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Bitsori M, Vergadi E, Germanakis I, Raissaki M, Galanakis E. Case Report: Α Case of Endocarditis and Embolic Stroke in a Child, Suggestive of Acute Q Fever Infection. Am J Trop Med Hyg 2020; 103:1435-1438. [PMID: 32748780 DOI: 10.4269/ajtmh.19-0932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Acute Q fever is usually asymptomatic or is associated with a mild self-limited course and a favorable outcome. The occurrence of endocarditis during acute infection by Coxiella burnetii is an emerging clinical entity observed in adults that has been attributed to an autoimmune complication of early infection. Herein, we report the first case of a previously healthy 2-year-old child with endocarditis complicated by septic embolic stroke, in which the identified microbiological evidence was suggestive of acute rather than chronic C. burnetii infection. The development of endocarditis in this case occurred in the absence of any autoimmune reaction, but in the context of a very mild form of congenital heart disease, a small ventricular septal defect, which might serve as a predisposing factor for endocarditis. This case suggests that acute Q fever endocarditis may affect children as well and can be attributed not only to autoimmune mechanisms but also to a potential effect of the infectious agent per se on the cardiac endothelium in patients with underlying heart defects, regardless of their severity.
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Affiliation(s)
- Maria Bitsori
- Department of Paediatrics, Heraklion University Hospital, Medical School, University of Crete, Heraklion, Greece
| | - Eleni Vergadi
- Department of Paediatrics, Heraklion University Hospital, Medical School, University of Crete, Heraklion, Greece
| | - Ioannis Germanakis
- Department of Paediatrics, Heraklion University Hospital, Medical School, University of Crete, Heraklion, Greece
| | - Maria Raissaki
- Department of Radiology, Heraklion University Hospital, Medical School, University of Crete, Heraklion, Greece
| | - Emmanouil Galanakis
- Department of Paediatrics, Heraklion University Hospital, Medical School, University of Crete, Heraklion, Greece
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Devaux CA, Osman IO, Million M, Raoult D. Coxiella burnetii in Dromedary Camels ( Camelus dromedarius): A Possible Threat for Humans and Livestock in North Africa and the Near and Middle East? Front Vet Sci 2020; 7:558481. [PMID: 33251255 PMCID: PMC7674558 DOI: 10.3389/fvets.2020.558481] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/28/2020] [Indexed: 01/09/2023] Open
Abstract
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.
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Affiliation(s)
- Christian A. Devaux
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
- CNRS, Marseille, France
| | - Ikram Omar Osman
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
- Faculty of Sciences Ben-Ben-M'Sik, University Hassan II, Casablanca, Morocco
| | - Matthieu Million
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Didier Raoult
- Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
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Psaroulaki A, Mathioudaki E, Vranakis I, Chochlakis D, Yachnakis E, Kokkini S, Xie H, Tsiotis G. In the Search of Potential Serodiagnostic Proteins to Discriminate Between Acute and Chronic Q Fever in Humans. Some Promising Outcomes. Front Cell Infect Microbiol 2020; 10:557027. [PMID: 33072625 PMCID: PMC7531360 DOI: 10.3389/fcimb.2020.557027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/12/2020] [Indexed: 12/19/2022] Open
Abstract
Coxiella burnetii is the agent that causes acute and chronic Q fever infections in humans. Although the isolates studied so far have shown that the two forms of the disease differ in virulence potential thus, implying a variance in their proteomic profile, the methods used do not deliver enough discriminatory capability and often, human infections may be mis-diagnosed. The current study adds further knowledge to the results that we have already published on the Coxiella outer membrane protein 1 (Com1). Herein we identified the proteins GroEL, Ybgf, OmpH, and UPF0422 as candidates for serodiagnostics of Q fever; following cloning, expression and purification they were further used as antigens in ELISA for the screening of patients' sera associated with chronic Q fever endocarditis, sera negative for phase I IgG, sera with at least one sample positive for phase I IgG and sera from patients who suffered from various rheumatic diseases. Blood donors were used as the controls. Sensitivity, specificity, positive predictive value, negative predictive value, and Cohen's kappa coefficient (κ) were calculated and we also performed binary logistic regression analysis to identify combinations of proteins with increased diagnostic yield. We found that proteins GroEL and Ybgf, together with Com1, play the most significant role in the correct diagnosis of chronic Q fever. Of these three proteins, it was shown that Com1 and GroEL present the highest sensitivity and specificity altogether. The results add to the existing knowledge that an antigen-based serodiagnostic test that will be able to correctly diagnose chronic Q fever may not be far from reality.
