Seroreactivity to Coxiella burnetii in an Agricultural Population and Prevalence of Coxiella burnetii Infection in Ticks of a Non-Endemic Region for Q Fever in South Korea
Abstract
:1. Introduction
2. Material and Methods
2.1. Study Setting and Participant Selection and Recruitment
2.2. Antibody Detection in Sera
2.3. Coxiella burnetii Identification in Ticks
2.4. Definitions
2.5. Statistical Analysis
3. Results
3.1. Baseline Characteristics of the Agricultural Population in This Study
3.2. Seroprevalence of Antibodies to Coxiella burnetii
3.3. Comparison of the Clinical Characteristics of the Coxiella burnetii-Positive and -Negative Groups
3.4. Coxiella burnetii in Ticks on Jeju Island
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Van Schaik, E.J.; Chen, C.; Mertens, K.; Weber, M.M.; Samuel, J.E. Molecular pathogenesis of the obligate intracellular bacterium Coxiella burnetii. Nat. Rev. Microbiol. 2013, 11, 561–573. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Yohannes, G.; Mekonen, S. Review on Query Fever (Q fever) in Small Ruminants and its Public Health Importance. Biomed. J Sci. Tech. Res. 2018, 3, 266–280. [Google Scholar]
- Raoult, D.; Marrie, T.; Mege, J. Natural history and pathophysiology of Q fever. Lancet Infect. Dis. 2005, 5, 219–226. [Google Scholar] [CrossRef]
- Eldin, C.; Mélenotte, C.; Mediannikov, O.; Ghigo, E.; Million, M.; Edouard, S.; Mege, J.-L.; Maurin, M.; Raoult, D. From Q Fever to Coxiella burnetii Infection: A Paradigm Change. Clin. Microbiol. Rev. 2017, 30, 115–190. [Google Scholar] [CrossRef] [Green Version]
- Cho, H.-C.; Hwang, S.; Kim, E.-M.; Park, Y.-J.; Shin, S.-U.; Jang, D.-H.; Chae, J.-S.; Choi, K.-S. Prevalence and Molecular Characterization of Coxiella burnetii in Cattle, Goats, and Horses in the Republic of Korea. Vector Borne Zoonotic Dis. 2021, 21, 502–508. [Google Scholar] [CrossRef]
- Tissot-Dupont, H.; Amadei, M.-A.; Nezri, M.; Raoult, D. Wind in November, Q Fever in December. Emerg. Infect. Dis. 2004, 10, 1264–1269. [Google Scholar] [CrossRef]
- Parker, N.R.; Barralet, J.H.; Bell, A.M. Q fever. Lancet 2006, 367, 679–688. [Google Scholar] [CrossRef]
- Duron, O.; Sidi-Boumedine, K.; Rousset, E.; Moutailler, S.; Jourdain, E. The Importance of Ticks in Q Fever Transmission: What Has (and Has Not) Been Demonstrated? Trends Parasitol. 2015, 31, 536–552. [Google Scholar] [CrossRef]
- Kim, J.H.; Choi, Y.-J.; Lee, K.S.; Kim, J.E.; Oh, J.-W.; Moon, J.-H. Severe Fever with Thrombocytopenia Syndrome with Q Fever Coinfection in an 8-Year-Old Girl. Pediatr. Infect. Dis. J. 2021, 40, e31–e34. [Google Scholar] [CrossRef]
- Im, J.H.; Baek, J.; Durey, A.; Kwon, H.Y.; Chung, M.-H.; Lee, J.-S. Current Status of Tick-Borne Diseases in South Korea. Vector Borne Zoonotic Dis. 2019, 19, 225–233. [Google Scholar] [CrossRef]
- Lee, J.-H.; Park, H.-S.; Jang, W.-J.; Koh, S.-E.; Park, T.-K.; Kang, S.-S.; Kim, B.-J.; Kook, Y.-H.; Park, K.-H.; Lee, S.-H. Identification of the Coxiella sp. Detected from Haemaphysalis longicornis Ticks in Korea. Microbiol. Immunol. 2004, 48, 125–130. [Google Scholar] [CrossRef]
