Environmental sampling coupled with real-time PCR and genotyping to investigate the source of a Q fever outbreak in a work setting

A Q fever outbreak was declared in February 2016 in a company that manufactures hoists and chains and therefore with no apparent occupational-associated risk. Coxiella burnetii infection was diagnosed by serology in eight of the 29 workers of the company; seven of them had fever or flu-like signs an...

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Bibliographic Details
Published in:	Epidemiology and infection Vol. 145; no. 9; pp. 1834 - 1842
Main Authors:	HURTADO, A., ALONSO, E., ASPIRITXAGA, I., ETXANIZ, I. LÓPEZ, OCABO, B., BARANDIKA, J. F., DE MURÚA, J. I. FERNÁNDEZ-ORTIZ, URBANEJA, F., ÁLVAREZ-ALONSO, R., JADO, I., GARCÍA-PÉREZ, L.
Format:	Journal Article
Language:	English
Published:	England Cambridge University Press 01-07-2017
Subjects:	Adolescent Adult Animals Bacteria Chains Coxiella burnetii - genetics Cranes Deoxyribonucleic acid Disease Outbreaks DNA Dust Dust control Environmental Microbiology Environmental monitoring Epidemics Epidemiology Exposure Farms Female Fever Genotype Genotyping Genotyping Techniques Goat Diseases - epidemiology Goat Diseases - microbiology Goats Health risk assessment Humans Immunoglobulins Infections Infectious diseases Investigations Loci Male Microbiology Milk Occupational Diseases - epidemiology Occupational Diseases - microbiology Occupational exposure Original Papers Outbreaks Pneumonia Polymerase chain reaction Polymorphism Prevalence Q fever Q Fever - epidemiology Q Fever - microbiology R&D Real time Real-Time Polymerase Chain Reaction Research & development Risk factors Sampling Seroepidemiologic Studies Serology Shedding Sheep Single-nucleotide polymorphism Spain - epidemiology Vehicles Zoonoses outbreak Q fever Coxiella burnetii dust genotyping
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Summary:	A Q fever outbreak was declared in February 2016 in a company that manufactures hoists and chains and therefore with no apparent occupational-associated risk. Coxiella burnetii infection was diagnosed by serology in eight of the 29 workers of the company; seven of them had fever or flu-like signs and five had pneumonia, one requiring hospitalisation. A further case of C. burnetii pneumonia was diagnosed in a local resident. Real-time PCR (RTi–PCR) showed a widespread distribution of C. burnetii DNA in dust samples collected from the plant facilities, thus confirming the exposure of workers to the infection inside the factory. Epidemiological investigations identified a goat flock with high C. burnetii seroprevalence and active shedding which was owned and managed by one of the workers of the company as possible source of infection. Genotyping by multispacer sequence typing (MST) and a 10-loci single-nucleotide polymorphism (SNP) discrimination using RTi–PCR identified the same genotype (MST18 and SNP type 8, respectively) in the farm and the factory. These results confirmed the link between the goat farm and the outbreak and allowed the identification of the source of infection. The circumstances and possible vehicles for the bacteria entering the factory are discussed.
ISSN:	0950-2688 1469-4409
DOI:	10.1017/S0950268817000796