Q Fever Infection in Patients with Febrile Illness at Selected Healthcare Facilities in Ghana.

Abstract

BACKGROUND Q fever is a zoonotic infection transmitted by an intracellular bacterium Coxiella burnetii. The most frequently observed clinical feature of Q fever is acute febrile illness, or in rare cases, chronic illnesses. This disease is under-diagnosed and under-reported because the symptoms are nonspecific, resembling other febrile illnesses such as malaria. Due to similarity of Q fever clinical symptoms to malaria and other febrile illness aetiologies, misdiagnosis could lead to clinical complications. In Ghana little is known about Q fever, hence the need for the study. AIM The aim of this study was to investigate Q fever infection in patients reporting with febrile illness at selected healthcare facilities in Ghana. METHOD This was a cross-sectional study conducted at 37 Military hospital, Accra, and three military healthcare facilities in Sekondi-Takoradi. Participants‘ which included military personnel and civilians, demographic data, clinical features and exposure data were obtained using a questionnaire. Depending on age, between 2 and 10 ml of venous blood was collected from consenting febrile patients at the selected healthcare facilities. Serum was collected and screened for phase II immunoglobulins M and G by Enzyme Linked Immunosorbent Assay (ELISA). Part of the serum was extracted and used for real-time Polymerase Chain Reaction (rt-PCR) and Loop Mediated Isothermal (LAMP) assays. RESULTS A total of 117 febrile patients were recruited into the study comprising 64 (54.70%) males and 53 (45.30%) females. An overall seroprevalence of 16.24% was recorded, comprising of 6.83% for IgM (indicating current or acute infection) and 11.11% for IgG (indicating recent or past infection). Clinical manifestation in study participants showed no significant association with the infection. The occupation of the participant was a statistically significant risk factor, with the unemployed having a greater likelihood of acquiring the infection. C. burnetii could not be detected by both rt-PCR and LAMP assays, this may have been due to late sample collection after the onset of symptoms. CONCLUSION The study clearly suggests the presence of Q fever among febrile patients in Ghana and occupation was a significant risk factor to Q fever exposure. Active surveillance is recommended to properly identify the source of transmission of C. burnetii.