Q fever
Historical review of human cases in Uruguay. A complementary approach from the medical and veterinarian sciences
DOI:
https://doi.org/10.29193/RMU.38.2.8Keywords:
PUBLIC HEALTH, ZOONOSES, Q FEVER, COXIELLA BURNETII, ONE HEALTH, URUGUAYAbstract
Q fever is a globally distributed zoonosis caused by the bacteria Coxiella burnetii. Bovines, sheep and goats are the most frequent source of infection in humans,
and it is mandatory for the latter to report the disease to the Ministry of Public Health. We reviewed the literature describing cases of Q fever in humans in Uruguay, focusing on epidemiological characteristics, and we discussed the diagnostic tests locally available. Nine published studies were included in the review, as well as the information in the professional diseases registry. 2.715 people with a suspicion of Q fever were collectively analyzed between 1956-2019, 959 (55.3%) of them being seropositive. Diagnosis were based on serology, clinical examination and/or a history of exposure while working. Epidemiologically, the cattle or material originating in it were considered as the most probable sources of exposure in most cases. Depending on the context cases arose, which were not systematically reported, they were mainly caused by exposure to sheep and cows in meat processing plants or in the meat chain (positive/evaluated: 863/1540; seropositive or symptomatic: 585); and to a lesser extent dairy cattle [milk sector (positive/evaluated: 20/58; symptomatic seropositive: 17) and diagnostic laboratory (positive/evaluated: 2/4; symptomatic seropositive: 1)] or wild ruminants (positive/evaluated: 25/117; symptomatic
seropositive: 17). Hyperthermia, headaches and sweating were reported. In all cases inhalation was adopted as the source of infection. Today, there are no PCR tests to detect C. burnetii in humans available locally, what constitutes a limitation to diagnosis, in particular in early stages. Interdisciplinary collaboration between animal and human health professionals is key to approach this zoonosis.
References
1) Eldin C, Mélenotte C, Mediannikov O, Ghigo E, Million M, Edouard S, et al. From Q fever to Coxiella burnetii infection: a paradigm change. Clin Microbiol Rev 2017; 30(1):115-90.
2) Conti Díaz IA. Enfermedades emergentes y reemergentes en Uruguay. Rev Méd Urug 2001; 17:180-99.
3) World Organization for Animal Health. OIE-Listed diseases, infections and infestations in force in 2020. Disponible en: https://www.oie.int/en/animal-health-in-the-world/oie-listed-diseases-2021/ [Consulta: 9 enero 2021].
4) Centers for Disease Control and Prevention. Bioterrorism agents/ diseases by category. Q fever fact sheet. 2020 Disponible en: https://emergency.cdc.gov/agent/agentlist-category.asp. [Consulta: 9 enero 2021].
5) Whitney EA, Massung RF, Candee AJ, Ailes EC, Myers LM, Patterson NE, et al. Seroepidemiologic and occupational risk survey for Coxiella burnetii antibodies among US veterinarians. Clin Infect Dis 2009; 48(5):550-7.
6) Maurin M, Raoult D. Q fever. Clin Microbiol Rev 1999; 12:518-53.
7) Hatchette TF, Hudson RC, Schlech WF, Campbell NA, Hatchette JE, Ratnam S, et al. Goat-associated Q fever: a new disease in Newfoundland. Emerg Infect Dis 2001; 7(3):413-9.
8) Signs KA, Stobierski MG, Gandhi TN. Q fever cluster among raw milk drinkers in Michigan, 2011. Clin Infect Dis 2012; 55(10):1387-9.
9) Cerf O, Condron R. Coxiella burnetii and milk pasteurization: an early application of the precautionary principle? Epidemiol Infect 2006; 134(5):946-51.
10) Langley JM, Marrie TJ, Leblanc JC, Almudevar A, Resch L, Raoult D. Coxiella burnetii seropositivity in parturient women is associated with adverse pregnancy outcomes. Am J Obstet Gynecol 2003; 189(1):228-32.