- Seo, M.-G.; Lee, S.-H.; Ouh, I.-O.; Lee, G.H.; Goo, Y.-K.; Kim, S.; Kwon, O.-D.; Kwak, D. Molecular Detection and Genotyping of Coxiella-Like Endosymbionts in Ticks that Infest Horses in South Korea. PLoS ONE 2016, 11, e0165784. [Google Scholar] [CrossRef]
- Seo, M.-G.; Ouh, I.-O.; Lee, S.-H.; Kim, J.W.; Rhee, M.H.; Kwon, O.-D.; Kim, T.-H.; Kwak, D. Prevalence of Coxiella burnetii in cattle at South Korean national breeding stock farms. PLoS ONE 2017, 12, e0177478. [Google Scholar] [CrossRef] [PubMed]
- Ministry of Agriculture, Food, and Rural Affairs Republic of Korea. Agriculture, Food, and Rural Affairs Statics Yearbook. Available online: https://atfis.or.kr/article/M001080000/view.do?articleId=3425&boardId=18&page=&searchKey=&searchString=&searchCategory= (accessed on 1 April 2021). (In Korean)
- Korea Centers for Disease Control and Prevention. Statistical System of Notifiable Disease Surveillance System (2010–2020). Available online: https://is.cdc.go.kr (accessed on 11 May 2021). (In Korean)
- Statics Korea. 2019 Agricultural Area Survey. Available online: http://www.kostat.go.kr/portal/korea/kor_nw/1/8/6/index.board (accessed on 1 May 2021). (In Korean)
- Focus Diagnotics. Q Fever IFA IgM. Available online: https://www.focusdx.com/pdfs/pi/US/IF0200M.pdf (accessed on 5 October 2020).
- Focus Diagnotics. Q Fever IFA IgG. Available online: https://www.focusdx.com/pdfs/pi/US/IF0200G.pdf (accessed on 5 October 2020).
- Goff, M.L.; Loomis, R.B.; Welbourn, W.C.; Wrenn, W.J. A Glossary of Chigger Terminology (Acari: Trombiculidae). J. Med. Entomol. 1982, 19, 221–238. [Google Scholar] [CrossRef] [PubMed]
- Chu, H.; Yoo, S.-J.; Hwang, K.-J.; Lim, H.-S.; Lee, K.; Park, M.-Y. Seroreactivity to Q Fever among Slaughterhouse Workers in South Korea. J. Prev. Med. Public Health 2017, 50, 195–200. [Google Scholar] [CrossRef] [PubMed]
- Kim, W.J.; Hahn, T.W.; Kim, D.Y.; Lee, M.G.; Jung, K.S.; Ogawa, M.; Kishimoto, T.; Lee, M.E.; Lee, S.J. Seroprevalence of Coxiella burnetii Infection in Dairy Cattle and Non-symptomatic People for Routine Health Screening in Korea. J. Korean Med. Sci. 2006, 21, 823–826. [Google Scholar] [CrossRef] [PubMed]
- Park, J.-H.; Hwang, S.D.; Acharya, D.; Lee, S.H.; Hwang, K.J.; Yoo, S.-J.; Lee, K. Seroreactivity and Risk Factors Associated with Coxiella burnetii Infection among Cattle Slaughterhouse Workers in South Korea. Int. J. Environ. Res. Public Health 2018, 15, 2264. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Yoo, J.R.; Heo, S.T.; Song, S.W.; Bae, S.G.; Lee, S.; Choi, S.; Lee, C.; Jeong, S.; Kim, M.; Sa, W.; et al. Severe fever with thrombocytopenia syndrome virus in ticks and SFTS incidence in humans, South Korea. Emerg. Infect. Dis. 2020, 26, 2292–2294. [Google Scholar] [CrossRef] [PubMed]
- Kim, M.; Heo, S.T.; Oh, H.; Oh, S.; Lee, K.H.; Yoo, J.R. Prognostic factors of severe fever with thrombocytopenia syndrome in South Korea. Viruses 2021, 13, 10. [Google Scholar] [CrossRef]
