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ISSN: 2574-1241 Volume 5- Issue 4: 2018 DOI: 10.26717/BJSTR.2018.09.001754 Gebremedhin Yohannes. Biomed J Sci & Tech Res

Review Article Open Access

Review on Q in Small and its Public Health Importance

Gebremedhin Yohannes* and Shallom Mekonen College of , Hawassa University, Ethiopia Received: Published: *Corresponding author: : September 07, 2018; September 18, 2018 Gebremedhin Yohannes, College of Veterinary Medicine, Hawassa University, PO Box 5, Hawassa, Ethiopia

Abstract

burnetii

Q fever is a disease caused by which is ubiquitous intracellular bacterial , with acute and chronic clinical manifestations. This bacterium is able to infect a wide range of animals, but , and are the principal reservoirs. Inhalation of contaminated aerosols is the main transmission route for humans. is a worldwide , which may occur in sporadic as well as epidemic forms. Because it is highly infectious for humans, Q fever is an important zoonosis with veterinarian laboraratory workers, farmers and abattoir workers at risk. The spectrum of clinical manifestations in humans and animals are diverse, ranging from seroconvesion without any clinical symptoms to fatal consequences. The acute in humans manifests as self-limitingCoxiella febrile burnetii illness, , or , whereas is the major manifestation in chronic cases. Infection in domestic animal is usually asymptomatic and remainsC. burnetii unrecognized, but it may cause abortion, especially in sheep and . In Ethiopia, the existence of against was reported in goats and sheep slaughtered at Addis Ababa abattoir, and its peri-urban. or from and are the basis of confirmatory diagnosis of infection. and is the recommended for humans. Cotrimoxazole and rifampin are the drugs of choice for the patients allergic or contradicted to . Oxytetracycline in the last trimester of pregnancy is usually recommended for animals. Control of Q fever in humans is largely dependent upon the control of infection in animals. The risk for transmission can be decreased through attention to proper sanitation when dealing with parturient animals and ensuring properKeywords: Coxiella Burnetiid of milk products.

Abbreviations: ; Q fever; Small ; Zoonotic

AIDS: Acquired Immune Deficiency Syndrome; BMG: Biochemistry and Molecular Genetics; BSL3: 3 Laboratory; CR3: Compliment Receptor Three; CSL: Coordinated Science Libratory; ELISA: Enzyme Linked Immunosorbant Assay; FQ: Fluoroquinolones; IAP: Integrin Association Protein; IgG: Immunoglobulin; IgM: Immunoglobulinm; LCV: Large Cell Variant; LPS: Lipopolysaccharides; LRI: Lower Respiratory Infection; LSP: Laboratory Support Processor; OIE: Organization of International Epizootics; PA: Pastoral Association; PCR: Polymerase Chain Reaction; SCV: Small Cell Variant

Introduction

Query fever (Q fever) was first observed in 1935 in Queensland, The etiologic organism of Q fever was first isolated by Burnet Australia as an outbreak of a febrile illness of unknown origin. It and Freeman (1937) and named it burnetii. It causes a was observed among abattoir workers and that is when Q fever mild disease in ruminants, but can cause abortions and still births was first acknowledged [1]. However, Mc Dade (1990) stated that in cattle, sheep and goats. It is also a zoonosis, a disease of animals Queensland was the state in which the disease described first and that can infect humans. infection can produce both Coxiella burnetii thus, named as Q fever, where the Q stood for Queensland. Q fever acute and chronic forms of the disease in humans. A self-limiting is a widespread disease caused by the , is febrile condition is the most frequent manifestation in most cases a small (0.2-1.0μm long and 0.2-0.4μm wide). The causative agent [3]. Spontaneous abortion, intrauterine foetal death, premature of Q fever in humans and animals, is an obligate gram-negative delivery or retarded intrauterine growth may occur in pregnant intracellular bacterium of the family Coxiellaecae [2]. It is able to women [4]. Mortality is a rare outcome of the acute form of the infect mammal, ,reptiles and arthropods but cattle, sheep disease. The major clinical manifestation of chronic form of Q fever Coxiella burnetii also produce and goats are the principal reservoirs. Q fever is listed in the is endocarditis with case fatality in untreated cases exceeding 10% OIE Terrestrial Animal Health Code and Member Countries and [5]. Beside zoonotic importance, Territories are obligated to report occurrences of the disease to the health and production problems in domestic ruminants including OIE according to the OIE Terrestrial Animal Health Code [3]. cattle. Infection in cattle usually remains unrecognized [6], but it

