Molecular prevalence of Coxiella burnetii in milk in Iran: a systematic review and meta-analysis

Epidemiological and molecular survey of Coxiella burnetii from the serum of patients suspected of brucellosis in west of Iran

Q fever is a global bacterial disease that affects both humans and animals. The etiological agent of the disease is Coxiella burnetii. The aim of the investigation was to detect the existence of C. burneti in the serum samples of patients with symptoms of fever and suspicion of brucellosis in the west of Iran. In the current survey, 150 Wright agglutination assay were collected from health centers in Lorestan, Hamadan, Ilam, Kermanshah, and Kurdistan provinces in 2023. DNA was extracted from all these samples, which were taken from individuals suspected of having brucellosis. Then, a nested PCR reaction was applied to diagnose C. burnetii for the transposon gene IS1111. The IS1111 gene replication assays, indicated that 3.3 % (95 % CI: 1.43 %-3.33 %) of the tested serum samples, were positive for C. burnetii. The highest prevalence of C. burnetii infection was found in the Kurdistan province at 6.67 % (95 % CI: 1.85 %-21.33 %). Additionally, a high affinity (ranging from 99 % to 100 %) was recognized among the IS1111 gene sequenced in the present study and those from different area around the world. These results provide strong evidence that individuals with brucellosis in west of Iran may also have C. burnetii co-infection with coxiellosis. Therefore, it is important to consider Q fever as a co-infection in patients suspected of brucellosis.

Prevalence of Coxiella burnetii in unpasteurized dairy products in west of Iran

Q fever is a zoonotic disease caused by Coxiella burnetii. This study investigated the prevalence of C. burnetii in traditional dairy products, specifically yogurt and cheese, in Lorestan Province. A total of 100 samples of traditional yogurt and unpasteurized cheese were collected from various regions. To analyze the genome of C. burnetii, DNA was purified and molecular detection was performed using nested PCR with primers specific to the IS1111 transposon gene. The results revealed a prevalence of 13.3 % (95 % CI: 6.9 %-24.16 %) in yogurt samples and 12.5 % (95 % CI: 5.46 %-26.11 %) in cheese samples. Additionally, a significant seasonal variation in contamination levels was observed, with a p-value of less than 0.05. However, no significant correlation was found between geographical location and the degree of contamination. These findings suggest that the contamination of dairy products with C. burnetii is likely due to the bacterium's 'spore-like' form and the lack of pasteurization in the traditional production of yogurt and cheese. While the direct risk of transmission via unpasteurized dairy products is considered low, these products should still be monitored in Q fever outbreaks.

Molecular detection and phylogeny analysis of Coxiella burnetii detected from cattle and buffalo milk based on plasmid cbhE gene in West Azerbaijan of Iran

Humans and animals may get Q fever, which is caused by the Gram-negative coccobacillus Coxiella burnetii. The symptoms of Q fever may include a self-limiting febrile illness, pneumonia, endocarditis, or hepatitis. Infections are classified as either acute or persistent. Cattle, sheep, and goats are the most prevalent reservoir animals for this zoonosis. This research was conducted to identify C. burnetii using transposable and isocitrate dehydrogenase genes (IS1111, icd) and QpH1 plasmids. A total of 142 samples of raw buffalo and cow milk were collected from various locations within the West Azerbaijan region (see map). We used "nested" PCR techniques using primers based on the IS1111 and icd genes of C. burnetii, as well as conserved and variable portions of plasmid sequences, to identify C. burnetii and their plasmids in milk samples from buffalo and calves. Out of 142 milk samples that were positive for the chromosomal transposable genes (IS1111 and icd) at a rate of 16.9 percent (95 percent CI: 14.5 percent to 19.6 percent) and 7.1 % (95 percent CI: 5.59 percent to 9.08 percent), respectively, 86 samples were positive for the QpH1 plasmid at a rate of 60.5 percent (95 percent CI: 52.35 percent to 68.2 percent). Based on a phylogenetic study of the icd and QpH1 genes, the majority of the isolates had a similarity of 99.45-99.9 percent. Conclusion: It was determined that the buffalo population in West Azerbaijan province represents a significant epidemiological factor with respect to Q fever and consequently public health.

