Pommier de Santi Vincent, Briolant Sébastien, Mahamat Aba, Ilcinkas Carole, Blanchet Denis, de Thoisy Benoit, Reynaud Yann, Hyvert Georges, Marié Jean-Lou, Edouard Sophie, Davoust Bernard, Raoult Didier
Military Center for Epidemiology and Public health, CESPA, Marseille, France; Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France.
Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France; Institut de Recherche Biomédicale des Armées, Brétigny-sur-Orge, France; Institut Pasteur, Cayenne, French Guiana, France.
Comp Immunol Microbiol Infect Dis. 2018 Feb;56:34-38. doi: 10.1016/j.cimid.2017.12.004. Epub 2018 Jan 9.
A Q fever epidemic occurred in 2013 in a small military residential area in Cayenne, French Guiana. A retrospective cohort study was conducted to identify Q fever risk factors. Confirmed acute Q fever case was defined as positive serology (IgM ≥ 50 and phase II IgG ≥ 200) and/or positive qPCR on serum or blood. In addition, wild mammals were captured at the study site and tested by serology and real-time PCR performed on blood, vaginal swabs and ticks. The attack rate was 20 percent (11/54). All the cases were symptomatic with fever >38.5 °C and community-acquired pneumonia for four cases. Log binomial multivariate models identified two independent risk factors associated with Q fever: to clean the house (RRa = 7.5 CI95% [1.03-55.3]) and to carry a three-toed sloth in arms (RRa = 2.6 CI95% [1.1-5.8]). Eighteen marsupial individuals were captured, all PCRs were negative but 17% (3/18) had a positive serology. Another study conducted after the epidemic found only one (1/4) three-tooth sloth (Bradypus tridactylus) with feces highly infectious for C. burnetii MST17. The same strain C. burnetii genotype 17 has been laboratory- confirmed in this mammal and in human cases. These results support the implication of three-toed-sloth in this epidemic. Human contamination mainly occurs through inhalation of infectious aerosols as suggested by high relative risk associated with house cleaning activities and pulmonary forms of the disease, and through direct contact with three- toed-sloth. Positive serological results among marsupials confirm wildlife exposure and suggest a more complex sylvatic transmission cycle among wild mammals.
2013年，法属圭亚那卡宴的一个小型军事住宅区发生了一场Q热疫情。开展了一项回顾性队列研究以确定Q热的风险因素。确诊的急性Q热病例定义为血清学阳性（IgM≥50且II期IgG≥200）和/或血清或血液的qPCR阳性。此外，在研究地点捕获野生哺乳动物，并通过对血液、阴道拭子和蜱进行血清学检测和实时PCR检测。发病率为20%（11/54）。所有病例均有症状，发热>38.5°C，4例为社区获得性肺炎。对数二项式多变量模型确定了与Q热相关的两个独立风险因素：打扫房屋（相对危险度RRa=7.5，95%置信区间[1.03-55.3]）和怀抱三趾树懒（RRa=2.6，95%置信区间[1.1-5.8]）。捕获了18只有袋动物个体，所有PCR检测均为阴性，但17%（3/18）血清学检测呈阳性。疫情发生后进行的另一项研究发现，只有一只（1/4）三趾树懒（褐喉三趾树懒）的粪便对贝氏柯克斯体MST17具有高度传染性。在这种哺乳动物和人类病例中，实验室已确认了相同的贝氏柯克斯体17基因型菌株。这些结果支持了三趾树懒与此次疫情有关。如与房屋清洁活动和该病肺部形式相关的高相对风险所表明的，人类感染主要通过吸入传染性气溶胶以及通过与三趾树懒直接接触发生。有袋动物血清学检测呈阳性证实了野生动物接触，并提示野生哺乳动物之间存在更复杂的野生动物传播循环。