11) Milazzo A, Hall R, Storm PA, Harris RJ, Winslow W, Marmion BP. Sexually transmitted Q fever. Clin Infect Dis 2001; 33(3):399-402.
12) Somma Moreira RE, Caffarena RM, Pérez G, Somma Saldías S, Monteiro M. Fiebre Q. Adel Microbiol Enf Infecc 1988; 7: 61-83.
13) Kersh GJ, Priestley R, Massung RF. Stability of Coxiella burnetii in stored human blood. Transfusion 2013; 53(7):1493-6.
14) Tissot-Dupont H, Amadei MA, Nezri M, Raoult D. Wind in november, Q fever in december. Emerg Infect Dis 2004; 10:1264-9.
15) Nusinovici S, Hoch T, Brahim ML, Joly A, Beaudeau F. The effect of wind on Coxiella burnetii transmission between cattle herds: a mechanistic approach. Transbound Emerg Dis 2017; 64(2):585-92.
16) Hechemy KE. History and prospects of Coxiella burnetii research. En: Toman R, Heinzen RA, Samuel JE, Mege JL, eds. Coxiella burnetii: recent advances and new perspectives in research of the Q fever bacterium. Dordrecht: Springer, 2012.
17) de Alarcón A, Villanueva JL, Viciana P, López-Cortés L, Torronteras R, Bernabeu M, et al. Q fever: epidemiology, clinical features and prognosis. A study from 1983 to 1999 in the South of Spain. J Infection 2003; 47(2):110-6.
18) Anderson A, Bijlmer H, Fournier PE, Graves S, Hartzell J, Kersh GJ, et al. Diagnosis and management of Q fever-United States, 2013: recommendations from CDC and the Q Fever Working Group. MMWR Recomm Rep 2013; 62(RR-03):1-30.
19) Olson JG, Jones FR, Blair PJ. Coxiella burnetii. En: Gillespie SH, Hawkey PM, eds. Principles and practice of clinical bacteriology. 2nd ed. Chichester: John Wiley & Sons, 2006:457-60.
20) Raoult D, Marrie TJ, Mege JL. Natural history and pathophysiology of Q fever. Lancet Infect Dis 2005; 5(4):219-26.
21) Wegdam-Blans MC, Kampschreur LM, Delsing CE, Bleeker-Rovers CP, Sprong T, van Kasteren ME, et al; The Dutch Q fever consensus group. Chronic Q fever: review of the literature and a proposal of new diagnostic criteria. J Infect 2012; 64:247-59.
22) Wielders CC, van Loenhout JA, Morroy G, Rietveld A, Notermans DW, Wever PC, et al. Long-term serological follow-up of acute Q-fever patients after a large epidemic. PLoS One 2015; 10(7):e0131848.
23) van Roeden SE, Wever PC, Kampschreur LM, Gruteke P, van der Hoek W, Hoepelman AIM, et al. Chronic Q fever-related complications and mortality: data from a nationwide cohort. Clin Microbiol Infect 2019; 25(11):1390-8.
24) Fenollar F, Fournier PE, Carrieri MP, Habib G, Messana T, Raoult D. Risks factors and prevention of Q fever endocarditis. Clin Infect Dis 2001; 33(3):312-6.
25) Kampschreur LM, Dekker S, Hagenaars JC, Lestrade PJ, Renders NH, de Jager-Leclercq MG, et al. Identification of risk factors for chronic Q fever, the Netherlands. Emerg Infect Dis 2012; 18(4):563-70.
26) Ayres JG, Smith EG, Flint N, Tunnicliffe WS, Fletcher TJ, Hammond K, et al. Protracted fatigue and debility after acute Q fever. Lancet 1996; 347:978-9.
27) van Asseldonk MA, Prins J, Bergevoet RH. 2013. Economic assessment of Q fever in the Netherlands. Prev Vet Med 2013; 112(1-2):27-34.
28) Salveraglio FJ, Bacigalupi JC, Srulevich S, Viera O. Comprobación epidemiológica y clínica de la fiebre Q en el Uruguay. AnFaMed 1956; 41(3/4):131-8.