- Yoo, J.R.; Heo, S.T.; Koh, Y.-S.; Kim, S.; Kim, S. Unusual genotypic distribution of Orientia tsutsugamushi strains causing human infections on Jeju Island. Am. J. Trop. Med. Hyg. 2014, 90, 507–510. [Google Scholar] [CrossRef] [Green Version]
- Yoo, J.R.; Heo, S.T.; Kang, J.H.; Park, D.; Kim, J.S.; Bae, J.H.; Woo, J.J.; Kim, S.; Lee, K.H. Mixed Infection with severe fever with thrombocytopenia syndrome virus and two genotypes of scrub typhus in a patient, South Korea. Am. J. Trop. Med. Hyg. 2018, 99, 287–290. [Google Scholar] [CrossRef] [Green Version]
- Heo, J.Y.; Choi, Y.W.; Kim, E.J.; Lee, S.H.; Lim, S.K.; Hwang, S.D.; Lee, J.Y.; Jeong, H.W. Clinical characteristics of acute Q fever patients in South Korea and time from symptom onset to serologic diagnosis. BMC Infect. Dis. 2019, 19, 903. [Google Scholar] [CrossRef]
- Melenotte, C.; Epelboin, L.; Million, M.; Hubert, S.; Monsec, T.; Djossou, F.; Mege, J.-L.; Habib, G.; Raoult, D. Acute Q fever endocarditis: A paradigm shift following the systematic use of transthoracic echocardiography during acute Q fever. Clin. Infect. Dis. 2019, 69, 1987–1995. [Google Scholar] [CrossRef]
- Melenotte, C.; Izaaryene, J.-J.; Gomez, C.; Delord, M.; Prudent, E.; Lepidi, H.; Mediannikov, O.; Lacoste, M.; Djossou, F.; Mania, A.; et al. Coxiella burnetii: A hidden pathogen in interstitial lung disease? Clin. Infect. Dis. 2018, 67, 1120–1124. [Google Scholar] [CrossRef]
- Melenotte, C.; Protopopescu, C.; Million, M.; Edouard, S.; Carrieri, P.; Eldin, C.; Angelakis, E.; Djossou, F.; Bardin, N.; Fournier, P.-E.; et al. Clinical Features and Complications of Coxiella burnetii Infections from the French National Reference Center for Q Fever. JAMA Netw. Open 2018, 1, e181580. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Baddour, L.M.; Wilson, W.R.; Bayer, A.S.; Fowler, V.G., Jr.; Tleyjeh, I.M.; Rybak, M.J.; Barsic, B.; Lockhart, P.B.; Gewitz, M.H.; Levison, M.E.; et al. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications. Circulation 2015, 132, 1435–1486. [Google Scholar] [CrossRef] [PubMed]
- The Korean Society of Infectious Diseases Korean Society for Chemotherapy. Clinical Guideline for the Diagnosis and Treatment of Cardiovascular Infections. Infect. Chemother. 2011, 43, 129–177. (In Korean) [Google Scholar] [CrossRef]
- Korea Centers for Disease Control and Prevention. Guideline of Q Fever. 2017. Available online: https://www.kdca.go.kr/npt/biz/npp/portal/nppSumryMain.do (accessed on 5 June 2020).
- Vanderburg, S.; Rubach, M.P.; Halliday, J.E.B.; Cleaveland, S.; Reddy, E.A.; Crump, J.A. Epidemiology of Coxiella burnetii infection in Africa: A One Health systemat-ic review. PLoS Negl. Trop. Dis. 2014, 8, e2787. [Google Scholar] [CrossRef] [PubMed]
- Anderson, A.; Bijlmer, H.; Fournier, P.-E.; Graves, S.; Hartzell, J.; Kersh, G.J.; Limonard, G.; Marrie, T.J.; Massung, R.F.; McQuiston, J.H.; et al. Diagnosis and management of Q fever—United States, 2013: Recommendations from CDC and the Q Fever Working Group. MMWR Recomm. Rep. 2013, 62, 1–30. [Google Scholar] [PubMed]
- Nahed, H.G.; Khaled, A. Seroprevalence of Coxiella burnetii antibodies among farm animals and human contacts in Egypt. J. Am. Sci. 2012, 8, 619–621. [Google Scholar]
