Serological evidence of exposure to some zoonotic microorganisms in cattle and humans with occupational exposure to livestock in Antioquia , Colombia

Bacteria belonging to Anaplasma, Ehrlichia, Rickettsia and Coxiella genera are considered emerging pathogens and livestock is one of the contexts where the transmission of these microorganisms can occur. The goal of this study was to determine serological evidence for the exposure to these bacteria in cattle and humans with occupational exposure to livestock in the subregions North and Magdalena Medio, Antioquia, Colombia, and to explore related factors. A cross-sectional study was conducted in 48 livestock farms distributed in six municipalities from both subregions: Belmira, Entrerríos and San Pedro de los Milagros (North), and Puerto Berrío, Puerto Nare and Puerto Triunfo (Magdalena Medio). Blood samples from 332 people and 384 bovines were evaluated by serology (IgM and IgG) screening for bacteria from the Anaplasma, Ehrlichia, Rickettsia, and Coxiella genera. Seropositivity in humans from both regions was 42.4% (95%CI: 31.2-55.1) for Anaplasma, 74.2% (95%CI: 66.0-84.4) for Ehrlichia, 72.5% (95%CI: 62.1-82.0) for Rickettsia, and 60.7% (95%CI: 59.7-69.1) for Coxiella burnetii. In cattle, seropositivity was 31.6% (95%CI: 19.9-44.2), 66.8% (95%CI: 55.2-78.1), 64.6% (95%CI: 53.8-74.5), and 61.6% (95%CI: 51.9-69.2), respectively. History of biting by ticks, milking, vaccination, having dogs and hens in the residence, as well as the consumption of raw milk derivatives were some factors associated with the infection by the bacteria studied. The results suggest a previous and recent exposure to these zoonotic bacteria genera in people with occupational exposure to livestock, as well as in cattle in the two studied subregions. Zoonoses; Serology; Cattle; Occupational Health ARTIGO ARTICLE This article is published in Open Access under the Creative Commons Attribution license, which allows use, distribution, and reproduction in any medium, without restrictions, as long as the original work is correctly cited. Eraso-Cadena MP et al. 2 Cad. Saúde Pública 2018; 34(10):00193617 Introduction Tick-transmitted infectious diseases in humans are considered zoonotic diseases 1. The livestock industry is one of the settings where such microorganisms are often detected, and the World Health Organization (WHO) considers this agricultural activity as one of the seven professional groups that is especially exposed to various zoonotic agents, given their close relationship with animals or their by-products, and the ongoing bidirectional transmission of diverse microorganisms 2. In Colombia, livestock farming occurs over the national territory as a major economic activity. The department of Antioquia hosts the largest bovine population of the country, where the Urabá, North, and Magdalena Medio subregions stand out as the largest producers at department level 3. Tick-borne diseases cause large economic losses, affecting cattle health and reducing the quality of by-products from the production system, such as meat, milk, and skins 4. The World Organization for Animal Health (OIE) suggests that some of these infectious diseases should be compulsorily reported for timely diagnosis and control due to their impact on animal welfare 5. However, Colombian surveillance programs often present underreporting regarding the etiological and clinical suspicion of tickborne diseases, further, adequate diagnostic and therapeutic alternatives are currently unavailable. Tick-borne diseases in humans, such as anaplasmosis, ehrlichiosis, rickettsiosis, and coxiellosis, develop with nonspecific symptoms like fever, headache, myalgia, and arthralgia 6. This clinical picture overlaps with other epidemiologically relevant pathologies recognized in the Colombian environment, such as malaria and dengue 7. Consequently, this similarity in symptoms may lead to an underestimation of the diagnosis and inadequate treatment of cases, which are usually recorded as unspecified fevers. Ticks are obligate hematophagous ectoparasites associated with the transmission of viruses, bacteria, and protozoa that affect both human and animal health 8. Wild and domestic animals are part of their life cycle. The distribution of ticks at heights over 2,600 meters above the sea level (m.a.s.l.) 9 and the microorganism-transmission capacity at the transovarial and transstadial stages inherent to its life cycle, created the conditions for the maintenance of a steady population size over time, therefore increasing the risk of pathogenic microorganism transmission to diverse hosts 10. In the Colombian livestock context, different tick species have been found to be naturally infected by Babesia 11, Rickettsia 12, Anaplasma and Ehrlichia 13 genera, making them potential biological vectors. In addition, there are reports of human clinical cases of babesiosis 14, anaplasmosis 15, ehrlichiosis 14 and coxiellosis 16 associated with livestock activities. Considering the representativeness of the North and Magdalena Medio subregions in livestock production in the department of Antioquia, Colombia, this study sought to determine, through serology screening, the level of exposure of cattle and people occupationally engaged in livestock activities to some tick-transmitted zoonotic agents, and to explore the associated factors with their detection in the studied subregions.


