We report a case of exposure to Coxiella burnetii in a surgical nurse who underwent an injury of her finger with a scalpel blade during a native aortic valve replacement with a bio-prosthetic cardiac valve conducted on a patient suffering from C. burnetii aortic endocarditis. Given the positivity of C. burnetii culture and PCR from the patient's aortic valve, she was prescribed prophylactic doxycycline 100 mg twice a day for 10 days. Q fever is an occupational zoonosis resulting usually of exposure to infected animals by inhalation of infected aerosols or consumption of contaminated raw milk. Apart from materno-foetal transmission, about 180 cases of human-to-human C. burnetii transmission have been published from 1949 to today, including transmission by blood transfusion, sexual relations, transmission in the healthcare setting to staff, patient attendants and other patients that were likely infected from inhalation of aerosol from respiratory or placental products, transmission to staff during autopsies of patients with Q fever and transmission in familial settings. As C. burnetii is a highly infectious bacterium, that may cause infection with a low inoculum, it should be added to the list of organisms which may be of concern following blood exposure among healthcare professionals.
Harman JB. Q fever in Great Britain; clinical account of eight cases. Lancet 1949; 254: 1028–30.
Deutsch DL, Peterson ET. Q fever: transmission from one human being to others. J Am Med Assoc 1950 May 27; 143(4): 348–50.
Siegert R, Simrock W, Stroder U. Uber einen epidemischen Ausbruch von Q-Fieber in einem Krankenhaus. Z. Tropenmed. Parasitol. 1950; 2: 1–40.
Trub CLP, Boese W, Posch J. Die Q-fieber-epidemia am Niederrhein 1958. Arch Hyg Bakteriol 1960; 144: 48–73.
Gerth HJ, Leidig U, Riemenschneider T. Q-fever epidemic in an institute of human pathology. Dtsch Med Wochenschr 1982; 107: 1391–5.
Raoult D, Stein A. Q fever during pregnancy-a risk for women, fetuses, and obstetricians. N Engl J Med 1994; 330: 371.
Kruszewska D, Lembowicz K, Tylewska-Wierzbanowska S. Possible sexual transmission of Q fever among humans. Clin Infect Dis 1996; 22: 1087–8.
Center for Disease Control. Q fever – California, Morb Mortal Wkly Rep. 1977; 16: 86.
Mann JS, Douglas JG, Inglis JM, Leitch AG. Q fever: person to person transmission within a family. Thorax 1986 Dec; 41(12): 974–5.
Milazzo A, Hall R, Storm PA, Harris RJ, Winslow W, Marmion BP. Sexually transmitted Q fever. Clin Infect Dis 2001; 33: 399–402.
Amit S, Shinar S, Halutz O, Atiya-Nasagi Y, Giladi M. Suspected person-to-person transmission of Q fever among hospitalized pregnant women. Clin Infect Dis 2014 Jun; 58(11): e146–7.
Million M, Bardin N, Bessis S, Nouiakh N, Douliery C, Edouard S, et al. Thrombosis and antiphospholipid antibody syndrome during acute Q fever: a cross-sectional study. Medicine (Baltimore) 2017; 96(29): e7578.
Million M, Roblot F, Carles D, D'Amato F, Protopopescu C, Carrieri MP, et al. Reevaluation of the risk of fetal death and malformation after Q Fever. Clin Infect Dis 2014; 59(2): 256–260.
Melenotte C, Protopopescu C, Million M, Edouard S, Carrieri MP, Eldin C, et al. Clinical features and complications of Coxiella burnetii fnfections from the French national reference center for Q fever. JAMA Netw Open 2018; 1(4): e181580.
Abou Abdallah R, Million M, Delerce J, Anani H, Diop A, Caputo A, et al. Pangenomic analysis of Coxiella burnetii unveils new traits in genome architecture. Front Microbiol 2022; 13: 1022356.
Melenotte C, Million M, Raoult D. New insights in Coxiella burnetii infection: diagnosis and therapeutic update. Expert Rev Anti Infect Ther 2020; 18(1): 75–86.
Long CM. Q fever vaccine development: current strategies and future considerations. Pathogens 2021 Sep 22; 10(10): 1223.
Eldin C, Mélenotte C, Mediannikov O, Ghigo E, Million M, Edouard S, et al. From Q fever to Coxiella burnetii infection: a paradigm change. Clin Microbiol Rev 2017 Jan; 30(1): 115–190.
Anderson A, Bijlmer H, Fournier PE, Graves S, Hartzell J, Kersh GJ, et al. Diagnosis and management of Q fever--United States, 2013: recommendations from CDC and the Q fever working group. MMWR Recomm Rep 2013 Mar 29; 62(RR-03): 1–30.
Obafemi AI, Le J. Perioperative Occupational Exposure to Coxiella burnetii-infected thoracic endovascular aneurysm stent graft. Int J Occup Environ Med 2017 Jan; 8(1): 46–49.