Endemic Q Fever in New South Wales, Australia: A Case Series (2005–2013)

Abstract

Abstract. Q fever is endemic in Australia, and during the period 2005-2013 our laboratory diagnosed 379 cases in New South Wales. To evaluate clinical symptoms, epidemiology, mode of diagnosis, antibody profiles, and treatment, a subset of 160 (42%) Q fever cases were analyzed in detail following the return of a questionnaire by the patient's doctor and from their laboratory reports. Overall, 82% patients were male and predominantly middle aged. The majority of patients (89%) had animal contact among which 63% were with cattle, 11% with sheep, and 7% with kangaroos. Clinical symptoms were nonspecific: myalgia (94%), fever (91%), headache (80%), acute fatigue (64%), and arthralgia (55%). Most cases (93%) were acute, and serology (immunofluorescence) was the main diagnostic modality. Positive real-time polymerase chain reaction results were useful in the diagnosis of both acute and chronic Q fever, as was the isolation of Coxiella burnetii in cell culture. Doxycycline was the antibiotic most commonly used. BACKGROUND

One Health research and training in Australia and New Zealand

“…The majority of research in Australia tends to focus on analysis of notified cases (35), unusual outbreaks, (36, 37), or animal and environmental sources (38). However, a recent study by Bond et al (39) demonstrated the application and outcomes of taking a One Health approach to an outbreak associated with a goat farm.…”

An unusual presentation of a known condition: Q fever manifesting as an acute abdomen

“…Q fever is an endemic zoonotic infection in Australia cause by Coxiella burnetii. It has been recognised in other parts of the world, especially among livestock rearing occupations, stock yard and abattoir workers [1][2][3]. Coxiella burnetii can be harboured in most herd and domestic animals including cattle, goats, sheep and dogs, Macropods such as kangaroos and wombats, and also in ticks that are associated with some of these animals [2,3].…”

“…It has been recognised in other parts of the world, especially among livestock rearing occupations, stock yard and abattoir workers [1][2][3]. Coxiella burnetii can be harboured in most herd and domestic animals including cattle, goats, sheep and dogs, Macropods such as kangaroos and wombats, and also in ticks that are associated with some of these animals [2,3]. Coxiella burnetii is particularly concentrated in the placenta, so although it is shed into bodily secretions including faeces, most human infections occur through contact with the placenta of infected animals [2,3].…”

“…Coxiella burnetii can be harboured in most herd and domestic animals including cattle, goats, sheep and dogs, Macropods such as kangaroos and wombats, and also in ticks that are associated with some of these animals [2,3]. Coxiella burnetii is particularly concentrated in the placenta, so although it is shed into bodily secretions including faeces, most human infections occur through contact with the placenta of infected animals [2,3]. Transmission can occur through inhalation of aerosolised particles contaminated by the secretions from infected animals, and ingestion of contaminated poultry or uncooked raw eggs [3,4].…”

“…Coxiella burnetii is particularly concentrated in the placenta, so although it is shed into bodily secretions including faeces, most human infections occur through contact with the placenta of infected animals [2,3]. Transmission can occur through inhalation of aerosolised particles contaminated by the secretions from infected animals, and ingestion of contaminated poultry or uncooked raw eggs [3,4]. The suspected mode of transmission in the above case was inhalation of aerosolised infected goat faeces when cleaning the contaminated truck with a high power jet water hose.…”