Introduction
Tick-transmitted infectious diseases in humans are considered zoonotic diseases 1 .The livestock industry is one of the settings where such microorganisms are often detected, and the World Health Organization (WHO) considers this agricultural activity as one of the seven professional groups that is especially exposed to various zoonotic agents, given their close relationship with animals or their by-products, and the ongoing bidirectional transmission of diverse microorganisms 2 .
In Colombia, livestock farming occurs over the national territory as a major economic activity.The department of Antioquia hosts the largest bovine population of the country, where the Urabá, North, and Magdalena Medio subregions stand out as the largest producers at department level 3 .Tick-borne diseases cause large economic losses, affecting cattle health and reducing the quality of by-products from the production system, such as meat, milk, and skins 4 .The World Organization for Animal Health (OIE) suggests that some of these infectious diseases should be compulsorily reported for timely diagnosis and control due to their impact on animal welfare 5 .However, Colombian surveillance programs often present underreporting regarding the etiological and clinical suspicion of tickborne diseases, further, adequate diagnostic and therapeutic alternatives are currently unavailable.
Tick-borne diseases in humans, such as anaplasmosis, ehrlichiosis, rickettsiosis, and coxiellosis, develop with nonspecific symptoms like fever, headache, myalgia, and arthralgia 6 .This clinical picture overlaps with other epidemiologically relevant pathologies recognized in the Colombian environment, such as malaria and dengue 7 .Consequently, this similarity in symptoms may lead to an underestimation of the diagnosis and inadequate treatment of cases, which are usually recorded as unspecified fevers.
Ticks are obligate hematophagous ectoparasites associated with the transmission of viruses, bacteria, and protozoa that affect both human and animal health 8 .Wild and domestic animals are part of their life cycle.The distribution of ticks at heights over 2,600 meters above the sea level (m.a.s.l.) 9 and the microorganism-transmission capacity at the transovarial and transstadial stages inherent to its life cycle, created the conditions for the maintenance of a steady population size over time, therefore increasing the risk of pathogenic microorganism transmission to diverse hosts 10 .In the Colombian livestock context, different tick species have been found to be naturally infected by Babesia 11 , Rickettsia 12 , Anaplasma and Ehrlichia 13 genera, making them potential biological vectors.In addition, there are reports of human clinical cases of babesiosis 14 , anaplasmosis 15 , ehrlichiosis 14 and coxiellosis 16 associated with livestock activities.
Considering the representativeness of the North and Magdalena Medio subregions in livestock production in the department of Antioquia, Colombia, this study sought to determine, through serology screening, the level of exposure of cattle and people occupationally engaged in livestock activities to some tick-transmitted zoonotic agents, and to explore the associated factors with their detection in the studied subregions.

Design and place of study
A cross-sectional study was performed in 48 farms in the North and Magdalena Medio subregions of Antioquia.For the North subregion, the study was conducted from September to October 2014, in the municipalities of Belmira, Entrerríos and San Pedro de los Milagros, where the temperature range from 13 to 19ºC, 79% relative humidity, and the altitude range is 1,850 to 2,540 m.a.s.l.For the Magdalena Medio subregion, from October to November 2015, in the municipalities of Puerto Berrío, Puerto Nare and Puerto Triunfo, where the temperature ranges from 32 to 43ºC, 53% relative humidity, and the altitude ranges from 125 to 150 m.a.s.l.These environmental conditions were verified during field sampling using a portable meteorological station (Ambient WS-2080; Ambient Weather, Chandler, U.S.A.).The estimated sample size for cattle and humans was proportionally distributed among eight cattle herds from the six municipalities included in this study (48 total herds).Livestock herds were selected in each municipality using simple random sampling on databases provided by the Cad.Saúde Pública 2018; 34 (10):00193617 main livestock associations in each area.Figure 1 illustrates the geographical distribution of the studied areas.Information on geographical coordinates was collected on the field using the Trimble Juno 3B GPS equipment (Westminster, U.S.A.), and represented using the ArcGIS 10.1 software (http:// www.esri.com/software/arcgis/index.html).