Molecular investigation of Coxiella burnetii in aborted fetus of small ruminants in southeast Iran

The domestic animal, known as a main reservoir of Coxiella burnetii, is susceptible to the occurrence of coxiellosis, which can lead to abortions in domestic animals, causing significant economic damage and posing risks to human health. Therefore, the purpose of this study is to investigate C. burnetii as the causative agent of Q fever in abortion samples of small ruminants in southeastern Iran. This study was conducted between 2020 and 2021 in Zarand city, located in Kerman province (southeast Iran). In this study, 50 abomasum swab samples of aborted sheep and goat fetuses were collected and analyzed using molecular methods to identify C. burnetii. The results revealed that 26% (n: 13) of the collected abortion samples were infected with C. burnetii. Among the positive samples, two (50%) belonged to goat abortion samples while 11 (23.9%) belonged to sheep abortion samples. This study demonstrates that C. burnetii is one of the causes of abortion in small ruminants in southeastern Iran. It is recommended to pay more attention to C. burnetii in domestic animals due to its significant economic impact on livestock and its potential implication for human health in Iran.

Molecular detection of Coxiella burnetii in ticks collected from Iran

The present study was conducted with the aim of investigating the prevalence and genetic structure of Coxiella burnetii in tick samples collected from domestic animals in Hormozgan province146 tick samples were randomly collected from cattle, sheep, goat, camel and dog herds in seven cities of Hormozgan. After the DNA was extracted from each tick sample; Nested-PCR method was used to identify the presence of C. burnetii using IS1111 transposon gene and isocitrate dehydrogenase icd gene. In addition, phylogenetic analysis and tree diagram were constructed based on IS1111 and icd genes. The results showed that out of 146 pool tick samples, 40 pool samples based on IS1111 gene and 32 pool samples based on icd gene were infected with C. burnetii. When results were stratified by livestock type, infection rates were highest in sheep ticks (37.5%, 95% CI: 21.2% - 57.29%), followed by cattle ticks (32.14%, 95% CI: 17.90% - 50.66%) and dog tick (15%, 95% CI: 70.6% - 29%). In camel and goat ticks, the infection rate was 15.90 and 23.07%, respectively. In conclusion, this study emphasizes the role of ticks as potential carriers of C. burneti. The results indicate the importance of cattle, sheep, goats, camels and dogs in Hormozgan region as effective factors in the epidemiology of Q fever and its impact on public health. In addition, a high degree of similarity (from 99% to 100%) was observed between IS1111 and icd genes in this study and recorded sequences from different regions of the world.

Genotyping and phylogenetic analysis of Coxiella burnetii in domestic ruminant and clinical samples in Iran: insights into Q fever epidemiology

Coxiella burnetii, a zoonotic pathogen, is the causative agent of Q fever, an endemic disease in Iran. However, there is currently a lack of available data on the genotypes of C. burnetii in the country. Here, we typed 26 C. burnetii isolates detected in milk, abortion, cotylodon, and cardiac valve samples from various geographical areas and hosts (7 cattle, 8 goats, 10 sheep, and 1 human) using Multilocus Variable Number Tandem Repeat Analysis (MLVA/VNTR) with five loci:ms24, ms27, ms28, ms33, and ms34. As IS1111 was observed to be spontaneously inserted in locus ms23 across all of our examined C. burnetii samples, five loci were employed for MLVA/VNTR genotyping. Among the 26 C. burnetii strains, 22 distinct genotypes (A-V) were identified in the discriminative loci. In silico analysis categorized Iranian C. burnetii strains into five genomic groups along with seven singletons, representing 11 exiting clonal complexes worldwide. Clusters 10 and 11 exclusively consisted of Iranian samples. These findings revealed high genotyping diversity among C. burnetii isolates in Iran. The genotypes circulating in Iran differed significantly from those found in other regions worldwide. To gain a comprehensive understanding of Q fever epidemiology in Iran, it is crucial to conduct large-scale studies that assess the distribution of C. burnetii genotypes across different geographical areas, hosts, and sources.

Molecular investigation of Coxiella burnetii and Francisella tularensis infection in ticks in northern, western, and northwestern Iran

