Chapter 63 :

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Preview this chapter:
Zoom in

, Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555816728/9781555814632_Chap63-1.gif /docserver/preview/fulltext/10.1128/9781555816728/9781555814632_Chap63-2.gif


This chapter talks about , Q fever and typing systems. Q fever can be latent and recrudesce during periods of relative immunosuppression, such as late pregnancy, causing fetal infection. Isolation must currently be performed in specialized high-containment biosafety level 3 facilities, as the agent is highly infectious and classified as a select agent and a CDC category B bioterrorism agent. IHC is an excellent method for the detection of antigens in tissue samples particularly cardiac valve tissues that are colonized during chronic Q fever. The detection of antibodies to C. burnetii is the most commonly used and effective method for the diagnosis of Q fever. The primary serologic assays in use today are the indirect immunofluorescent antibody (IFA) assay, the complement fixation (CF) test, and the enzyme-linked immunosorbent assay (ELISA), with the IFA assay being the gold standard and most commonly used method. The diagnosis of chronic Q fever is best performed at reference laboratories that have BSL-3 facilities for the propagation and storage of phase I organisms since is classified as a U.S. category B bioterrorism agent. The recommended treatment for acute Q fever is doxycycline, although strains with partial doxycycline resistance have been reported. Chronic Q fever, especially Q fever endocarditis, requires long-term antibiotics and often valve replacement. Tissue specimens (e.g., heart valve, liver, and bone marrow) are most often positive in chronic Q fever, although peripheral blood leukocytes from such patients can be positive or negative.

Citation: Graves S, Massung R. 2011. , p 1027-1034. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch63

Key Concept Ranking

Q fever
Type IV Secretion Systems
Highlighted Text: Show | Hide
Loading full text...

Full text loading...


Image of FIGURE 1

Electron micrograph of purified showing both LCV and SVC forms. (Courtesy of Rocky Mountain Laboratories, NIAID, NIH.)

Citation: Graves S, Massung R. 2011. , p 1027-1034. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch63
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of FIGURE 2

Hematoxylin and eosin stain of liver biopsy in a patient with acute Q fever. A doughnut ring granuloma is shown. Original magnification, ×400. (Courtesy of H. Lepidi, Marseille, France.)

Citation: Graves S, Massung R. 2011. , p 1027-1034. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch63
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of FIGURE 3

Alkaline phosphatase IHC on the heart valve from a patient with chronic Q fever endocarditis. microorganisms are stained pink within mononuclear cells. Original magnification, ×400.

Citation: Graves S, Massung R. 2011. , p 1027-1034. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch63
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of FIGURE 4

Identification of C. in shell vial culture at day 6 by the use of specific monoclonal antibody-based direct fluorescent-antibody test. Original magnification, ×1,000.

Citation: Graves S, Massung R. 2011. , p 1027-1034. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch63
Permissions and Reprints Request Permissions
Download as Powerpoint


