Screening of post-mortem tissue donors for Coxiella burnetii infection after large outbreaks of Q fever in The Netherlands

BMC Infectious Diseases

Boris M Hogema⁴  Hans L Zaaijer³  Mirjam HA Hermans¹  Nicole HM Renders¹  D Willemijn Maas²  Marja J van Wijk² 

[1] Regional Laboratory Medical Microbiology and Infection Prevention, Jeroen Bosch Hospital, PO Box 90153, 5200ME ‘s Hertogenbosch, The Netherlands;BISLIFE Foundation, PO Box 309, 2333BD Leiden, The Netherlands;Department of Clinical Virology (CINIMA), Academic Medical Center, PO Box 22660, 1100DD Amsterdam, The Netherlands;Department of Blood-borne Infections and Viral Diagnostic Services, Sanquin blood supply foundation, PO Box 9892, 1006AN Amsterdam, The Netherlands

关键词: Outbreaks;    Zoonotic infections;    Serological screening;    Tissue transplantation;    Q fever;    Coxiella burnetii;   

Others  :  1135138
DOI  :  10.1186/1471-2334-14-6

 received in 2013-07-23, accepted in 2013-12-24,  发布年份 2014

【 摘 要 】

Background

After the largest outbreaks of Q fever ever recorded in history occurred in the Netherlands, concern arose that Coxiella may be transmitted via donated tissues of latent or chronically infected donors. The Dutch Health Council recently advised to screen tissue donors, donating high risk tissues, for Coxiella infection.

Methods

After validation of an enzyme immunoassay (EIA) test for IgG antibodies against phase 2 of C. burnetii for use on post-mortem samples, serum samples of 1033 consecutive Dutch post-mortem tissue donors were tested for IgG antibodies against phase 2 of C. burnetii. Confirmation of reactive results was done by immunofluorescence assay (IFA). All available tissues (corneas, heart valves, skin and bone marrow) from donors with IgG reactivity were tested for presence of Coxiella DNA by PCR. Risk factors for IgG reactivity were investigated.

Results

After validation of the tests for use on post-mortem samples, 50/1033 donors (4.8%) screened positive for phase 2 anti-Coxiella IgG by EIA, and 31 were confirmed by IFA (3.0%). One donor showed a serological profile compatible with chronic infection. All tested tissues (25 corneas, 6 heart valves, 4 skin and 3 bone marrow) from donors with IgG reactivity tested negative for the presence of Coxiella DNA. Except for living in a postal code area with a high number of Q fever notifications, no risk factors for IgG reactivity were found.

Conclusions

The strong correlation between notifications and seroprevalence confirms that the used assays are sufficiently specific for use on post-mortem samples, although one has to be aware of differences between batches. Thus, this study provides a validated method for screening tissue donors for infection with Coxiella burnetii that can be used in future outbreaks.

