Acute Q fever in febrile patients in northwestern of Iran

Esmaeili, Saber; Golzar, Farhad; Ayubi, Erfan; Naghili, Behrooz; Mostafavi, Ehsan

doi:10.1371/journal.pntd.0005535

Cited by 28 publications

(12 citation statements)

References 39 publications

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“…Prolonged fever is the most common feature of acute Q fever, and other symptoms and signs include malaise, headache, fatigue, atypical pneumonia, or hepatitis. [2] Acute Q fever often presents initially as acute febrile illness of unclear etiology that, if untreated, can progress to a persistent focalized infection such as endocarditis, with a reported mortality rate of up to 20%. [3] Therefore, recognizing Q fever in an early differential diagnosis is important for selecting an appropriate treatment and monitoring strategy.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic usefulness of molecular detection of Coxiella burnetii from blood of patients with suspected acute Q fever

Bae¹,

Jin

Park³

et al. 2019

Medicine

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Diagnosis of Q fever is difficult due to the lack of distinct clinical features that distinguish it from other febrile diseases. Serologic testing is the gold standard method for diagnosing Q fever, but antibody formation may not be detectable for 2 to 3 weeks from symptom onset, limiting early diagnosis. We thus evaluated the diagnostic utility of polymerase chain reaction (PCR) to detect Coxellia burnetii DNA in serum from patients with suspected acute Q fever. All adult patients with suspected acute Q fever were prospectively enrolled at a tertiary-care hospital from January 2016 through July 2018. Acute Q fever was diagnosed using clinical and laboratory criteria: fever with at least one other symptoms (myalgia, headache, pneumonia, or hepatitis) and single phase II immunoglobulin G (IgG) antibody titers ≥1:200 or immunoglobulin M (IgM) antibody titer ≥1:50 (probable), or a fourfold increase or seroconversion in phase II IgG antibody titers as measured by indirect immunofluorescence assays between paired samples (confirmed). We performed PCR targeting the transposase gene insertion element IS1111a of C. burnetii . Of the 35 patients with suspected acute Q fever, 16 (46%) were diagnosed with acute Q fever including 8 probable and 8 confirmed cases; the remaining 19 (54%) were diagnosed with other febrile diseases. The proportion of males diagnosed with Q fever was higher than those diagnosed with other febrile diseases (88% vs 44%, P = .03), but there were no other significant differences in clinical characteristics between the 2 groups. The Q fever PCR sensitivity was 81% (95% confidence interval [CI], 54–96), specificity was 90% (95% CI, 67–99), positive predictive value was 87% (95% CI, 63–96), and negative predictive value was 85% (95% CI, 67–94). Q fever PCR testing using blood from patients with suspected acute Q fever seems to be a rapid and useful test for early diagnosis of Q fever.

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Section: Introductionmentioning

confidence: 99%

Diagnostic usefulness of molecular detection of Coxiella burnetii from blood of patients with suspected acute Q fever

Bae¹,

Jin

Park³

et al. 2019

Medicine

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“…burnetii seroprevalence levels varied between febrile patients, pregnant women and individuals with risky occupations (hunters, butchers, health workers, veterinary workers and veterinary students). Most (63.6%) of the coxiellosis studies on human subjects were conducted among febrile patients [ 107 , 113 , 120 , 124 , 127 , 129 , 131 ], while 27.3% were conducted among at-risk individuals [ 111 , 115 , 116 , 118 , 125 , 138 ] and 9.1% among pregnant women [ 122 ]. Pooled prevalence among at-risk individuals was relatively higher (19.8–68%), than the pooled prevalence among febrile patients (5.3–35.2%).…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2018

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BackgroundTick-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.MethodsUsing 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.ResultsA 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.DiscussionBased 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.ConclusionGiven 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...

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“…In the recent years, the different epidemiological profile of C. burnetii infections was reported in Iran. In the seroprevalence studies Q fever infection rates varied from 7.8% to 68% in the different sources (animals and high-risk population) (Khalili and Sakhaee, 2009;Aflatoonian et al, 2014;Azizzadeh et al, 2014;Esmaeili et al, 2014;Esmaeili et al, 2017Nokhodian et al, 2017). In the molecular studies the prevalence rate of C. burnetii DNA was reported from 0% to 48.15% in various samples (animals, human and ticks) by amplification of different genes included IS1111, 16S rRNA and Com1 (Rahimi et al, 2010;Dehkordi 2011;Jamshidi et al, 2014;Khademi et al, 2014;Nokhodian et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Molecular Analysis of Coxiella Burnetii by Isocitrate Dehydrogenase Gene Sequence-Based Typing and PCR-RFLP in Isfahan, Iran.

Nokhodian¹,

Khalili²,

Ataei³

et al. 2019

jwpr

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In the recent years, considerable advances have been made in the detection and genotyping of Coxiella burnetii, the causative agent of Q fever. The selection of appropriate genotyping method has enabled description of the clonal diversity of C. burnetii around the word. Since, in the place of study, C. burnetii genotyping has not been done, the icd gene Restriction fragment length polymorphism (RFLP) and sequence-based typing for differentiation between the genomic detected C. burnetii from the various sources and compared the two methods is used. In a observational study, a total of 15 genomic positive cases of C. burnetii infection from different sources in Isfahan province (Central Iran) were enrolled and underwent two genotyping methods: the icd gene PCR-RFLP and icd gene sequence-based typing. The degree of similarity between the icd gene sequences was high (98.3-100%). In compare with C. burnetii Nine Mile icd gene sequence, the nucleotide sequences were different at 11 positions, which resulted in 7 differences in the amino acid sequences. After digesting the 370 bp amplified icd gene fragments all the samples indicated only one band of 370bp, while amplified C. burnetii Nine Mile strain icd gene were digested into two bands with sizes of 221bp and 149bp. The results of two genotyping methods matched together. Used methods in present study were cheaper and easier than new methods and they can used for detection of acute and chronic phases of infection.

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Acute Q fever in febrile patients in northwestern of Iran

Cited by 28 publications

References 39 publications

Diagnostic usefulness of molecular detection of Coxiella burnetii from blood of patients with suspected acute Q fever

Diagnostic usefulness of molecular detection of Coxiella burnetii from blood of patients with suspected acute Q fever

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

Molecular Analysis of Coxiella Burnetii by Isocitrate Dehydrogenase Gene Sequence-Based Typing and PCR-RFLP in Isfahan, Iran.

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