{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T01:42:22Z","timestamp":1785807742077,"version":"3.56.0"},"reference-count":36,"publisher":"American Society for Microbiology","issue":"11","license":[{"start":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T00:00:00Z","timestamp":1762214400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T00:00:00Z","timestamp":1762214400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"name":"Bilateral Research Cooperation Quebec-Flanders","award":["G0AEZ24N"],"award-info":[{"award-number":["G0AEZ24N"]}]},{"name":"European Society for Clinical Microbiology and Infectious diseases","award":["2024"],"award-info":[{"award-number":["2024"]}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2025,11,4]]},"abstract":"ABSTRACT<\/jats:title>\n \n \n \n Coxiella burnetii<\/jats:italic>\n and\n Bartonella<\/jats:italic>\n species cause febrile illness and infective endocarditis in low- and middle-income countries (LMICs). This study investigated whether seropositivity to\n C. burnetii<\/jats:italic>\n or\n Bartonella<\/jats:italic>\n could be detected among patients with persistent fever for which an infectious or inflammatory etiological diagnosis had been previously established in three LMICs. Our study tested sera from Cambodian, Nepalese, and Sudanese participants using indirect immunofluorescent antibody assays (IFA) for\n C. burnetii<\/jats:italic>\n and\n Bartonella<\/jats:italic>\n . Seropositivity rates for both pathogens were assessed across tropical and inflammatory etiologies of fever and compared to ubiquitous bacterial infections considered as a \u201creference group,\u201d as they were not expected to cause serologic cross-reactivity. A total of 1,313 individuals underwent IFA, including 560\/1,313 (42.7%) from Sudan, 432 (32.9%) from Nepal, and 321 (24.5%) from Cambodia. Overall, 57 (4.3%) and 60 (4.6%) participants tested positive for\n C. burnetii<\/jats:italic>\n and\n Bartonella<\/jats:italic>\n species, respectively. Forty-four (3.4%) individuals tested positive for both\n C. burnetii<\/jats:italic>\n and\n Bartonella<\/jats:italic>\n species (75.4% positive agreement).\n C. burnetii<\/jats:italic>\n positivity did not differ significantly between the three countries (\n P<\/jats:italic>\n = 0.44), while\n Bartonella<\/jats:italic>\n seropositivity was predominantly identified in Nepal (\n P<\/jats:italic>\n < 0.001). Compared to the reference group,\n C. burnetii<\/jats:italic>\n and\n Bartonella<\/jats:italic>\n seropositivity were more common among participants with visceral leishmaniasis,\n P. falciparum<\/jats:italic>\n malaria, leptospirosis, brucellosis, scrub typhus, and systemic lupus erythematosus (SLE), though only statistically significant for the latter two diagnoses. Further studies are necessary to investigate\n C. burnetii<\/jats:italic>\n and\n Bartonella<\/jats:italic>\n seropositivity in LMICs and to disentangle cross-reactivity, previous infection, or co-infection.\n <\/jats:p>\n <\/jats:sec>\n \n IMPORTANCE<\/jats:title>\n \n Coxiella burnetii<\/jats:italic>\n and\n Bartonella<\/jats:italic>\n spp. are important but under-recognized causes of febrile illness and infective endocarditis in low- and middle-income countries (LMICs). This study evaluated the seroprevalence of these pathogens among patients with confirmed causes of persistent fever in Sudan, Nepal, and Cambodia. Despite the diagnostic utility of serologic testing for these infections, its performance in LMICs\u2014where co-infections and background seropositivity are common\u2014remains poorly characterized. The findings suggest notable seropositivity for\n C. burnetii<\/jats:italic>\n and\n Bartonella<\/jats:italic>\n among patients with a set of tropical and inflammatory diagnoses, including visceral leishmaniasis,\n Plasmodium falciparum<\/jats:italic>\n malaria, leptospirosis, brucellosis, scrub typhus, and systemic lupus erythematosus. These results highlight the potential for cross-reactivity and underscore the need for context-specific validation. Enhanced understanding of serologic test characteristics is essential for accurate diagnosis in resource-limited settings.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1128\/spectrum.01675-25","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T13:00:50Z","timestamp":1758286850000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":4,"title":["Coxiella burnetii<\/i>\n and\n Bartonella<\/i>\n species serology of febrile patients with an established infectious or inflammatory diagnosis in Sudan, Nepal, and Cambodia"],"prefix":"10.1128","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6894-2262","authenticated-orcid":true,"given":"Carl","family":"Boodman","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02gfys938","id-type":"ROR","asserted-by":"publisher"}],"name":"Division of Infectious Diseases, Department of Internal Medicine, University of Manitoba","place":["Winnipeg, Canada"]},{"name":"Department of Clinical Sciences, Institute of Tropical Medicine","place":["Antwerp, Belgium"]},{"id":[{"id":"https:\/\/ror.org\/008x57b05","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Medical Sciences, University of Antwerp","place":["Antwerp, Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Edouard","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0068ff141","id-type":"ROR","asserted-by":"publisher"}],"name":"Institut Hospitalo-Universitaire en Maladies infectieuses (IHU\u2013M\u00e9diterran\u00e9e Infection)","place":["Marseille, France"]},{"id":[{"id":"https:\/\/ror.org\/0068ff141","id-type":"ROR","asserted-by":"publisher"}],"name":"French reference center for rickettsioses, Q fever and bartonelloses, IHU\u2013M\u00e9diterran\u00e9e Infection","place":["Marseille, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"van Griensven","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine","place":["Antwerp, Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanika Deshpande","family":"Koirala","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05et9pf90","id-type":"ROR","asserted-by":"publisher"}],"name":"B. P. Koirala Institute of Health Sciences","place":["Dharan, Nepal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basudha","family":"Khanal","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05et9pf90","id-type":"ROR","asserted-by":"publisher"}],"name":"B. P. Koirala Institute of Health Sciences","place":["Dharan, Nepal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suman","family":"Rijal","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05et9pf90","id-type":"ROR","asserted-by":"publisher"}],"name":"B. P. Koirala Institute of Health Sciences","place":["Dharan, Nepal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narayan Raj","family":"Bhattarai","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05et9pf90","id-type":"ROR","asserted-by":"publisher"}],"name":"B. P. 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