Long-term persistence of Coxiella burnetii after acute primary Q fever

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dc.contributor.authorMarmion, B.
dc.contributor.authorStorm, P.
dc.contributor.authorAyres, J.
dc.contributor.authorSemendric, L.
dc.contributor.authorMathews, L.
dc.contributor.authorWinslow, W.
dc.contributor.authorTurra, M.
dc.contributor.authorHarris, R.
dc.date.issued2005
dc.description.abstract<h4>Background</h4>Long-term persistence of C. burnetii in infected animals was established in the 1950s and 60s, but the implications for human Q fever are not fully explored.<h4>Aim</h4>To compare the prevalence of markers of infection in a cohort of Q fever patients in Australia (up to 5 years after infection) with those in the 1989 Birmingham cohort (12 years after infection).<h4>Design</h4>Case follow-up study.<h4>Methods</h4>C. burnetii was tested for by: (i) antibodies to Phase 1 and 2 antigens in the three immunoglobulin classes; (ii) detection of DNA in bone marrow and peripheral blood mononuclear cells by PCR assays directed against several different targets in the genome; and (iii) attempts to isolate coxiellas in cell culture or mice from PCR-positive samples. Amplicon specificity was verified by fluorometric probing and by sequencing. Cross-contamination was excluded by extensive use of non-template controls, and in particular by the use of certain IS1111a target sequences.<h4>Results</h4>Irrespective of clinical state, both groups remained seropositive, principally exhibiting medium levels of IgG antibody against C. burnetii Phase 2 antigen. C. burnetii genomic DNA was detected by PCR in 65% of bone marrow aspirates from Australian patients and approximately 88% of Birmingham patients. No coxiella were isolated from PCR positive samples.<h4>Discussion</h4>We propose a provisional model for persistence. In Q fever without sequelae, the process is largely confined to the bone marrow. In Q fever fatigue syndrome (QFS), it is modulated by the patient's immunogenetic background to give higher levels of coxiella genomes in bone marrow and increased shedding into the peripheral blood. In Q fever endocarditis, late pregnancy, or during iatrogenic or other immunosuppression, the multiplication cycle is prolonged, and a potential source of live organisms.
dc.description.statementofresponsibilityB.P. Marmion, P.A. Storm, J.G. Ayres, L. Semendric, L. Mathews, W. Winslow, M. Turra and R.J. Harris
dc.identifier.citationQJM: an international journal of medicine, 2005; 98(1):7-20
dc.identifier.doi10.1093/qjmed/hci037
dc.identifier.issn1460-2725
dc.identifier.issn1460-2393
dc.identifier.urihttp://hdl.handle.net/2440/17156
dc.language.isoen
dc.publisherOxford Univ Press
dc.source.urihttps://doi.org/10.1093/qjmed/hci009
dc.subjectLiver
dc.subjectLeukocytes, Mononuclear
dc.subjectCells, Cultured
dc.subjectBone Marrow
dc.subjectAnimals
dc.subjectMice, Knockout
dc.subjectHumans
dc.subjectMice
dc.subjectCoxiella burnetii
dc.subjectQ Fever
dc.subjectDNA, Bacterial
dc.subjectAntibodies, Bacterial
dc.subjectAntigens, Bacterial
dc.subjectFollow-Up Studies
dc.subjectPolymerase Chain Reaction
dc.subjectCarrier State
dc.titleLong-term persistence of Coxiella burnetii after acute primary Q fever
dc.typeJournal article
pubs.publication-statusPublished

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