Information collection and processing of blood samples
This study included males and females over 18 years of age, who had contact with the bovine reference population, and who voluntarily agreed to participate in this research.All participants signed an informed consent form.A structured survey was conducted to collect and describe some sociodemographic, hygiene-sanitary and clinical aspects about each participant.The information about cattle included age, sex, breed and medical and veterinary management history.The blood samples from people and cattle were collected without any preservatives.A multiple test was conducted for the serological screening of cattle and humans, using a single cut-off point (dilution ≥ 1:16) and a custom-made commercial kit prepared by Fuller Laboratories (Fullerton, U.S.A.).To detect IgM and IgG antibodies an indirect immunofluorescence assay (IFA -the analytical sensitivity and specificity were estimated by the manufacturer in 98-100%) was used.The plates contained fixed antigens of Anaplasma phagocytophilum, Ehrlichia chaffeensis, Rickettsia rickettsii, and phase I and phase II Coxiella burnetii, obtained from axenic cultures of these microorganisms.Samples were processed, and results were analyzed according to the manufacturer's instructions.Results were read using an Eclipse 55i microscope (Nikon, Tokyo, Japan) with an Intensilight epifluorescence system (Nikon, Tokyo, Japan) using 40X objective lens.Each IFA was read by two independent observers, blind to the sample.In the case of ambiguous readings, a third reading was performed to reach a final consensus.When necessary, the sample was re-processed and read again by both analysts.
The socio-demographic, hygiene-sanitary and clinical characteristics reported by the participants and the registered characteristics of the studied bovine population, were described as means of absolute (n) and relative frequencies (%) for the qualitative variables, and summary measures for the quantitative variables.Associated factors with seropositivity were explored; crude odds ratio and adjusted odds ratio were estimated using binary logistic regression to control confounding factors.The bivariate (crude association measures) and multivariate analyses (regression-adjusted measures) considered a 0.05 statistical significance level and 95% confidence level.The standard entry method of simultaneous variables (the enter method) was used for the regression model; all independent variables were entered in the equation at the same time to determine confounding and highly correlated ones.Statistical analysis was performed using the software SPSS for Windows, version 22.0 (IBM SPSS, Armonk, U.S.A.).This study was endorsed by the Ethics Committee on Health Research of the Universidad Pontificia Bolivariana (Record n. 7, May 23, 2012).

Socio-demographic, clinical, and health description of humans included in the study
Three hundred and thirty-two people were analyzed in total; 189 subjects from the North subregion and 143 from the Magdalena Medio subregion.In the Northern area, the study group consisted of 166 (87.8%) men and 23 (12.2%) women with a median age of 40 years.Most of the analyzed population resided in rural areas (82.5%) and milking was the most frequent activity on the farm (74.1%).The presence of ticks at the farm was reported by 18% of the population and 5.8% reported a history of tick bites.Preparation of foods derived from raw milk was reported by 51.3% of the individuals and usual consumption of foods derived from raw milk by 83.1%.Regarding the presence of domestic animals in the household, dogs were the most reported (71.4%), followed by cattle (66.7%) and horses (41.8%).
Most individuals from the Magdalena Medio subregion were men (82.5%) with a median age of 42 years.Regarding the place of residence, 83.2% of the participants lived in rural areas.The main work activities performed at the farm included cattle corralling (44.8%), milking (44.1%), and direct routine contact with bovine biological fluids while performing farm-related tasks (66.2%).The participants Cad.Saúde Pública 2018; 34 (10):00193617 reported high values for the presence of ticks in the farms (85.3%), as well as a history of tick biting (62.9%) and involvement of immature ticks in biting (53.1%).Regarding the possession of domestic animals in the household, dogs (70.6%) and cattle (70.6%) were the most frequent.Preparation of foods derived from raw milk was reported by 50.3% of the individuals, and 59.4% reported their consumption on a regular basis (Table 1).

