Gorączka q
Rokowania, prognozy i postęp choroby
Gorączka Q, wywoływana przez Coxiella burnetii, występuje w postaci ostrej i przewlekłej, z odmiennym rokowaniem. Ostra postać cechuje się niską śmiertelnością (~2%) i zwykle pełnym powrotem do zdrowia po odpowiednim leczeniu. Diagnostyka opiera się na modelach o wysokiej wartości predykcyjnej ujemnej (NPV 91,7-99,5%), co pozwala skutecznie wykluczyć ostrą infekcję. Przewlekła forma rozwija się u 1-5% pacjentów i wiąże się z wysoką śmiertelnością (12-25%), szczególnie w przypadku zapalenia wsierdzia, które jest zawsze śmiertelne bez leczenia. Ryzyko zapalenia wsierdzia u pacjentów z wadą zastawki i przebytą ostrą infekcją wynosi około 40%. Kluczowe czynniki prognostyczne śmiertelności to wiek (HR 1,11), udar mózgu przy rozpoznaniu (HR 7,09), zapalenie wsierdzia na zastawce sztucznej (HR 6,04), brak czterokrotnego spadku IgG i IgA fazy I po roku leczenia (HR 5,69) oraz obecność IgM fazy II po roku leczenia (HR 12,08).
Rokowanie w Gorączce Q (Prognoza, przewidywanie wyników)
Gorączka Q jest chorobą odzwierzęcą wywoływaną przez bakterię Coxiella burnetii, która może występować w postaci ostrej lub przewlekłej. Rokowanie znacząco różni się w zależności od stadium choroby, czynników ryzyka pacjenta oraz wdrożonego leczenia.12
Rokowanie w ostrej Gorączce Q
Ostra postać Gorączki Q ma zazwyczaj korzystne rokowanie z niskim wskaźnikiem śmiertelności wynoszącym około 2%. Większość pacjentów z ostrą infekcją powraca do pełnego zdrowia bez długotrwałych następstw, szczególnie jeśli wdrożono odpowiednie leczenie.3
Wartość predykcyjna objawów klinicznych w rozpoznawaniu ostrej Gorączki Q jest ograniczona, ale mogą one być pomocne w wykluczeniu tego schorzenia na korzyść innych infekcji układu oddechowego. Badania wykazały, że negatywne wartości predykcyjne (NPV) modeli diagnostycznych wahają się między 91,7% a 99,5%, co pozwala z dużą pewnością wykluczyć obecność ostrej Gorączki Q.4
Przewlekła Gorączka Q i jej rokowanie
Przewlekła postać Gorączki Q rozwija się u około 1-5% pacjentów z ostrą infekcją i może wystąpić w okresie od kilku miesięcy do lat, a nawet dekad po początkowej infekcji. W przeciwieństwie do ostrej postaci, przewlekła Gorączka Q charakteryzuje się wysoką śmiertelnością sięgającą 12-25% przypadków, a nieleczone zapalenie wsierdzia związane z przewlekłą Gorączką Q jest zawsze śmiertelne.567
Przewlekła postać najczęściej manifestuje się jako zapalenie wsierdzia u pacjentów z istniejącymi wcześniej wadami zastawkowymi lub naczyniowymi. Ryzyko rozwoju zapalenia wsierdzia u pacjentów z rozpoznaną wadą zastawki i przebytą ostrą Gorączką Q wynosi około 40%.8
Czynniki prognostyczne w zapaleniu wsierdzia na tle Gorączki Q
Wieloletnie obserwacje prowadzone przez Francuskie Narodowe Centrum Referencyjne ds. Chorób Riketsyjnych zidentyfikowały kluczowe czynniki prognostyczne związane ze śmiertelnością w zapaleniu wsierdzia na tle Gorączki Q:9
- Wiek pacjenta (współczynnik ryzyka 1,11, 95% CI 1,05-1,18, p=0,003)
- Udar mózgu przy rozpoznaniu (współczynnik ryzyka 7,09, 95% CI 2,00-25,10, p=0,001)
- Zapalenie wsierdzia na zastawce sztucznej (współczynnik ryzyka 6,04, 95% CI 1,47-24,80, p=0,044)
- Brak czterokrotnego spadku IgG i IgA fazy I po roku leczenia (współczynnik ryzyka 5,69, 95% CI 1,00-32,22, p=0,049)
- Obecność IgM fazy II po roku leczenia (współczynnik ryzyka 12,08, 95% CI 3,11-46,85, p=0,005)
Monitorowanie i czas trwania leczenia
Optymalny czas trwania leczenia doksycykliną i hydroksychlorochiną w zapaleniu wsierdzia spowodowanym Gorączką Q wynosi 18 miesięcy dla zastawek natywnych i 24 miesiące dla zastawek sztucznych. Czas ten powinien być wydłużony tylko w przypadku braku korzystnej odpowiedzi serologicznej.1011
Pacjenci powinni być monitorowani serologicznie przez co najmniej 5 lat ze względu na ryzyko nawrotu. Pacjenci z czynnikami ryzyka sercowo-naczyniowego dla choroby przewlekłej (np. wada zastawki serca, przeszczep naczyniowy lub tętniak) w czasie ostrej infekcji powinni być monitorowani serologicznie i poddawani badaniu fizykalnemu w odstępach 3, 6, 12, 18 i 24 miesięcy.1213
