Prevalence of Coxiella burnetii in clinically healthy German sheep flocks

<p>Abstract</p> <p>Background</p> <p>Current epidemiological data on the situation of <it>Coxiella (C.) burnetii </it>infections in sheep are missing, making risk assessment and the implementation of counteractive measures difficult. Using the German state of Thuringia as a model example, the estimated sero-, and antigen prevalence of <it>C. burnetii </it>(10% and 25%, respectively) was assessed at flock level in 39/252 randomly selected clinically healthy sheep flocks with more than 100 ewes and unknown abortion rate.</p> <p>Results</p> <p>The CHECKIT™ Q-fever Test Kit identified 11 (28%) antibody positive herds, whereas real-time PCR revealed the presence of <it>C. burnetii </it>DNA in 2 (5%) of the flocks. Multiple-locus variable number of tandem repeats analysis of 9 isolates obtained from one flock revealed identical profiles. All isolates contained the plasmid QpH1.</p> <p>Conclusions</p> <p>The results demonstrate that <it>C. burnetii </it>is present in clinically inconspicuous sheep flocks and sporadic flare-ups do occur as the notifications to the German animal disease reporting system show. Although <it>C. burnetii </it>infections are not a primary veterinary concern due to the lack of significant clinical impact on animal health (with the exception of goats), the eminent zoonotic risk for humans should not be underestimated. Therefore, strategies combining the interests of public and veterinary public health should include monitoring of flocks, the identification and culling of shedders as well as the administration of protective vaccines.</p

Are brucellosis, Q fever and melioidosis potential causes of febrile illness in Madagascar?

Brucellosis, Q fever and melioidosis are zoonoses, which can lead to pyrexia. These diseases are often under-ascertained and underreported because of their unspecific clinical signs and symptoms, insufficient awareness by physicians and public health officers and limited diagnostic capabilities, especially in low-resource countries. Therefore, the presence of Brucella spp., Coxiella burnetii and Burkholderia pseudomallei was investigated in Malagasy patients exhibiting febrile illness. In addition, we analyzed zebu cattle and their ticks as potential reservoirs for Brucella and C. burnetii, respectively. Specific quantitative real-time PCR assays (qPCRs) were performed on 1020 blood samples drawn from febrile patients. In total, 15 samples (1.5%) were Brucella-positive, mainly originating from patients without travel history, while DNA from C. burnetii and Bu. pseudomallei was not detected. Anti-C. burnetii antibodies were found in four out of 201 zebu serum samples (2%), whereas anti-Brucella antibodies could not be detected. Brucella DNA was detected in a single zebu sample. Three out of 330 ticks analyzed (1%) were positively tested for C. burnetii DNA but with high Ct values in the qPCR assay. Our data suggest that zebus as well as Amblyomma and Boophilus ticks have to be considered as a natural reservoir or vector for C. burnetii, but the risk of cattle-to-human transmission is low. Since bovine brucellosis does not seem to contribute to human infections in Madagascar, other transmission routes have to be assumed

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity &gt; 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Coxiella burnetii – Epidemiological studies on the prevalence and distribution in sheep and cattle herds in Germany