- Noden, B.H.; Tshavuka, F.I.; Van Der Colf, B.E.; Chipare, I.; Wilkinson, R. Exposure and Risk Factors to Coxiella burnetii, Spotted Fever Group and Typhus Group Rickettsiae, and Bartonella henselae among Volunteer Blood Donors in Namibia. PLoS ONE 2014, 9, e108674. [Google Scholar] [CrossRef] [Green Version]
- Lacheheb, A.; Raoult, D. Seroprevalence of Q-fever in Algeria. Clin. Microbiol. Infect. 2009, 15, 167–168. [Google Scholar] [CrossRef] [Green Version]
- Mediannikov, O.; Fenollar, F.; Socolovschi, C.; Diatta, G.; Bassene, H.; Molez, J.-F.; Sokhna, C.; Trape, J.-F.; Raoult, D. Coxiella burnetii in Humans and Ticks in Rural Senegal. PLoS Negl. Trop. Dis. 2010, 4, e654. [Google Scholar] [CrossRef] [Green Version]
- Prabhu, M.; Nicholson, W.L.; Roche, A.J.; Kersh, G.J.; Fitzpatrick, K.A.; Oliver, L.D.; Massung, R.F.; Morrissey, A.B.; Bartlett, J.A.; Onyango, J.J.; et al. Q Fever, Spotted Fever Group, and Typhus Group Rickettsioses among Hospitalized Febrile Patients in Northern Tanzania. Clin. Infect. Dis. 2011, 53, e8–e15. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Mobarez, A.M.; Amiri, F.B.; Esmaeili, S. Seroprevalence of Q fever among human and animal in Iran; A systematic review and meta-analysis. PLoS Negl. Trop. Dis. 2017, 11, e0005521. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Tozer, S.J.; Lambert, S.B.; Sloots, T.P.; Nissen, M.D. Q fever seroprevalence in metropolitan samples is similar to rural/remote samples in Queensland, Australia. Eur. J. Clin. Microbiol. Infect. Dis. 2011, 30, 1287–1293. [Google Scholar] [CrossRef] [PubMed]
- Schimmer, B.; Notermans, D.W.; Harms, M.G.; Reimerink, J.H.J.; Bakker, J.; Schneeberger, P.; Mollema, L.; Teunis, P.; Van Pelt, W.; Van Duynhoven, Y. Low seroprevalence of Q fever in The Netherlands prior to a series of large outbreaks. Epidemiol. Infect. 2012, 140, 27–35. [Google Scholar] [CrossRef] [PubMed]
- Head, J.R.; Bumburidi, Y.; Mirzabekova, G.; Rakhimov, K.; Dzhumankulov, M.; Salyer, S.J.; Knust, B.; Berezovskiy, D.; Kulatayeva, M.; Zhetibaev, S.; et al. Risk Factors for and Seroprevalence of Tickborne Zoonotic Diseases among Livestock Owners, Kazakhstan. Emerg. Infect. Dis. 2020, 26, 70. [Google Scholar] [CrossRef] [PubMed]
- Lieberman, D.; Lieberman, D.; Ben-Yaakov, M.; Lazarovich, Z.; Hoffman, S.; Ohana, B.; Friedman, M.G.; Dvoskin, B.; Leinonen, M.; Boldur, I. Infectious etiologies in acute exacerbation of COPD. Diagn. Microbiol. Infect. Dis. 2001, 40, 95–102. [Google Scholar] [CrossRef]
- Porter, S.R.; Czaplicki, G.; Mainil, J.; Horii, Y.; Misawa, N.; Saegerman, C. Q fever in Japan: An update review. Vet. Microbiol. 2011, 149, 298–306. [Google Scholar] [CrossRef] [Green Version]
- Park, J.-H.; Chu, H.; Yoo, S.-J.; Hwang, K.-J.; Lim, H.-S. Serologic Survey and Risk Factors for Coxiella burnetii Infection among Dairy Cattle Farmers in Korea. J. Korean Med. Sci. 2018, 33, 245. [Google Scholar] [CrossRef] [PubMed]
