Q Fever: An Emerging Reality in Portugal

Abstract

Q fever is a zoonosis caused by Coxiella burnetii with worldwide distribution at the increasing expression in Europe and endemic in Portugal. It is transmitted by inhalation of aerosols containing spores, main reservoir being cattle, goats and sheep as by ingesting cottage cheese or unpasteurized milk. The majority of patients are asymptomatic; however, they may present with fever, atypical pneumonia, acute hepatitis, cutaneous manifestations and rarely with cardiac or neurological involvement. Although most cases are selflimited, focal persistent or chronic Q fever can manifest years after the onset, wherefore follow-up is essential. The clinical heterogeneity may be so variable that the disease is often diagnosed only if it has been systematically considered. It should be especially taken into account in the presence of risk factors as valvular or joint prostheses, immunocompromised patients, pregnant women and epidemiological setting. The authors present a rare case of Coxiella burnetii pneumonia with cutaneous and hepatic manifestations without any risk factor. This case aims to emphasize the importance of Q fever in the differential diagnosis of fever or atypical pneumonia, even in the absence of known risk factors. The diagnosis is often challenging for clinicians and it is necessary to maintain a high index of suspicion. In Europe and specifically in Portugal is mandatory to report the cases to establish the real impact of this disease.

Seropositivity for Coxiella burnetii in Wild Boar (Sus scrofa) and Red Deer (Cervus elaphus) in Portugal

“…According to the European Union (EU) annual Q fever epidemiological report for 2019, 1069 human cases were notified in the EU/European Economic Area, 958 (90%) of which were confirmed [ 34 ]. In Portugal the disease is endemic in humans with an incidence of 0.11 cases per 100,000 inhabitants, with the highest number of cases reported in the central and southern regions of the country [ 35 ].…”

The relevance of the wild reservoir in zoonotic multi‐host pathogens: The links between Iberian wild mammals andCoxiella burnetii

“…Indeed, in 2019, more than 33% of the overall number of cases were notified by Spain (ECDC, 2021). Q fever is endemic in Portugal as well (Lencastre Monteiro et al., 2021). The human risk of acquiring C. burnetii from wildlife depends on the prevalence and distribution of the infection in wildlife, the degree of pathogen excretion by wildlife and patterns of human–wildlife interactions (Plowright et al., 2017).…”