi. Bulgular: Çalışmaya yaş ortalaması 49,23±12,07 yıl, 7’si (%57) erkek olan 14 olgu dahil edildi. Olguların sadece 5’i (%35,7) çiftçi, dördü (%28,57) hayvancılık yapıyordu. Kırsal alanda yaşama 9 (%64,28) olguda mevcuttu. En sık semptomlar ateş yüksekliği (%100), öksürük (%71,42) ve miyalji (%57,14) idi. Olguların tamamı akut Q ateşi olgusu olup, endokardit hiçbir olguda saptanmadı. Sonuç: Ülkemizin Q ateşi hastalığı için olası endemik bölgelerden olması nedeniyle, özellikle kırsal kesimde yaşayan, hayvancılıkla uğraşma, pastörize edilmemiş süt/süt ürünü tüketme gibi risk faktörleri olan hastalarda pnömoni başta olmak üzere birçok hastalığın ayırıcı tanısında düşünülmesi gerektiğini vurgulamak istedik.

Risk Factors for and Seroprevalence of Tickborne Zoonotic Diseases among Livestock Owners, Kazakhstan

Crimean-Congo hemorrhagic fever (CCHF), Q fever, and Lyme disease are endemic to southern Kazakhstan, but population-based serosurveys are lacking. We assessed risk factors and seroprevalence of these zoonoses and conducted surveys for CCHF-related knowledge, attitudes, and practices in the Zhambyl region of Kazakhstan. Weighted seroprevalence for CCHF among all participants was 1.2%, increasing to 3.4% in villages with a known history of CCHF circulation. Weighted seroprevalence was 2.4% for Lyme disease and 1.3% for Q fever. We found evidence of CCHF virus circulation in areas not known to harbor the virus. We noted that activities that put persons at high risk for zoonotic or tickborne disease also were risk factors for seropositivity. However, recognition of the role of livestock in disease transmission and use of personal protective equipment when performing high-risk activities were low among participants.

Coxiella burnetii in Dromedary Camels (Camelus dromedarius): A Possible Threat for Humans and Livestock in North Africa and the Near and Middle East?

The "One Health" concept recognizes that human health is connected to animal health and to the ecosystems. Coxiella burnetii-induced human Q fever is one of the most widespread neglected zoonosis. The main animal reservoirs responsible for C. burnetii transmission to humans are domesticated ruminants, primarily goats, sheep, and cattle. Although studies are still too sparse to draw definitive conclusions, the most recent C. burnetii serosurvey studies conducted in herds and farms in Africa, North Africa, Arabian Peninsula, and Asia highlighted that seroprevalence was strikingly higher in dromedary camels (Camelus dromedarius) than in other ruminants. The C. burnetii seroprevalence in camel herds can reach more than 60% in Egypt, Saudi Arabia, and Sudan, and 70 to 80% in Algeria and Chad, respectively. The highest seroprevalence was in female camels with a previous history of abortion. Moreover, C. burnetii infection was reported in ticks of the Hyalomma dromedarii and Hyalomma impeltatum species collected on camels. Even if dromedary camels represent <3% of the domesticated ruminants in the countries of the Mediterranean basin Southern coast, these animals play a major socioeconomic role for millions of people who live in the arid zones of Africa, Middle East, and Asia. In Chad and Somalia, camels account for about 7 and 21% of domesticated ruminants, respectively. To meet the growing consumers demand of camel meat and milk (>5 million tons/year of both raw and pasteurized milk according to the Food and Agriculture Organization) sustained by a rapid increase of population (growth rate: 2.26-3.76 per year in North Africa), dromedary camel breeding tends to increase from the Maghreb to the Arabic countries. Because of possible long-term persistence of C. burnetii in camel hump adipocytes, this pathogen could represent a threat for herds and breeding farms and ultimately for public health. Because this review highlights a hyperendemia of C. burnetii in dromedary camels, a proper screening of herds and breeding farms for C. burnetii is urgently needed in countries where camel breeding is on the rise. Moreover, the risk of C. burnetii transmission from camel to human should be further evaluated.