- Fournier, P.-E.; Marrie, T.J.; Raoult, D. Diagnosis of Q fever. J. Clin. Microbiol. 1998, 36, 1823–1834. [Google Scholar] [CrossRef] [PubMed] [Green Version]
Variables | All (n = 230) | CNG (n = 148) | CPG (n = 82) | p |
---|---|---|---|---|
Sex, male (n, %) | 157 (68.3) | 103 (69.6) | 54 (65.8) | 0.559 |
Age (mean ± SD) | 62.9 ± 11.9 | 62.4 ± 12.6 | 63.7 ± 10.7 | 0.424 |
<40 years | 9 (3.9) | 7 (4.7) | 2 (2.4) | 0.074 |
40 to 49 years | 28 (12.2) | 23 (15.5) | 5 (6.1) | |
50 to 59 years | 47 (20.4) | 23 (15.5) | 24 (29.3) | |
60 to 69 years | 68 (29.6) | 42 (28.4) | 26 (31.7) | |
70 to 79 years | 66 (28.7) | 45 (30.4) | 21 (25.6) | |
≥80 years | 12 (5.2) | 8 (5.4) | 4 (4.9) | |
Comorbidities (n, %) | ||||
Hypertension | 87 (37.8) | 56 (37.8) | 31 (37.8) | 0.996 |
Diabetes | 37 (16.1) | 25 (16.9) | 12 (14.6) | 0.711 |
Kidney disease | 1 (0.4) | 0 (0) | 1 (1.2) | 0.357 |
Liver disease | 1 (0.4) | 0 (0) | 1 (1.2) | 0.357 |
Stroke | 3 (1.3) | 2 (1.4) | 1 (1.2) | 1.000 |
Married (n, %) | 228 (99.1) | 147 (99.3) | 81 (98.8) | 0.587 |
Household member (n, %) | 0.492 | |||
1 generation | 137 (59.6) | 91 (61.5) | 46 (56.1) | |
2 generations | 62 (27.0) | 36 (24.3) | 26 (31.7) | |
3 generations | 31 (13.5) | 21 (14.2) | 10 (12.2) | |
Type of farming (n, %) | 0.022 | |||
Fruit farming | 167 (72.6) | 100 (67.6) | 67 (81.7) | |
Field | 63 (27.4) | 48 (32.4) | 15 (18.3) | |
Total farming period, years | 34.2 ± 17.4 | 34.2 ± 17.4 | 34.2 ± 17.4 | 0.47 |
Farming period per day, hours | 6.2 ± 2.6 | 6.1 ± 2.6 | 6.2 ± 2.5 | 0.73 |
withs farming equipment (n, %) | 204 (88.7) | 131 (88.5) | 73 (89.0) | 1.00 |
with greenhouse (n, %) | 122 (53.0) | 122 (53.0) | 39 (47.6) | 0.22 |
with an animal shed (n, %) | 11 (4.8) | 8 (5.4) | 8 (5.4) | 0.55 |
Wearing protective equipment (n, %) | ||||
Glasses | 9 (3.9) | 7 (4.7) | 2 (2.4) | 0.221 |
Mask | 149 (64.5) | 94 (63.1) | 55 (67.1) | 0.291 |
Gloves | 87 (37.7) | 57 (38.3) | 30 (36.6) | 0.261 |
Apron | 11 (4.8) | 8 (5.4) | 3 (3.7) | 0.255 |
Boots | 163 (70.6) | 99 (66.4) | 64 (78.1) | 0.105 |
Immunogloblin | IgM | IgG | ||||
---|---|---|---|---|---|---|
IFA titer | 1:16 | 1:16 | 1:256 | |||
Phase | Phase I | Phase II | Phase I | Phase II | Phase I | Phase II |
Results | 13.9% (32/230) | 16.9% (39/230) | 15.6% (36/230) | 23.0% (53/230) | 1.3% (3/230) | 3.9% (9/230) |
Sum * | 20.0% (46/230) | 23.0% (53/230) | 3.9% (9/230) | |||
Total sum * | 35.6% (82/230) |
Sample No. | Location | YY-MM-DD | Species of Tick | Developmental Stage of Tick | BLAST |
---|---|---|---|---|---|
4th-A6 | SH | 2016-08-26 | H.long | Adult (F) | Uncultured Coxiella sp. clone XCP-1 16S ribosomal RNA gene, partial sequence (99%) |
4th-A7 | SH | 2016-08-26 | H.long | Adult (F) | Uncultured Coxiella sp. clone XCP-1 16S ribosomal RNA gene, partial sequence (92%) |
10th-G6 | BM | 2016-12-08 | H.long | Nymph | Uncultured Coxiella sp. clone XCP-1 16S ribosomal RNA gene, partial sequence (89%) |
12th-E11 | HD | 2017-01-10 | H.long | Nymph | Uncultured Coxiella sp. clone XCP-1 16S ribosomal RNA gene, partial sequence (99%) |
16th-A4 | SH | 2017-03-09 | H.long | Nymph | Uncultured Coxiella sp. clone XCP-1 16S ribosomal RNA gene, partial sequence (99%) |
