Immunisation with purified Coxiella burnetii phase I lipopolysaccharide confers partial protection in mice independently of co-administered adenovirus vectored vaccines.

Q fever is a highly infectious zoonosis caused by the Gram-negative bacterium Coxiella burnetii. The worldwide distribution of Q fever suggests a need for vaccines that are more efficacious, affordable, and does not induce severe adverse reactions in vaccine recipients with pre-existing immunity against Q fever. Potential Q fever vaccine antigens include lipopolysaccharide (LPS) and several C. burnetii surface proteins. Antibodies elicited by purified C. burnetii lipopolysaccharide (LPS) correlate with protection against Q fever, while antigens encoded by adenoviral vectored vaccines can induce cellular immune responses which aid clearing of intracellular pathogens. In the present study, the immunogenicity and the protection induced by adenoviral vectored constructs formulated with the addition of LPS were assessed. Multiple vaccine constructs encoding single or fusion antigens from C. burnetii were synthesised. The adenoviral vectored vaccine constructs alone elicited strong cellular immunity, but this response was not correlative with protection in mice. However, vaccination with LPS was significantly associated with lower weight loss post-bacterial challenge independent of co-administration with adenoviral vaccine constructs, supporting further vaccine development based on LPS.

Q Fever Severe Pericarditis With Cardiac Tamponade: A Case Report.

Q fever can present in acute or chronic form with a wide range of clinical symptoms and presentations. Here we report severe pericarditis with cardiac tamponade due to a chronic Coxiella burnetii (C. burnetii) infection. Our report emphasizes and justifies the importance of serological testing for chronic Q fever in patients with unexplained pericarditis, particularly in areas where C. burnetii is endemic.

Is there a higher risk of exposure to Coxiella burnetii for pre-clinical veterinary students?

Coxiella burnetii is globally distributed but evidence of zoonotic transmission in the Caribbean region is scarce. The bacterium presence is suspected on the Caribbean island of St. Kitts. The risk of exposure of veterinary students was reported in other regions of the world but is not documented in the Caribbean region. The present study aimed to evaluate the risk of exposure to C. burnetii for pre-clinical veterinary students (mostly coming from the U.S.) attending an island-based veterinary school. A cross-sectional study was conducted to compare incoming and outgoing veterinary students' seroprevalence. Serology was performed using indirect immunofluorescence assay to test Coxiella burnetii Phase I and Phase II immunoglobulins M and G. Background data were gathered using a standardized questionnaire. A parallel study enrolled veterinary school employees in the same university. Of the 98 participants (48 incoming and 50 outgoing students), 41 (41.8%, 95 %CI: 31.9-52.2) were seropositive to C. burnetii. There was no significant difference between the two groups (45.8% for incoming vs. 38.0% for outgoing students) (p = 0.4). No risk factors (demographic, animal handling practices or background) were significantly more reported in the seropositive group. In the employee study, the seroprevalence was high with 8/15 seropositives (53.3%, 95 %CI: 26.6-78.7). Pre-clinical veterinary students do not have a higher risk of exposure to C. burnetii by attending the veterinary school in St. Kitts, but they are highly exposed before arrival on the island (seroprevalence of 45.8%). Most of these participants had experience with animals either through farming or previous veterinary technician employment. This indicates a high exposure in the U.S. young population aiming to become veterinarians. There is an urgent need to increase C. burnetii surveillance in animals and humans to apply relevant prevention and control measures, including recommendations for vaccination of students and professionals at risk.

IEA World Congress of Epidemiology 2021

The proceedings contain 729 papers. The topics discussed include: are we treating our older generations appropriately?;demographics of postural orthostatic tachycardia syndrome in adult population;antecedent cardiovascular disease, medication use, and risk of developing ALS: a population-based nested case-control study;a cross sectional study on respiratory morbidity among traffic police personnel in Hyderabad, Telangana;traditional Japanese diet score and cancer incidence and mortality - a 23-year longitudinal global study;neighborhood built and social environmental attributes associated with frailty among mid-to-older aged Australian adults;environmental contamination of Coxiella burnetii in and around an endemically infected goat farm;rapid evidence for practice modules: using team-based learning to teach evidence-based medicine;investigation of COVID-19 outbreak in a south west state of Nigeria: preliminary findings;epidemiology of Kawasaki disease in Japan, 2017?2018: results from the nationwide survey;and associations of endothelial function, arterial elasticity, and arterial stiffness with adiponectin and skeletal muscle mass.

