Volume 4, Number 1—March 1998
Q Fever in French Guiana: New Trends
To the Editor: Q fever, the endemic disease caused by the rickettsial organism Coxiella burnetii, was first described in French Guiana in 1955 (1). Only sporadic cases were reported until 1996 when three patients were hospitalized in the intensive care unit of the Cayenne Hospital for acute respiratory distress syndrome. One of the patients died. Many cases of Q fever were diagnosed in the general population at the same time. A seroepidemiologic study was performed to determine whether the increase in cases was due to an increase in incidence or to an improvement in diagnosis. All paired samples of sera (acute-phase and convalescent-phase) from patients sent to the arbovirus laboratory for diagnosis of dengue infection from January 1, 1992, to December 31, 1996, were tested for antibodies to C. burnetii by immunofluorescence. All positive samples were also tested for immunoglobulin (IgM) by the same method; the IgG and IgM titers were determined by using a serial twofold dilution. A diagnosis of Q fever was made when there was a seroconversion from negative to positive or a twofold increase in IgG titer associated with the presence of IgM in the second sample.
One hundred and fifty-one of 426 paired sera collected between 1992 and 1996 were from patients recently infected with dengue fever. Twenty-five (9.1%) of 275 remaining sera were from Q fever patients. Significant differences were observed in the rates of Q fever in different years (p < 0.01); one (1.9%) of 53 was positive in 1992, five (9.1%) of 55 in 1993, five (8.6%) of 58 in 1994, three (4.8%) of 63 in 1995; a large increase was observed in 1996 (11 [23.9%] of 46). Differences by residence were also assessed. Rates of infection were higher in Cayenne (21 [13.0%] of 161) than in rural areas (4 [3.5%] of 114) (p < 0.01).
This study shows that cases of Q fever have occurred in French Guiana in recent years and that a significant increase in the incidence rate occurred in 1996. The reasons for this increase are unclear, and further studies of the epidemiology of Q fever in French Guiana are necessary. The epidemiology of Q fever is unusual in French Guiana because the rates of infection are much higher in Cayenne, the capital city, than in rural areas. No link with classical sources of infection (cattle, sheep, or goat birth products, or work in a slaughterhouse) was found. Indeed, Cayenne, with 80,000 inhabitants, is located near the Atlantic Ocean, and the prevailing winds blow from the sea. Airborne contamination from rural areas is therefore impossible. Furthermore, no large farm is in the immediate vicinity of the city. For identical reasons, contamination from the abattoirs is not likely; they are located on the west side of the city, near the Cayenne River, and the winds blow from the east. In our study, cases were almost equally distributed throughout the city, although many patients came from the same area.
A seroepidemiologic study to determine possible new sources of infection (e.g., dogs, cats) and estimate rates of seropositivity in cattle and sheep and a case-control study on new cases are being conducted.
- Floch H. La pathologie vétérinaire en Guyane française (les affections des porcins, des caprins et des ovins). Rev Elev Med Vet Pays Trop. 1955;8:11–3.