1. Amano, K.-I.,, J. C. Williams,, S. R. Missler,, and V. N. Reinhold. 1987. Structure and biological relationships of Coxiella burnetii lipopolysaccharides. J. Biol. Chem. 262:47404747.
2. Anderson, A. D.,, D. Kruszon-Moran,, A. D. Loftis,, G. Mc- Quillan,, W. L. Nicholson,, R. A. Priestley,, A. J. Candee,, N. E. Patterson,, and R. F. Massung. 2009. Seroprevalence of Q fever in the United States, 2003-2004. Am. J. Trop. Med. Hyg. 81:691694.
3. Ayres, J. G.,, E. G. Smith,, and N. Flint. 1996. Protracted fatigue and debility after acute Q fever. Lancet 347:978979.
4. Beare, P. A.,, N. Unsworth,, M. Andoh,, D. E. Voth,, A. Omsland,, S. D. Gilk,, K. P. Williams,, B. W. Sobral,, J. J. Kupko III,, S. F. Porcella,, J. E. Samuel,, and R. A. Heinzen. 2009. Comparative genomics reveal extensive transposonmediated genomic plasticity and diversity among potential effector proteins within the genus Coxiella. Infect. Immun. 77:642656.
5. Botelho-Nevers, E.,, P. E. Fournier,, H. Richet,, F. Fenollar,, H. Lepidi,, C. Foucault,, A. Branchereau,, P. Piquet,, M. Maurin,, and D. Raoult 2007. Coxiella burnetii infection of aortic aneurysms or vascular grafts: report of 30 new cases and evaluation of outcome. Eur. J. Clin. Microbiol. Infect. Dis. 26:635640.
6. Brennan, R. E.,, and J. E. Samuel. 2003. Evaluation of Coxiella burnetii antibiotic susceptibilities by real-time PCR assay. J. Clin. Microbiol. 41:18691874.
7. Brenner, D.,, N. R. Krieg,, and J. T. Staley. 2005. Bergey’s Manual of Systematic Bacteriology, 2nd ed., vol. 2. The Proteobacteria. Part B, the Gammaproteobacteria, 210-241. Springer, New York, NY.
8. Buhariwalla, F.,, B. Cann,, and T. J. Marrie. 1996. A dogrelated outbreak of Q fever. Clin. Infect. Dis. 23:753755.
9. Camacho, M. T.,, I. Outschoorn,, A. Tellez,, and J. Sequi. 2005. Autoantibody profiles in the sera of patients with Q fever: characterization of antigens by immunofluorescence, immunoblot and sequence analysis. J. Autoimmun. Dis. 2:10.
10. Capo, C.,, A. Moynault, Y. Collette,, D. Olive,, E. J. Brown,, D. Raoult,, and J.-L. Mege. 2003. Coxiella burnetii avoids macrophage phagocytosis by interfering with the spatial distribution of complement receptor 3. J. Immunol. 170:42174225.
11. Carcopino, X.,, D. Raoult,, F. Bretelle,, L. Boubli,, and A. Stein. 2007. Managing Q fever during pregnancy: the benefits of long-term cotrimoxazole therapy. Clin. Infect. Dis. 45:548555.
12. Cohen, N. J.,, M. Papernik,, J. Singleton,, J. Segreti,, and M. E. Eremeeva. 2007. Q fever in an American tourist returning from Australia. Travel Med. Infect. Dis. 5(3):194195.
13. Coleman, S. A.,, E. R. Fischer,, D. Howe,, D. J. Mead,, and R. A. Heinzen. 2004. Temporal analysis of Coxiella burnetii morphological differentiation. J. Bacteriol. 186:73447352.
14. Cooper, A.,, R. Layton,, L. Owens,, N. Ketheesan,, and B. Govan. 2007. Evidence for classification of a crayfish pathogen as a member of the genus Coxiella. Lett. Appl. Microbiol. 45:558563.
15. Denison, A.,, R. F. Massung,, and H. A Thompson. 2007. Analysis of the O-antigen biosynthesis regions of phase II isolates of Coxiella burnetii. FEMS Microbiol. Lett. 267:102107.
16. Derrick, E. H. 1973. The course of infection with Coxiella burnetii. Med. J. Aust. 1:10511057.
17. Derrick, E. H.,, and D. J. W. Smith. 1940. Studies in the epidemiology of Q fever. 2. The isolation of three strains of Rickettsia burnetii from the bandicoot Isoodon torosus. Aust. J. Exp. Biol. Med. Sci. 18:99102.
