Q Fever in Greenland

We report a patient with Q fever endocarditis in a settlement in eastern Greenland (Isortoq, Ammassalik area).Likely animal sources include sled dogs and seals.Q fever may be underdiagnosed in Arctic areas but may also represent an emerging infection.Q fever is a zoonosis caused by the small intracellular bacterium Coxiella burnetii.Main reservoirs for this bacterium are cattle, goats, and sheep, although a wide range of animals may be infected (1,2).C. burnetii can survive in a spore-like form under harsh conditions (2).In animals, C. burnetii infection is often latent; the bacteria may be persistently shed into the environment, especially at the time of giving birth (2).In humans, most acute cases result in asymptomatic or mild infl uenza-like disease; severe disease develops in a few patients.Primary manifestations include pneumonia, hepatitis, and fever of unknown origin.Q fever has been described in >59 countries (1) but not in Arctic areas.We report a patient with Q fever in Greenland. The PatientThe patient, a 40-year-old man, who resided in Greenland all his life, lived in Isortoq (population 100), a small settlement in the Ammassalik area (population 3,000) of eastern Greenland (Figure ).He had worked as a hunter and a sanitation worker (garbage collector).The Ammassalik area includes the main town of Tasiilaq and 5 settlements.Isortoq is located on an island off the coast of Greenland.Access is by helicopter, boat during the summer, and dog sleds and snowmobiles during the winter.The main occupation is hunting, especially of seals, which are consumed locally.All other food is imported though Tasiilaq.All imported meat is frozen, and only ultra-high-temperaturepasteurized milk is available.Terrestrial mammals in the area include sled dogs, polar foxes, and a few domesticated cats.Sea mammals include seals and walruses.Polar bears are abundant throughout eastern Greenland; the nearest sheep, horses, and musk oxen are >1,000 km away.There are no cows and goats in Greenland.