We report a case of Q fever in a man who presented with fever of 40 days duration associated with thrombocytosis. Serological and molecular analysis (polymerase chain reaction) confirmed infection with Coxiella burnetii. A field study was conducted by collecting blood samples from the patient's family and from the animals in the patient's house. The patient's wife and 2 of 13 dogs showed seroreactivity. Our data indicate that C. burnetii may be an underrecognized cause of fever in Brazil and emphasize the need for clinicians to consider Q fever in patients with a febrile illness, particularly those with a history of animal contact.

Abstract. Q fever is an important cause of undifferentiated fever that is rarely recognized or reported in Brazil. The objective of this study was to look for the presence of Coxiella burnetii during a dengue fever outbreak in the municipality of Itaboraí, Rio de Janeiro, Brazil, where this bacterium had previously infected humans and domesticated animals. Blood samples from clinically suspected dengue fever patients were tested by polymerase chain reaction (PCR) for C. burnetii; the DNA was detected in nine (3.3%) of 272 patients. One was coinfected with dengue virus, which was also detected in another 166 (61.3%) patients. The nucleotide sequence of PCR amplification and DNA sequencing of the IS1111 transposase elements in the genome of C. burnetii exhibited 99% identity with the sequence in GenBank. The detection of C. burnetii in patients suspected of dengue fever indicates that awareness and knowledge of Q fever should be strengthened and that this bacterium is present in Brazil. Finally, because a negative molecular result does not completely rule out the diagnosis of Q fever and the serological assay based on seroconversion was not available, the actual number of this zoonosis is likely to be much higher than that reported in this study.

Q fever is a worldwide zoonosis caused by Coxiella burnetii—a small obligate intracellular Gram-negative bacterium found in a variety of animals. It is transmitted to humans by inhalation of contaminated aerosols from urine, feces, milk, amniotic fluid, placenta, abortion products, wool, and rarely by ingestion of raw milk from infected animals. Nested PCR can improve the sensitivity and specificity of testing while offering a suitable amplicon size for sequencing. Serial dilutions were performed tenfold to test the limit of detection, and the result was 10× detection of C. burnetti DNA with internal nested PCR primers relative to trans-PCR. Different biological samples were tested and identified only in nested PCR. This demonstrates the efficiency and effectiveness of the primers. Of the 19 samples, which amplify the partial sequence of C. burnetii, 12 were positive by conventional PCR and nested PCR. Seven samples—five spleen tissue samples from rodents and two tick samples—were only positive in nested PCR. With these new internal primers for trans-PCR, we demonstrate that our nested PCR assay for C. burnetii can achieve better results than conventional PCR.

Background: Chikungunya is a viral disease that is transmitted by mosquitoes. It is characterized by an acute onset of fever and severe arthralgia. Methods: We describe six cases of acute and post-acute chikungunya in which viral RNA was detected in semen. Conclusions: The most prolonged detection period was 56 days after illness onset. We attempted to cultivate positive semen samples, but virus isolation was unsuccessful in all cases.

RESUMOUm grande número de viajantes visita anualmente, por estudo, turismo ou trabalho o continente africano. Um caso de adenomegalia cervical e hepatoesplenomegalia associado à febre de duas semanas de duração com teste sorológico positivo para Bartonella sp em uma paciente de 22 anos do sexo feminino que retornou da África do Sul após realização de trabalho de campo com primatas em área silvestre é apresentado. Palavras-chaves: Doença febril do viajante. Adenomegalia. Bartoneloses. ABSTRACTA large number of travelers visit the African continent annually for studying, tourism or business reasons. The authors report a case of cervical adenomegaly, hepatomegaly and splenomegaly associated with a two-week history of fever and seropositivity for Bartonella sp in a 22-year-old female patient who returned from South Africa after field work with primates in a wild area. Key-words: Fever in traveler. Adenomegaly. Bartonellosis. Embora a maioria dos casos febris procedentes dos países tropicais tenha a malária, a dengue ou a febre tifóide como diagnósticos mais comuns, nas duas últimas décadas, as rickettsioses, em especial na África do Sul, têm sido mais frequentemente notificadas. Dados disponíveis na literatura científica e nos sítios GeoSentinel, especializados em medicina do viajante, mostram mais de 450 casos confirmados de rickettsioses, com maior concentração na África SubSaariana 1-3 .Rickettsioses são doenças infecciosas transmitidas por artrópodes, causadas por rickettsias que ocorrem, exceto o tifo epidêmico, como pequenos surtos ou casos isolados. Sob o aspecto taxonômico, embora sejam consideradas como grupo de doenças causadas por proteobacterias do subgrupo α1, Bartonella sp e Coxiella burnetti, pertencentes ao subgrupo α 2 e subgrupo g, respectivamente, ainda permanecem sendo estudadas no campo da rickettsiologia 4 .Quanto às bartoneloses, até 1993, Bartonella bacilliformis, causadora da doença de Carrion, era considerada a única do gênero, mas, após a reorganização taxonômica e a identificação de novas espécies, um amplo espectro clínico da doença tem sido identificado desde adenomegalia à endocardite 5 .O objetivo deste relato de caso é alertar para a ocorrência das rickettsioses lato sensu como doença importada, em especial, da África do Sul, e enfatizar que as rickettsioses devem ser consideradas mesmo na ausência de exantema e de lesão de inoculação.Paciente do sexo feminino, branca, 22 anos, estudante, natural do Rio de Janeiro, com início da doença em 28/08/2009 com dor na região cervical e mal-estar. Em 06/09/2009, percebeu adenomegalia cervical direita associada com febre alta (não aferida), cefaléia, mialgia, anorexia, astenia, apatia, náuseas e vômitos. Recém chegada da África do Sul, onde, por 60 dias, realizou trabalho em área silvestre com coleta de fezes de macacos, a paciente se automedicou com doxiciclina (200mg/dia), pois dois casos de febre maculosa foram confirmados em membros da equipe, 10 dias antes do seu retorno para o Brasil. Sem resposta à doxiciclina, procurou assistência médi...