Q fever in Bulgaria and Slovakia.

As a result of dramatic political and economic changes in the beginning of the 1990s, Q-fever epidemiology in Bulgaria has changed. The number of goats almost tripled; contact between goat owners (and their families) and goats, as well as goats and other animals, increased; consumption of raw goat milk and its products increased; and goats replaced cattle and sheep as the main source of human Coxiella burnetii infections. Hundreds of overt, serologically confirmed human cases of acute Q fever have occurred. Chronic forms of Q fever manifesting as endocarditis were also observed. In contrast, in Slovakia, Q fever does not pose a serious public health problem, and the chronic form of infection has not been found either in follow-ups of a Q-fever epidemic connected with goats imported from Bulgaria and other previous Q-fever outbreaks or in a serologic survey. Serologic diagnosis as well as control and prevention of Q fever are discussed.

[Current status of the Q-rickettsial endocarditis problem and the 1st case reported in Bulgaria]. / Suvremenno sustoianie na problema za Q-riketsiozniia endokardit s prinos na purviia sluchai v Bulgariia.

A vast literary review on Q-rickettsial endocarditis is presented--spread, frequency, predilection, clinical course, laboratory findings, diagnosis, treatment, prognosis. The first case of Q-rickettsial endocarditis in Bulgaria is reported. The case was proved by the high titre of the specific antibodies while the patient was still alive and post mortem by visualizing the causative agent in the aortic valve and by its isolation through inoculation of material from the aortic valve. The infection was not influenced by high doses of penicillin, gentamycin and brulamycin but was suppressed by vibramycin in combination with lincomycin and biseptol. The lethal outcome was due to severe heart failure. It is suggested that other cases of Q-rickettsial endocarditis should be expected since Q-fever is widely spread in Bulgaria and the characteristics of the disease, its diagnosis and treatment ought to be well known.

Incidence of Q fever in two inadequately investigated occupational groups.

In 1973 the authors investigated the incidence of Q fever serologically by means of the reaction of complement fixation (RCF) and the method of immunofluorescent titration (MIFT) in two inadequately investigated occupational groups--communal workers from the town of Russe and medical workers in obstetric departments of several towns in North Bulgaria. In addition, they carried out comparative studies in order to characterize the incidence and the degree of affection from the same disease in other persons exposed and not exposed at work in the same area--transport workers and blood donors. Out of 198 communal workers, 91 (45.95 +/- 3.54%) had positive titres for Q fever (1:8--1:512). A high incidence of Q fever was established in dustmen (61.40%), sweepers (46.55%) and drivers of dust cars (38.00%), i.e. persons collecting and rendering harmless the garbage of big town. Out of 174 medical workers in obstetric departments 65 (37.36% +/- 3.78%) were positive in titres 1:8--1:512. A high incidence of Q fever was established in obstetricians (57.14%), midwives (38.11%) and hospital attendants (34.38%), i.e. persons providing medical care for pregnant women or women in childbirth. In both groups the occupational hazard increases with the length of service. Out of 244 transport workers 82 (33.60% +/- 3.02%) were positive for Q fever, and out of 237 blood donors 19 (8.01 +/- 2.54%) were serologically positive for Q fever. The authors suggest continued investigation of these two occupational groups.