18. Dupuis, G.,, J. Petite,, O. Peter,, and M. Vouilloz. 1987. An important outbreak of human Q fever in a Swiss alpine valley. Int. J. Epidemiol. 16:282287.
19. Enserick, M. 2010. Questions abound in Q fever explosion in the Netherlands. Science 327:266267.
20. Field, P. R.,, J. L. Mitchell,, A. Santiago,, D. J. Dickeson,, S. W. Chan,, D. W. Ho,, A. M. Murphy,, A. J. Cuzzubbo,, and P. L. Devine. 2000. Comparison of a commercial enzyme-linked immunosorbent assay with immunofluorescence and complement fixation tests for detection of Coxiella burnetii (Q fever) immunoglobulin M. J. Clin. Microbiol. 38:16451647.
21. Field, P. R.,, J. G. Hunt,, and A. M. Murphy. 1983. Detection and persistence of specific IgM antibody to Coxiella burnetii by enzyme-linked immunosorbent assay: a comparison with immunofluorescence and complement fixation tests. J. Infect. Dis. 148:477487.
22. Fournier, P. E.,, and D. Raoult. 2003. Comparison of PCR and serology assays for early diagnosis of acute Q fever. J. Clin. Microbiol. 41:50945098.
23. Ghigo, E.,, A. Honstettre,, C. Capo,, J. P. GorVel,, D. Raoult,, and J.-L. Mege. 2004. Link between impaired maturation of phagosomes and defective Coxiella burnetii killing in patients with chronic Q fever. J. Infect. Dis. 190:17671772.
24. Gidding, H. F.,, C. Wallace,, G. L. Lawrence,, and P. B McIntyre. 2009. Australia’s natural Q fever vaccination program. Vaccine 27:20372041.
25. Hartzell, J. D.,, S. W. Peng,, R. N. Wood-Morris,, D. M. Sarmiento,, J. F. Collen,, P. M. Robben,, and K. A. Moran. 2007. Atypical Q fever in U.S. soldiers. Emerg. Infect. Dis. 13:12471249.
26. Heinzen, R. A.,, and T. Hackstadt. 1996. A developmental stage-specific histone H1 homolog of Coxiella burnetii. J. Bacteriol. 178:50495052.
27. Helbig, K. J.,, R. J. Harris,, J. Ayres,, H. Dunckley,, A. Lloyd,, J. Robson,, and B. P. Marmion. 2005. Immune response genes in the post Q fever fatigue syndrome, Q fever endocarditis and uncomplicated acute primary Q fever. QJM 98:565574.
28. Hilbink, F.,, M. Penrose,, E. Kovacova,, and J. Kozar. 1993. Q fever is absent from New Zealand. Int. J. Epidemiol. 22:945949.
29. Hoover, T. A.,, D. W. Culp,, M. H. Vodkin,, J. C. Williams,, and H. A. Thompson. 2002. Chromosomal DNA deletions explain phenotypic characteristics of two antigenic variants, phase II and RSA 514 (crazy) of the Coxiella burnetii Nine Mile strain. Infect. Immun. 70:67266733.
30. Kim, S. G.,, E. H. Kim,, C. J. Lafferty,, and E. Dubovi. 2005. Coxiella burnetii in bulk tank milk samples, United States. Emerg. Infect. Dis. 11:619621.
31. Klee, S. R.,, J. Tyczka,, H. Ellerbrok,, T. Franz,, S. Linke,, G. Baljer,, and B. Appel. 2006. Highly sensitive real-time PCR for specific detection and quantification of Coxiella burnetii. BMC Microbiol. 6:2.
32. Kosatsky, T. 1984. Household outbreak of Q-fever pneumonia related to a parturient cat. Lancet ii:14471449.
33. Kovácová, E.,, J. Gallo,, S. Schramek,, J. Kazár,, and R. Brezina. 1987. Coxiella burnetii antigens for detection of Q fever antibodies by ELISA in human sera. Acta Virol. 31:254259.
34. Leone, M.,, Y. Bechah,, S. Meghari,, H. Lepidi,, C. Capo,, D. Raoult,, and J.-L. Mege. 2007. Coxiella burnetii infection in C57BL/6 mice aged 1 or 14 months. FEMS Immunol. Med. Microbiol. 50:396400.
35. Lever, M. S.,, K. R. Bewley,, B. Dowsett,, and G. Lloyd. 2004. In vitro susceptibility of Coxiella burnetii to azithromycin, doxycycline, ciprofloxacin and a range of newer fluoroquinolones. Int. J. Antimicrob. Agents 24:194196.