Diese Dissertation setzt sich mit dem Zoonoseerreger Coxiella burnetii und seiner Verbreitung in Schaf- und Rinderbeständen in Deutschland auseinander. Der Stellenwert dieser Zoonose in Bezug auf das Gefährdungspotential für die öffentliche Gesundheit, die Notwendigkeit prophylaktischer Maßnahmen und Bekämpfungsstrategien und die Problematik der Diagnostik eines intrazellulären Bakteriums der Risikogruppe 3 „Z“ werden diskutiert. Im Rahmen dieser Arbeit wurden Untersuchungen sowohl in unauffälligen, nicht geimpften Rinder- und Schafbeständen als auch in Beständen mit erhöhten Abortraten oder klinischer Symptomatik durchgeführt. Retrospektiv durchgeführte epidemiologische Erhebungen nach zwei Q-Fieber-Ausbrüchen sind ebenso Thema. Auf Einzeltierbasis konnten in unauffälligen Rinderherden Seroprävalenzen im Jahresmittel bis zu 9% und monatliche Durchschnittswerte bis zu 24,7% nachgewiesen werden. Der Untersuchungsumfang umfasste 1.640 Seren. Die Ergebnisse der Untersuchungen in 40 klinisch gesunden, nicht geimpften Schafherden führten zu einer Herdenprävalenz von 5% und einer Seroprävalenz von 25%. Im Jahr 2009 wurde in 75% der getesteten Nachgeburten C. burnetii-DNA nachgewiesen. Neun Isolate konnten gewonnen werden, die nach phylogenetischer Systematik in die gleiche Gruppe einzuordnen sind. In diesem Fall basierten die Auswertungen auf einem Probenumfang von 1.158 Serumproben, je 440 Vaginal- und Rektalabstrichen, 71 Nachgeburten sowie sechs Föten. Die Erreger- und Antikörpernachweise in klinisch auffälligen Rinderherden wurden mittels Milchproben durchgeführt. Dieses Medium bietet den Vorteil, aus nur einer Probe sowohl direkte als auch indirekte diagnostische Verfahren durchführen zu können. Die Ergebnisse der Tankmilchproben zeigten Genomnachweise von C. burnetii bis zu 62,5% und serologische Nachweise bis zu 68,3%. Die höchsten ermittelten DNA-Nachweise bei den Einzelmilchproben lagen bei 60,0%, die höchsten ermittelten Antikörpernachweise bei 62,2%. In der Gesamtheit wurden 2.980 Tank- und Einzelmilchproben untersucht. Im Zusammenhang mit den epidemiologischen Erhebungen der vorgestellten Q-Fieber-Ausbrüche wurden Prävalenzen von 16,7% und Seroprävalenzen von 76,2% ermittelt. Die Untersuchungsbefunde beider Tierarten zeigen bezüglich der Nachweise von C. burnetii und der gebildeten Antikörper keinen konstanten Verlauf. Vielmehr stellt sich eine ständige Dynamik im Infektionsverlauf dar, die von Jahr zu Jahr und teilweise sogar von Monat zu Monat Schwankungen unterworfen ist. In Bezug auf die Diagnostik wird deutlich, dass einmalige Untersuchungen immer nur Momentaufnahmen darstellen. Die Inkonsistenz von Erregerausscheidung und Antikörperbildung stellen eine ständige Herausforderung bei der Interpretation eines Infektionsgeschehens dar. Die Qualität diagnostischer Aussagen bezüglich C. burnetii und die Einschätzung des jeweiligen, aktuellen Gefährdungspotentials von Q-Fieber und Coxiellose sind abhängig von Langzeitstudien. Neben der Schwierigkeit der Interpretation diagnostischer Daten gestalten sich auch Vergleiche erhobener Datensätze verschiedener Studien als schwierig. Die geschilderten Abweichungen der Ergebnisse bei standardisierten, kommerziell erhältlichen Testsystemen veranschaulichen diese Problematik. Betrachtet man die Q-Fieber-Literatur weltweit, so lässt sich gerade in Bezug auf das Studiendesign und die Umsetzung der Studiendurchführung eine erhebliche Variationsbreite feststellen, wodurch direkte Vergleiche teilweise sogar unmöglich sind. Die Impfung von Rinder- und Schafbeständen als Bekämpfungsstrategie dürfte zukünftig eine wachsende Bedeutung erfahren. Durch die nachgewiesene Reduktion der Erregerausscheidung und Verringerung der Abortrate stellt sie eine gute Möglichkeit zur Eindämmung der C. burnetii-Infektionen bei Nutztieren und damit indirekt zur Vermeidung humaner Erkrankungen dar. Nach wie vor ungeklärt bleibt die große Diskrepanz zwischen höheren Meldezahlen beim Rind und weitaus häufiger auftretenden Ausbruchsgeschehen beim Schaf. Neben der genetischen Variabilität des C. burnetii-Genoms, die erst durch umfangreichere Daten auf dem Gebiet der Genomsequenzierung bewertet werden kann, spielen unterschiedliche Umgebungsparameter in den Haltungsbedingungen beider Tierarten eine Rolle. Dies zeigt auch der Q-Fieber-Ausbruch in den Niederlanden, bei dem nicht nur der Tierart Ziege eine Relevanz zukommt, sondern vor allem auch der extensiven Tierhaltung. Hohe Tierzahlen pro Bestand und Fläche, die auch in Deutschland das landwirtschaftliche Bild prägen, stellen bei aerogen übertragbaren Erregern auch ein entsprechend hohes Übertragungsrisiko dar. Humane Q-Fieber- Infektionen unterliegen aufgrund der unklaren Klinik einer hohen Dunkelziffer. Gleiches gilt für die Rinder- und Schafbestände. Da in den Beständen eine bestehende Infektion lange unbemerkt bleiben kann, wird der Eintrag des Erregers häufig erst durch die Rückverfolgung humaner Erkrankungsfälle festgestellt. C. burnetii ist grundsätzlich kein Erreger, der große Seuchenzüge