Emerging Q Fever Infection in Türkiye

A rare case of spotted fever group rickettsiosis in southern Iran: diagnostic challenges and review.

Retrospective Analysis of Chronic Q Fever Cases at a Tertiary Care Center from 2007 to 2023

Chronic Q fever, caused by Coxiella burnetii, presents significant diagnostic and management challenges due to its variable presentation and high morbidity, especially among patients with underlying cardiac or vascular disease. In the United States, cases are rising, often without identifiable exposures, and diagnostic delays remain common. We conducted a retrospective cohort study of chronic Q fever cases at the Mayo Clinic from 2007 to 2023. Patients with clinical evidence and a phase I IgG titer ≥1:1024 and/or positive PCR for C. burnetii were included. Data were abstracted from electronic health records, including demographics, exposures, clinical manifestations, diagnostics, treatments, and outcomes. Statistical analyses assessed factors influencing diagnostic delay and treatment response. We identified 33 patients with chronic Q fever (median age 56; 88% male). Median time to diagnosis was 99 days with 11.4 days between Infectious Diseases (ID) evaluation and diagnosis. Animal exposure was reported in 17 patients (52%), while eight (24%) had no identifiable exposure. Patients primarily presented with prosthetic valve endocarditis (n=14, 42%), or vascular graft infection (n=9, 27%). The majority were treated with doxycycline and hydroxychloroquine (n=25, 75%) and 14 patients (42%) required surgical intervention. Mortality attributable to chronic Q fever was 6% (n=2). Chronic Q fever remains under-recognized, with substantial diagnostic delays prior to treatment. Cardiovascular infection predominates, and surgical intervention is often required despite prolonged antimicrobial therapy. Early specialist evaluation and standardized diagnostic pathways may improve outcomes.

Q fever outbreak in a slaughterhouse in Brazil: description and decade-later investigation.

PURPOSE To describe the first Q fever outbreak in Brazil and the long-term clinical and serological outcomes of affected individuals ten years after the outbreak. METHODS A follow-up investigation was conducted among patients involved in a Q fever outbreak that occurred in 2015 in a slaughterhouse in Barbosa, São Paulo State, Brazil. Clinical records from the acute phase were reviewed, and patients were reevaluated ten years later through clinical assessment, review of medical history, serological testing, and molecular analysis. RESULTS The outbreak affected 17 of 40 slaughterhouse workers (attack rate = 42.5%) and was likely associated with the inhalation of Coxiella burnetii during the slaughter of pregnant cows. Patients presented with prolonged fever, headache, myalgia, pneumonia, hepatitis, and hematuria; six required hospitalization. Ten years later, 14 patients were reevaluated. Of these, 10 developed complications compatible with chronic Q fever, including cardiac and respiratory disorders, as well as persistent fatigue. One woman experienced a premature birth after becoming pregnant following the outbreak. In 2025, one patient presented a phase I antibody endpoint titer of 1:1024 and a history of endocarditis, suggesting persistent infection. CONCLUSION This study provides a unique description of the long-term clinical and serological outcomes of workers involved in the first documented Q fever outbreak in Brazil and emphasizes the importance of post-outbreak surveillance and prolonged clinical follow-up.

High prevalence of Q fever among patients clinically diagnosed with brucellosis in a Kenyan pastoralist community

Coxiella burnetii is a zoonotic bacterial agent responsible for Q fever in both humans and animals. Ruminants are the most common livestock species associated with Q fever infections in humans. The disease presentation in humans range from asymptomatic, non-specific symptoms to fatal illness. In Kenya, no healthcare indicators seek to clinically diagnose and report Q fever because there are no readily available diagnostic technologies. We conducted a prospective observational study with paired serological sampling leveraging on the existing equipment in the Kajiado County referral laboratory to demonstrate antibodies to Coxiella burnetii in sera of febrile patients presenting with Brucella-like symptoms using the indirect immunofluorescent assay (IFA) and a fluorescent microscope provided for diagnosis of tuberculosis. A total of 100 paired blood samples were obtained from consenting and assenting study subjects. A pilot-tested questionnaire was used to collect patient's socio-demographic information, knowledge of Q fever disease, and community practices that put them at risk of exposure. Coxiella burnetii phase I (IgG) and phase II (IgM) antibodies were characterized, while Brucella spp. IgG antibodies were demonstrated using an indirect enzyme-linked immunosorbent assay (iELISA) and febrile Brucella agglutination test (FBAT). The overall seroprevalence of C. burnetii IgG and IgM antibodies was 49% and 27%, respectively, compared to only 13% reactivity with Brucella ELISA. Q fever prevalence substantially exceeded that of brucellosis in patients presenting with brucellosis-like symptoms in this pastoral community, suggesting a substantial burden of undiagnosed Q fever.

Cluster of 19 cases of eosinophilic meningitis due to Angiostrongylus cantonensis in Lifou, New Caledonia: an outbreak investigation

Eosinophilic meningitis due to Angiostrongylus cantonensis (AC) is an emerging parasitic disease worldwide but remains endemic in the Pacific region. In New Caledonia, sporadic cases occur each year, and the route of transmission is often unclear. In January 2023, an unusual cluster of three cases occurred in a village on Lifou Island following week-long community festivities, leading to an epidemiological investigation to determine the outbreak scope, the source of contamination, and inform public health interventions. We conducted a retrospective epidemiological and environmental investigation in one month after the suspected exposure. Cases were defined according to international criteria and classified as confirmed, probable, or suspected. Clinical data, attendance at the festivities and food exposures were collected from medical records and interviews. Environmental observations focused on potential contamination sources in food preparation areas. Serological analyses were performed in symptomatic and asymptomatic exposed individuals. Descriptive statistics were used to summarize demographic, clinical, and exposure characteristics. Nineteen cases were identified, including three confirmed and sixteen suspected cases; no probable cases were identified. Headache was the predominant symptom, often associated with vomiting or paresthesias. All cases attended festivities on December 27, 2022 suggesting a common exposure during that day. The median incubation period was 3 weeks (IQR: 2–4). Two exposure hypotheses were identified: beverages diluted with rainwater and contamination of blended fruit juice. Environmental investigations revealed rats and gastropods around rainwater reservoirs and food preparation areas, including on utensils left to dry outdoors. No AC DNA was detected in water samples. Serology for AC was positive in all confirmed cases (3/3), in 13 of 14 tested suspected cases, and in all ten exposed asymptomatic individuals tested 9 months after the outbreak. This investigation highlights the diagnostic and epidemiological challenges of neuroangiostrongyliasis in endemic areas, where mild presentations often remain unconfirmed and where the value of serological testing is limited by the lack of baseline seroprevalence data. The findings support the hypothesis of accidental incorporation of a heavily infected gastropod into blended fruit juice during preparation, potentially facilitated by open-air kitchen practices in rural Pacific settings.

Rickettsial Infections in Febrile Paediatric Patients: Observations from a Tertiary Care Hospital in Cumilla, Bangladesh

Rickettsial infections in children are underdiagnosed but potentially severe and recognition, High clinical suspicion, early recognition and prompt appropriate therapy are essential to reduce morbidity and mortality.