36. Luhrmann, A.,, and C. R. Roy. 2007. Coxiella burnetii inhibits activation of host cell apoptosis through a mechanism that involves preventing cytochrome c release from mitochondria. Infect. Immun. 75:52825289.
37. Maltezou, H. C.,, and D. Raoult. 2002. Q fever in children. Lancet Infect. Dis. 2:686689.
38. Marmion, B. P. 2007. Q fever: the long journey to control by vaccination. Med. J. Aust. 186:164165.
39. Marmion, B. P.,, F. O. MacCallum,, A. Rowlands,, and C. C. Thiel. 1951. The effect of pasteurization on milk containing Rickettsia burnetii. Mon. Bull. Minist. Health Public Health Lab. Serv. 10:119128.
40. Marmion, B. P.,, M. Shannon,, I. Maddocks,, P. Storm,, and I. Penttila. 1996. Protracted debility and fatigue after Q fever. Lancet 347:977978.
41. Marrie, T. J.,, N. Campbell,, S. A. McNeil,, D. Webster,, and T. F. Hatchette. 2008. Q fever update, maritime Canada. Emerg. Infect. Dis. 14:6769.
42. Maurin, M.,, A. M. Benoliel,, P. Bongrand,, and D. Raoult. 1992. Phagolysosomal alkalinization and the bacteriocidal effect of antibiotics: the Coxiella burnetii paradigm. J. Infect. Dis. 166:10971102.
43. Maurin, M.,, and D. Raoult. 1999. Q fever. Clin. Microbiol. Rev. 12:518553.
44. Mege, J. L.,, M. Maurin,, C. Capo,, and D. Raoult. 1997. Coxiella burnetii: the ‘query’ bacterium. A model of immune subversion by a strictly intracellular microorganism. FEMS Microbiol. Rev. 19:209217.
45. Milazzo, A.,, R. Hall,, P. A. Storm,, R. J. Harris,, W. Winslow,, and B. P Marmion. 2001. Sexually transmitted Q fever. Clin. Infect. Dis. 33:399402.
46. Munckhof, W. J.,, N. Runnegar,, T. J. Gray,, C. Taylor,, C. Palmer,, and A. Holley. 2007. Two rare severe and fulminant presentations of Q fever in patients with minimal risk factors for this disease. Int. Med. J. 37:775778.
47. Nagaoka H.,, M. Akiyama,, M. Sugieda,, T. Nishio,, S. Akahane,, H. Hattori,, T. Ho,, H. Fukushi,, and K. Harai. 1996. Isolation of Coxiella burnetii from children with influenza-like symptoms in Japan. Microbiol. Immunol. 40:147151.
48. Omsland, A.,, D. C. Cockrell,, D. Howe,, E. R. Fischer,, K. Virtaneva,, D. E. Sturdevant,, S. F. Porcella,, and R. A. Heinzen. 2009. Host cell-free growth of the Q fever bacterium Coxiella burnetii. Proc. Natl. Acad. Sci. USA 106:44304434.
49. Osorio, S.,, C. Sarria,, P. Gonzalez-Ruano,, E. C. Casal,, and A. Garcia. 2003. Nosocomial transmission of Q fever. J. Hosp. Infect. 54:162168.
50. Panning, M.,, J. Kilwinski,, S. Greiner-Fischer,, M. Peters,, S. Kramme,, D. Frangoulidis,, H. Meyer,, K. Henning,, and C. Drosten. 2008. High throughput detection of Coxiella burnetii by real-time PCR with internal control system and automated DNA preparation. BMC Microbiol. 8:77.
51. Peacock, M. G.,, R. N. Philip,, J. C. Williams,, and R. S. Faulkner. 1983. Serological evaluation of Q fever in humans: enhanced phase I titers of immunoglobulins G and A are diagnostic for Q fever endocarditis. Infect. Immun. 41:10891098.
52. Péter, O.,, G. Dupuis,, D. Bee,, R. Lüthy,, J. Nicolet,, and W. Burgdorfer. 1988. Enzyme-linked immunosorbent assay for diagnosis of chronic Q fever. J. Clin. Microbiol. 26:19781982.
53. Pinsky, R. L.,, D. B. Fishbein,, C. R. Greene,, and K. F. Gensheimer. 1991. An outbreak of cat-associated Q fever in the United States. J. Infect. Dis. 164:202204.
54. Pope, J. H.,, W. Scott, and R Dwyer. 1960. Coxiella burnetii in kangaroos and kangaroo ticks in western Queensland. Aust. J. Exp. Biol. 38:1728.