Case report: post-Covid-19 arthritis and peri arthritis

We present the case of a 63 years old male patient known for type 2 diabetes and sleep apnoea. He was admitted as inpatient for a nontraumatic severe and disabling left hip pain. The pain started progressively one month ago. The medical history was otherwise irrelevant, with no general symptoms nor other symptoms suggestive of an inflammatory disease. To mention a history of an asymptomatic SARS-COV2 infection, diagnosed by a naso-pharyngial PCR, approximately 10 days before the onset of the pain. On physical examination, the patient was afebrile. The palpation of the inguinal region was tender on palpation with marked limitation of the hip range of motion. The spine and other peripheral joints were painless without inflammatory sign. Moreover, there was no skin lesion nor inguinal lymph nods enlargement. Due to the importance of pain with marked functional limitation, the patient is hospitalized for investigations and pain-management. On blood sample there was a mild increase of inflammatory markers (CRP 25mg/l, VS 20mm/h) with normal cell count. Standard X-rays of the pelvis and hip were normal. The MRI of the hip showed a mild coxo-femoral arthritis with marked inflammation of the surrounding musculature. An arthrocentesis was performed and 2ml of serous fluid was aspirated. There were no crystals. The cellularity could not be tested due to small amounts of fluid. The synovial culture showed a polymicrobious growth compatible with contamination. In summary, we were facing a patient with an acute and very painful hip monoarthritis. There was no history of gastrointestinal or urinary tract infection, the search for C. trachomatis and N. gonorrhoea in urines was negative. An extensive serologic testing (HIV, HBV, HCV, HBV, HCV, HIV, Lyme, Syphilis, Coxiella, Bartonella, Brucella & Quantiferon) and the search for T. whipplei were negative as well. There was no HLA-B27 and rheumatoid factor, ACPA, ANA, ANCA and specific antibodies related to polymyositis were negative. The chest-abdomen-pelvis scan showed no sign of neoplasia. To rule out a vasculitis we proceeded to a PET-CT, which showed no sign of vasculitis or myositis. Considering the timing of the onset of the symptoms and the absence of any other diagnosis, the patient was diagnosed with reactive arthritis caused by SARS-COV2. The patient was treated with Diclofenac 150 mg/day and opioids. The clinical evaluation one month after discharge showed a spontaneous significant improvement.

Molecular Epidemiology and Species Diversity of Tick-Borne Pathogens of Animals in Egypt: A Systematic Review and Meta-Analysis.

Ticks and tick-borne pathogens (TTBPs) are listed among the most serious concerns harming Egyptian livestock's productivity. Several reports on tick-borne pathogens (TBPs) from various geographical regions in the country were published. However, data on the molecular characterization of TBPs are the most beneficial for understanding the epidemiology of this important group of pathogens. In this study, we present the first meta-analysis on the molecular epidemiology and species diversity of TBPs infecting animals in Egypt. All published studies on TBPs were systematically collected from various databases (PubMed, Scopus, ScienceDirect, the Egyptian Knowledge Bank, and Google Scholar). Data from eligible papers were extracted and subjected to various analyses. Seventy-eight studies were found to be eligible for inclusion. Furthermore, ticks infesting animals that were molecularly screened for their associated pathogens were also included in this study to display high species diversity and underline the high infection risk to animals. Theileria annulata was used as parasite model of TBPs to study the genetic diversity and transmission dynamics across different governorates of Egypt. This study extends cross-comparisons between all published molecular data on TBPs in Egypt and provides resources from Egyptian data in order to better understand parasite epidemiology, species diversity, and disease outcome as well as the development and implementation of prevention and control methods for public health, veterinary care practitioners, and animal owners all over the country.