Description of some characteristics and history of clinical and veterinary management of cattle
Three hundred and eighty-four bovines were evaluated in total.In the North subregion, the studied bovine population were 192 females, most of them born at the farm, with a median age of 60 months.
Regarding the breeds tested in this region, 79.2% were Bos taurus and 20.8% were crossbreeds (Table 2).The proportions of male and female bovines studied in Magdalena Medio (192 cattle) were similar.

Results of the serological screening in humans and cattle from both subregions
Seropositivity was obtained for Anaplasma, Ehrlichia, Rickettsia, and Coxiella genera in individuals and cattle from the six municipalities analyzed.When analyzing the frequency of positive samples for both types of antibodies at the same time, 11  3).
The highest frequency of anti-Anaplasma spp.IgM antibodies in people was detected in San Pedro de los Milagros, where 84.1% (53/63) of the samples were positive.Anti-Ehrlichia spp.IgM antibodies were mostly found in Entrerríos in 98.4% (62/63), and anti-Rickettsia spp.IgM antibodies were found in equal proportions in Belmira and San Pedro de los Milagros with 100% (63/63) positivity.For anti-C.burnetii IgM antibodies, the highest frequency was found in Belmira, with 98.4% (62/63).Regarding the detection of IgG-type antibodies in every studied bacterial genus, the highest frequency of anti-Anaplasma spp.IgG was found in the municipality of Belmira, with 60.3% (38/63

Exploratory analysis of variables related to serological evidence of exposure in the studied human and animal populations
No IgM antibody associated factors were observed in the four microorganisms analyzed in both subregions after a multivariate adjustment.However, after analyzing data on the detection of IgG antibodies in individuals from the North subregion, a significant increase in exposure to Anaplasma spp.
Cad. Saúde Pública 2018; 34 (10):00193617 to C. burnetii increased significantly and was related to the period cattle had been in the farms (regardless of their origin), thus resulting in the detection of IgG antibodies in bovines from the North subregion (Table 4).

Table 4
Exploratory analysis of variables related with seropositive (IgG antibodies) to Anaplasma, Ehrlichia, Rickettsia and Coxiella in the analyzed people and cattle from the North and Magdalena Medio subregions of the department of Antioquia, Colombia.