Tularemia and Q fever are endemic diseases in Iran; however, little information is available on the prevalence of the causative agents, Coxiella burnetii and Francisella tularensis, in Iranian ticks. This study investigated C. burnetii and F. tularensis among hard ticks in this country. We collected ticks from livestock and other mammals in Guilan, Mazandaran, Golestan (northern Iran), Kurdistan (western Iran), and West Azerbaijan (northwestern Iran) provinces. Genomic DNA from collected ticks was extracted and screened for C. burnetii and F. tularensis using Real-time PCR. A total of 4,197 ticks (belonging to 12 different species) were collected, and Ixodes ricinus (46.4%), Rhipicephalus turanicus (25%), and Rhipicephalus sanguineus sensu lato (19.1%) were the most collected species. Of 708 pooled tick samples, 11.3% and 7.20% were positive for C. burnetii and F. tularensis, respectively. The genus of Rhipicephalus had the highest (18.3%) C. burnetii infection among the collected tick pools (P<0.001). Furthermore, the most positive pools for F. tularensis belonged to Haemaphysalis spp. (44.4%). Kurdistan had the most significant percentage of C. burnetii-infected ticks (92.5%), and there was a meaningful relationship between the provinces and the infection (P< 0.001). The ticks from Golestan exhibited the highest F. tularensis infection rate (10. 9%), and the infection showed no significant relationship with the provinces (P = 0.19). Ticks collected from grasslands had a higher Coxiella burnetii infection rate than those collected from animals (39.4% vs. 7.9%; p<0.01). However, ticks collected from animal surfaces had a slightly higher rate of Francisella tularensis infection than those collected from grasslands (7.6% vs. 3.9%; p = 0.24). Here, we demonstrated the presence of both pathogens in the north (Guilan, Mazandaran, and Golestan provinces), the west (Kurdistan province), and the northwest (West Azerbaijan province) of Iran. The public health system should pay particular attention to tick bites in veterinary medicine and humans.

A cross-sectional study of Q fever in Camels: Risk factors for infection, the role of small ruminants and public health implications for desert-dwelling pastoral communities

Q fever represents an important 'neglected zoonosis', with high prevalences recorded across the Middle East region. Among rural desert-dwelling communities in the region, camel milk is largely consumed raw, due to perceptions of dromedaries as a uniquely clean livestock species mentioned in the Qur'an and Islamic hadith, while milk from other livestock species is usually boiled. As a result, camels present a unique public health threat among such communities from milk-borne pathogens, including Coxiella burnetii. In view of this, a cross-sectional study was conducted among dromedary herds in southern Jordan between September 2017 and October 2018, including 404 camels from 121 randomly selected herds. In addition, 510 household members associated with these herds were interviewed regarding potential high-risk practices for zoonotic transmission. Weight adjusted camel population seroprevalence for C. burnetii was 49.6% (95% CI: 44.7-54.5), with evidence of maternally derived immunity in calves ≤6 months old. Adjusted herd-level prevalence was 76.0% (95% CI 72.7-80.2). It was estimated 30.4% (144/477) of individuals consumed raw milk from infected herds monthly or more. Following multivariable logistic regression analysis, seropositive status in camels was found to be associated with increasing age, high herd tick burdens, keeping the herd together throughout the year including when calving, and owning larger (>50) sheep and goat flocks, with goats presenting a higher risk than sheep. Racing camel status was found to be protective. Socioculturally appropriate interventions aimed at raising awareness of potential risks associated with drinking raw camel milk, alongside appropriate livestock management interventions, should be considered.

Comprehensive analysis of PTPN gene family revealing PTPN7 as a novel biomarker for immuno-hot tumors in breast cancer

Background: The non-receptor protein tyrosine phosphatase (PTPN) gene family has been considered to be involved in the oncogenesis and development of multiple cancers. However, its prognostic utility and immunological relevance in breast cancer (BrCa) have not been clarified.

Methods: A transcriptional level interpretation of the expressions and prognostic values was analyzed using the data from The Cancer Genome Atlas (TCGA) cohort. In addition, GO and DAVID pinpoint the functional enrichment of PTPNs. Moreover, the immune correlations of PTPN7 in BrCa and pan-cancer were further investigated based on the TCGA cohort and were testified using the in-house and the Gene Expression Omnibus (GEO) cohorts.

Results: For systematic analysis of the PTPN family, we found that the expression levels of PTPN1, PTPN6, PTPN7, PTPN18, PTPN20, and PTPN22 was promoted in tumor tissues while comparing with paraneoplastic tissues during our study. We further investigated their functions and protein-protein interactions (PPI), and these results strongly suggested that PTPN family was associated with protein dephosphorylation. Next, we performed an immunological relevance analysis and found that PTPN7 was correlated with immune infiltration, suggesting a stronger association of PTPN7 with immuno-hot tumors in BrCa. In addition, results from the in-house cohort confirmed the positive correlation between PTPN7 and PD-L1. The pan-cancer analysis revealed that PTPN7 was related to PD-L1 and CTLA-4 expression in almost all cancer types. Finally, the predictive value of PTPN7 for immunotherapy was significant in two independent GEO cohorts.

Conclusion: In conclusion, this is the first extensive research on the correlation between PTPN family expression and immune characterization in BrCa. As results, PTPN7 expression is associated with immuno-hot tumors and could be a promising predictive biomarker for immunotherapy in not only BrCa but multiple cancers.