Special Issue: Microbiologists making waves around the South Pacific. (Special Issue: Microbiologists making waves around the South Pacific.)

This special issue includes 11 articles focusing on development of container laboratories in response to COVID-19;COVID-19 in Fiji;Pacific Regional Infectious Disease Association (PRIDA) - capacity-building for microbiology and infectious disease across the Pacific;meningococcal surveillance in Southeast Asia and the Pacific;tropical fever in remote tropics;movement of arboviruses between Indonesia and Western Australia;Rotavirus surveillance informs diarrhoea disease burden in the WHO Western-Pacific region;surveillance for One Health and high consequence veterinary pathogens (Brucellosis, Coxiellosis and Foot and Mouth Disease) in Southeast Asia - Lao PDR and Cambodia in focus and the importance of international partnerships;Avian influenza H5N1.

Old zoonotic agents and novel variants of tick-borne microorganisms from Benguela (Angola), July 2017.

BACKGROUND: Ticks and tick-borne diseases constitute a real threat for the livestock industry, which is increasing in Angola. In addition, ticks are vectors of zoonoses of public health concern, and scarce information is available from this country. In an effort to contribute to the prevention of zoonotic infectious diseases affecting humans and animals, the molecular screening of certain tick-related microorganisms collected on cattle in Angola was performed under a 'One Health' scope. METHODS: Ticks collected from cattle in Cubal (Benguela Province, Angola) in July 2017 were analysed in pools using specific PCR assays for bacteria (Rickettsia, Anaplasmataceae, Borrelia, Coxiella and Spiroplasma) and protozoa (Theileria and Babesia) detection. RESULTS: A total of 124 tick specimens were grouped in 25 pools (two Amblyomma variegatum, three Hyalomma truncatum, 16 Rhipicephalus decoloratus, two Rhipicephalus duttoni, one Rhipicephalus evertsi mimeticus and one Rhipicephalus sp.). The amplified microorganisms were (pools): Rickettsia africae (two A. variegatum and one R. decoloratus), Rickettsia aeschlimannii (three H. truncatum), Ehrlichia spp. (six R. decoloratus), Coxiella spp. (all but H. truncatum), Francisella sp. (one H. truncatum), Spiroplasma sp. closely related to Spiroplasma ixodetis (three R. decoloratus), Babesia bigemina (two R. decoloratus) and Babesia spp. (two A. variegatum). The obtained nucleotide sequences from Ehrlichia spp., two Coxiella genotypes (from R. duttoni and Rhipicephalus sp.), Francisella sp. and Babesia spp. (from A. variegatum) reached low identities with known genetically characterized species. CONCLUSIONS: This study demonstrates the circulation in Angola of the pathogen R. aeschlimannii and potential novel tick-related microorganisms belonging to Ehrlichia, Coxiella, Francisella, Spiroplasma and Babesia spp. and corroborates the presence of R. africae and B. bigemina. Our results should be considered in developing protocols for the management of fever of unknown origin and for veterinary practices. Further studies are required to evaluate the risk of tick-borne diseases in Angola.

Clinically mild encephalitis/encephalopathy with a reversible splenial lesion of the corpus callosum in childhood: a single-center experience

Background/aim: Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a rare clinicoradiological syndrome that typically presents with central nervous system symptoms such as loss of consciousness, seizure, headache, and ophthalmoparesis. Materials and methods: Here, we highlight the characteristics of this syndrome together with the clinical and MRI findings of 6 pediatric patients with MERS. Results: Between January 2017 and October 2020, 6 patients with MERS (3 boys and 3 girls) presented to our center. The mean age was 122 ± 54.6 (min-max: 44-180) months. None of the patients had a chronic disease. In our study, infectious agents were detected in 4 patients (66.6%), while noninfectious causes (one seizure and the other hyponatremia) were detected in two patients. All of our cases were discharged without any sequelae after an average of 12.1 ± 7 (min–max: 4–20) days of hospitalization. In 1 patient (case 6), control MRI could not be performed, and the radiological recovery of our other patients was shown to be between 14 days and 2 months. Conclusion: MERS is an acute encephalopathy with good prognosis and should be considered by neurologists in differential diagnosis due to its variable clinical presentation and specific MRI findings.