Discussion
In this study, serological signs of exposure to Anaplasma, Ehrlichia, Rickettsia and Coxiella genera were detected in bovines and in people working in cattle raising in the North and Magdalena Medio subregions.This finding denotes the circulation of these zoonotic agents in the livestock context in the studied subregions, suggesting that their role as potential etiological agents of associated infectious diseases must be considered to establish some type of differential diagnosis for both cattle and humans.IFA is the most used technique for screening the studied type of infections; however, this test is hindered by the interference of cross-reactions between different microorganisms.For example, species from the genus Anaplasma exhibit seroreactivity between them, as well as with other Rickettsia and Ehrlichia, given the existing phylogenetical relation that was demonstrated through the analysis of the 16S rRNA gene 17 .Likewise, there are reports of the occurrence of coinfections of C. burnetii and species from the Rickettsia genus 18 .Therefore, for cases that require more specific species differentiation, future studies should explore serological screening methods with molecular techniques like polymerase chain reactions and in vitro culture 19 .In addition, it is important to consider that the cut-off point used in this study was employed for screening and research in apparently healthy people working at farms; higher cut-off points values, measured in paired serum (seroconversion), should be employed in clinical diagnosis and treatment, according to the dynamics of antibodies production of each zoonosis 20 .Accordingly, if higher cut-off points were used, the frequencies reported in this study are expected to be lower since they would indicate active diseases, not exposure in the livestock context.
A. phagocytophilum is considered the etiologic agent of human granulocytic anaplasmosis.In Colombia, there are reports of cases in people working at livestock farms in the departments of Bolívar 15 , Córdoba and Sucre, where exposure to this zoonotic agent has been suggested 21 .Regarding cattle, reports claim the possibility of these animals being asymptomatically infected by Anaplasma spp. 22, in some instances, this species has been considered the cause of conditions such as fever, anemia, and of decrease in milk production depending on the animal's age or immune status 23 .In species like Anaplasma marginale, a recognized etiological agent of bovine anaplasmosis, an extensive genetic strain diversity has been described 24 , which may be related to various courses of clinical evolution in this type of infection.Considering IgG seropositivity associated factors for Anaplasma in bovines from the Magdalena Medio subregion, the findings of this study suggest that exposure increased significantly with age, similarly to Wesonga et al. 25 .
Anaplasma has been detected in Rhipicephalus microplus cattle ticks, in Dermacentor nitens collected from horses 13 , and in R. microplus, Amblyomma cajennense and Amblyomma maculatum ticks collected in buffaloes 26 , demonstrating a wide circulation in diverse hosts and potential vector species.Clinical reports show that Anaplasma transmission does not occur exclusively by tick bites, documents in the literature link this microorganism to transmission through blood transfusions 27 , such transmission route for this microorganism is still poorly understood.Transplacental transmission has also been reported as the infection of calves has been observed since birth, thus becoming a potential infection source for other hosts 28 .In addition, mechanical transmission has been reported through fomites contaminated with infected blood 29 or through diptera of the Tabanus and Stomoxys genera 30 .Several animals, such as cattle, horses, goats, buffaloes, and canids are involved in the life cycle of Anaplasma.Infections have been reported in tropical countries like Colombia, Costa Rica and Brazil.
On the other hand, there is currently little evidence recording the circulation of the Ehrlichia species related to cattle or to the livestock context in Colombia, which contrasts with the exposure to Ehrlichia genus found in this study.However, literature reports exposure to Ehrlichia ruminantium in bovines from cattle systems in Tanzania 31 and molecular detection of this microbial agent in cattle systems in Turkey 32 .In Colombia, Ehrlichia species has been detected in hosts such as dogs, and Ehrlichia canis infection has been identified as the cause canine monocytic ehrlichiosis 33 ; also, its relation to infections in human cases has been suggested.In countries like Costa Rica, the circulation of this species has been detected in samples from blood donors 34 , while in Brazil, studies made in rural areas have shown exposure to E. canis in dogs and E. chaffensis in humans and horses 35 .Some studies have shown the circulation of Ehrlichia sp. in bovine ticks (R. microplus), and in dog ticks (Rhipicephalus san-Cad.Saúde Pública 2018; 34 (10):00193617 guineus).E. canis, Anaplasma platys and A. phagocytophilum have been detected in dog ticks in tropical countries like Costa Rica 36 , where cases in humans have also been diagnosed.This microorganism has a high diversity of host species.E. chaffeensis has been described as the species responsible for human monocytic ehrlichiosis; further, it has also been identified as an etiological agent of infections in dogs and cattle, among other animals.Susceptibility to this zoonotic agent has been experimentally tested in bovine cattle, causing fever, lethargy and in some severe cases, the death of the animal 37 .
Regarding the results obtained in this study about the exposure of people and cattle from the studied regions to the Rickettsia genus, several research in Colombia have consistently suggested the circulation of spotted fever group rickettsiosis detected in equines (horses, mules and donkeys) and cattle 38 .R. rickettsii is considered the most virulent species in the group responsible for the Rocky Mountain spotted fever, whose vector-borne transmission can be transstadial and transovarial 6 , with 10-60% of cases described as fatal if not treated rapidly.In countries like Costa Rica, the circulation of different Rickettsia species has been confirmed both in ticks associated to different hosts like horses, cattle, and dogs, and in humans 39 .In Panamá, spotted fever group rickettsiosis have been isolated in ticks from domestic animals in areas near the Colombian border 40 , suggesting their potential circulation in other tropical countries.In addition, the circulation of A. cajennense ticks extracted from skin and clothing of people has also been detected, suggesting the affinity of these arthropods for humans 12 .IFA is the most used technique to diagnose rickettsial diseases; however, the presence of cross-reactions between the different species of Rickettsia and with other bacterial genera must be considered.Although in vitro culture screening is the reference test for Rickettsia, its application is not common given the need for a Biosafety Level 3 Laboratory.Therefore, in clinical instances with symptomatic patients, other aspects must be considered for the diagnosis, such as seroconversion and higher cut-off points for antibody titers ≥ 1:64 for IgG and ≥ 1:32 for IgM 41 .