Biomedical Journal of Scientific & Technical Research (BJSTR) 6914 Biomedical Journal of Scientific & Technical Research Volume 9- Issue 1: 2018

Source of Infection causes sporadic reproductive problems such as abortion, infertility Coxiella burnetii and mastitis [7]. Coxiella burnetii is considered a pathogen with no host In Ethiopia, the existence of antibody against specificity and it was shown that infection may occur in a wide range Coxiella burnetii was reported in goats and sheep slaughtered at Addis Ababa of vertebrates, including wild and domestic mammals, birds and abattoir, and its peri-urban zone [8]. A seroprevalence of 6.5% arthropods [2]. Babudieri (1959) [15] stated that Seroprevalence of Coxiella burnetii was also reported in Addis Ababa abattoir workers [9]. To assess was detected in virtually all of the animal kingdom. However, the in pastoral livestock in southeast clinical Q fever is mostly seen in humans. Cattle, sheep and goats Ethiopia, a cross-sectional study was carried out in three livestock are considered to be the most common source of human infection species (cattle, camels and goats).The study was conducted from [16].Method of Transmission July 2008 to August 2010, and eight pastoral associations from the Coxiella burnetii selected districts were included in the study Sera from a total of 1830 animals, comprising 862 cattle, 458 camels and 510 goats bacteria have unique properties that contribute were screened initially Out of sera from total of 1830 animals, 20% to their transmission between hosts: Coxiella Coxiella burnetii were randomly selected (180 cattle, 90 camels and 98 goats) and burnetii a) unlike other members of the , the life cycle of tested for C. burnetii using ELISA. The seroprevalence of is not dependent on arthropods as vectors; and were 31.6% (95% CI, 24.7-39.5), 90.0% (95% CI, 81.8- b) the SCV form is highly resistant in harsh environment. 94.7) and 54.2% (95% CI, 46.1-62.1) in cattle, camels and goats, Inhalation of contaminated fomites is the most common mode of respectively. The seroprevalence of C. burnetii found in this study is transmission to humans [16]. high in all the three animals species studied. Therefore, the objective of this review is to highlight Q fever in the small ruminants and its Domestic ruminants serve as the primary source of human role in Coxiella burnetii publicEtiology health importance. infection [5]. However; many other animal species may play a transmission. Parturient cattle, ewes and Coxiella burnetii goats can excrete very high quantities of bacteria through amniotic Q fever is caused by obligate intracellular bacteria called fluid and foetal membranes [6]. Direct contamination by aerosols [10]. Which has a cell membrane similar to Gram may occur from these products of parturition. Abortive animals may also shed Coxiella burnetii negative bacteria [11]. The agent differs from other rickettsiae in its may continue to shed bacteria for a long period. Infected animals filterability and high degree of resistance to physical and chemical Coxiella burnetii in milk, urine, faeces and uterine agents. It has been found to have several different plasmids, the discharge [6]. Milk is the most common shedding route for goats functions of which are not yet understood. can be and cattle, whereas ewes shed bacteria most commonly in faeces highly pleomorphic when it reproduces inside the phagolysosomes and vaginal mucus [6]. Excreted bacteria contaminate fomites such of an invaded host cell. Two different forms can be distinguished as wool, clothing, straw, manure etc., which may serve as vehicles under an electron microscope: one, large and bacilliform and the for transmission [17]. other coccoid, which develops from the former and has greater Indirect transmission to humans may result from the handling electronic density. A third form appears in the large cells after Coxiella burnetii passage through embryonated eggs or BGM cell cultures when of contaminated farm utensils, straw, manure, or by dust from they have been kept in suboptimal temperature conditions or farm vehicles. may also spread through the air, and therefore, infection may occur in a person without any history fresh medium has not been added. These small, high-density forms Coxiella burnetii are similar to spores. The morphogenesis is comparable, but not of animal contact [17]. However, in some studies it was shown identical to cell differentiation in the formation of endospores. that wind spread is not an important mode of These small forms are responsible for the high resistance of the transmission [18]. Ingestion of contaminated milk and milk agentEpidemology to environmental factors and many disinfectants [12]. products could be a potential source of human infection. However, it was not evident in an experimental study. Rare, but sporadic cases of human-to-human transmission of Q fever have occurred to Coxiella burnetii Q fever is a worldwide zoonosis, which may occur in sporadic attendants during autopsies and following contact with a pregnant as well as epidemic forms. It may be emerging disease, probably woman [19]. Sexual transmission of infection related to climate change Very recently, Dave and others published was also reported in a study [20]. and wild carnivores may a review on the impact of climate change on the emergence of hu- be infected by ingestion of contaminated ruminant placenta or Coxiella burnetii man vector borne diseases [13]. Many animals and arthropods act birth products, or by the aerosol route [2]. Although are not as reservoirs of infection. However, the most commonly identified essential for the life cycle of , they may still play an sources of human are farm animals such as cattle, goats, important role in transmission of the infection in wild vertebrates and sheep, Pets, including , rabbits, and dogs, have also been as shown in (Figure 1) [21]. demonstrated to be potential sources of urban outbreaks of disease [14].