55. Powell, O. 1960. Q fever: clinical features in 72 cases. Aust. Ann. Med. 9:214223.
56. Ransom, S. E.,, and R. J. Huebner. 1951. Studies on the resistance of Coxiella burnetii to physical and chemical agents. Am. J. Hyg. 53:110119.
57. Raoult, D. 2000. Q fever 1985-1998. Clinical and epidemiologic features of 1,383 infections. Medicine 79:109123.
58. Raoult, D. 2003. Use of macrolides for Q fever. Antimicrob. Agents Chemother. 47:446.
59. Raoult, D.,, T. Marrie,, and J. Mege. 2005. Natural history and pathophysiology of Q fever. Lancet Infect. Dis. 5:219226.
60. Raoult, D.,, and A. Stein. 1994. Q fever during pregnancy—a risk for women, fetuses and obstetricians. N. Engl. J. Med. 330:371.
61. Raoult, D.,, H. Torres,, and M. Drancourt. 1991. Shell-vial assay: evaluation of a new technique for determining antibiotic susceptibility, tested in 13 isolates of Coxiella burnetii. Antimicrob. Agents Chemother. 35:20702077.
62. Rolain, J. M.,, and D. Raoult. 2005. Molecular detection of Coxiella burnetii in blood and sera during Q fever. QJM 98:615617.
63. Rustscheff, S.,, L. Norlander,, A. Macellaro,, A. Sjostedt,, S. Vene,, and M. Carlsson. 2000. A case of Q fever acquired in Sweden and isolation of the probable etiological agent, Coxiella burnetii, from an indigenous source. Scand. J. Infect. Dis. 32:605607.
64. Seshadri, R.,, L. R. Hendrix,, and J. E. Samuel. 1999. Differential expression of translational elements by life cycle variants of Coxiella burnetii. Infect. Immun. 67:60266033.
65. Seshadri, R.,, I. Paulsen,, and J. A. Eisen,, T. D. Read,, K. E. Nelson,, W. C. Nelson,, N. L. Ward,, H. Tettelin,, T. M. Davidsen,, M. J. Beanan,, R. T. Deboy,, S. C. Daugherty,, L. M. Brinkac,, R. Madupu,, R. J. Dodson,, H. M. Khouri,, K. H. Lee,, H. A. Carty,, D. Scanlan,, R. A. Heinzen,, H. A. Thompson,, J. E. Samuel,, C. M. Fraser,, and J. F. Heidelberg. 2003. Complete genome sequence of the Q fever pathogen Coxiella burnetii. Proc. Natl. Acad. Sci. USA 100:54555460.
66. Seshadri, R.,, and J. E. Samuel. 2001. Characterization of a stress-induced alternative sigma factor, RpoS, of Coxiella burnetii and its expression during the development cycle. Infect. Immun. 69:48744883.
67. Shannon, J. G.,, D. Howe,, and R. A. Heinzen. 2005. Virulent Coxiella burnetii does not activate human dendritic cells: role of lipopolysaccharide as a shielding molecule. Proc. Natl. Acad. Sci. USA 102:87228727.
68. Spellman, D. W. 1982. Q fever: a study of 111 consecutive cases. Med. J. Aust. 1:547553.
69. Stoker, M. G.,, and P. Fiset. 1956. Phase variation of the Nine Mile and other strains of Rickettsia burneti. Can. J. Microbiol. 2:310321.
70. Syrucek, L.,, and K. Raska. 1956. Q fever in domestic and wild birds. Bull. W. H. O. 15:329337.
71. Syrucek, L.,, O. Sobelavsky,, and I. Gutvirth. 1958. Isolation of Coxiella burnetii from human placentas. J. Hyg. Epidemiol. Microbiol. Immunol. 11:2935.
72. Tigertt, W. D.,, A. S. Benenson,, and R. E. Shope. 1956. Studies on Q fever in man. Trans. Assoc. Am. Physicians 69: 98104.
73. Tissot-Dupont, H.,, M.-A. Amadei,, M. Nezri,, and D. Raoult. 2004. Wind in November, Q fever in December. Emerg. Infect. Dis. 10:12641269.
74. Tissot-Dupont, H.,, X. Thirion,, and D. Raoult. 1994. Q fever serology: cutoff determination for microimmunofluorescence. Clin. Diagn. Lab. Immunol. 1:189196.
75. To, H.,, N. Kako,, G. Q. Zhang,, H. Otsuka,, M. Ogawa,, O. Ochiai,, S. A. V. Nguyen,, T. Yamaguchi,, H. Fukushi,, N. Nagaoka,, M. Akiyama,, K. Amano,, and K. Hirai. 1996. Q fever pneumonia in children in Japan. J. Clin. Microbiol. 34:647651.