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Affiliation(s)
- Anna Psaroulaki
- Department of Clinical Microbiology and Microbial Pathogenesis, School of Medicine, University of Crete, Heraklion, Greece
| | - Eirini Mathioudaki
- Laboratory of Biochemistry, Department of Chemistry, School of Science and Engineering, University of Crete, Heraklion, Greece
| | - Iosif Vranakis
- Department of Clinical Microbiology and Microbial Pathogenesis, School of Medicine, University of Crete, Heraklion, Greece
| | - Dimosthenis Chochlakis
- Department of Clinical Microbiology and Microbial Pathogenesis, School of Medicine, University of Crete, Heraklion, Greece
| | - Emmanouil Yachnakis
- Unit of Biomedical Data Analysis, Department of Mother and Child Health, University of Crete, Heraklion, Greece
| | - Sofia Kokkini
- Department of Clinical Microbiology and Microbial Pathogenesis, School of Medicine, University of Crete, Heraklion, Greece
| | - Hao Xie
- Max Planck Institute of Biophysics, Frankfurt, Germany
| | - Georgios Tsiotis
- Laboratory of Biochemistry, Department of Chemistry, School of Science and Engineering, University of Crete, Heraklion, Greece
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Vranakis I, Kokkini S, Yachnakis E, Tselentis Y, Chochlakis D, Psaroulaki A. Q fever in Greece: Findings of a 13 years surveillance study. Comp Immunol Microbiol Infect Dis 2020; 69:101340. [PMID: 32014623 DOI: 10.1016/j.cimid.2019.101340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 07/12/2019] [Accepted: 07/26/2019] [Indexed: 10/25/2022]
Abstract
Q fever is an endemic disease in different parts of Greece. The current study aimed to investigate the prevalence of acute Q fever disease in Greece through the operation of the national reference centre for Q fever. A total of 5397 sera were received from febrile patients under the suspicion of Q fever infection during a 13 years period (2001-20013). A questionnaire was filled in by the clinicians containing certain clinical/epidemiological/demographic information. The diagnosis was based both on IFA (IgG and IgM phase II antibodies against Coxiella burnetii) and on molecular means. A total of 685 (12.7 %) samples were initially tested positive for acute Q fever. The mean (±SD) age of patients was 55.3 years (±18.7). Out of the 489 convalescent samples, 134 (27.4 %) samples indicated a minimum of a four-fold seroconversion and were considered as laboratory confirmed cases of acute Q fever. Pneumonia was the most frequently encountered clinical symptom with presence in 6.8 % of all positive samples. Forty six (46) patients were laboratory confirmed as chronic Q fever cases. Climate seemed to influence the distribution of Q fever cases throughout the years. The findings of the current study comply with past studies carried out elsewhere that had demonstrated a clear relation of the disease with temperature, south winds, etc. This study represents the first large scale attempt to gather a long period information on Q fever infection in Greece. The findings of the current study support the fact that Q fever is an important endemic zoonotic disease in Greece and needs increased awareness by clinical physicians and health care system.