No Influence of Previous Coxiella burnetii Infection on ICU Admission and Mortality in Emergency Department Patients Infected with SARS-CoV-2.

BACKGROUND: the geographical similarities of the Dutch 2007-2010 Q fever outbreak and the start of the 2020 coronavirus disease 19 (COVID-19) outbreak in the Netherlands raised questions and provided a unique opportunity to study an association between Coxiella burnetii infection and the outcome following SARS-CoV-2 infection. METHODS: We performed a retrospective cohort study in two Dutch hospitals. We assessed evidence of previous C. burnetii infection in COVID-19 patients diagnosed at the ED during the first COVID-19 wave and compared a combined outcome of in-hospital mortality and intensive care unit (ICU) admission using adjusted odds ratios (OR). RESULTS: In total, 629 patients were included with a mean age of 68.0 years. Evidence of previous C. burnetii infection was found in 117 patients (18.6%). The combined primary outcome occurred in 40.2% and 40.4% of patients with and without evidence of previous C. burnetii infection respectively (adjusted OR of 0.926 (95% CI 0.605-1.416)). The adjusted OR of the secondary outcomes in-hospital mortality, ICU-admission and regular ward admission did not show an association either. CONCLUSION: no influence of previous C. burnetii infection on the risk of ICU admission and/or mortality for patients with COVID-19 presenting at the ED was observed.

EFSA and ECDC publishes EU One Health 2020 zoonoses report

The European Food Safety Authority (EFSA) and the European Centre for Disease Prevention and Control (ECDC) have published the EU One Health 2020 Zoonoses Report. Campylobacteriosis was the most reported zoonosis in the EU in 2020, with 120,946 cases compared to more than 220,000 the previous year. This was followed by salmonellosis, which affected 52,702 people, compared to 88,000 in 2019. The number of reported foodborne outbreaks fell by 47%, with the report acknowledging the impact of the COVID-19 pandemic in the drop in reported zoonotic diseases in humans. The next most commonly reported diseases were yersiniosis, with 5,668 cases, and infections caused by Shiga toxin-producing Escherichia coli, with 4,446 cases. Listeriosis was the fifth most reported zoonosis, mainly affecting people over the age of 64. Listeriosis and West Nile virus (WNV) infections were the diseases with the highest case fatality and hospitalisation rates, with most locally acquired human infections of WNV reported in Greece, Spain and Italy. The report also monitors foodborne outbreaks in the EU, events during which at least two people contract the same illness from the same contaminated food. A total of 3,086 foodborne outbreaks were reported in 2020, with Salmonella remaining the most frequently detected agent, causing around 23% of outbreaks. The most common sources of salmonellosis outbreaks were eggs, egg products and pig meat. The report also includes data on Mycobacterium bovis, Mycobacterium caprae, Brucella, Trichinella, Echinococcus, Toxoplasma gondii, rabies, Q fever and tularaemia.

Acute Q Fever With Dermatologic Manifestations, Molecular Diagnosis, and No Seroconversion.

We herein described a case of acute infection by Coxiella burnetii (acute Q fever) that started with a short incubation period and showed prominent dermatological manifestations and unusual serological behavior. The infection was confirmed by molecular detection through real-time polymerase chain reaction using genomic DNA collected from peripheral blood.

Seropositivity rates of zoonotic pathogens in small ruminants and associated public health risks at informal urban markets in Zambia.