Wartość prognostyczna badań serologicznych
Przydatność serologii w przewidywaniu wyników leczenia jest kwestionowana. W niektórych badaniach znaczna liczba pacjentów z ostrą Gorączką Q wykazywała wysokie miana przeciwciał przeciwko antygenom fazy I, ale nie zaobserwowano ewolucji do postaci przewlekłej. Wysokie miana IgG fazy I, a nawet ich postępujące podwyższanie po ostrej infekcji Gorączki Q, nie zawsze wskazują lub przewidują rozwój przewlekłej Gorączki Q.14
Francuscy badacze zaproponowali algorytm oparty na serologii i amplifikacji genomowej w celu zapobiegania rozwojowi postaci przewlekłych. W ich badaniu analizowano skuteczność PCR w próbkach krwi do diagnostyki form przewlekłych (głównie zapalenia wsierdzia).15
Gorączka Q a ciąża
Kobiety zakażone podczas ciąży powinny być monitorowane serologicznie i klinicznie w takich samych odstępach czasu po porodzie. Ryzyko niekorzystnego wpływu na płód oraz ryzyko rozwoju przewlekłej Gorączki Q u matki jest najwyższe, gdy ostra infekcja występuje w pierwszym trymestrze ciąży.16
Nowe podejście diagnostyczne
Współczesne metody diagnostyczne umożliwiają klinicystom wyjście poza diagnozę przewlekłej Gorączki Q i rozpoznanie, czy pacjenci mają raczej przetrwałe ogniskowe zakażenie Coxiella burnetii. Dokładna identyfikacja przetrwałych ogniskowych zakażeń C. burnetii poprawi wyniki leczenia pacjentów, zapobiegając długoterminowym, narządowo specyficznym, śmiertelnym powikłaniom (np. zakażenia naczyniowe stanowią ryzyko pęknięcia naczyń, zapalenie węzłów chłonnych stanowi ryzyko chłoniaka) oraz unikając działań niepożądanych leków u pacjentów z izolowanymi podwyższonymi wynikami badań serologicznych.17
Zapobieganie zakażeniom
Zapobieganie zakażeniom C. burnetii ma kluczowe znaczenie dla poprawy rokowania. Badania przeprowadzone w Korei Południowej wskazują na potrzebę zachowania ostrożności podczas kontaktu z bydłem, kozami lub owcami, zwłaszcza podczas badania przedubojowego, przy kontakcie ze zwierzętami zakażonymi C. burnetii lub gdy istnieje ryzyko kontaktu ocznego z pochodnymi pochodzenia zwierzęcego. Zaleca się konsekwentne stosowanie odpowiednich środków ochrony osobistej i innych środków ochronnych, w tym mycie powierzchni ciała po pracy, aby zapobiec zakażeniom C. burnetii.18
Czynniki ryzyka znacząco związane z seroprewalencją Gorączki Q to: badanie przedubojowe bydła, kóz lub owiec, rozpryskiwanie krwi zwierzęcej do oczu lub wokół nich oraz kontakt ze zwierzętami chorymi na Gorączkę Q w poprzednim roku.19
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Materiały źródłowe
- #1 Signs and symptoms do not predict, but may help rule out acute Q fever in favour of other respiratory tract infections, and reduce antibiotics overuse in primary care | BMC Infectious Diseases | Full Texthttps://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-020-05400-0
Whereas signs and symptoms of disease do not appear to predict acute Q fever, they may help rule it out in favour of other respiratory conditions, prompting a delayed or non-prescribing approach instead of early empiric doxycycline in primary care patients with non-severe presentations. […] Given the poor to moderate performance of our prediction models, our study suggests that signs and symptoms of disease do not accurately predict acute human Q fever in GP patients, confirming findings from a Dutch study in hospitalized patients. […] However, signs and symptoms may be useful in ruling out acute Q fever in favour of other acute lower respiratory tract infections. […] Predictive values are greatly impacted by prevalence of the disease in the base population. Positive predictive values (PPV) tend to be low in situations where prevalence in the base population is low, as was the case in our study, where post-outbreak seroprevalence of prior exposure to Coxiella burnetii in the base population was estimated a mere 2.9%. […] Conversely, negative predictive values (NPV) tend to be high under circumstances of low disease prevalence. With NPV ranging between 91.7 to 99.5%, our models were able to rule out the presence of acute Q fever with a relatively high degree of confidence.