Regarding the exploration of associated factors with the detection of anti-Rickettsia IgG antibodies, the results of this study suggest a higher probability of infection by this microorganism in people engaged with milking and vaccination activities in cattle farms, as well as in people who have dogs in their household.The presence of several animals at home, dogs and horses being the most frequent, was noted after the survey analysis.This information is important since these animals have been reported as hosts of several of the microorganisms tested in this study.This last observation coincides with a recent report performed in urban areas of Costa Rica, in which dogs were found to have a serological imprint of exposure to spotted fever group rickettsiosis, especially in places with known human infections.These findings hypothesize that dogs could be infection vectors in these scenarios 42 , which highlights the importance of the associated factors identified in this study as variables to be considered by the human and animal health sectors in subsequent studies seeking to identify the transmission dynamics of this type of zoonotic agent in the Colombian environment.
The exploration of the associated factors with seropositivity for C. burnetii found in people evaluated in this study proved that there is a greater probability of exposure to this microorganism in people who reported tick biting history and the consumption of food derived from raw milk.These factors are biologically plausible because vector-borne transmission of C. burnetii is considered secondary, and the main transmission mechanisms such as inhalation, contact with biological fluids from infected animals, and ingestion of contaminated products have been described.C. burnetii has been detected in different biological fluids like urine, feces, milk, and placenta of infected animals; tropism of this microbial agent by cells of the reproductive system has been evidenced, thus affecting consumers of unpasteurized milk 43 .Corroborating these results, C. burnetii has been previously detected in bovine milk from Colombia 44 .In addition, serological evidence of exposure to this zoonotic agent in people engaged in livestock activities has also been reported in the departments of Córdoba and Sucre, in towns like La Ceja, Envigado and Caracoli, also being found in other Antioquia regions 45 .In some cases, C. burnetii has been linked to chronic cardiac conditions, such as endocarditis 46 , in people with occupational exposure to livestock.IFA is the most used method to diagnose C. burnetii; cross-reactions have also been detected, in this case, with Bartonella species 47 .All these aspects must be considered for its diagnosis, in addition to the patient's clinical history and seroconversion during clinical evolution.
In Latin America, C. burnetii infection has been reported in people living in rural areas dedicated to livestock activities in Minas Gerais, Brazil 48 .In Argentina, exposure to this zoonotic agent was Cad.Saúde Pública 2018; 34 (10):00193617 reported in people living under poor sanitary conditions with domestic animals, such as cats and dogs 49 .In countries like Spain, exposure to this microorganism has been detected in dairy cattle 50 and in sheep.Regarding the detection of this agent in ticks, it has been described in the Amblyomma and Rhipicephalus genera of specimens collected in Brazil, Colombia, Kenya, and China 51 .McDaniel et al. 52 suggests that coxiellosis, or Q fever, should be one of the highly suspected zoonotic diseases in people with occupational exposure to cattle, and that early diagnoses must be made to achieve successful treatments, given the serious medical conditions, like endocarditis, observed in 65% of cases.Based on these data, we suggest that C. burnetii infections should also be considered in the Colombian environment for a differential and etiological diagnosis in people occupationally exposed to livestock, especially if they are used to consuming raw milk and raw milk-derived foods.
Anthropogenic activities related to the livestock production system are known to favor the contact with animals and hence, the development of zoonotic diseases.Although the North and Magdalena Medio subregions of Antioquia present contrasting ecological and productive conditions, the exposure of cattle and humans to the studied microorganisms was detected in both subregions.Milk production is considered the main economic and agricultural activity in Northern Antioquia, while breeding and dual-purpose activities are more frequent in livestock systems in the Magdalena Medio subregion 53 .
Climate change and global warming have been described as enhancers of the geographical expansion of vectors related to infectious diseases in the livestock context 54 , benefiting the development of diseases that affect both animals and humans.Moreover, ungulates have been cited as the main vertebrate hosts of zoonotic pathogens when compared to animals like rodents, primates, and bats 55 .The distribution of zoonotic agents related to cattle has also been claimed to be similar throughout the Americas, as well as in Oceania, Africa, Asia, and Europe 52 .Although the results obtained in this study are relevant, some of them remain as research questions to be answered with greater certainty in future longitudinal studies.For example, it could be important to determine how different cattle breeds, dairy farming vs breeding and dual-purpose activities, cattle management characteristics, weather, and tick infestation rates could be influencing the exposure dynamics to these zoonotic agents in the studied regions.
According to this study, time of work and direct contact with cattle (milking, vaccination, livestock slaughtering and corralling) were associated with the exposure to the studied zoonotic agents.Therefore, occupational health measures must be addressed in the livestock cattle context, taking biosecurity actions in the work field, such as the proper use of face masks, gloves, boots, preventive actions against tick bites, among others.Consumption of raw milk and foods derived from it must be considered when studying the transmission of this kind of zoonotic agents (as it has been demonstrated for C. burnetii) so control procedures are adequately followed.In addition, considering that people working in livestock activities in Colombia are exposed to the studied infections, the infectious agents involved should be included in differential and etiological diagnoses for clinical cases of acute febrile syndrome in people with this type of occupation.In general, the findings from this study indicate the exposure to these microorganisms in the livestock context.Consequently, promotion and prevention programs specifically aimed at this type of occupational exposure are required, thus addressing this problem in a comprehensive, cooperative and articulated manner in public and animal health sectors.