und hohe Mortalität in Deutschland verursacht. Die Relevanz dieses Erregers und die Priorität von epidemiologischen Erhebungen und diagnostischen Maßnahmen unterliegen daher ständig neuen Diskussionen. Die häufig in der Anzahl der Erkrankungsfälle begrenzten Q-Fieber-Ausbrüche führen teilweise zur Unterschätzung des Gefährdungspotentials dieses Erregers. Nur mittels längerfristiger Betrachtungen der Rinder- und Schafherden können gezielte Risikobewertungen und bei Bedarf entsprechende Bekämpfungsmaßnahmen erfolgen.This dissertation exposes the zoonotic Coxiella burnetii and its distribution in sheep and cattle herds in Germany. The importance of this zoonosis in terms of the potential hazard to public health, the need for preventive measures and control strategies and the problem of diagnosis of an intracellular bacterium of risk group 3 "Z" will be discussed. In this study investigations were carried out in clinically healthy non-vaccinated cattle herds and sheep flocks and in herds with increased abortion rate or clinical symptoms. Furthermore, retrospectively conducted epidemiological surveys are discussed by two Q fever outbreaks. In clinically healthy cattle herds, seroprevalence up to 9%, and monthly average up to 24.7% were detected. 1640 sera were examined for this purpose. The results of investigations in 40 clinically healthy unvaccinated sheep flocks led to a prevalence at herd level of 5% and a seroprevalence of 25%. In the afterbirths tested in 2009 C. burnetii DNA was detected in 75%. Nine isolates of the same phylogenetic group could be isolated. In this case the evaluations were based on a sample size of 1158 serum samples, 440 vaginal swabs, 440 rectal swabs, 71 afterbirths and 6 fetuses. The detection of C. burnetii and antibodies in clinically healthy cattle herds was performed using milk samples. This medium has the advantage of being able to carry out direct and indirect diagnostic methods from the same sample. The results of bulk milk samples showed evidence of C. burnetii genome up to 62.5% and antibody detection up to 68.3%. In the individual milk samples, we found the highest DNA evidence at 60.0% and the highest antibody detection at 62.2%. A total of 2980 tank and individual milk samples were examined. In the context of the epidemiological surveys of the described Q fever outbreaks, a prevalence of 16.7% and a seroprevalence 76.2% were determined. A constant course of C. burnetii and evidence of antibody detection cannot be determined in both species. It presents a continuous dynamic in the course of infection which varies from year to year and sometimes even month to month. It is clear that one-time studies represent only snapshots. The inconsistency of excretion and seroconversion are a constant challenge in the interpretation of the infection with C. burnetii. Long-term studies are required for the quality of the diagnostic statements and the assessment of the current risk potential of Q fever and coxiellosis. In addition to the difficulty of interpretation of diagnostic data, it is difficult to compare records of different studies. The described deviations of results in standardized, commercially available test systems illustrate this problem. In the international published literature on Q fever, there is wide variation in study design and implementation of the study conduct. Direct comparisons are therefore partly impossible. For the treatment and prophylaxis of coxiellosis, the importance of vaccination of cattle and sheep flocks increases. Through the demonstrated reduction of excretion and the abortion rate, it represents a good way to control C. burnetii infections and to prevent human disease. Still unclear is the large discrepancy between reporting higher numbers of cattle and much more frequent outbreaks in sheep. In addition to the genetic variability of C. burnetii genome, which can only be assessed by genome sequencing, the type of livestock of both species is important. The Q fever outbreak in the Netherlands shows that not only the species goat, but also the extensive farming is relevant. The transmission of airborne transmissible agents is increased by high animal stocking densities in herds and areas. There is a high number of unreported cases of human Q fever infections due to unspecific clinical symptoms. The same applies to cattle and sheep stocks. In the stocks, an infection may remain unnoticed for a long time, so the initial entry of the pathogen often can only be traced back by analysing human disease cases. C. burnetii is not a bacterium that causes large epidemics and high mortality in Germany. Therefore, the relevance of the pathogen and priority of epidemiological surveys and diagnostic measures often lead to discussions. Most Q fever outbreaks are limited in the number of patients. This is partially caused by underestimation of the hazard of this pathogen. Only by performing long-term studies of herds and flocks, specific risks can be assessed and when necessary appropriate control measures can be applied