- #2https://link.springer.com/article/10.1007/s11908-012-0264-6
Q fever is an ubiquitous zoonosis caused by Coxiella burneti, an intracellular bacterium that can produce acute or chronic infections in humans. […] However, the serological profile for diagnosis and the real value of serology for predicting outcome are controversial, and management dilemmas for many patients with Q fever infection are continuously emerging. […] The utility of serology for predicting the outcome is largely questioned. […] In this study, a considerable number of patients with acute Q fever exhibited high antibodies titers to phase I antigens, but no evolution to chronic form was observed. […] High titers of phase I IgG and even progressive elevation of them after an acute Q fever infection do not indicate or predict the development of chronic Q fever in this report.
- #3 Diagnosis and Management of Q Fever — United States, 2013https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6203a1.htm
Q fever has acute and chronic stages that correspond to two distinct antigenic phases of antibody response. […] Chronic disease is rare (5% of patients with acute infections) and typically is characterized by endocarditis in patients with preexisting risk factors such as valvular or vascular defects. […] Unlike acute Q fever, which has a low mortality rate (2%), chronic Q fever endocarditis is always fatal if untreated. […] A clinical assessment of patients with acute Q fever should be performed to determine whether they are at high risk for subsequent chronic infection. […] Approximately 40% of persons with a known valvulopathy with an acute Q fever diagnosis subsequently develop infective endocarditis. […] The initial clinical signs and symptoms in patients with chronic Q fever often are nonspecific and highly variable.
- #4 Signs and symptoms do not predict, but may help rule out acute Q fever in favour of other respiratory tract infections, and reduce antibiotics overuse in primary care | BMC Infectious Diseases | Full Texthttps://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-020-05400-0
Whereas signs and symptoms of disease do not appear to predict acute Q fever, they may help rule it out in favour of other respiratory conditions, prompting a delayed or non-prescribing approach instead of early empiric doxycycline in primary care patients with non-severe presentations. […] Given the poor to moderate performance of our prediction models, our study suggests that signs and symptoms of disease do not accurately predict acute human Q fever in GP patients, confirming findings from a Dutch study in hospitalized patients. […] However, signs and symptoms may be useful in ruling out acute Q fever in favour of other acute lower respiratory tract infections. […] Predictive values are greatly impacted by prevalence of the disease in the base population. Positive predictive values (PPV) tend to be low in situations where prevalence in the base population is low, as was the case in our study, where post-outbreak seroprevalence of prior exposure to Coxiella burnetii in the base population was estimated a mere 2.9%. […] Conversely, negative predictive values (NPV) tend to be high under circumstances of low disease prevalence. With NPV ranging between 91.7 to 99.5%, our models were able to rule out the presence of acute Q fever with a relatively high degree of confidence.
- #5 Diagnosis and Management of Q Fever — United States, 2013https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6203a1.htm
Q fever has acute and chronic stages that correspond to two distinct antigenic phases of antibody response. […] Chronic disease is rare (5% of patients with acute infections) and typically is characterized by endocarditis in patients with preexisting risk factors such as valvular or vascular defects. […] Unlike acute Q fever, which has a low mortality rate (2%), chronic Q fever endocarditis is always fatal if untreated. […] A clinical assessment of patients with acute Q fever should be performed to determine whether they are at high risk for subsequent chronic infection. […] Approximately 40% of persons with a known valvulopathy with an acute Q fever diagnosis subsequently develop infective endocarditis. […] The initial clinical signs and symptoms in patients with chronic Q fever often are nonspecific and highly variable.