29) Salveraglio FJ, Bacigalupi JC, Srulevich S, Viera O. Investigation of Q fever in Uruguay. Hoja Tisiológica 1956; 16(2):104-17.
30) Somma Moreira RE, Caffarena RM, Pérez G, Somma Saldías S, Monteiro M. Fiebre Q en Uruguay. Rev Inst Med Trop Sao Paulo 1987; 29(3):168-73.
31) Somma Moreira RE, Caffarena RM, Pérez G, Somma Saldías S, Monteiro M. Analysis of Q fever in Uruguay. Rev Infect Dis 1987; 9(2):386-7.
32) Peluffo E, Bauzá CA, Somma Moreira RE, Vallone EF, de Vallone RM, Tosí HC. Fiebre Q en el niño: primer caso nacional. Arch Pediatr Urug 1966; 37:1-8.
33) Ortiz Molina H, Caffarena RM, Somma Moreira RE. Fiebre Q: tres brotes en un frigorífico del Uruguay. Vet Argentina 1987; 4(31):58-63.
34) Braselli AT, Somma Moreira RE, Pérez G. Brote familiar de fiebre Q. Rev Méd Urug 1989; 110-4.
35) Resbani JC, Somma Moreira RE, Caffarena RM, Huertas E, Pérez G. Fiebre Q: brote en una planta lechera en Uruguay. Vet Argentina 1993; 10:161.
36) Moreira Eglinger LE, Braselli AT. Fiebre Q: endocarditis a Coxiella burnetii. Primera comunicación nacional. Rev Méd Urug 1994; 10:131-7.
37) Hernández S, Lyford-Pike V, Alvarez ME, Tomasina F. Q fever outbreak in an experimental wildlife breeding station in Uruguay. Rev Patol Trop 2007; 36(2):129-40.
38) Rabaza A, Giannitti F, Fraga M, Macías-Rioseco M, Corbellini LG, Riet-Correa F, et al. Serological evidence of human infection with Coxiella burnetii after occupational exposure to aborting cattle. Vet Sci 2021; 8(9):196.
39) Macías-Rioseco M, Riet-Correa F, Miller MM, Sondgeroth K, Fraga M, Silveira C, et al. Bovine abortion caused by Coxiella burnetii: report of a cluster of cases in Uruguay and review of the literature. J Vet Diagn Invest 2019; 31(4):634-9.
40) Alves J, Almeida F, Duro R, Ferraz R, Silva S, Sobrinho-Simões J, et al. Presentation and diagnosis of acute Q fever in Portugal: a case series. IDCases 2016; 7:34-7.
41) Berri M, Laroucau K, Rodolakis A. The detection of Coxiella burnetii from ovine genital swabs, milk and fecal samples by the use of a single touchdown polymerase chain reaction. Vet Microbiol 2000; 72(3-4):285-93.
42) Centers for Disease Control and Prevention. National Center for Emerging and Zoonotic Infectious Diseases. Atlanta, GA: CDC. Disponible en: https://emergency.cdc.gov/agent/agentlist-category.asp#b [Consulta: 9 enero 2021].
43) Fournier PE, Raoult D. Predominant immunoglobulin A response to phase II antigen of Coxiella burnetii in acute Q fever. Clin Diagn Lab Immunol 1999; 6(2):173-7.
44) Dupont HT, Thirion X, Raoult D. Q fever serology: cutoff determination for microimmunofluorescence. Clin Diagn Lab Immunol 1994; 1(2):189-96.
45) Herremans T, Hogema BM, Nabuurs M, Peeters M, Wegdam-Blans M, Schneeberger P, et al. Comparison of the performance of IFA, CFA, and ELISA assays for the serodiagnosis of acute Q fever by quality assessment. Diagn Microbiol Infec Dis 2013; 75(1):16-21.
46) Schneeberger PM, Hermans MH, van Hannen EJ, Schellekens JJ, Leenders AC, Wever PC. Real-time PCR with serum samples is indispensable for early diagnosis of acute Q fever. Clin Vaccine Immunol 2010; 17(2):286-90.