76. Tonge, J. I.,, and J. M. Kennedy. 1963. An outbreak of Q fever in an abattoir near Brisbane. Med. J. Aust. 50:340343.
77. Uhaa, I. J.,, D. B. Fishbein,, J. G. Olson,, C. C. Rives,, D. M. Waag,, and J. C. Williams. 1994. Evaluation of specificity of indirect enzyme-linked immunosorbent assay for diagnosis of human Q fever. J. Clin. Microbiol. 32:15601565.
78. Vadovic, P.,, K. Slaba,, M. Fodorova,, L. Skultety,, and R. Toman. 2005. Stuctural and functional characterization of the glycan antigens involved in immunobiology of Q fever. Ann. N. Y. Acad. Sci. 1063:149153.
79. Varghees, S.,, K. Kiss,, G. Frans,, O. Braha,, and J. E. Samuel. 2002. Cloning and porin activity of the major outer membrane protein P1 from Coxiella burnetii. Infect. Immun. 70:67416750.
80. Voth, D. E.,, and R. A. Heinzen. 2009. Sustained activation of Akt and Erk1/2 is required for Coxiella burnetii antiapoptotic activity. Infect. Immun. 77:205213.
81. Voth, D. E.,, D. Howe,, and R. A. Heinzen. 2007. Coxiella burnetii inhibits apoptosis in human THP-1 cells and monkey primary alveolar macrophages. Infect. Immun. 75:42634271.
82. Voth, D. E.,, and R. A. Heinzen. 2007. Lounging in a lysosome: the intracellular life of Coxiella burnetii. Cell. Microbiol. 9:829840.
83. Waag, D.,, J. Chulay,, T. Marrie,, M. England,, and J. Williams. 1995. Validation of an enzyme immunoassay for serodiagnosis of acute Q fever. Eur. J. Clin. Microbiol. Infect. Dis. 14:421427.
84. Wagg, D. M.,, and J. C. Williams. 1988. Immune modulation by Coxiella burnetii: characterization of a phase I immunosuppressive complex differentially expressed among strains. Immunopharmacol. Immunotoxicol. 10:231260.
85. Welsh, H. H.,, E. H. Lennette,, F. R. Abinanti,, J. F. Winn,, and W. Kaplan. 1959. Q fever studies. XXI. The recovery of Coxiella burnetii from the soil and surface water of premises harboring infected sheep. Am. J. Hyg. 70:1420.
86. Whitney, E. A.,, R. F. Massung,, A. J. Candee,, E. C. Ailes,, L. M. Myers,, N. E. Patterson,, and R. L. Berkelman. 2009. Seroepidemiologic and occupational risk survey for Coxiella burnetii antibodies among US veterinarians. Clin. Infect. Dis. 48:550557.
86a. Wilson, D. E.,, and L. C. Chosewood (ed.). 2007. Biosafety in microbiological and biomedical laboratories, 5th ed. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, and National Institutes of Health. Washington, DC. http://www.cdc.gov/OD/ohs/biosfty/bmbl5/bmbl5toc.htm.
87. Wong, R. C. W.,, R. Wilson,, R. Silcock,, L. M. Kratzing,, and D. Looke. 2001. Unusual combination of positive IgG autoantibodies in acute Q fever. Int. Med. J. 31:432435.
88. Zamboni, D. S.,, M. A. Campos,, A. C. T. Torrecilhas,, K. Kiss,, J. E. Samuel,, D. T. Golenbock,, F. N. Lauw,, C. R. Roy,, I. C. Almeida,, and R. T. Gazzinelli. 2004. Stimulation of Toll-like receptor 2 by Coxiella burnetii is required for macrophage production of pro-inflammatory cytokines and resistance to infection. J. Biol. Chem. 279:5440554415.
89. Zamboni, D. S.,, S. McGrath,, M. Rabinovitch,, and C. R. Roy. 2003. Coxiella burnetii expresses type IV secretion system proteins that function similarly to components of the Legionella pneumophila Dot/Icm system. Mol. Microbiol. 49:965976.

This is a required field
Please enter a valid email address
Please check the format of the address you have entered.
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error