【 授权许可】

   
2014 van Wijk et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]ECDC: Risk assessment on Q fever. Stockholm; 2010. http://www.ecdc.europa.eu/en/publications/Publications/1005_TER_Risk_Assessment_Qfever.pdf webcite
• [2]Kampschreur LM, Dekker S, Hagenaars JCJP, Lestrade PJ, Renders NHM, De Jager-Leclercq MGL, Hermans MHA, Groot CAR, Groenewold RHH, Hoepelman AIM, Wever PC, Oosterheert JJ: Identification of risk factors for chronic Q fever, the Netherlands. Emerg Infect Dis 2012, 18:563-570.
• [3]Raoult D, Houpikian P, Dupont H, Riss J, Arditi-Djiane JJ, Brouqui P: Treatment of Q fever endocarditis: comparison of 2 regimens containing doxycycline and ofloxacin or Hydroxychloroquine. Arch Intern Med 1999, 159(2):167-173.
• [4]Raoult D, Marrie T: Q fever. Clin Infect Dis 1995, 20:489-496.
• [5]Kanfer E, Farrag N, Price C, MacDonald D, Coleman J, Barrett AJ: Q fever following bone marrow transplantation. Bone Marrow Transplant 1988, 3:165-166.
• [6]Criley JM, Carty AJ, Besch-Williford CL, Franklin CL: Coxiella burnetii infection in C.B-17 scid-bg mice xenotransplanted with fetal bovine tissue. Comp Med 2001, 51:357-360.
• [7]Harris RJ, Storm PA, Lloyd A, Arens M, Marmion BP: Long-term persistence of Coxiella burnetii in the host after primary Q fever. Epidemiol Infect 2000, 124:543-549.
• [8]Marmion BP, Storm PA, Ayres JG, Semendric L, Mathews L, Winslow W, Turra M, Harris RJ: Long-term persistence of Coxiella burnetii after acute primary Q fever. QJM 2005, 98:7-20.
• [9]Van Wijk MJ, Hogema BM, Maas DW, Bokhorst AG: A Q fever outbreak in the Netherlands: consequences for tissue banking. Transfus Med Hemother 2011, 38:357-364.
• [10]Health Council of the Netherlands: Q fever: risk of transmission via blood or other body material. 2011. http://www.gezondheidsraad.nl/sites/default/files/201115EQfever.pdf webcite
• [11]Wegdam-Blans MCA, Nabuurs-Franssen MH, Horrevorts AM, Peeters MF, Schneeberger PM, Bijlmer HA: Laboratory diagnosis of acute Q fever. Ned Tijdschr Geneeskd 2010, 154:A2388.
• [12]Wegdam-Blans MC, Wielders CC, Meekelenkamp J, Korbeeck JM, Herremans T, Tjhie HT, Bijlmer HA, Koopmans MP, Schneeberger PM: Evaluation of commonly used serological tests for detection of Coxiella burnetii antibodies in well-defined acute and follow-up sera. Clin Vaccine Immunol 2012, 19:1110-1115.
• [13]Wegdam-Blans MC, Kampschreur LM, Delsing CE, Bleeker-Rovers CP, Sprong T, van Kasteren ME, Notermans DW, Renders NH, Bijlmer HA, Lestrade PJ, Koopmans MP, Nabuurs-Franssen MH, Oosterheert JJ: Chronic Q fever: review of the literature and a proposal of new diagnostic criteria. J Infect 2012, 64:247-259.
• [14]Hogema BM, Slot E, Molier M, Schneeberger PM, Hermans MH, Van Hannen EJ, Van der Hoek W, Cuijpers HT, Zaaijer HL: Coxiella burnetii infection among blood donors during the, Q-fever outbreak in the Netherlands. Transfusion 2009, 2012(52):144-150.
• [15]Schneeberger PM, Hermans MH, van Hannen EJ, Schellekens JJ, Leenders AC, Wever PC: Real-time PCR with serum samples is indispensable for early diagnosis of acute Q fever. Clin Vaccine Immunol 2010, 17:286-290.
• [16]Raoult D, Tissot-Dupont H, Foucault C, Gouvernet J, Fournier PE, Bernit E: Q fever 1985–1998. Clinical and epidemiologic features of 1,383 infections. Medicine (Baltimore) 2000, 79:109-123.
• [17]Herremans T, Hogema BM, Nabuurs M, Peeters M, Wegdam-Blans M, Schneeberger P, Nijhuis C, Notermans DW, Galama J, Horrevoets A, Van Loo IH, Vlaminckx B, Zaaijer HL, Koopmans MP, Berkhout H, Socolovschi C, Raoult D, Stenos J, Nocholson W, Bijlmer H: Comparison of the performance of IFA, CFA, and ELISA assays for the serodiagnosis of acute Q fever by quality assessment. Diagn Microbiol Infect Dis 2013, 75:16-21.
• [18]Schimmer B, Notermans DW, Harms MG, Reimerink JH, Bakker J, Schneeberger P, Mollema L, Teunis P, Van Pelt W, Van Duynhoven Y: Low seroprevalence of Q fever in The Netherlands prior to a series of large outbreaks. Epidemiol Infect 2012, 140:27-35.
• [19]Kampschreur LM, Hagenaars JC, Wielders CC, Elsman P, Lestrade PJ, Koning OH, Oosterheert JJ, Renders NH, Wever PC: Screening for Coxiella burnetii seroprevalence in chronic Q fever high-risk groups reveals the magnitude of the Dutch Q fever outbreak. Epidemiol Infect 2013, 141:847-851.
• [20]Peacock MG, Philip RN, Williams JC, Faulkner RS: Serological evaluation of O fever in humans: enhanced phase I titers of immunoglobulins G and A are diagnostic for Q fever endocarditis. Infect Immun 1983, 41:1089-1098.