Seroprevalence of Coxiella burnetii (Q fever) Exposure in Humans on Reunion Island

After the documentation of sporadic cases of Q fever endocarditis, we conducted a serosurvey to assess Coxiella burnetii exposure on Reunion Island. Two hundred forty-one stored frozen human sera were analyzed using an immunofluorescence assay. The weighted seroprevalence of Q fever was of 6.81% (95% confidence interval, 4.02%–9.59%). Despite the absence of infection in youths <20 years of age, exposure was not driven by age or by gender. There was a spatial disparity in exposure across the island, with higher prevalence being reported in regions where ruminant farms are present. The seroprevalence pattern suggests that Q fever is endemic on Reunion Island.

Occurrence and risk factors of Coxiella burnetii in domestic ruminants in Lebanon

Coxiella burnetii causes diseases in humans (Q fever) and animals, domestic ruminants playing a major role in the epidemiology of the infection. Information on C. burnetii infection in Lebanon is scanty. In order to assess the prevalence of C. burnetii infection in ruminants, a cross-sectional study was undertaken in 2014. A total of 1633 sera from ruminants (865 cattle, 384 sheep and 384 goats) from 429 farms (173 cattle, 128 sheep and 128 goats), in seven provinces of Lebanon were randomly selected and assayed for the presence of antibodies. 39.86% of farms (95% CI: 35.23-44.56) resulted positive. The seroprevalence was 30.63% in Cattle-farms, 46.88% in sheep-farms and 45.31% in goat-farms. Milk samples collected from 282 seropositive animals (86 cows, 93 sheep and 103 goats) from 171 positive farms were tested by a high sensitive Real-Time PCR targeted to the IS1111 transposon of C. burnetii. The overall prevalence in farms was estimated to be 14.04%. Cattle-, sheep- and goat farm prevalence rates were 15.09%, 10% and 17.24%, respectively. The findings of the study show that C. burnetii prevalence in Lebanese domestic ruminants is related to animal species and farming practices. Indeed, the mixed herds with sheep (p < 0.01), the presence of common lambing/kidding areas (p < 0.001) in farms where the use of disinfectants was not a routine practice (p < 0.05) were identified as important risk factors. The results of the study provide baseline information for setting up herd management and public health measures for the prevention and control of Q fever in Lebanon.

Seroprevalence of Q fever among high-risk occupations in the Ilam province, the west of Iran

Background

Q fever is a zoonotic disease of great public health importance in Iran. This disease is presented with high phase I antibody development in chronic and high phase II antibody in the acute form of illness. This study was conducted to evaluate the seroprevalence of Q fever among high-risk occupations in the Ilam province in Western Iran.

Methods and findings

In this cross-sectional study, 367 sera samples were collected from five groups comprised of animal husbandry workers, farmers, butchers, slaughterhouse workers, and park rangers. The collected sera were tested for IgG antibodies against Coxiella burnetii using ELISA. The seroprevalence of antibodies against C. burnetii in phase I and II was 24.38% and 26.37%, respectively (i.e., 32.42% overall). Low educational level, living in rural areas, keeping sheep/goats, ages older than 50 years, and a history of arthropod bites positively correlated with increased risk of Q fever infection. Animal husbandry workers (45.13%) were at higher risk of contracting Q fever compared with other occupations in the study (17.11%).

Conclusions

High seroprevalence of C. burnetii among high-risk occupations is a serious challenge in the Ilam province. In addition, the high seroprevalence of endemic Q fever in rural and nomadic areas and a higher concentration of occupations who are directly engaged with livestock demonstrate the critical need for preventive medicine education and training in regards to mitigating risk for disease contraction in susceptible groups.

Tick-borne zoonoses in the Order Rickettsiales and Legionellales in Iran: A systematic review

BACKGROUND

Tick-borne zoonoses in the Order Rickettsiales and Legionellales cause infections that often manifest as undifferentiated fevers that are not easy to distinguish from other causes of acute febrile illnesses clinically. This is partly attributed to difficulty in laboratory confirmation since convalescent sera, specific diagnostic reagents, and the required expertise may not be readily available. As a result, a number of tick-borne zoonoses are underappreciated resulting in unnecessary morbidity, mortality and huge economic loses. In Iran, a significant proportion of human infectious diseases are tick-borne, with anecdotal evidence suggesting that tick-borne zoonoses are widespread but underreported in the country. Epidemiological review is therefore necessary to aid in the effective control and prevention of tick-borne zonooses in Iran. The aim of this review is to provide an in-depth and comprehensive overview of anaplasmosis, ehrlichiosis, spotted fever group rickettsioses and coxiellosis in Iran.

METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, all relevant publications on tick-borne zoonoses in the Order Rickettsiales and Legionellales in Iran were searched using a number of search terms. The search was confined to authentic resources from repositories of popular data bases among them PubMed, Web of Science, Google Scholar, Science Direct, SpringerLink and SCOPUS. The search items included peer reviewed journals, books and book chapters published between 1996 and 2017.

RESULTS

A total of 1 205 scientific publications and reports were sourced, of which 63 met the search criteria and were reviewed. Of the 63 articles reviewed, 36 (57.1%) reported on coxiellosis, 15 (23.8%) on anaplasmosis, 11 (17.5%) on ehrlichiosis and 1(1.6%) on spotted fever group rickettsiae in a large scale study involving four countries, among them Iran. The existence of tick-borne pathogens in the Order Rickettsiales and Legionellales was confirmed by molecular, serological and microscopic techniques conducted on samples obtained from sheep, cattle, goats, camels, poultry, animal products (milk and eggs), dogs, ticks and even human subjects in different parts of the country; pointing to a countrywide distribution.

DISCUSSION

Based on the review, coxiellosis, anaplasmosis, ehrlichiosis, and SFG rickettsiae can be categorized as emerging tick-borne zoonotic diseases in Iran given the presence of their causiative agents (C. burnetii, A. phagocytophilum, A. marginale, A. bovis, A. ovis, A. central, E. canis, E. ewingii, E. chaffeensis and R. conorii) collectively reported in a variety of domestic animals, animal products, arthropods and human beings drawn from 22 provinces in Iran.

CONCLUSION

Given the asymptomatic nature of some of these zoonoses, there is a high likelihood of silent transmission to humans in many parts of the country, which should be considered a public health concern. Presently, information on the transmission intensity of tick-borne zoonoses caused by pathogens in the Order Rickettsiales and Legionellales to humans and its public health impact in Iran is scanty.

Seroprevalence of Q fever among human and animal in Iran; A systematic review and meta-analysis

BACKGROUND

Q fever is a main zoonotic disease around the world. The aim of this meta-analysis was to estimate the overall seroprevalence of Coxiella burnetii among human and animal population in Iran.

METHODS

Major national and international databases were searched from 2005 up to August 2016. We extracted the prevalence of Q fever antibodies (IgG) as the main primary outcome. We reported the prevalence of the seropositivity as point and 95% confidence intervals.

RESULTS

The overall seroprevalence of IgG phase I and II antibodies of Q fever in human was 19.80% (95% CI: 16.35-23.25%) and 32.86% (95% CI: 23.80-41.92%), respectively. The herd and individual prevalence of C. burnetii antibody in goat were 93.42% (95% CI: 80.23-100.00) and 31.97% (95% CI: 20.96-42.98%), respectively. The herd and individual prevalence of Q fever antibody in sheep's were 96.07% (95% CI: 89.11-100.00%) and 24.66% (95% CI: 19.81-29.51%), respectively. The herd and individual prevalence of C. burnetii antibody in cattle were 41.37% (95% CI: 17.88-64.86%) and 13.30% (95% CI: 2.98-23.62%), respectively. Individual seropositivity of Q fever in camel and dog were 28.26% (95% CI: 21.47-35.05) and 0.55% (0.03-2.68), respectively.

CONCLUSION

Seroprevalence of Q fever among human and domestic animals is considerable. Preventative planning and control of C. burnetii infections in Iran is necessary. Active surveillance and further research studies are recommended, to more clearly define the epidemiology and importance of C. burnetii infections in animals and people in Iran.

Coxiella burnetii Infection Is Lower in Children than in Adults After Community Exposure: Overlooked Cause of Infrequent Q Fever Reporting in the Young

BACKGROUND

Q fever is rarely reported in children/adolescents. Although lower reporting rates are commonly attributed to milder disease and subsequent underdiagnosis in infected children/adolescents, pertinent evidence is scarce. We present data from a large, well-defined single-point source outbreak of Q fever to fill this gap.