Informal livestock markets are an important source of animal-derived proteins for growing urban populations in countries such as Zambia. In parallel, they can also constitute pathways of zoonotic pathogen transmission to humans. This risk is aggravated by limited disease monitoring and poor control systems with regards to biosecurity and public health. The aim of this study was to investigate the risks for spread of zoonotic diseases in Zambia's two largest informal small ruminant markets, located in Lusaka and Kasumbalesa, through combining seroepidemiology with interviews and observations. In April, May and September 2018, serum samples (n = 237) were collected and analysed for antibodies for the zoonotic pathogens Brucella spp., Coxiella (C.) burnetii and Rift Valley fever virus (RVFV), using commercially available enzyme linked immunosorbent assays (ELISA). In addition, slaughterhouse activities were observed and semi-structured interviews and focus group discussions held with slaughterhouse workers and small ruminant traders, focusing on the handling of animals and meat, and the perceptions of zoonotic disease risks at slaughter and consumption. The study found seropositivity rates of 10.1% (95% confidence interval [CI] 6.60-14.7) for Brucella spp., 5.9% (95% CI 3.27-9.71) for C. burnetii, and 0.8% (95% CI 0.10-3.01) for RVFV. Interviews with value chain members and observations at the slaughterhouse revealed unsanitary procedures and multiple occupational hazards for slaughterhouse workers. This study showed that the Zambian informal small ruminant trade system poses risks to public health, and that these risks are exacerbated by a lack of information about food-borne diseases and how associated risks can be mitigated amongst value chain actors. The results of this study can be used to formulate preventive measures to improve informal meat markets and reduce the risks to public health.

[For Once Not Corona Virus - an Uncommon Cause of Fever and Hepatitis]. / Für einmal nicht Coronavirus ­ Eine nicht alltägliche Ursache für Fieber und Hepatitis.

For Once Not Corona Virus - an Uncommon Cause of Fever and Hepatitis Abstract. Our case reports acute Q fever as uncommon cause of fever, typically accompanied by pneumonia and/or hepatitis. It is caused by Coxiella burnetii, a bacterium which is generally hosted by live stock and affects humans by inhaling aerosols of the animals' excrements. If detected, it may be treated effectively. It should be considered in patients living in a typical environment or with a typical history. The route of our patient's infection remains unclear since he plausibly denied contact with any animals.

Frenemies within: An Endocarditis Case in Behçet's Disease.

A 57-year female patient diagnosed with Behçet's disease, on azathioprine, was noticed to have at a routine examination antinuclear and antiphospholipid antibodies. An overlapping lupus-like syndrome was diagnosed; hydroxychloroquine and aspirin were added. Three years later, the patient presented with dyspnea and sweating, with no fever. A cardiac bruit was noted; a giant vegetation was detected by echocardiography. Laboratory revealed severe thrombocytopenia, antiphospholipid antibodies and low complement. Blood cultures were positive for Abiotrophia defectiva serology and also revealed a chronic Coxiella burnetii infection. Antibiotic therapy, low-dose anticoagulation and control of the underlying disease mildly improved the platelet count, which fully recovered only after cardiac valve replacement. However, the Behçet's disease, initially quiescent, flared after the therapy of infections. We discuss potential links between Behçet's disease and the occurrence of antinuclear and antiphospholipid antibodies and Coxiella endocarditis in this setting. We also highlight the differences between the endocarditis in Behçet's disease, antiphospholipid syndrome, Coxiella burnetii and Abiotrophia defectiva infection, respectively. Intracellular infections may modify the presentation of autoimmune diseases. Confounding clinical features of Coxiella persistent infection and non-bacterial thrombotic endocarditis in Behçet's disease warrant further insight.

Hepatic Manifestations of Nonhepatotropic Infectious Agents Including Severe Acute Respiratory Syndrome Coronavirus-2, Adenovirus, Herpes Simplex Virus, and Coxiella burnetii.

Nonhepatotropic viruses such as adenovirus, herpes simplex virus, flaviviruses, filoviruses, and human herpes virus, and bacteria such as Coxiella burnetii, can cause liver injury mimicking acute hepatitis. Most of these organisms cause a self-limited infection. However, in immunocompromised patients, they can cause severe hepatitis or in some cases fulminant hepatic failure requiring an urgent liver transplant. Hepatic dysfunction is also commonly seen in patients with severe acute respiratory syndrome coronavirus-2 infection. Patients with preexisting liver diseases are likely at risk for severe coronavirus disease 2019 (COVID-19) and may be associated with poor outcomes.