Cite this article: : 6914 Gebremedhin Y, Shallom M. Review on Q fever in Small Ruminants and its Public Health Importance. Biomed J Sci&Tech Res 9(1)- 2018. BJSTR. MS.ID.001754.DOI 10.26717/ BJSTR.2018.09.001754. Biomedical Journal of Scientific & Technical Research Volume 9- Issue 1: 2018

Figure 1: Source and Transmission of Q fever.

Risk Factors Agent factor region. But most cases of Q fever have been reported in the spring or early summer [5]. Human Q fever has been shown to have a relationship with rainfall rather than season [18]. A high prevalence The severity of the infection depends on the strains of the Coxiella of Q fever was observed among people living in close proximity to infecting bacteria. Phase I type bacteria are more virulent than the burnetii infectedPathogenesis animals or in areas with a high livestock density [29]. phase II type [22]. Acute infection in humans is caused by Coxiella burnetii genomic type I-III, whereas type IV and V are responsible forHost chronic factor infection. The virulence of type VI is unknown [23]. The pathogenesis of infection in humans and animals is not clearly understood. But, it is believed that bacterial LPS play an important role in the pathogenesis of Q fever Age and gender are the two risk factors which are shown to in both humans and animals [2]. The organism probably follows influence the occurrence of Q fever in humans. People aged 30- the oropharyngeal route as its port of entry into the lungs and 60 years are the most vulnerable group, and the clinical disease intestines of both humans and animals [18]. It is highly infectious, is mostly prevalent in men [5]. People with a previous history of and a very low dose is sufficient to initiate infection [30]. Primary valvulopathy, an immunosuppressive disease like AIDS and pregnant multiplication takes place in the regional lymph nodes after the Coxiella burnetii women are the most susceptible [24]. People in certain occupations initial entry, and a transient bacteraemia develops which persists like veterinarians, animal farm workers, abattoir workers and for five to seven days [31]. has two morphologically laboratory personnel are at a higher risk of being infected or Coxiella burnetii distinct cell variants; an intracellular and metabolically active large seropositive than others; and studies show a comparatively higher cell variant (LCV) and a spore like small cell variant (SCV) [32]. These prevalence in these groups [25]. A relationship of Coxiella two forms are morphologically and functionally distinct. The LCV infection with age and sex was also found in animals, particularly burnetii is larger, elongated less electron-dense bacteria and metabolically in cattle. Several studies have shown that the prevalence of active and replicating large bacteria [33]. While, the SCV presents infection increases with age or with the number of parity a compact rod-shaped with a very dense central region and it is in cattle and sheep [25]. considered the metabolically dormant and less replicating [34].