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Affiliation(s)
- Iosif Vranakis
- Laborotary of Clinical Microbiology and Microbial Pathogenesis, Parasitology, Zoonoses and Geographical Medicine, School of Medicine, University of Crete, Heraklion, Crete, 71100, Greece
| | - Sofia Kokkini
- Laborotary of Clinical Microbiology and Microbial Pathogenesis, Parasitology, Zoonoses and Geographical Medicine, School of Medicine, University of Crete, Heraklion, Crete, 71100, Greece
| | - Emmanouil Yachnakis
- Laborotary of Clinical Microbiology and Microbial Pathogenesis, Parasitology, Zoonoses and Geographical Medicine, School of Medicine, University of Crete, Heraklion, Crete, 71100, Greece
| | - Yannis Tselentis
- Laborotary of Clinical Microbiology and Microbial Pathogenesis, Parasitology, Zoonoses and Geographical Medicine, School of Medicine, University of Crete, Heraklion, Crete, 71100, Greece
| | - Dimosthenis Chochlakis
- Laborotary of Clinical Microbiology and Microbial Pathogenesis, Parasitology, Zoonoses and Geographical Medicine, School of Medicine, University of Crete, Heraklion, Crete, 71100, Greece
| | - Anna Psaroulaki
- Laborotary of Clinical Microbiology and Microbial Pathogenesis, Parasitology, Zoonoses and Geographical Medicine, School of Medicine, University of Crete, Heraklion, Crete, 71100, Greece.
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BRANDWAGT DAH, HERREMANS T, SCHNEEBERGER PM, HACKERT VH, HOEBE CJPA, PAGET J, VAN DER HOEK W. Waning population immunity prior to a large Q fever epidemic in the south of The Netherlands. Epidemiol Infect 2016; 144:2866-72. [PMID: 27075042 PMCID: PMC9150411 DOI: 10.1017/s0950268816000741] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 02/11/2016] [Accepted: 03/22/2016] [Indexed: 11/07/2022] Open
Abstract
Historical survey data suggest that the seroprevalence of antibodies against Coxiella burnetii in the general population of The Netherlands decreased from more than 40% in 1983 to 2·4% in 2007, just before the start of the large 2007-2010 Q fever epidemic. To assess whether the sharp decline in seroprevalence was real, we performed a cross-sectional study using historical samples. We tested samples using a contemporary commercial indirect immunofluorescence assay. In plasma samples from the south of The Netherlands from 1987, we found an age- and sex-standardized seroprevalence of 14·4% (95% confidence interval 11·2-18·3). This was significantly lower than a 1983 estimate from the same area (62·5%), but significantly higher than 2008 (1·0%) and 2010 (2·3%) estimates from the same area. The study suggests that there was a steady and sharp decline in Q fever seroprevalence in the south of The Netherlands from 1987 to 2008. We assume that seroprevalence has decreased in other parts of The Netherlands as well and seroprevalence surveys in other European countries have shown a similar declining trend. Waning population immunity in The Netherlands may have contributed to the scale of the 2007-2010 Q fever epidemic. For a better understanding of the infection dynamics of Q fever, we advocate an international comparative study of the seroprevalence of C. burnetii.
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Affiliation(s)
- D. A. H. BRANDWAGT
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands
- Municipal Health Service (GGD) region Utrecht, Zeist, The Netherlands
| | - T. HERREMANS
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - P. M. SCHNEEBERGER
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, ’s-Hertogenbosch, The Netherlands
| | - V. H. HACKERT
- South Limburg Public Health Service, Geleen, The Netherlands
- Maastricht University Medical Centre, School of Public Health and Primary Care, Maastricht, The Netherlands
| | - C. J. P. A. HOEBE
- South Limburg Public Health Service, Geleen, The Netherlands
- Maastricht University Medical Centre, School of Public Health and Primary Care, Maastricht, The Netherlands
| | - J. PAGET
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - W. VAN DER HOEK
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands
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Abstract
From 2007 to 2010, The Netherlands experienced a major Q fever outbreak with more than 4000 notifications. Previous studies suggested that Q fever patients could suffer long-term post-infection health impairments, especially fatigue. Our objective was to assess the Coxiella burnetii antibody prevalence and health status including fatigue, and assess their interrelationship in Herpen, a high-incidence village, 7 years after the outbreak began. In 2014, we invited all 2161 adult inhabitants for a questionnaire and a C. burnetii indirect fluorescence antibody assay (IFA). The health status was measured with the Nijmegen Clinical Screening Instrument (NCSI), consisting of eight subdomains including fatigue. Of the 70·1% (1517/2161) participants, 33·8% (513/1517) were IFA positive. Of 147 participants who were IFA positive in 2007, 25 (17%) seroreverted and were now IFA negative. Not positive IFA status, but age <50 years, smoking and co-morbidity, were independent risk factors for fatigue. Notified participants reported significantly more often fatigue (31/49, 63%) than non-notified IFA-positive participants (150/451, 33%). Although fatigue is a common sequel after acute Q fever, in this community-based survey we found no difference in fatigue levels between participants with and without C. burnetii antibodies.
