Saturday, October 28, 2017

PRO/AH/EDR> Q fever - Chile: (LG, LR) dairy industry workers

Q FEVER - CHILE: (LOS LAGOS, LOS RIOS) DAIRY INDUSTRY WORKERS
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Date: Fri 27 Oct 2017
Source: EFE [machine transl, edited]
<http://www.cooperativa.cl/noticias/pais/salud/autoridades-confirmaron-brote-de-fiebre-q-provocada-por-bacteria-del-ganado/2017-10-27/182654.html>


Chilean authorities confirmed that 43 people in the south of the
country are infected with Q fever, caused by bacteria found in cattle,
so the government has asked for advice from international experts.
Undersecretary of Health, Jaime Burrows, explained that the 43
patients are inhabitants of the regions of Los Lagos and Los Ríos, in
southern Chile, and 20 of them were hospitalized. It should be noted
that most of the cases are workers in the dairy industry.

Q fever, which is transmitted to humans through contact with animals,
has symptoms such as fever, as well as gastrointestinal and
respiratory complaints. Because it is the 1st time that an outbreak of
this magnitude has occurred in Chile, the Ministry of Health requested
assistance from Australian experts to investigate the cases.

Burrows said that "it is working to control the outbreak" and detailed
that patients are receiving antimicrobial treatment. "Unfortunately,
about 10 percent of patients will develop chronic infection and we are
evaluating the protocols to follow them in the long term," he added.

The head of the Livestock Protection Division of the Agricultural and
Livestock Service, José Ignacio Gómez, clarified that the bacterium
causing the Q fever does not survive the milk pasteurization process.
"It is impossible for the milk that is bought and consumed by the
population to cause the Q fever," he said.

Q fever, a zoonosis caused by the bacteria _Coxiella burnetii_, is an
organism that does not produce symptoms in animals. The disease was
initially described in 1937 in Australia as a fever of unknown
etiology.

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[Q fever, often acquired by close exposure to animals, is infectious
with a very low inoculum and may be aerosolized over a significant
distance. _Coxiella burnetii_, the causative agent, was discovered in
1937. This organism is an agent that can be resistant to heat and
desiccation and is highly infectious by the aerosol route. A single
inhaled organism may produce clinical illness. Indeed, in [non-human]
primates, the dose to kill 50 percent of primates was found to be 1.7
organisms (1).

Cattle, sheep, and goats are the primary reservoirs of _C. burnetii_.
Infection has been noted in a wide variety of other animals, including
other species of livestock and in domesticated pets. _C. burnetii_
does not usually cause clinical disease in these animals, although
abortion in goats and sheep has been linked to _C. burnetii_
infection. Organisms are excreted in milk, urine, and feces of
infected animals. Most importantly, during birthing, the organisms are
shed in high numbers within the amniotic fluids and the placenta.
Contact with contaminated wool is known to be a mode of transmission
(2).

The organisms can be resistant to heat, drying, and many common
disinfectants. These features enable the bacteria to survive for long
periods in the environment. This very stable form of _C. burnetii_ is
associated with compact small cell variants of the organism that are
produced during standard replication along with the less resistant
large cell form, metabolically dormant and spore-like (3).

Infection of humans usually occurs by inhalation of these organisms
from air that contains airborne barnyard dust contaminated by dried
placental material, birth fluids, and excreta of infected herd
animals. Humans are often very susceptible to the disease, and very
few organisms may be required to cause infection.

Ingestion of contaminated milk, followed by regurgitation and
inspiration of the contaminated food, is a less common mode of
transmission. Other modes of transmission to humans, including tick
bites and human-to-human transmission are rare.

References
----------
1. Lille RD, Perrin TL, Armstrong C: An institutional outbreak of
pneumonitis. III. Histopathology in man and rhesus monkeys in the
pneumonitis due to the virus of "Q fever." Pub Hlth Rep 1941; 56(4):
149-55; available at <http://www.jstor.org/stable/4583593>
2. Maurin M, Raoult D: Q fever. Clin Microbiol Rev 1999; 12(4):
518-53; available at
<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC88923/>
3. Norlander L: Q fever epidemiology and pathogenesis. Microbes Infect
2000; 2(4): 417-24.

A good recent review on Q fever can be found at:
Melgar TA, Bauler TJ, Lutwick LI. Q fever in man: a One Health
paradigm disease. In: The principles and practices of Q fever: the One
Health paradigm. Simeos JCC, Anastacio SF, Da Silva GJ (eds). Nova
Scientific Publishers: New York, 2017; pp 1-24. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/5112>.]

[See Also:
Q fever - Australia (02): (QL) native animal source
http://promedmail.org/post/20170923.5335445
Q fever - Australia: (VI) occupational exposure, animal auction
facility http://promedmail.org/post/20170720.5192560
Q fever - Israel: RFI http://promedmail.org/post/20170717.5180136
Q fever - Germany: (RP) sheep cell therapy, 2014
http://promedmail.org/post/20170416.4974554
2016
----
Q fever - Australia (03): (SA) spike in disease
http://promedmail.org/post/20161231.4735189
Q fever - Australia (02): (VI) meat processing workers
http://promedmail.org/post/20160824.4437074
Q fever - Australia: (NS) vaccination
http://promedmail.org/post/20160706.4328443
Q fever - Netherlands: human, 2007-2015, fatalities
http://promedmail.org/post/20160531.4256718
2015
----
Q fever - Australia (02): (VI)
http://promedmail.org/post/20151019.3726962
Q fever - USA, Canada: ex Germany (RP) sheep cell therapy, 2014
http://promedmail.org/post/20151002.3684869
Q fever - Australia: (NS) http://promedmail.org/post/20150717.3516801
Q Fever - Brazil: (SP) http://promedmail.org/post/20150318.3238647
2014
----
Q fever - China: ex Chile, alpaca, RFI
http://promedmail.org/post/20140901.2740390]
.................................................jt/ll/ec/lxl
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