Prevalence is higher in dairy cows than in beef cattle [26]. The SCV are shed by infected animals. After infection the Among the dairy cattle breeds, prevalence was reported to be organism attaches to the cell membrane of phagocytic cell. After higher in Holstein [27]. Increasing animal density increases the Coxiella burnetii phagocytosis, the phagosome containing the SCV fuses with infection load in the environment, and is therefore, a potential risk the lysosome. The SCV are metabolically activated in the acidic factor of infection. Several studies in cattle show phagolysosomes and can undergo vegetative growth to form LCV that seroprevalence increases with an increasing herd size [27,28]. [5]. The LCV and the activated SCV can both divide by binary fission Flock size is reported to have a similar effect in sheep [29]. Several [32]. and the LCV can also undergo sporogenic differentiation [2]. management factors such as housing systems, isolation of a newly Coxiella burnetii The spores that are produced can undergo further development to introduced animal may also contribute to the seroprevalence of become metabolically inactive SCV [35,36]. And both spores and Coxiella Season, Environmentinfection andin animals Management [28]. Factors SCV can then be released from the infected host cell by either cell burnetii lysis or exocytosis [5]. The acidic environment also protects from the effects of , as the efficacy of antibiotics Seasonal variation is observed in the occurrence of human Q is decreased in the acidic PH [37]. The SCV and spore forms are fever. This variation, however, varies according to geographical more difficult to denature than LCV [38]. Cite this article: 6915 Gebremedhin Y, Shallom M. Review on Q fever in Small Ruminants and its Public Health Importance. Biomed J Sci&Tech Res 9(1)- 2018. BJSTR. MS.ID.001754. DOI: 10.26717/ BJSTR.2018.09.001754. Biomedical Journal of Scientific & Technical Research Volume 9- Issue 1: 2018

Coxiella burnetii Coxiella burnetii

also has two distinct antigenic phases, Phase I enters monocytes or macrophages; the and Phase II, based on changes that occur in the organism during in only known target cells, by phagocytosis in humans [41,42]. The vitro culture. The primary significance of these two phases is that phagocytotic process differs for phase I and phase II bacteria. to phase II antigens are made during the early stages Phase II bacteria enter the host’s cells through CR3-receptor Coxiella burnetii of the infection, but antibodies to phaseI antigens predominate mediated phagocytosis by activating the CR3 receptors [42]. On if the organism persists longer. This switch is used to distinguish the other hand, the attachment of phase I to a acute from chronic infections in people, although it is not currently monocyte is aided by leukocyte response integrin (LRI) αvβ3, and Coxiella burnetii employed in animals. Phase I bacteria (wild virulent type) with a integrin-associated protein (IAP) [42]. In spontaneous infections, smooth full length LPS were isolated from infected humans, animals the phase I survives within the phagocytic cells, C. burnetii and arthropods [5]. Phase I bacterium converts to an avirulent as the internalisation of the bacteria by these cells is poor. In Coxiella burnetii phase II with rough LPS after several passages in embryonated contrast, uptake of the phase II by monocyte is rapid Coxiella burnetii Coxiella burnetii can only induce egg or cell cultures [39]. The virulence and the pathogenicity of [43]. Infection with phase II induces secretion of the are associated with genetic characteristics, both IgG and IgM, whereas phase I plasmid groups and type of strains [23], and also with host factors IgM production in (Figure2) [5]. such as pregnancy [40].

Figure 2: Binding & entry.

Clinical Signs Clinical Signs of Q fever in Humans Clinical Sign of Q Fever in Small Ruminants Coxiella burnetii

infections produce both acute and chronic forms of clinical manifestations in humans. However, 60% infection Most cases of animal infection are asymptomatic [44]. The remains asymptomatic with a few patients developing severe illness organism is found in the blood, lungs, liver and spleen during [6]. The of Q fever is 2-3 weeks, depending on the acute experimental infection, whereas chronically infected animals route of infection [5]. Clinical signs of acute Q fever are nonspecific persistently shed bacteria in their faeces and urine. Infection in most and vary among patients. A self-limiting febrile condition is the domestic animals remains unrecognised. Coxiellosis is considered a most frequent manifestation in clinical cases, which is accompanied cause of abortion and reproductive disorders in domestic animals Coxiella burnetii by severe , , and a cough [3,17]. A [2]. There is scientific evidence to support the hypothesis that prolonged fever, which may reach 39-40oC, usually stays for 2-4 can induce epidemics of reproductive failure days and then gradually decreases to a normal level through the in sheep and goats, but not in cattle Reproductive disorders in following 5-14 days [5]. A typical pneumonia is another common domestic animals include endometritis, metritis, stillbirth, reduced Coxiella symptom of acute Q fever. Pneumonia is mild in most cases being birth weight and infertility [45]. The herd level prenatal mortality burnetii characterised by a dry cough, fever, and minimal respiratory and rate of still birth were not associated with the level of distress. antibodies in bulk tank milk in Danish dairy cattle [46]. Abortion rate is comparatively higher in ewes and goats than Patients may also develop hepatitis with , but in cows. Abortion is usually observed in late pregnancy in both without , subclinical hepatitis and granulomatous hepatitis ewes and cattle [47]. In most abortive cases, the aborted foetus with a prolonged fever [5]. Generally, hepatitis develops in young appears normal. Discoloured exudate and intracotyledonary immunosuppressed patients, whilst pneumonia is often seen in fibrous thickening may be observed in an infected placenta. Severe older patients [48]. is found in 2% of patients with myometrial and metritis are the frequently observed the acute illness, which may be accompanied by pericarditis. Skin clinical manifestations in goats and cows, respectively [6]. Cite this article: : 6916 Gebremedhin Y, Shallom M. Review on Q fever in Small Ruminants and its Public Health Importance. Biomed J Sci&Tech Res 9(1)- 2018. BJSTR. MS.ID.001754.DOI 10.26717/ BJSTR.2018.09.001754. Biomedical Journal of Scientific & Technical Research Volume 9- Issue 1: 2018