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Knowledge, attitudes and practices related to tuberculosis in pharmacy workers in a cross-sectional survey in El Agustino, Peru

<div><p>Introduction</p><p>Although the worldwide incidence of tuberculosis (TB) is slowly decreasing, annual infection rates in Peru remain among the highest in the Americas. Pharmacies could play an important role in facilitating early detection of TB. However, the awareness, expertise and cooperation of pharmacy workers is fundamental. This study explored the TB-related knowledge, attitudes and practices of pharmacy workers in a district with one of the highest incidences of TB in Peru.</p><p>Methods</p><p>This cross-sectional study applied a questionnaire that was administered face to face using smartphones with one pharmacy worker at each of 45 randomly selected pharmacies in the El Agustino district of Lima, Peru.</p><p>Results</p><p>Participants were primarily female (78%) and had an average age of 31.3 years old (range 18–57 years old). Only 11% of participants were pharmacists with complete university training. The pharmacy workers’ knowledge was adequate; however, workers had important knowledge gaps and myths regarding prevention of TB transmission. Most pharmacy workers (77%) reported they would send a client with a history of cough for more than two weeks to a healthcare center, while 23% reported they would offer them antitussive medication or antibiotics. Almost all workers reported talking with clients about diseases and reported respiratory symptoms as one of the most common causes for consultation (60%). Most participants expressed interest in learning more about TB and expanding their involvement in the fight against TB in their community.</p><p>Conclusion</p><p>Pharmacy workers have adequate knowledge about TB. However, we identified gaps in knowledge with respect to prevention of TB transmission. Pharmacy workers commonly see patients with respiratory symptoms and some offer recommendations, including for treatment. Pharmacy workers are willing to learn more and contribute to TB control and could be a valuable asset in the control and prevention of TB in Peru. To achieve this integration of pharmacy workers into TB control and prevention, more research is needed.</p></div

Characterization of a plant cell suspension culture of Vitis vinifera: biomass composition assessment before C13-metabolic flux analysis

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Microevolution of the chromosomal region of acute disease antigen A (adaA) in the query (Q) fever agent Coxiella burnetii.

The acute disease antigen A (adaA) gene is believed to be associated with Coxiella burnetii strains causing acute Q fever. The detailed analysis of the adaA genomic region of 23 human- and 86 animal-derived C. burnetii isolates presented in this study reveals a much more polymorphic appearance and distribution of the adaA gene, resulting in a classification of C. burnetii strains of better differentiation than previously anticipated. Three different genomic variants of the adaA gene were identified which could be detected in isolates from acute and chronic patients, rendering the association of adaA positive strains with acute Q fever disease disputable. In addition, all adaA positive strains in humans and animals showed the occurrence of the QpH1 plasmid. All adaA positive isolates of acute human patients except one showed a distinct SNP variation at position 431, also predominant in sheep strains, which correlates well with the observation that sheep are a major source of human infection. Furthermore, the phylogenetic analysis of the adaA gene revealed three deletion events and supported the hypothesis that strain Dugway 5J108-111 might be the ancestor of all known C. burnetii strains. Based on our findings, we could confirm the QpDV group and we were able to define a new genotypic cluster. The adaA gene polymorphisms shown here improve molecular typing of Q fever, and give new insights into microevolutionary adaption processes in C. burnetii

Participants’ TB-related knowledge as demonstrated by the percentage of correct answers per question, pharmacy workers, El Agustino, Lima, Peru (N = 45).

<p>Participants’ TB-related knowledge as demonstrated by the percentage of correct answers per question, pharmacy workers, El Agustino, Lima, Peru (N = 45).</p