METHODS

We compared (A) Q fever testing and notification rates in children/adolescents who were 0-19 years of age with those in adults 20+ years of age in October 2009; (B) serological attack rates of acute Q fever in children/adolescents with the rates in adults after on-source exposure on the outbreak farm's premises; (C) incidence of Q fever infection in children/adolescents with that in adults after off-source exposure in the municipality located closest to the farm.

RESULTS

(A) Children/adolescents represented 19.3% (59,404 of 307,348) of the study area population, 12.1% (149 of 1217) of all subjects tested in October 2009 and 4.3% (11 of 253) of notified laboratory-confirmed community cases. (B) Serological attack rate of acute Q fever in children with on-source exposure was 71% (12 of 17), similar to adults [68% (40 of 59)]. (C) Incidence of infection in children/adolescents after community (off-source) exposure was 4.5% (13 of 287) versus 11.0% (12 of 109) in adults (adjusted odds ratio: 0.36; 95% confidence interval: 0.16-0.84; P = 0.02). No children/adolescents reported clinical symptoms. Proportion of notified infections was significantly lower in children/adolescents (2.5%) than in adults (10.4%; risk ratio: 0.26; 95% confidence interval: 0.08-0.80, P = 0.02).

CONCLUSION

Notified Q fever was less frequent in children/adolescents than in adults. Although underrecognition contributed to this phenomenon, lower rates of infection in children after community exposure played an unexpected major role. On-source (presumed high-dose) exposure, by contrast, was associated with high serological and clinical attack rates not only in adults but also in children/adolescents. Our findings allow for improved age-specific clinical and public health risk assessment in Q fever outbreaks.

An Unusual Manifestation of Q Fever: Peritonitis

Q fever has rarely been reported and can be difficult to diagnose, especially in immunocompromised patients. In the present report, we describe an unusual case of Q fever that presented as peritonitis and was treated with long-term combination therapy with doxycycline, ciprofloxacin and rifampicin for five weeks in a patient who had been on peritoneal dialysis for six years due to hypertensive nephropathy.

Vaccination against Q fever for biodefense and public health indications

Coxiella burnetii is the etiological agent of Q fever, a disease that is often spread to humans via inhalational exposure to the bacteria from contaminated agricultural sources. Outbreaks have been observed all over the world with larger foci generating interest in vaccination programs, most notably in Australia and the Netherlands. Importantly, exposure rates among military personnel deployed to the Middle East can be relatively high as measured by seroconversion to C. burnetii-specific antibodies. Q fever has been of interest to the biodefense community over the years due to its low infectious dose and environmental stability. Recent advances in cell-free growth and genetics of C. burnetii also make this organism easier to culture and manipulate. While there is a vaccine that is licensed for use in Australia, the combination of biodefense- and public health-related issues associated with Q fever warrant the development of a safer and more effective vaccine against this disease.

Seroepidemiological study of Q fever in small ruminants from Southeast Iran

The aim of the present study was to determine the prevalence of Coxiella burnetii antibodies in small ruminants in Southeast Iran. A total of 368 small ruminant blood samples (241 caprine blood samples and 127 ovine blood samples) were collected from January to May of 2011 in Southeast Iran. A commercial ELISA test kit was employed to identify specific antibodies against C. burnetii in the sheep and goats. Seropositivity in the examined counties ranged from 17.1% to 39.2%. Of the animals tested, 97 animals (26.4%), including 43 sheep (33.9%) and 54 goats (22.4%), had antibodies to C. burnetii. The results of the current study reveal the high prevalence of antibody positivity in small ruminants in Southeast Iran. Thus, sheep and goats are important reservoirs in this area. Additionally, we performed a logistic regression to the identify risk factors for positivity and concluded that age was an important risk factor (P<0.001).

Serologic survey for Coxiella burnetii phase II antibodies among slaughterhouse workers in Kerman, southeast of Iran

OBJECTIVE

To determine the presence of antibodies against phase II among slaughterhouse workers in Kerman, southeast of Iran.

METHODS

The antibody titers of the serum samples were measured by enzyme-linked immuno sorbent assay using phase II Coxiella burnetii as the antigen [kit (Virion\Serion, Wurzburg, Germany) according to the manufacturer's protocol].

RESULTS

The positive rate of IgG antibody was 68% in the slaughterhouse workers.