rashes and neurologic disorders such as meningoencephalitis or parturition for detection and identification of C.burnetii in animals. encephalitis, lymphocytic and peripheral neuropathy If possible, vaginal swabs at the day of parturition (or taken less have also been observed in acute Q fever cases. Spontaneous than 8 day after) should be collected in order to limit the number abortion, intrauterine foetal death, premature delivery or retarded of false-negative PCR results. Milk from the tank, individual milk or intrauterine growth may occur in women that become infected colostrums, vaginal or faecal sample can be taken for investigating during pregnancy [4]. Pregnant woman may become chronically bacterialIsolation shedding of the Agent[52]. infected and abort in subsequent pregnancies [5]. Mortality is Coxiella a rare outcome of the acute form of the disease. However, severe burnetii respiratory distress and myocarditis may lead to death [49]. Due to the zoonotic nature of the agent, isolation of is not performed for routine diagnosis in veterinary An infection which lasts for more than six months after the medicine. The main reasons are the high level of expertise required, onset is defined as chronic Q fever. This happens in less than 5% the time consumed and requirement of the BSL3 laboratories of [50]. The major clinical manifestation of this form of the disease confinement [53]. Therefore, isolation of bacteria is done using is endocarditis [3]. It occurs in 60-70% of all chronic cases [5]. The the shell-vial cell culture techniques or culture in the yolk sacs of case fatality of Q fever endocarditis is less than 10% when patients embryonated eggs [54]. Isolation of the Coxiellosis from positive are treated with antibiotics. The aortic and mitral valves are usually PCR samples was amplified through infection of 6-7 days old specific affected [5]. Unspecific signs like intermittent fever, cardiac failure, free Embryonated chicken egg in the yolk sac. The weakness, fatigue, weight loss or may be present. Other were carried out in sterile conditions, through the opening in the manifestations are , osteoarthritis, chronic hepatitis, center of an air chamber. The embryos were incubated at 37˚С with hepatomegaly, splenomegaly, digital clubbing, purpuric rash and an the ovoscopy being carried out on a daily basis during the period Diagnosis arterial embolism [3]. of 15 days. In order to detect the coxiellas by light microscope we Coxiella burnetii prepared smears of yolk sacs of CE, the preparations were stained by the classical methodology of Gimenez stain and displayed by There are no specific clinical sign of infection Coxiella burnetii light microscopy [55]. Especially, in their yolk sacs, which became in human and animals. Therefore, laboratory diagnosis is the a useful indicator of the Coxiellosis infection in diligently stained only way to confirm the disease. Since is highly preparations of yolk sacs, dot-like oval and spherical coxiellae, infectious, biosafety level 3 laboratories and experienced laboratory coloured in different shades of red, or in violet, were observed and personnel are required to handle the contaminated specimens located in the cytoplasm of the endodermal cells in the shape of [51]. For laboratory diagnosis in the context of serial abortion or inclusions or with a diffusion distribution in (Figure 3).

Figure 3: Staining.