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.

Q Fever Endocarditis in Northeast Iran

This report presents a case of chronic Q fever endocarditis. A 60-year-old male farmer and rancher was admitted to the hospital with symptoms of weight loss, fever, severe sweating, weakness, and anorexia. PCR was negative for C. burnetii in the blood sample, but phase I and II IgG antibodies against C. burnetii were positive (1 : 16384 and 1 : 2048, respectively) by the indirect immunofluorescent assay (IFA). According to the adjusted Duke criteria, Q fever endocarditis was confirmed, and the patient was successfully treated with doxycycline and hydroxychloroquine.

Identification of Coxiella burnetii in Raw Milk of Livestock Animal in Iran

Coxiella burnetii is the causative agent of Q fever in humans and animals. This study aimed to determine the frequency of C. burnetii in milk samples of dairy animals (goats, sheep, and cattle) in some selected regions in Iran, where there is no information about prevalence of C. burnetii. In this study, 162 individual milk samples were collected from 43 farms in three provinces (Tehran, Hamadan, and Mazandaran). Real-time PCR was used for the detection of IS1111a element of C. burnetii. In total, 23 of 162 samples (14.2%, 95% confidence interval (CI): 9.65–20.2%) were positive for C. burnetii by real-time PCR. C. burnetii was detected in 10.17% (95% CI: 4.74–20.46) of goat milk samples. In sheep milk samples, 18.6% (95% CI: 9.74–32.62) were positive, and C. burnetii was detected in 15% (95% CI: 8.1–26.11) of cattle milk samples. Molecular evidence of the presence of C. burnetii was seen in milk samples of dairy animals in all the studied regions. These findings demonstrated that C. burnetii infection, especially in raw milk samples, deserves more attention from the health care system and veterinary organization in Iran.

First isolation and molecular phylogenetic analysis of Coxiella burnetii in lactating cows

Q fever is an infectious disease of animals and humans, caused by globally distributed C. burnetii. In Iraq, there are no previous studies associated with the detection of the organism in cattle. An overall of 130 lactating cows were submitted to direct collection of milk samples. Initially, the samples of milk were tested using the molecular polymerase chain reaction (PCR) assay targeting three genes (16S rRNA, IS1111a transposase, and htpB). However, positive results (18.46%; 24/130) were detected only with the 16s rRNA gene. Concerning risk factors, the highest prevalence of C. burnetii was showed in the district of Badra (42.86%), whereas the lowest - in Al-Numaniyah and Al-Suwaira districts (P=0.025). There was no significant variation in positivity between the months of sampling period (P=0.082) and between age groups (P=0.076). Crossbred cows (20.69%) showed a higher positivity than local and pure breeds (P=0.043). Milk of positive samples (n=24) was used for cultivation of C. burnetii into specific pathogen free-embryonated chicken eggs (SPF-ECEs). After three passages into SPF-ECEs, contents of yolk sac were collected, subjected for DNA extraction, and re-tested by PCR assay using the primer of 16s rRNA gene only. Of 24 cultivated milk samples, 12.5% (3/24) were positive for C. burnetii. Finally, the positive local isolates were analysed phylogenetically and reported in NCBI-Genbank under the accession numbers of MN121700.1, MN121701.1, and MN121702.1. In conclusion, this is a unique study as it detected C. burnetii in Iraqi lactating cows, and confirmed that organism was shed actively through milk, suggesting that these animals can play a role as a reservoir for organism with potential risk for transmission of infection from these animals to humans as well as to other animal species.

Current approaches for the detection of Coxiella burnetii infection in humans and animals

Q fever (coxiellosis), caused by Coxiella burnetii, is an emerging or re-emerging zoonotic disease of public health significance and with worldwide distribution. As a causal agent of the one among the 13 global priority zoonoses, having the infectious dose as low as one bacterium, C. burnetii has been regarded as an obligate intracellular bacterial pathogen. The agent has been classified as a Group B bioterrorism agent by the Centre for Disease Control and Prevention (CDC), and the disease is included in the World Organisation for Animal Health (OIE) list of notifiable diseases. It is mainly transmitted through airborne route in humans and animals. Isolation of C. burnetii, using standard routine laboratory culture techniques was impossible until formulation of axenic-based medium. However, it is still to be included among routinely isolated laboratory pathogen, accounting prolonged incubation period (~7 days) and requirement of specific oxygen concentration (2.5% O₂). Therefore, indirect diagnostic tools have been mainly used for its diagnosis. So far serology has been mostly used for testing for C. burnetii infection. The detection of C. burnetii DNA by PCR in various clinical samples have also been widely used. The disease has remained largely under-reported, underdiagnosed and as a masked zoonosis; and therefore, needs to be explored through well-planned scientific studies for knowing its true status and likely it impact in humans and animals by employing state-of-the-art diagnostics, identifying its diverse and new host range, as well as risk factors involved in different geo-climatic, behavioural and social settings as well as risk groups. Here, we reviewed the current approaches used for the detection of C. burnetii infection in humans and animals at the population and individual level.