47) Schimmer B, Dijkstra P, Vellema P, Schneeberger PM, Hackert R, ter Schegget R, et al. Sustained intensive transmission of Q fever in the south of the Netherlands, 2009. Euro Surveill 2009; 14(19):19210.
48) Grace D, Mutua F, Ochungo P, Kruska R, Jones K, Brierley L, et al. Mapping of poverty and likely zoonoses hotspots. London: International Livestock Research Institute, 2012.
49) Dehove A. One world, one health. Transbound Emerg Dis 2010; 57(1‐2):3-6.
50) De Giusti M, Barbato D, Lia L, Colamesta V, Lombardi AM, Cacchio D, et al. Collaboration between human and veterinary medicine as a tool to solve public health problems. Lancet Planet Health 2019; 3(2):e64-e65.
2) Conti Díaz IA. Enfermedades emergentes y reemergentes en Uruguay. Rev Méd Urug 2001; 17:180-99.
3) World Organization for Animal Health. OIE-Listed diseases, infections and infestations in force in 2020. Disponible en: https://www.oie.int/en/animal-health-in-the-world/oie-listed-diseases-2021/ [Consulta: 9 enero 2021].
4) Centers for Disease Control and Prevention. Bioterrorism agents/ diseases by category. Q fever fact sheet. 2020 Disponible en: https://emergency.cdc.gov/agent/agentlist-category.asp. [Consulta: 9 enero 2021].
5) Whitney EA, Massung RF, Candee AJ, Ailes EC, Myers LM, Patterson NE, et al. Seroepidemiologic and occupational risk survey for Coxiella burnetii antibodies among US veterinarians. Clin Infect Dis 2009; 48(5):550-7.
6) Maurin M, Raoult D. Q fever. Clin Microbiol Rev 1999; 12:518-53.
7) Hatchette TF, Hudson RC, Schlech WF, Campbell NA, Hatchette JE, Ratnam S, et al. Goat-associated Q fever: a new disease in Newfoundland. Emerg Infect Dis 2001; 7(3):413-9.
8) Signs KA, Stobierski MG, Gandhi TN. Q fever cluster among raw milk drinkers in Michigan, 2011. Clin Infect Dis 2012; 55(10):1387-9.
9) Cerf O, Condron R. Coxiella burnetii and milk pasteurization: an early application of the precautionary principle? Epidemiol Infect 2006; 134(5):946-51.
10) Langley JM, Marrie TJ, Leblanc JC, Almudevar A, Resch L, Raoult D. Coxiella burnetii seropositivity in parturient women is associated with adverse pregnancy outcomes. Am J Obstet Gynecol 2003; 189(1):228-32.
11) Milazzo A, Hall R, Storm PA, Harris RJ, Winslow W, Marmion BP. Sexually transmitted Q fever. Clin Infect Dis 2001; 33(3):399-402.
12) Somma Moreira RE, Caffarena RM, Pérez G, Somma Saldías S, Monteiro M. Fiebre Q. Adel Microbiol Enf Infecc 1988; 7: 61-83.
13) Kersh GJ, Priestley R, Massung RF. Stability of Coxiella burnetii in stored human blood. Transfusion 2013; 53(7):1493-6.
14) Tissot-Dupont H, Amadei MA, Nezri M, Raoult D. Wind in november, Q fever in december. Emerg Infect Dis 2004; 10:1264-9.
15) Nusinovici S, Hoch T, Brahim ML, Joly A, Beaudeau F. The effect of wind on Coxiella burnetii transmission between cattle herds: a mechanistic approach. Transbound Emerg Dis 2017; 64(2):585-92.
16) Hechemy KE. History and prospects of Coxiella burnetii research. En: Toman R, Heinzen RA, Samuel JE, Mege JL, eds. Coxiella burnetii: recent advances and new perspectives in research of the Q fever bacterium. Dordrecht: Springer, 2012.
