Seroprevalence of Coxiella Burnetii phase i and phase ii antibodies and associated risk factors among patients with brucella-like illness in Meto health centre, Kajiado,Kenya

Abstract

Coxiella burnetii is a zoonotic bacterial agent responsible for Q fever in both humans and animals. Ruminants are the most common livestock species associated with Q fever infections in humans. The disease presentation in humans range from asymptomatic, non-specific symptoms to fatal illness. In Kenya, no healthcare indicators seek to clinically diagnose and report Q fever majorly because there are no readily available diagnostic technologies. This cross-sectional study leveraged on the existing equipment in the Kajiado County referral laboratory to demonstrate antibodies to Coxiella burnetii in sera of febrile patients presenting with Brucella-like symptoms in Meto Health Centre, Kajiado Kenya, using the Indirect Immunofluorescent assay (IFA). A total of 100 paired blood samples were obtained from consenting and assenting study subjects. A pre-tested questionnaire was used to collect patient’s socio-demographic information, knowledge of Q fever disease, and community practices that put them at risk of exposure. Coxiella burnetii phase I (IgG) and phase II (IgM) antibodies were characterized using IFA, while Brucella spp. IgG antibodies were demonstrated using the Indirect Enzyme-Linked Immunosorbent assay (iELISA), Rose Bengal Test (RBT), and Febrile Brucella Agglutination Test (FBAT). The overall seroprevalence of C. burnetii antibodies was 49.0% (95% CI: 39.42-58.65, p-value: 0.920) for Phase I IgG antibodies and 27.0% (95% CI: 19.27-36.43, p-value: <0.001) for phase II IgM antibodies. Brucella species results varied with the serological test used. RBT demonstrated a seroprevalence of 1.0% (95% CI: 0.18-5.45, p-value <0.001), while FBAT and indirect ELISA had 6.0% (95% CI: 2.78-12.48, p-value <0.001), and 13.0% (95% CI: 7.76-20.98, p-value: <0.001) seroprevalence respectively. Study participants' knowledge of Q fever disease was deficient at 0%. The overall co-infections between C. burnetii and Brucella spp. were 11.0% (95% CI: 8.25-18.63, p-value: <0.001). The chi-square (X²) values and corresponding p-values for gender, age, and occupation did not exhibit statistical significance. Gender had an X² value of 0.160 (p=0.689), age had X² of 1.365 (p=0.714), and occupation had X² of 3.037 (p=0.219). Multivariable logistic regression analysis was appliedto ascertain community-level risk predictors for Q fever disease. The practice of boiling milk at home had 91/100 study participants responding yes, but still exhibited a seropositivity of 59.3% (95%CI = 0.664-156.732. OR=10.201). Assisting a birthing animal and the practice of taking raw blood during community ceremonies were statistically significant both had p values of less than 0.001. In conclusion, the seroprevalence of acute and chronic Q fever disease was demonstrated. C burnetii and Brucella spp. co-infections and exposure cultural practices were reported. The prerequisite equipment for the IFA method used to determine Q fever disease were the fluorescent microscope and water bath, which were resident equipment used in other Lab procedures in the referral Hospital. Cold chain facilities were also available and in use, thus this study strongly recommended the diagnosis of Q fever illness using Indirect Immunofluorescent assay as a point-of-care test at Hospital and peripheral laboratories, likewise, the healthcare workers and community sensitization was strongly recommended.