四个低收入和中等收入国家持续性发热疾病患者中伯氏考克斯氏体和巴尔通体属感染的证据。
Evidence of Coxiella burnetii and Bartonella species infections among patients with persistent febrile illness in four low- and middle-income countries.
作者信息
Boodman Carl, Edouard Sophie, van Griensven Johan, Koirala Kanika Deshpande, Khanal Basudha, Rijal Suman, Bhattarai Narayan Raj, El Safi Sayda, Phe Thong, Lim Kruy, Lutumba Pascal, Chappuis François, Yansouni Cédric P, Barbé Barbara, van Esbroeck Marjan, Verdonck Tine, Boelaert Marleen, Fournier Pierre-Édouard, Bottieau Emmanuel
机构信息
Division of Infectious Diseases, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of Medical Sciences, University of Antwerp, Antwerp, Belgium.
Institut Hospitalo-Universitaire en Maladies infectieuses (IHU-Méditerranée Infection), Marseille, France; French Reference Center for Rickettsioses, Q Fever And Bartonelloses, IHU-Méditerranée Infection, Marseille, France.
出版信息
Clin Microbiol Infect. 2025 Aug;31(8):1389-1393. doi: 10.1016/j.cmi.2025.04.038. Epub 2025 May 6.
OBJECTIVES
This study investigated whether infections due to Coxiella burnetii, Bartonella species or Tropheryma whipplei could be identified among biobanked samples associated with persistent fever in four low- or middle-income countries.
METHODS
The NIDIAG consortium ("Better DIAGnosis of Neglected Infectious Diseases") prospectively investigated in 2013-2014 the aetiological spectrum of 1922 patients with persistent febrile illness (fever greater than 7 days) in Cambodia, Nepal, Sudan, and the Democratic Republic of Congo (DRC). Our study retrospectively tested serum and blood samples from the 745 patients (38.8%) who remained without an identified cause of fever. Indirect immunofluorescent antibody assays (IFA) were performed (except in the DRC) to assess immunoglobulin response to C. burnetii and Bartonella antigens. DNA extracts from whole blood samples were tested for C. burnetii, Bartonella genus, B. quintana, B. henselae and T. whipplei by qPCR.
RESULTS
Evidence of infection with C. burnetii or Bartonella sp. was found in 124 persistent fever cases (16.6%). IFA for IgG to C. burnetii phase I and II antigens identified 59 (7.9%) positive sera: 31/333 (9.3%) from Sudan, 16/278 (5.8%) from Nepal, and 12/54 (22.2%) from Cambodia. Eight individuals had C. burnetii anti-phase I IgG titres ≥ 1:800. Bartonella IFA identified 60 (8.1%) IgG positive sera, with 49/278 (17.6%) positive samples from Nepal, 7/333 (2.1%) from Sudan and 4/54 (7.4%) from Cambodia. One serum from Sudan had anti-Bartonella IgG titres of 1:800. C. burnetii DNA was detected from blood in 3 individuals from Sudan and one individual from the DRC, whereas B. quintana DNA was present in a blood sample from a Nepalese individual. All qPCR tests for T. whipplei were negative.
DISCUSSION
Direct and indirect evidence of C. burnetii or Bartonella sp. infections was observed in persistent fever cases. Further studies are necessary to elucidate the burden of these diseases in low- or middle-income countries.
目的
本研究调查了在四个低收入或中等收入国家中，与持续性发热相关的生物样本库样本中是否能检测到伯氏考克斯体、巴尔通体属或惠普尔嗜组织细胞菌感染。
方法
NIDIAG联盟（“改善被忽视传染病的诊断”）在2013年至2014年对柬埔寨、尼泊尔、苏丹和刚果民主共和国的1922例持续性发热疾病（发热超过7天）患者的病因谱进行了前瞻性研究。我们的研究对745例（38.8%）仍未明确发热原因的患者的血清和血液样本进行了回顾性检测。进行了间接免疫荧光抗体试验（IFA）（刚果民主共和国除外），以评估对伯氏考克斯体和巴尔通体抗原的免疫球蛋白反应。通过qPCR对全血样本的DNA提取物进行检测，以检测伯氏考克斯体、巴尔通体属、五日热巴尔通体、汉赛巴尔通体和惠普尔嗜组织细胞菌。
结果
在124例持续性发热病例（16.6%）中发现了伯氏考克斯体或巴尔通体属感染的证据。针对伯氏考克斯体I期和II期抗原的IgG的IFA检测出59例（7.9%）阳性血清：31例/333例（9.3%）来自苏丹，16例/278例（5.8%）来自尼泊尔，12例/54例（22.2%）来自柬埔寨。8名个体的伯氏考克斯体抗I期IgG滴度≥1:800。巴尔通体IFA检测出60例（8.1%）IgG阳性血清，其中49例/278例（17.6%）阳性样本来自尼泊尔，7例/333例（2.1%）来自苏丹，4例/54例（7.4%）来自柬埔寨。一份来自苏丹的血清的抗巴尔通体IgG滴度为1:800。在3名来自苏丹的个体和1名来自刚果民主共和国的个体的血液中检测到伯氏考克斯体DNA，而在一名尼泊尔个体的血液样本中存在五日热巴尔通体DNA。所有针对惠普尔嗜组织细胞菌的qPCR检测均为阴性。
讨论
在持续性发热病例中观察到了伯氏考克斯体或巴尔通体属感染的直接和间接证据。有必要进一步开展研究，以阐明这些疾病在低收入或中等收入国家的负担。
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