Staining

sensitivity especially with vaginal swabs, milk and a fecal sample [58]. The routine diagnosis of Coxiellosis in aborted ruminant is to Serological Tests detect the pathogen using staining techniques. Smears are usually Complement fixation test (CFT) stained by stamp, Gimenez, Machiavello or Giemsa stain [2]. The Coxiella burnetii presence of large masses of red-colored coccobacilli will indicate burnetii Coxiella burnetii a strong presumptive diagnosis of . However, these Although the CF test is prescribed by OIE as a diagnostic method diagnostic methods are poorly sensitive and not specific due to for C. , its sensitivity is week. Antibodies of possible with the other such as Brucella spp in sheep and goat cannot be detected frequently by the antigen of or sp [56]. This followed by serological analysis by the specific test [56]. However, its use is now infrequent, as it has the complement fixation test or better by ELISA [57]. However, displayed a lower sensitivity than the ELISA [60]. The advantage of stanining techniques cannot be specific and they have reduced CFT is that it does not require host specie-specific antibodies [61]. Cite this article: 6917 Gebremedhin Y, Shallom M. Review on Q fever in Small Ruminants and its Public Health Importance. Biomed J Sci&Tech Res 9(1)- 2018. BJSTR. MS.ID.001754. DOI: 10.26717/ BJSTR.2018.09.001754. Biomedical Journal of Scientific & Technical Research Volume 9- Issue 1: 2018

This test is highly specific, but weakly sensitive [62,63]. Moreover, delivered weak and moribund. Brucella is a life longer infection CFT cannot detect early stages of infection as the complement fixing it causes orchitis, epididymitis, synovitis generally it will cause antibodies do not appear in exposed individuals in early stages of sterility in male. Hygromatous swellings, especially of the knees, the infection [64] Therefore, samples from both convalescent and and nonsuppurative arthritis of the stifle joints may occur and in acute phases are required to accurately diagnose the infection. It case of female animals it causes abortion around the 7th month of has been shown that the antigens used in CFT often fail to identify pregnancy. Retention of the placenta and metritis are also common. seropositiveImmunofluorescence sheep and goats Assay [65]. (IFA) also causes abortion in the last 2 months of gestation followed by fever, and sever and foul-smelling of Coxiella burnetii (Philadelphia,Public Health 2002) Importance [78]. IFA is a species-specific test and is not often used for diagnosis infection in animals. It has been widely used and remains a frequently used method for diagnosis of human Because it is highly infectious for humans, Q fever is an important infection [5,25,66]. The IFA allows for the differentiation between zoonosis with veterinarian laboraratory workers, farmers and a suspected acute and chronic clinical infection in humans, based abattoir workers at risk. Surveys have shown that significance on the ratio of phase I and phase II IgG antibodies [67]. If the phase numbers of livestock handlers have antibodies indicating exposure I titer is greater than or equal to phase II, the sample is indicative to the organism. Less than half of people infected become ill, and of chronic exposure and if phase II titer is greater than the phase I most infections are mild. But affected persons can develop a high titer, the sample is indicative of an acute exposure. There is no yet fever with , muscle pains, sore throat and , anyEnzyme commercial linked kitImmunosorbant using IFA for veterinary Assay (ELISA) investigation [68]. chest and stomach pains. The fever can last for one or two weeks, and lead to pneumonia or affect the liver. Treatment involves long term antibiotic therapy. In a small percentage of cases, a chronic Several studies in humans have shown that enzyme-linked severe debilitating disease occurs. People with suppressed Immune immunosorbant assay (ELISA) has a higher sensitivity than CFT systems and those with pre-existing heart valve problems are at and IFA [28]. It is recommended as a useful diagnostic tool for risk of this , which is often fatal There is also a post sero-epidemiological ELISA can detect antibodies against both Q fever syndrome of chronic fatigue Q fever is the second most phase I and phase II antibodies [5]. This test has a higher sensitivity commonly reported laboratory infection with several recorded than the CFT in animal studies [69-71]. CFT is a quick diagnostic outbreaks involving 15 or more personsCoxiella [79]. burnetii technique it allows the testing of a large number of samples at the same time and is a popular tool for sero-epidemiological studies in In humans, initial exposure to may result in animalsPolymerase [71]. chain reaction (PCR) asymptomatic or mild infection but also in acute or chronic disease [24] . The clinical diagnosis can be very difficult. The reasons for this high clinical polymorphism are largely unknown, even Coxiella Recently, several polymerase chain reaction (PCR) techniques if risk factors of severity (e.g., pregnancy, immunosuppression, burnetii have been developed and successfully used to detect preexisting cardiac valvulopathy, vascular grafts, and aneurysms) DNA in cell cultures and in clinical samples [72-75]. have been described. Although rarely fatal, the disease may lead to for Coxiella burnetii This technique is highly sensitive and specific,and is a rapid tool substantial morbidity and can be highly debilitating, even under detection [76]. PCR also has improved the treatment. Most human cases result from the inhalation of dust diagnosisDifferential of Q Dfeveriagnosis in veterinary science [77]. Treatmentparticles contaminated by infected livestock or animal products [2]. Treatment of Acute Q Fever