- #6 Diagnosis and Management of Q Fever — United States, 2013https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6203a1.htm
Chronic Q fever is rare, occurring in 5% of persons with acute infection, and might occur within a few months, years, or even decades after the initial acute infection. […] Patients with cardiovascular risk factors for chronic disease (e.g., heart valve defect, vascular graft, or aneurysm) at the time of acute infection should be serologically monitored and receive a physical examination at intervals of 3, 6, 12, 18, and 24 months. […] Women infected during pregnancy should be serologically and clinically monitored at the same intervals after delivery. […] The risk for adverse effects on the fetus and the risk that the mother will develop chronic Q fever are highest when an acute infection occurs during the first trimester. […] Chronic Q fever is rarely reported in children.
- #7 Q Fever: Causes, Symptoms, Diagnosis, Prevention & Treatmenthttps://my.clevelandclinic.org/health/diseases/17883-q-fever
Chronic Q fever is a serious form of Q fever that can affect your heart, your blood vessels, your bones and other parts of your body. It affects 1 to 5% of people whove had a C. burnetii infection. It can start months or years after your initial symptoms go away and can lead to life-threatening complications. […] Chronic Q fever can be life-threatening. […] A small number of people (1 to 5%), usually those with underlying conditions, go on to develop chronic Q fever. If you have chronic Q fever, youll have to be treated for 18 months or longer. […] The mortality (death) rate for chronic Q fever is 12 to 25%.
- #8 Diagnosis and Management of Q Fever — United States, 2013https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6203a1.htm
Q fever has acute and chronic stages that correspond to two distinct antigenic phases of antibody response. […] Chronic disease is rare (5% of patients with acute infections) and typically is characterized by endocarditis in patients with preexisting risk factors such as valvular or vascular defects. […] Unlike acute Q fever, which has a low mortality rate (2%), chronic Q fever endocarditis is always fatal if untreated. […] A clinical assessment of patients with acute Q fever should be performed to determine whether they are at high risk for subsequent chronic infection. […] Approximately 40% of persons with a known valvulopathy with an acute Q fever diagnosis subsequently develop infective endocarditis. […] The initial clinical signs and symptoms in patients with chronic Q fever often are nonspecific and highly variable.
- #9 Long-term outcome of Q fever endocarditis: a 26-year personal survey – PubMedhttps://pubmed.ncbi.nlm.nih.gov/20637694/
Q fever endocarditis caused by Coxiella burnetii is a potentially fatal disease characterised by a chronic evolution. To assess the long-term outcome and identify prognostic factors for mortality, surgical treatment, and serological changes in Q fever endocarditis, we did a retrospective study in the French National Referral Centre. […] In a multivariate Cox regression analysis, the major determinants associated with mortality were age (hazard ratio 1.11, 95% CI 1.05-1.18, p=0.003), stroke at diagnosis (7.09, 2.00-25.10, p=0.001), endocarditis on a prosthetic valve (6.04, 1.47-24.80, p=0.044), an absence of a four-times decrease of phase I IgG and IgA at 1 year (5.69, 1.00-32.22, p=0.049), or the presence of phase II IgM at 1 year (12.08, 3.11-46.85, p=0.005). […] The optimum duration of treatment with doxycycline and hydroxychloroquine in Q fever endocarditis is 18 months for native valves and 24 months for prosthetic valves. This duration should be extended only in the absence of favourable serological outcomes. Patients should be serologically monitored for at least 5 years because of the risk of relapse.