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Morroy G, van der Hoek W, Albers J, Coutinho RA, Bleeker-Rovers CP, Schneeberger PM. Population Screening for Chronic Q-Fever Seven Years after a Major Outbreak. PLoS One 2015; 10:e0131777. [PMID: 26132155 PMCID: PMC4489093 DOI: 10.1371/journal.pone.0131777] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/05/2015] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION From 2007 through 2010, the Netherlands experienced a large Q-fever epidemic, with 4,107 notifications. The most serious complication of Q-fever is chronic Q-fever. METHOD In 2014, we contacted all 2,161 adult inhabitants of the first village in the Netherlands affected by the Q-fever epidemic and offered to test for antibodies against Coxiella burnetii using immunofluorescence assay (IFA) to screen for chronic infections and assess whether large-scale population screening elsewhere is warranted. RESULTS Of the 1,517 participants, 33.8% were IFA-positive. Six IFA-positive participants had an IgG phase I titer ≥1:512. Two of these six participants were previously diagnosed with chronic Q-fever. Chronic infection was diagnosed in one of the other four participants after clinical examination. CONCLUSIONS Seven years after the initial outbreak, seroprevalence remains high, but the yield of screening the general population for chronic Q-fever is low. A policy of screening known high-risk groups for chronic Q-fever in outbreak areas directly following an outbreak might be more efficient than population screening. A cost-effectiveness analysis should also be performed before initiating a population screening program for chronic Q-fever.
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Affiliation(s)
- Gabriëlla Morroy
- Department of Infectious Disease Control, Municipal Health Service Hart voor Brabant, 's-Hertogenbosch, the Netherlands
- Department of Primary and Community Care, Academic Collaborative Centre AMPHI, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wim van der Hoek
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Jelle Albers
- Department of Infectious Disease Control, Municipal Health Service Hart voor Brabant, 's-Hertogenbosch, the Netherlands
| | - Roel A. Coutinho
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands
| | - Chantal P. Bleeker-Rovers
- Department of Internal Medicine, Division of Infectious Diseases, Radboud Expertise Center for Q-fever, Radboud university medical center, Nijmegen, the Netherlands
| | - Peter M. Schneeberger
- Department of Medical Microbiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
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Antibody kinetics in serological indication of chronic Q fever: the Greek experience. Int J Infect Dis 2013; 17:e977-80. [PMID: 23773241 DOI: 10.1016/j.ijid.2013.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 04/08/2013] [Accepted: 04/25/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Q fever caused by the pathogen Coxiella burnetii may have both acute and chronic manifestations. Although paired sera are not required for the diagnosis of chronic Q fever, monitoring of antibody titers can be used to examine the course of treatment. Monitoring both phase II and phase I antibodies may be of limited diagnostic value, but it is a useful means of determining the response to treatment and possible disease relapses. METHODS In the current survey we determined IgG and IgM of both phase I and phase II for 35 patients suffering from chronic Q fever in an attempt to draw conclusions on the kinetics of the antibodies throughout the course of the disease. RESULTS Overall, 33 cases were included in the study. Of the 33 patients, 32 had a good outcome. CONCLUSIONS Our findings support the general belief that a long period of serological monitoring is required for patients with chronic Q fever.
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