In animals the includes other causes of abortion and infertility like , , , Acute Q fever is generally self-limited and many patients recover and salmonellosis. In case of leptospirosis abortion occurs with without antimicrobial therapy Treatment for acute Q fever is not or without placental degeneration and encephalitis, Abortion routinely recommended for asymptomatic persons or for those usually occurs 3-4 weeks later. In coordination, excessive whose symptoms have resolved, although it might be considered salivation, conjunctivitis and muscular rigidity are the common in those at high risk of developing chronic Q fever (e.g., valvular signs additionally hemoglobinuria, pallor of mucosa and jaundice heart disease, vascular graft, aneurysm, and immunosuppression also seen. Most affected animals are found dead, apparently [80].Doxycycline at 200 mg daily for 14 days is the recommended from septicemia. Listeriosis has signs like edema, septicemia, regimen for acute cases of Q fever [5]. Unless patients are allergic encephalitis and meningoencephalitis, called circling disease in its to Doxycycline, pregnant, or younger than 8 years (cotrimoxazole) common form. Affected animals circle, in one direction only and Cotrimoxazole and rifampin are also drugs of choice for patients display swallowing, fever, blindness and head pressings. allergic to or in whom tetracyclines contradicted. Long-term (>5 Paralysis and death follow in 2 to 3 days and there is also weeks) use of cotrimoxazole with folinic acid is recommended for necrosis of the placenta which leads to abortion. Listerial abortion pregnant women [4]. usually Occurs in late gestation. The fetus may be macerated or Cite this article: : 6918 Gebremedhin Y, Shallom M. Review on Q fever in Small Ruminants and its Public Health Importance. Biomed J Sci&Tech Res 9(1)- 2018. BJSTR. MS.ID.001754.DOI 10.26717/ BJSTR.2018.09.001754. Biomedical Journal of Scientific & Technical Research Volume 9- Issue 1: 2018

Treatment of Chronic Q Fever

received the approval of the Australian authorities in1989.Results converge today towards the use of a phase I , as the phase Endocarditis is the most common form of chronic Q fever II are 100 times less effective against the colonisation of Combination therapy should be considered standard treatment for mouse spleen than phase I vaccines [83]. However, patients with Q fever endocarditis. The current recommendation proved more effective in nulliparous animals than in parous for treatment of Q fever endocarditis is oral Doxycycline (100 mg animals. Furthermore, vaccination did not clear infection in twice daily) plushydroxychloroquine (200 mg 3 times daily)1 for previously infected goats and cattle [80]. Phase I vaccines are more at least 18 months; however, therapy may need to be prolonged. Coxiella burnetii prior effective, but vaccination is contraindicated for individuals who For patients unable to tolerate , an alternative had sero converted or had been exposed to regimen of Doxycycline plus an FQ for a minimum of 3 to 4years has to . It is preferable to select sero negative herds or been proposed. Doxycycline plus rifampin has also been suggested animals for immunization, and to continue vaccination over several as an alternative therapy; however, drug interactions may limit the years in young animals [80]. usefulness of this combination Patients who receive prolonged Conclusion and Recommendations hydroxychloroquine treatment should have an ophthalmologic examination every 12 months. At-risk populations should be Q fever is a worldwide zoonosis, which may occur in sporadic as screened for glucose-6-phosphate dehydrogenase deficiency well as epidemic forms. The most commonly identified sources of before receiving hydroxychloroquine therapy, and patients who human infections are farm animals such as cattle, goats, and sheep, receive treatment with Doxycycline should be reminded about Pets, including cats, rabbits, and dogs, have also been demonstrated photosensitivity. to be potential sources of urban outbreaks of disease. It is also Endovascular complications are another major group of known to be a cause of reproductive failure in domestic animals, reservoir for Coxiella burnetii chronic infections (9%) In a report of 30 cases, surgical treatment including cattle. Domestic ruminants are considered the main (aortic aneurysm repair or graft replacement) at time of Q . The causative agent is transmitted [81]. Diagnosis was significantly associated with survival (23 of to humans through direct contact with reproductive products of 24 patients who survived underwent surgery; only 2 of 8 patients animals. Aerosol transmission of the disease occurs through the who died underwent surgery) because a variety of antibiotic inhalation of contaminated materials, and large human outbreaks regimens were used in this series, the optimal regimen could have been linked to wind dispersion from sites where infected not be determined. However, most patients were treated with animals are kept. combination Doxycycline-hydroxychloroquine. Two injections of Therefore, based on the above conclusion the following Oxytetracycline (20 mg per kg body weight) in the last trimester recommendations are forwarded: of pregnancy are usually recommended for animals, although this may not completely suppress abortions or stop bacterial shedding a) There should be give attention to proper sanitation duringControl parturitions and Prevention [82]. when dealing with parturient animals and ensuring proper pasteurization of milk products.