17) de Alarcón A, Villanueva JL, Viciana P, López-Cortés L, Torronteras R, Bernabeu M, et al. Q fever: epidemiology, clinical features and prognosis. A study from 1983 to 1999 in the South of Spain. J Infection 2003; 47(2):110-6.
18) Anderson A, Bijlmer H, Fournier PE, Graves S, Hartzell J, Kersh GJ, et al. Diagnosis and management of Q fever-United States, 2013: recommendations from CDC and the Q Fever Working Group. MMWR Recomm Rep 2013; 62(RR-03):1-30.
19) Olson JG, Jones FR, Blair PJ. Coxiella burnetii. En: Gillespie SH, Hawkey PM, eds. Principles and practice of clinical bacteriology. 2nd ed. Chichester: John Wiley & Sons, 2006:457-60.
20) Raoult D, Marrie TJ, Mege JL. Natural history and pathophysiology of Q fever. Lancet Infect Dis 2005; 5(4):219-26.
21) Wegdam-Blans MC, Kampschreur LM, Delsing CE, Bleeker-Rovers CP, Sprong T, van Kasteren ME, et al; The Dutch Q fever consensus group. Chronic Q fever: review of the literature and a proposal of new diagnostic criteria. J Infect 2012; 64:247-59.
22) Wielders CC, van Loenhout JA, Morroy G, Rietveld A, Notermans DW, Wever PC, et al. Long-term serological follow-up of acute Q-fever patients after a large epidemic. PLoS One 2015; 10(7):e0131848.
23) van Roeden SE, Wever PC, Kampschreur LM, Gruteke P, van der Hoek W, Hoepelman AIM, et al. Chronic Q fever-related complications and mortality: data from a nationwide cohort. Clin Microbiol Infect 2019; 25(11):1390-8.
24) Fenollar F, Fournier PE, Carrieri MP, Habib G, Messana T, Raoult D. Risks factors and prevention of Q fever endocarditis. Clin Infect Dis 2001; 33(3):312-6.
25) Kampschreur LM, Dekker S, Hagenaars JC, Lestrade PJ, Renders NH, de Jager-Leclercq MG, et al. Identification of risk factors for chronic Q fever, the Netherlands. Emerg Infect Dis 2012; 18(4):563-70.
26) Ayres JG, Smith EG, Flint N, Tunnicliffe WS, Fletcher TJ, Hammond K, et al. Protracted fatigue and debility after acute Q fever. Lancet 1996; 347:978-9.
27) van Asseldonk MA, Prins J, Bergevoet RH. 2013. Economic assessment of Q fever in the Netherlands. Prev Vet Med 2013; 112(1-2):27-34.
28) Salveraglio FJ, Bacigalupi JC, Srulevich S, Viera O. Comprobación epidemiológica y clínica de la fiebre Q en el Uruguay. AnFaMed 1956; 41(3/4):131-8.
29) Salveraglio FJ, Bacigalupi JC, Srulevich S, Viera O. Investigation of Q fever in Uruguay. Hoja Tisiológica 1956; 16(2):104-17.
30) Somma Moreira RE, Caffarena RM, Pérez G, Somma Saldías S, Monteiro M. Fiebre Q en Uruguay. Rev Inst Med Trop Sao Paulo 1987; 29(3):168-73.
31) Somma Moreira RE, Caffarena RM, Pérez G, Somma Saldías S, Monteiro M. Analysis of Q fever in Uruguay. Rev Infect Dis 1987; 9(2):386-7.
32) Peluffo E, Bauzá CA, Somma Moreira RE, Vallone EF, de Vallone RM, Tosí HC. Fiebre Q en el niño: primer caso nacional. Arch Pediatr Urug 1966; 37:1-8.
33) Ortiz Molina H, Caffarena RM, Somma Moreira RE. Fiebre Q: tres brotes en un frigorífico del Uruguay. Vet Argentina 1987; 4(31):58-63.
34) Braselli AT, Somma Moreira RE, Pérez G. Brote familiar de fiebre Q. Rev Méd Urug 1989; 110-4.