16th-A5 | SH | 2017-03-09 | H.long | Nymph | Uncultured Coxiella sp. clone XCP-1 16S ribosomal RNA gene, partial sequence (99%) |
30th-C4 | JJ | 2017-11-01 | H.long | Nymph | Uncultured Coxiella sp. clone XCP-1 16S ribosomal RNA gene, partial sequence (99%) |
35th-C2 | JJ | 2018-01-18 | H.long | Nymph | Uncultured Coxiella sp. clone XCP-1 16S ribosomal RNA gene, partial sequence (99%) |
35th-C4 | JJ | 2018-01-18 | H.long | Nymph | Uncultured Coxiella sp. clone XCP-1 16S ribosomal RNA gene, partial sequence (99%) |
35th-C6 | JJ | 2018-01-18 | H.long | Nymph | Uncultured Coxiella sp. clone XCP-1 16S ribosomal RNA gene, partial sequence (99%) |
35th-E4 | HD | 2018-01-18 | H.long | Nymph | Uncultured Coxiella sp. clone XCP-1 16S ribosomal RNA gene, partial sequence (99%) |
35th-E9 | HD | 2018-01-18 | H.long | Nymph | Uncultured Coxiella sp. clone XCP-1 16S ribosomal RNA gene, partial sequence (99%) |
35th-E10 | HD | 2018-01-18 | H.long | Nymph | Uncultured Coxiella sp. clone XCP-1 16S ribosomal RNA gene, partial sequence (99%) |
35th-G3 | BM | 2018-01-18 | H.long | Nymph | Uncultured Coxiella sp. clone XCP-1 16S ribosomal RNA gene, partial sequence (99%) |
35th-G4 | BM | 2018-01-18 | H.long | Nymph | Uncultured Coxiella sp. clone XCP-1 16S ribosomal RNA gene, partial sequence (99%) |
35th-A1 | AW | 2018-01-18 | H.long | Nymph | Uncultured Coxiella sp. clone XCP-1 16S ribosomal RNA gene, partial sequence (99%) |
35th-A2 | AW | 2018-01-18 | H.long | Nymph | Uncultured Coxiella sp. clone XCP-1 16S ribosomal RNA gene, partial sequence (99%) |
35th-A3 | AW | 2018-01-18 | H.long | Nymph | Uncultured Coxiella sp. clone XCP-1 16S ribosomal RNA gene, partial sequence (99%) |
37th-A4 | SH | 2017-11-06 | H.long | Nymph | Uncultured Coxiella sp. clone XCP-1 16S ribosomal RNA gene, partial sequence (99%) |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Yoo, J.-R.; Kim, M.-S.; Heo, S.-T.; Oh, H.-J.; Oh, J.-H.; Ko, S.-Y.; Kang, J.-H.; Lee, S.-K.; Jeong, W.-S.; Seong, G.-M.; et al. Seroreactivity to Coxiella burnetii in an Agricultural Population and Prevalence of Coxiella burnetii Infection in Ticks of a Non-Endemic Region for Q Fever in South Korea. Pathogens 2021, 10, 1337. https://doi.org/10.3390/pathogens10101337
Yoo J-R, Kim M-S, Heo S-T, Oh H-J, Oh J-H, Ko S-Y, Kang J-H, Lee S-K, Jeong W-S, Seong G-M, et al. Seroreactivity to Coxiella burnetii in an Agricultural Population and Prevalence of Coxiella burnetii Infection in Ticks of a Non-Endemic Region for Q Fever in South Korea. Pathogens. 2021; 10(10):1337. https://doi.org/10.3390/pathogens10101337
Chicago/Turabian StyleYoo, Jeong-Rae, Mi-Sun Kim, Sang-Taek Heo, Hyun-Joo Oh, Jung-Hwan Oh, Seo-Young Ko, Jeong-Ho Kang, Sung-Kgun Lee, Woo-Seong Jeong, Gil-Myeong Seong, and et al. 2021. "Seroreactivity to Coxiella burnetii in an Agricultural Population and Prevalence of Coxiella burnetii Infection in Ticks of a Non-Endemic Region for Q Fever in South Korea" Pathogens 10, no. 10: 1337. https://doi.org/10.3390/pathogens10101337