Coxiella burnetii is the agent of Q fever, or ``query fever,'' a zoonosis first described in Australia in 1937. Since this first description, knowledge about this pathogen and its associated infections has increased dramatically. We review here all the progress made over the last 20 years on this topic. C. burnetii is classically a strict intracellular, Gram-negative bacterium. However, a major step in the characterization of this pathogen was achieved by the establishment of its axenic culture. C. burnetii infects a wide range of animals, from arthropods to humans. The genetic determinants of virulence are now better known, thanks to the achievement of determining the genome sequences of several strains of this species and comparative genomic analyses. Q fever can be found worldwide, but the epidemiological features of this disease vary according to the geographic area considered, including situations where it is endemic or hyperendemic, and the occurrence of large epidemic outbreaks. In recent years, a major breakthrough in the understanding of the natural history of human infection with C. burnetii was the breaking of the old dichotomy between ``acute'' and ``chronic'' Q fever. The clinical presentation of C. burnetii infection depends on both the virulence of the infecting C. burnetii strain and specific risks factors in the infected patient. Moreover, no persistent infection can exist without a focus of infection. This paradigm change should allow better diagnosis and management of primary infection and long-term complications in patients with C. burnetii infection.

https://hal.archives-ouvertes.fr/hal-01496178/document

From Q Fever to Coxiella burnetii Infection: a Paradigm Change.

Q fever is a zoonotic disease considered as emerging or re-emerging in many countries. It is caused by Coxiella burnetii, a bacterium developing spore-like forms that are highly resistant to the environment. The most common animal reservoirs are livestock and the main source of infection is by inhalation of contaminated aerosols. Although the culture process for Coxiella is laborious, advances on the knowledge of the life cycle of the bacterium have been made. New tools have been developed to (i) improve the diagnosis of Q fever in humans and animals, and especially animal shedders, (ii) perform epidemiological studies, and (iii) prevent the disease through the use of vaccines. This review summarizes the state of the knowledge on the bacteriology and clinical manifestations of Q fever as well as its diagnosis, epidemiology, treatment and prevention in order to understand what factors are responsible for its emergence or re-emergence.

/pdf/is-q-fever-an-emerging-or-re-emerging-zoonosis-4zaf3b5fu7.pdf

Is Q Fever an emerging or re-emerging zoonosis?

Q fever, a worldwide zoonosis caused by Coxiella burnetii, can be transmitted from animal reservoirs to humans by the inhalation of infected aerosols. We investigated the epidemiology of Q fever in the Bouches-du-Rhone district of southern France, particularly the role of wind and rainfall in C. burnetii transmission. During the winter of 1998 to 1999, an unexpected number of cases were diagnosed in the area. This statistically higher incidence was associated with an increased frequency of the mistral 1 month before onset of disease, i.e., shortly after the main lambing season. These data confirm that wind plays a role in C. burnetii transmission, a factor that can be monitored but not prevented. Further studies are needed to identify and confirm preventable individual behavioral risk factors for Q fever.

/pdf/wind-in-november-q-fever-in-december-36pwkzp1i9.pdf

Wind in November, Q fever in December.

Comparison of Coxiella burnetii Shedding in Milk of Dairy Bovine, Caprine, and Ovine Herds

https://lib.dr.iastate.edu/cgi/viewcontent.cgi?article=1042&context=fshn_hs_pubs

A 100-Year Review: Advances in goat milk research.

In the spring of 1999 in rural Newfoundland, abortions in goats were associated with illness in goat workers. An epidemiologic investigation and a serologic survey were conducted in April 1999 to determine the number of infections, nature of illness, and risk factors for infection. Thirty-seven percent of the outbreak cohort had antibody titers to phase II Coxiella burnetii antigen >1:64, suggesting recent infection. The predominant clinical manifestation of Q fever was an acute febrile illness. Independent risk factors for infection included contact with goat placenta, smoking tobacco, and eating cheese made from pasteurized goat milk. This outbreak raises questions about management of such outbreaks, interprovincial sale and movement of domestic ungulates, and the need for discussion between public health practitioners and the dairy industry on control of this highly infectious organism.

https://courses.washington.edu/zepi526/Papers08/hachette_Qfever_EID.pdf

Goat-Associated Q Fever: A New Disease in Newfoundland

During the spring of 1999, an outbreak of Q fever resulted in 30 abortions among 174 (17%) goats in a caprine cooperative in Newfoundland. The intent of this study was to determine the natural history of Coxiella burnetii infection in goats. Twenty-four goats on one farm were followed through the next two kidding seasons following the Q fever outbreak. Antibodies to phases I and II C. burnetii were determined using an indirect immunofluorescence assay and samples of placentas were cultured for C. burnetii and polymerase chain reaction was used to identify C. burnetii DNA. Phase I antibody was present in high levels and was maintained over the study period, while phase II antibody levels declined to the seronegative range in 60% of the infected goats. Molecular studies suggest that excretion of C. burnetii in the placenta of infected goats seems to be limited to the next kidding season following an outbreak. We therefore conclude that C. burnetii infection in goats seems to be limited to two kidding season...

Natural history of Q fever in goats.

The seroprevalence of Coxiella burnetii among cattle, sheep, and goats in Newfoundland was determined by microimmunofluorescence. Seropositivity to phase II antigen increased in sheep from 3.1% in 1997 to 23.5% in 1999-2000 (P < 0.001). Cows (24%) had antibodies to phase I antigen; goats (15.6%) had antibodies to phase II antigen. Seroprevalence of C. burnetii is increasing among sheep.

Seroprevalence of Coxiella burnetii in selected populations of domestic ruminants in Newfoundland.

Coxiella burnetii is an obligate intracellular pathogen known to be the causative agent of Q fever, a zoonosis with a worldwide occurrence. The most common reservoirs for infection in humans are domestic farm animals such as cattle, goats, and sheep. Although C. burnetii can cause abortion and still birth, most animals have a persistent, relatively asymptomatic subclinical infection. Infection in humans usually manifests as a self-limiting febrile illness, pneumonia, or hepatitis.

Caprine-associated Q fever in Newfoundland.

Since the 1990s, reports of Q fever in Nova Scotia, Canada, have declined. Passive surveillance for Q fever in Nova Scotia and its neighboring provinces in eastern Canada indicates that the clinical manifestation of Q fever in the Maritime provinces is pneumonia and that incidence of the disease may fluctuate.

/pdf/q-fever-update-maritime-canada-5e7f6shmsh.pdf

Q Fever Update, Maritime Canada

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