title: Evaluation of Patients with Community-Acquired Pneumonia Caused by Zoonotic Pathogens in an Area with a High Density of Animal Farms.
abstract: Intensive animal farming could potentially lead to outbreaks of infectious diseases. Clinicians are at the forefront of detecting unusual diseases, but the lack of specificity of zoonotic disease symptoms makes this a challenging task. We evaluated patients with community-acquired pneumonia (CAP) with known and unknown aetiology in an area with a high livestock density and a potential association with animal farms in the proximity. Between 2008 and 2009, a period coinciding with a large Q fever outbreak in the Netherlands, patients with CAP were tested for the presence of possible respiratory pathogens. The presence and number of farm animals within 1 km of the patients' home address were assessed using geographic information system (GIS) and were compared between cases and age-matched control subjects. Of 408 patients with CAP, pathogens were detected in 275 (67.4%) patients. The presence of sheep and the number of goats were associated with CAP caused by Coxiella burnetii in a multiple logistic regression model (P < 0.05). CAP with unknown aetiology was not associated with the presence of animal farms (P > 0.10). The use of GIS in combination with aetiology of CAP could be potentially used to target diagnostics and to identify outbreaks of rare zoonotic disease.
authors.affiliation: Department of Medical Microbiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.|Laboratory of Medical Microbiology and Immunology, St. Elisabeth Hospital, Tilburg, The Netherlands.
authors.forename: E G W
authors.initials: EG
authors.lastname: Huijskens
authors.affiliation: Division Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
authors.forename: L A M
authors.initials: LA
authors.lastname: Smit
authors.affiliation: Laboratory of Medical Microbiology and Immunology, St. Elisabeth Hospital, Tilburg, The Netherlands.|Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: J W A
authors.initials: JW
authors.lastname: Rossen
authors.affiliation: Division Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Heederik
authors.affiliation: Department of Virology, Erasmus Medical Centre, Rotterdam, The Netherlands.|National Institute of Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Koopmans
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000822:Animal Husbandry; D000818:Animals; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D016997:Coxiella burnetii / Q000302:isolation & purification; D004196:Disease Outbreaks; D005260:Female; D040362:Geographic Information Systems; D006041:Goats; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology*; D011778:Q Fever / Q000453:epidemiology; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012307:Risk Factors; D012756:Sheep; D055815:Young Adult; D015047:Zoonoses / Q000453:epidemiology* / Q000382:microbiology*
keywords: Coxiella burnetii; Zoonosis; community-acquired pneumonia; geographic information system; respiratory pathogens