Three Decades of Coxiella burnetii in Pakistan: A Narrative Review

Abstract

Background: Coxiella burnetii, the etiological agent of Q fever, is a globally distributed zoonotic pathogen with significant public health implications, particularly in agrarian economies. Objective: This study aimed to comprehensively evaluate the epidemiological trends, geographical distribution, host and environmental reservoirs, and methodological frameworks of C. burnetii research in Pakistan, with a particular focus on prevalence patterns and public health implications. Methods: A narrative review design was employed, encompassing a systematic literature search across PubMed, Scopus, Web of Science, and Google Scholar up to April 2025. Studies were included if they focused on C. burnetii in Pakistan and were published in English. A total of 15 studies were selected after screening (n = 15). Data were extracted on study location, design, sampling strategy, sample size, host species, and prevalence rates. Ethical standards were maintained following the Declaration of Helsinki. Data were synthesized using Microsoft Excel and analyzed descriptively via GraphPad Prism. Results: The review found a notably higher concentration of studies in Punjab province (80%) with random sampling being the dominant methodology (87%). Sheep and goats showed the highest mean blood prevalence (41.23% and 38.86%, respectively), with notable tick vector involvement and soil-based environmental persistence (16.97%). Human samples showed a mean prevalence of 14.57%, reinforcing zoonotic risk. Clinically, underdiagnosis remains a challenge due to nonspecific symptomology and lack of routine screening. Conclusion: C. burnetii poses a significant and underrecognized zoonotic threat in Pakistan, especially in high-density livestock areas. Findings support the need for a One Health approach integrating veterinary, environmental, and clinical surveillance to mitigate disease transmission and inform targeted interventions in human healthcare.