CONCLUSIONS

Our findings suggest that slaughterhouse workers in Kerman area have a higher risk of infection and should consider potential infection with Coxiella burnetii.

Q fever in France, 1985-2009

To assess Q fever in France, we analyzed data for 1985–2009 from the French National Reference Center. A total of 179,794 serum samples were analyzed; 3,723 patients (one third female patients) had acute Q fever. Yearly distribution of acute Q fever showed a continuous increase. Periodic variations were observed in monthly distribution during January 2000–December 2009; cases peaked during April–September. Q fever was diagnosed more often in patients in southeastern France, where our laboratory is situated, than in other areas. Reevaluation of the current positive predictive value of serologic analysis for endocarditis was performed. We propose a change in the phase I (virulent bacteria) immunoglobulin G cutoff titer to >1,600. Annual incidences of acute Q fever and endocarditis were 2.5/100,000 persons and 0.1/100,000 persons, respectively. Cases and outbreaks of Q fever have increased in France.

Low seroprevalence of Q fever in The Netherlands prior to a series of large outbreaks

The Netherlands has experienced large community outbreaks of Q fever since 2007. Sera and questionnaires containing epidemiological data from 5654 individuals were obtained in a nationwide seroprevalence survey used to evaluate the National Immunization Programme in 2006–2007. We tested these sera for IgG phase-2 antibodies against Coxiella burnetii with an ELISA to estimate the seroprevalence and to identify determinants for seropositivity before the Q fever outbreaks occurred. Overall seroprevalence was 1·5% [95% confidence interval (CI) 1·3–1·7]. Corrected for confirmation with immunofluorescence results in a subset, the estimated seroprevalence was 2·4%. Seropositivity ranged from 0·48% (95% CI 0·00–0·96) in the 0–4 years age group to 2·30% (95% CI 1·46–3·15) in the 60–79 years age group. Keeping ruminants, increasing age and being born in Turkey were independent risk factors for seropositivity. The low seroprevalence before the start of the outbreaks supports the hypothesis that The Netherlands has been confronted with a newly emerging Q fever problem since spring 2007.

Low seroprevalence of Q fever in The Netherlands prior to a series of large outbreaks

The Netherlands has experienced large community outbreaks of Q fever since 2007. Sera and questionnaires containing epidemiological data from 5654 individuals were obtained in a nationwide seroprevalence survey used to evaluate the National Immunization Programme in 2006–2007. We tested these sera for IgG phase-2 antibodies against Coxiella burnetii with an ELISA to estimate the seroprevalence and to identify determinants for seropositivity before the Q fever outbreaks occurred. Overall seroprevalence was 1·5% [95% confidence interval (CI) 1·3–1·7]. Corrected for confirmation with immunofluorescence results in a subset, the estimated seroprevalence was 2·4%. Seropositivity ranged from 0·48% (95% CI 0·00–0·96) in the 0–4 years age group to 2·30% (95% CI 1·46–3·15) in the 60–79 years age group. Keeping ruminants, increasing age and being born in Turkey were independent risk factors for seropositivity. The low seroprevalence before the start of the outbreaks supports the hypothesis that The Netherlands has been confronted with a newly emerging Q fever problem since spring 2007.

The first serologic study of Q fever in sheep in Iran

Coxiella burnetii is an obligate intracellular microorganism that causes Q fever in humans and animals. In ewes, C. burnetii infections are generally asymptomatic, but they can lead to abortions, stillbirths, and delivery of weak and unviable lambs. Serological assays are suitable for screening herds. Enzyme-linked immunosorbent assays (ELISA) technique has a high sensitivity and a good specificity. The aim of this study was to investigate the presence of anti-C. burnetii antibodies among sheep in southeast Iran. A total of 85 serum samples were collected from ten sheep flocks from April to September 2009. Serum samples were tested for Q fever antibodies using a commercial indirect ELISA kit. Antibodies were detected in 25 sera (29.42%) of 85 samples. Sixteen female (18.82%) and nine male (10.58%) cases had antibodies specific to C. burnetii. There is significant difference in seropositivity between male and female groups (P < 0.05). This first study of C. burnetii seroprevalence in sheep in southeast Iran has indicated that seropositive animals can be found throughout the country. Further work is now required to characterize the epidemiology of the infection more thoroughly.