- #10 Long-term outcome of Q fever endocarditis: a 26-year personal survey – PubMedhttps://pubmed.ncbi.nlm.nih.gov/20637694/
Q fever endocarditis caused by Coxiella burnetii is a potentially fatal disease characterised by a chronic evolution. To assess the long-term outcome and identify prognostic factors for mortality, surgical treatment, and serological changes in Q fever endocarditis, we did a retrospective study in the French National Referral Centre. […] In a multivariate Cox regression analysis, the major determinants associated with mortality were age (hazard ratio 1.11, 95% CI 1.05-1.18, p=0.003), stroke at diagnosis (7.09, 2.00-25.10, p=0.001), endocarditis on a prosthetic valve (6.04, 1.47-24.80, p=0.044), an absence of a four-times decrease of phase I IgG and IgA at 1 year (5.69, 1.00-32.22, p=0.049), or the presence of phase II IgM at 1 year (12.08, 3.11-46.85, p=0.005). […] The optimum duration of treatment with doxycycline and hydroxychloroquine in Q fever endocarditis is 18 months for native valves and 24 months for prosthetic valves. This duration should be extended only in the absence of favourable serological outcomes. Patients should be serologically monitored for at least 5 years because of the risk of relapse.
- #11 Q Fever: Causes, Symptoms, Diagnosis, Prevention & Treatmenthttps://my.clevelandclinic.org/health/diseases/17883-q-fever
Chronic Q fever is a serious form of Q fever that can affect your heart, your blood vessels, your bones and other parts of your body. It affects 1 to 5% of people whove had a C. burnetii infection. It can start months or years after your initial symptoms go away and can lead to life-threatening complications. […] Chronic Q fever can be life-threatening. […] A small number of people (1 to 5%), usually those with underlying conditions, go on to develop chronic Q fever. If you have chronic Q fever, youll have to be treated for 18 months or longer. […] The mortality (death) rate for chronic Q fever is 12 to 25%.
- #12 Long-term outcome of Q fever endocarditis: a 26-year personal survey – PubMedhttps://pubmed.ncbi.nlm.nih.gov/20637694/
Q fever endocarditis caused by Coxiella burnetii is a potentially fatal disease characterised by a chronic evolution. To assess the long-term outcome and identify prognostic factors for mortality, surgical treatment, and serological changes in Q fever endocarditis, we did a retrospective study in the French National Referral Centre. […] In a multivariate Cox regression analysis, the major determinants associated with mortality were age (hazard ratio 1.11, 95% CI 1.05-1.18, p=0.003), stroke at diagnosis (7.09, 2.00-25.10, p=0.001), endocarditis on a prosthetic valve (6.04, 1.47-24.80, p=0.044), an absence of a four-times decrease of phase I IgG and IgA at 1 year (5.69, 1.00-32.22, p=0.049), or the presence of phase II IgM at 1 year (12.08, 3.11-46.85, p=0.005). […] The optimum duration of treatment with doxycycline and hydroxychloroquine in Q fever endocarditis is 18 months for native valves and 24 months for prosthetic valves. This duration should be extended only in the absence of favourable serological outcomes. Patients should be serologically monitored for at least 5 years because of the risk of relapse.
- #13 Diagnosis and Management of Q Fever — United States, 2013https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6203a1.htm
Chronic Q fever is rare, occurring in 5% of persons with acute infection, and might occur within a few months, years, or even decades after the initial acute infection. […] Patients with cardiovascular risk factors for chronic disease (e.g., heart valve defect, vascular graft, or aneurysm) at the time of acute infection should be serologically monitored and receive a physical examination at intervals of 3, 6, 12, 18, and 24 months. […] Women infected during pregnancy should be serologically and clinically monitored at the same intervals after delivery. […] The risk for adverse effects on the fetus and the risk that the mother will develop chronic Q fever are highest when an acute infection occurs during the first trimester. […] Chronic Q fever is rarely reported in children.
- #14https://link.springer.com/article/10.1007/s11908-012-0264-6
Q fever is an ubiquitous zoonosis caused by Coxiella burneti, an intracellular bacterium that can produce acute or chronic infections in humans. […] However, the serological profile for diagnosis and the real value of serology for predicting outcome are controversial, and management dilemmas for many patients with Q fever infection are continuously emerging. […] The utility of serology for predicting the outcome is largely questioned. […] In this study, a considerable number of patients with acute Q fever exhibited high antibodies titers to phase I antigens, but no evolution to chronic form was observed. […] High titers of phase I IgG and even progressive elevation of them after an acute Q fever infection do not indicate or predict the development of chronic Q fever in this report.
- #15https://link.springer.com/article/10.1007/s11908-012-0264-6
The authors from the French National Reference Center for Rickettsial Diseases describe their experience with the largest series of the world. Considerations about the optimum duration of treatment are provided with special consideration to serology. […] In this study, the efficacy of PCR in blood samples for the diagnosis of chronic forms (mainly endocarditis) is analysed. […] French authors propose in this study an algorithm based in serology and genomic amplification for preventing the development of chronic forms.
