The epidemic of Q fever in 2018 to 2019 in Zhuhai city of China determined by metagenomic next-generation sequencing

Abstract

Q fever is a worldwide zoonosis caused by Coxiella burnetii (Cb). From January 2018 to November 2019, plasma samples from 2,382 patients with acute fever of unknown cause at a hospital in Zhuhai city of China were tested using metagenomic next-generation sequencing (mNGS). Of those tested, 138 patients (5.8%) were diagnosed with Q fever based on the presence of Cb genomic DNA detected by mNGS. Among these, 78 cases (56.5%) presented from Nov 2018 to Mar 2019, suggesting an outbreak of Q fever. 55 cases with detailed clinical information that occurred during the outbreak period were used for further analysis. The vast majority of plasma samples from those Cb-mNGS-positive patients were positive in a Cb-specific quantitative polymerase chain reaction (n = 38) and/or indirect immunofluorescence assay (n = 26). Mobile phone tracing data was used to define the area of infection during the outbreak. This suggested the probable infection source was Cb-infected goats and cattle at the only official authorized slaughterhouse in Zhuhai city. Phylogenic analysis based on genomic sequences indicated Cb strains identified in the patients, goat and cattle were formed a single branch, most closely related to the genomic group of Cb dominated by strains isolated from goats. Our study demonstrates Q fever was epidemic in 2018–2019 in Zhuhai city, and this is the first confirmed epidemic of Q fever in a contemporary city in China.

Identification of Tick-Borne Pathogens and Genotyping of Coxiella burnetii in Rhipicephalus microplus in Yunnan Province, China

“…The sporadic human Q fever cases and several small outbreaks of Q fever that occurred in leather factories or goat/sheep farms were reported in China ( Yu, 2000 ). In 2018–2019, an epidemic of human Q fever in Zhuhai city of China was determined by mNGS ( Huang et al, 2021 ). In the present study, C. burnetii were detected in 3.10% of Rh.…”

Case Report: Diagnosis of Acute Q Fever With Aseptic Meningitis in a Patient by Using Metagenomic Next-Generation Sequencing

“…As a novel pathogen identification method, mNGS also can make a fast detection of difficult-to-culture pathogens such as C. burnetii ( 23 , 24 ). Mingxing Huang reported the epidemic of acute Q fever in Zhuhai city confirmed by mNGS, which shows mNGS has higher sensitivity compared to 72.2% seropositivity rate and 95% qPCR positive rate ( 25 ). Owing to the complexity of mNGS results, interpreting them may be the greatest challenge.…”

Diverse and atypical manifestations of Q fever in a metropolitan city hospital: Emerging role of next-generation sequencing for laboratory diagnosis of Coxiella burnetii

“…In our setting, the NGS was performed in a private laboratory with the cost of RMB 4,500 (~698 USD) per sample and the turn-around-time for these two cases were two days, making the use of this robust technology pragmatic and affordable in the clinical setting. It is of note that Q fever has been diagnosed a few times using NGS in the literature [ 20 – 22 ], including a recent outbreak in southern China [ 21 ]. In that outbreak, plasma samples from 138 out of 2382 patients who had fever of unknown source were tested positive for C .…”

“…In that outbreak, plasma samples from 138 out of 2382 patients who had fever of unknown source were tested positive for C . burnetii sequences by NGS and the outbreak was finally traced to goats and cattle in a slaughterhouse [ 21 ]. With its low equipment cost, short turn-around-time and portable size, the recent invention of the Oxford Nanopore Technologies’ MinION device and further improvement of its sequencing accuracy will make the use of NGS within clinical microbiology laboratories feasible in the near future.…”