Three Decades of Coxiella burnetii in Pakistan: A Narrative Review

Abstract

Background: Coxiella burnetii is a short, pleomorphic, strictly intracellular Gram-negative coccobacillary bacterium that principally affects macrophages and causes abortion in animals. Objective: The purpose of this study was to narrate a review about the scope of C. burnetii in Pakistan. Methods: The review was carried out by a systematic search of PubMed, Web of Science, Scopus, and Google Scholar using keywords “Coxiella burnetii”, “Q fever”, “Pakistan”, and “epidemiology”, “molecular detection”, “serological detection” and “epidemiological surveys”. Only publications which focused on Pakistan in terms of geographic and in English language were included in the search. Studies that weren’t focused on Pakistan were excluded. A total of 18 papers were initially screened, among them 3 duplicates were removed, and the final 15 papers were screened for data related to author, year of publication, province, type of study, sampling design, sample size, type of samples, host type, and prevalence were extracted. The data were processed and analyzed using Microsoft Excel and GraphPad Prism. Results: Since 2016, research on C. burnetii in Pakistan has been particularly characterized by an increase in publication of C. burnetii research, but has been more focused in Punjab province and little in other provinces. Most studies used cross-sectional designs, and random sampling was the most common method of sampling, but the diversity of the sampling strategies noted in some studies may limit generalizability. The highest prevalence rates of C. burnetii were observed in sheep blood samples (41.23%) and goats (38.86%). Furthermore, the presence of ticks on other hosts, raw meat, and soil (16.97%) reported evidence of high zoonotic and environmental transmission potential of C. burnetii. Conclusion: These findings also highlighted the importance of small ruminants as a critical reservoir and to accelerate surveillance in areas outside Punjab. The future research needed to address the public health impact of Q fever will rely on a One Health approach that considers the health of people, animals, and their environment and includes targeted interventions and enhanced surveillance.