During outbreak, some sanitary measures should be applied b) Immunization of occupationally exposed persons, such to reduce transmission of the disease within the animals .changes as abattoir workers, livestock handlers, veterinarians etc. is in the farming practices including manure management such as advised. covering and natural composting or ploughing of manure, treating c) It is highly imperative that clinically suspected animals in the manure lime(or calcium cyanide [83] and the removal of animal farm should be prudently investigated for tracing the source of birth and abortion products [82].Disinfection of the infected human infection. premises including paths and general environments of holding and the implementation of a farm animal breeding However the d) Serological investigation of wildlife should be conducted to Coxiella burnetii in an effectiveness of different control measures remain uncertain .It Referencesidentify the reservoirs of Q fever infection. has been reported that the prevalence of 1. infected herd usually declines over time ,even without taking any Abebe A (1990) Prevalence of Q fever infection in the Addis Ababa control measures. This is probably due to natural immunization of 2. abattoir Ethiopia. MedicalCoxiella Journal burnetii 28: 119-122. Coxiella burnetii suspected animals [82]. have been shown to reduce Agerholm J (2013) associated reproductive disorders abortion, shedding of and the occurrence of in domestic animals- a critical review. Acta Veterinary a Scandinavia 55: 3. infection in animals Outbreak vaccinating herds that are already 13. infected [83]. The inactivated phase I vaccine protects efficiently Aitken I, Bogel K, Cracea E (2010) Q fever in Europe: Current aspects against abortion and has been shown to prevent bacterial shedding of etiology, epidemiology, human infection, diagnosis and therapy. 4. Infection 15: 323-327. in vaginal mucus, , and particularly in milk. CoxiellaAmano burnetii K, Williams J (1984) Chemical and immunological Vaccine trials with killed vaccines in animals show a good characterization of lipopolysaccharides from Phase-I and Phase-II and persistent antibody response and suggest that vaccination 5. . Journal of Bacteriology 160: 994-1002. Coxiella burnetii can limit the excretion of the organism .A vaccine inactivated by Angelakis E, Roult D (2010) Q fever veterinary microbiology 140: 297- formaldehyde prepared from the strain of phase I , 309. Cite this article: 6919 Gebremedhin Y, Shallom M. Review on Q fever in Small Ruminants and its Public Health Importance. Biomed J Sci&Tech Res 9(1)- 2018. BJSTR. MS.ID.001754. DOI: 10.26717/ BJSTR.2018.09.001754. Biomedical Journal of Scientific & Technical Research Volume 9- Issue 1: 2018

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Cite this article: 6921 Gebremedhin Y, Shallom M. Review on Q fever in Small Ruminants and its Public Health Importance. Biomed J Sci&Tech Res 9(1)- 2018. BJSTR. MS.ID.001754. DOI: 10.26717/ BJSTR.2018.09.001754. Biomedical Journal of Scientific & Technical Research Volume 9- Issue 1: 2018

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Cite this article: : 6922 Gebremedhin Y, Shallom M. Review on Q fever in Small Ruminants and its Public Health Importance. Biomed J Sci&Tech Res 9(1)- 2018. BJSTR. MS.ID.001754.DOI 10.26717/ BJSTR.2018.09.001754.