Molecular detection of Coxiella burnetii in horse sera in Iran

Coxiella burnetii is a zoonotic bacterium that can infect a wide range of animals including horses. However, its circulation dynamics in and through horses are still unclear. The aim of this study was to evaluate prevalence of C. burnetii and its genomic characteristics in horse sera samples in the North of Iran (Golestan Province). The samples were collected in 2018 and the age, sex, and breed of each animal were recorded. Nested-PCR was used to detect C. burnetii based on the presence of the transposable gene IS1111. The results showed that 7.50 % (P < 0.05; 95 % CI: 0.5 %-0.12 %) of the examined sera samples were positive for C. burnetii. Based on the resuls, prevalence of C. burnetii in the age groupof < Years 1-5 (p-value <0.05, 95 % CI: 1 %-8 %) was less than the age group of >6 years old (p-value <0.05, 95 %, CI: 7 %-19.8 %). In previous studies, it was concluded that the horses' population in Golestan Province should be considered as an important factor in the epidemiology of Q fever and consequently in public health. Further studies should be implemented to evaluate if horses may be relevant indicators of zoonotic risk in urban and suburban endemic areas.

Seroprevalence of Five Zoonotic Pathogens in Wild Ruminants in Xinjiang, Northwest China

Wild ruminants are at risk for zoonotic pathogen infection as a result of interactions with domestic animals and humans. One way to assess the level of a wild ruminant disease in a population is to determine the seroprevalence of the pathogen of interest. The objective of this study was to determine the seroprevalence of five zoonotic pathogens in wild ruminants in Xinjiang, Northwest China. In 2009 and 2011-2015, 258 wild ruminant sera samples were collected from various species. Samples were obtained from 30 Siberian ibexes, 94 goitered gazelles, 6 Tibetan antelopes, 32 argali sheep, 16 roe deer, 20 blue sheep, 56 red deer, and 4 wild yaks, in 10 regions of Xinjiang. Samples were tested using antibodies against Brucella spp., Chlamydophila abortus, Coxiella burnetii, Toxoplasma gondii, and West Nile virus. Seropositivity was detected for all five pathogens, with detection rates of Brucella spp., C. abortus, C. burnetii, T. gondii, and West Nile virus of 2.3% (95% confidence interval [CI], 0.5-4.2%), 6.2% (95% CI, 3.3-9.1%), 7.8% (95% CI, 4.5-11.0%), 2.3% (95% CI, 0.5-4.2%), and 0.8% (95% CI, 0-1.8%), respectively. The level of pathogens differed for different species and different regions. The results indicate that seropositivity to zoonotic pathogens is common among wild ruminants in Xinjiang, Northwest China, with C. burnetii and C. abortus detected at the highest levels. This study provides a baseline for future assessment of spillover events.

Prevalence of Coxiella burnetii in milk collected from buffalo (water buffalo) and cattle dairy farms in Northwest of Iran

The present study was conducted to determine the prevalence of C. burnetii in raw milk samples collected from water buffalos and cattle in Northwest of Iran (West Azerbaijan Province). A total number of 840 milk samples were randomly collected from buffalos and cattle belonged to three different geographical regions in west Azerbaijan (the map is necessary). The milk samples were collected seasonally during 2018 and the age of animals were recorded. All the milk samples were subjected to DNA extraction. Nested-PCR was used to detect C. burnetii based on the transposable gene IS1111. The results showed that 16.9% (95% CI: 14.5%-19.6%) of the examined milk samples (19.3% buffalo and 14.6% cattle samples) were positive for C. burnetii. There was a significant difference in C. burnetii shedding in milk between different age groups in cattle but not in buffalos (p value <0.05). The shedding of C. burnetii in milk was highly prevalent in summer (31.1%) (p < 0.05, 95% CI: 26.1%-38.4%). There were significant regional and seasonal variations in the prevalence of C. burnetii in the examined milk samples. It was concluded that buffalo population in west Azerbaijan should be considered as an important factor in the epidemiology of Q fever and consequently in public health.