Figure 1
Figure 1Geographic location of the municipalities included in this study.

Table 1
Socio-demographic, clinical and sanitary characteristics of the participants.

Table 1 (continued)
* Corresponds to a self-report made by each participant of the study about the occupational history and after asking if he/she thinks that some of the mentioned signs and/or symptoms occur frequently.
* Breeds were categorized to better note the frequencies; ** Bos indicus: within the group of bovines of Indian origin also known as zebu cattle, breeds like Brahman, Zebu, Gyr, and Simbrah were included; Bos taurus: bovines of European origin, within this group breeds like Holstein, Jersey, Ayrshire, Simmental, Brown Swiss, Normande, Senepol, and Swedish Red were included; Colombian creoles: Bon and Romosinuano. of

Table 3
Frequencies of IgM/IgG antibodies detected simultaneously for the genera Anaplasma, Ehrlichia, Rickettsia and Coxiella in people and cattle from the North and Magdalena Medio subregions of the department of Antioquia, Colombia.was observed, which is directly related to the length of time (in years) of work with cattle and to the direct contact with cattle in work activities performed in farms.However, in the Magdalena Medio subregion such relation involved the participation in livestock corralling.The exposure to Rickettsia spp. in the North subregion showed greater likelihood in individuals who performed milking and vaccination, as well as in participants who reported having dogs in their residence.In the Magdalena Medio subregion, no associated factors with Rickettsia spp.infection were observed.Regarding exposure to Ehrlichia spp., no associated factors in the North subregion were found; however, in Magdalena Medio, individuals who had direct occupational contact with cattle presented a higher probability of exposure to infection by this microorganism.Participants from the North subregion who reported tick bite history, participation in livestock slaughter and cohabitation with hens in their residence showed a higher probability of presenting serological evidence of exposure to C.
#: number of positive samples; 95%CI: 95% confidence interval.*WithoutpositivedataforIgM/IgG antibodies detected at same time.infectionburnetii.Data analysis from Magdalena Medio showed a greater probability of exposure to infection by this zoonotic agent in people consuming raw milk products.In the Magdalena Medio subregion, it was observed that serological evidence (IgG antibodies) for exposure to Anaplasma spp.and anti-Rickettsia spp. in cattle significantly increased with age.Exposure Cad.Saúde Pública 2018; 34(10):00193617 Cad. Saúde Pública 2018; 34(10):00193617 Contributors M. P. Eraso-Cadena performed research, analyzed data and wrote the paper.L. P. Molina-Guzmán designed research, performed research and analyzed data.X. Cardona designed research and performed research.J. A. Cardona-Arias and L. A. Ríos-Osorio designed research and analyzed data.L. A. Gutierrez-Builes designed research, analyzed data and wrote the paper.