35) Resbani JC, Somma Moreira RE, Caffarena RM, Huertas E, Pérez G. Fiebre Q: brote en una planta lechera en Uruguay. Vet Argentina 1993; 10:161.
36) Moreira Eglinger LE, Braselli AT. Fiebre Q: endocarditis a Coxiella burnetii. Primera comunicación nacional. Rev Méd Urug 1994; 10:131-7.
37) Hernández S, Lyford-Pike V, Alvarez ME, Tomasina F. Q fever outbreak in an experimental wildlife breeding station in Uruguay. Rev Patol Trop 2007; 36(2):129-40.
38) Rabaza A, Giannitti F, Fraga M, Macías-Rioseco M, Corbellini LG, Riet-Correa F, et al. Serological evidence of human infection with Coxiella burnetii after occupational exposure to aborting cattle. Vet Sci 2021; 8(9):196.
39) Macías-Rioseco M, Riet-Correa F, Miller MM, Sondgeroth K, Fraga M, Silveira C, et al. Bovine abortion caused by Coxiella burnetii: report of a cluster of cases in Uruguay and review of the literature. J Vet Diagn Invest 2019; 31(4):634-9.
40) Alves J, Almeida F, Duro R, Ferraz R, Silva S, Sobrinho-Simões J, et al. Presentation and diagnosis of acute Q fever in Portugal: a case series. IDCases 2016; 7:34-7.
41) Berri M, Laroucau K, Rodolakis A. The detection of Coxiella burnetii from ovine genital swabs, milk and fecal samples by the use of a single touchdown polymerase chain reaction. Vet Microbiol 2000; 72(3-4):285-93.
42) Centers for Disease Control and Prevention. National Center for Emerging and Zoonotic Infectious Diseases. Atlanta, GA: CDC. Disponible en: https://emergency.cdc.gov/agent/agentlist-category.asp#b [Consulta: 9 enero 2021].
43) Fournier PE, Raoult D. Predominant immunoglobulin A response to phase II antigen of Coxiella burnetii in acute Q fever. Clin Diagn Lab Immunol 1999; 6(2):173-7.
44) Dupont HT, Thirion X, Raoult D. Q fever serology: cutoff determination for microimmunofluorescence. Clin Diagn Lab Immunol 1994; 1(2):189-96.
45) Herremans T, Hogema BM, Nabuurs M, Peeters M, Wegdam-Blans M, Schneeberger P, et al. Comparison of the performance of IFA, CFA, and ELISA assays for the serodiagnosis of acute Q fever by quality assessment. Diagn Microbiol Infec Dis 2013; 75(1):16-21.
46) Schneeberger PM, Hermans MH, van Hannen EJ, Schellekens JJ, Leenders AC, Wever PC. Real-time PCR with serum samples is indispensable for early diagnosis of acute Q fever. Clin Vaccine Immunol 2010; 17(2):286-90.
47) Schimmer B, Dijkstra P, Vellema P, Schneeberger PM, Hackert R, ter Schegget R, et al. Sustained intensive transmission of Q fever in the south of the Netherlands, 2009. Euro Surveill 2009; 14(19):19210.
48) Grace D, Mutua F, Ochungo P, Kruska R, Jones K, Brierley L, et al. Mapping of poverty and likely zoonoses hotspots. London: International Livestock Research Institute, 2012.
49) Dehove A. One world, one health. Transbound Emerg Dis 2010; 57(1‐2):3-6.
50) De Giusti M, Barbato D, Lia L, Colamesta V, Lombardi AM, Cacchio D, et al. Collaboration between human and veterinary medicine as a tool to solve public health problems. Lancet Planet Health 2019; 3(2):e64-e65.
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Published
2022-06-28
How to Cite
1.
Rabaza A, Giannitti F, Fraga M, Pérez Lorenzo C, Hirigoyen D. Q fever: Historical review of human cases in Uruguay. A complementary approach from the medical and veterinarian sciences. Rev. Méd. Urug. [Internet]. 2022 Jun. 28 [cited 2024 Nov. 23];38(2):e38209. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/887
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