- #16 Diagnosis and Management of Q Fever — United States, 2013https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6203a1.htm
Chronic Q fever is rare, occurring in 5% of persons with acute infection, and might occur within a few months, years, or even decades after the initial acute infection. […] Patients with cardiovascular risk factors for chronic disease (e.g., heart valve defect, vascular graft, or aneurysm) at the time of acute infection should be serologically monitored and receive a physical examination at intervals of 3, 6, 12, 18, and 24 months. […] Women infected during pregnancy should be serologically and clinically monitored at the same intervals after delivery. […] The risk for adverse effects on the fetus and the risk that the mother will develop chronic Q fever are highest when an acute infection occurs during the first trimester. […] Chronic Q fever is rarely reported in children.
- #17 No Such Thing as Chronic Q Fever – Volume 23, Number 5âMay 2017 – Emerging Infectious Diseases journal – CDChttps://wwwnc.cdc.gov/eid/article/23/5/15-1159_article
Modern diagnostic methods enable clinicians to look beyond a diagnosis of chronic Q fever and discern whether patients instead have persistent focalized Coxiella burnetii infection(s). […] Use of these methods and development of criteria to define and treat such infections, especially cardiovascular infections, will improve the prognosis for patients previously thought to have chronic Q fever. […] Accurate identification of persistent focalized C. burnetii infections will improve patient outcomes by preventing long-term, organ-specific, lethal complications (e.g., vascular infections are a risk for vascular rupture, lymphadenitis is a risk for lymphoma) and by avoiding drug side effects in patients with isolated elevated serologic test results. […] Clinicians should look beyond a diagnosis of chronic Q fever to determine whether a patient might have persistent focalized infection(s). […] The term fever in Q fever has evolved from a pathologic picture per se to a clinical epiphenomenon; it is now time to evolve from the concept of chronic Q fever to one of persistent focalized C. burnetii infection(s).
- #18 Seroepidemiologic evidence of Q fever and associated factors among workers in veterinary service laboratory in South Korea | PLOS Neglected Tropical Diseaseshttps://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0010054
The incidence of Q fever has rapidly increased in South Korea since 2015. […] This study suggests the need for precautions when contact with cattle, goats, or sheep is expected, especially during the antemortem inspection, when dealing with C. burnetii infected animals, or when there is a risk of ocular contact with animal derivatives. Therefore, we recommend the consistent use of appropriate personal protective equipment and other protective measures including PPE treatment and washing of body surfaces after work to prevent C. burnetii infections among VSL staff in South Korea. […] Our findings suggest precautions be taken when contacting cattle, goats, or sheep, especially during the antemortem inspection, and dealing with C. burnetii infected animals, and when there is a risk of ocular contact with animal derivatives, such as the use of appropriate personal protective equipment, and compliance with other measures that prevent C. burnetii infections among VSL staff in South Korea. […] The risk factors found to be significantly associated with the seroprevalence of Q fever were: the antemortem inspection of cattle, goats, or sheep, having animal blood splashed into or around eyes, and contact with animals having Q fever during the previous year.
- #19 Seroepidemiologic evidence of Q fever and associated factors among workers in veterinary service laboratory in South Korea | PLOS Neglected Tropical Diseaseshttps://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0010054
The incidence of Q fever has rapidly increased in South Korea since 2015. […] This study suggests the need for precautions when contact with cattle, goats, or sheep is expected, especially during the antemortem inspection, when dealing with C. burnetii infected animals, or when there is a risk of ocular contact with animal derivatives. Therefore, we recommend the consistent use of appropriate personal protective equipment and other protective measures including PPE treatment and washing of body surfaces after work to prevent C. burnetii infections among VSL staff in South Korea. […] Our findings suggest precautions be taken when contacting cattle, goats, or sheep, especially during the antemortem inspection, and dealing with C. burnetii infected animals, and when there is a risk of ocular contact with animal derivatives, such as the use of appropriate personal protective equipment, and compliance with other measures that prevent C. burnetii infections among VSL staff in South Korea. […] The risk factors found to be significantly associated with the seroprevalence of Q fever were: the antemortem inspection of cattle, goats, or sheep, having animal blood splashed into or around eyes, and contact with animals having Q fever during the previous year.