Q fever and pregnancy: disease, prevention, and strain specificity

• Published in: European journal of clinical microbiology & infectious diseases Vol. 32; no. 3; pp. 361 - 368
• Main Authors: Angelakis, E., Million, M., D’Amato, F., Rouli, L., Richet, H., Stein, A., Rolain, J.-M., Raoult, D.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.03.2013; Springer; Springer Nature B.V
• Subjects: Abortion; Abortion, Septic - microbiology; Adult; Anti-Bacterial Agents - therapeutic use; Antibiotics; Bacterial diseases; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Clinical isolates; Cloning; cotrimoxazole; Coxiella burnetii; Coxiella burnetii - classification; Coxiella burnetii - genetics; Coxiella burnetii - isolation & purification; Coxiella burnetii - pathogenicity; Disease; DNA, Bacterial - chemistry; DNA, Bacterial - genetics; Effectiveness; Epidemics; Female; Fetal Mortality; Fetuses; Fever; France - epidemiology; Genotype; Genotypes; Human bacterial diseases; Humans; Hypotheses; Infection; Infections; Infectious diseases; Internal Medicine; Medical Microbiology; Medical sciences; Miscarriage; Morbidity; Obstetrics; Plasmids; Plasmids - analysis; Pregnancy; Pregnancy Complications, Infectious - epidemiology; Pregnancy Complications, Infectious - microbiology; Pregnancy Complications, Infectious - prevention & control; Public health; Q fever; Q Fever - epidemiology; Q Fever - microbiology; Q Fever - prevention & control; Rickettsial diseases; Sequence Analysis, DNA; Serology; Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use; Tropical bacterial diseases; Virulence; Womens health; France; Netherlands; Spain; Rubella Virus; Plasmid Sequence; Strain Specificity; Renal Agenesis; Obstetrical Outcome; Infection; Pregnancy; Prevention; Rickettsialosis; Microbiology; Rickettsial infection; Q fever; Bacteriosis; Strain specificity
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-012-1750-3

The link between fetal morbidity and Q fever and the necessity of long-term antibiotics for Coxiella burnetii infection during pregnancy have been recently questioned in the Netherlands, where the clone responsible for the Q fever outbreak harbors the QpH1 plasmid. In this context, we assessed pregnancy outcomes according to antibiotic administration in a new series and compared the plasmid type between isolates associated with abortion and other clinical isolates to determine if there is a link between genotype and abortion in humans. All French patients who received a diagnosis of Q fever during pregnancy at the French National Referral Centre for Q Fever from 2006 through July 2011 were included. On the other hand, the plasmid types of 160 clinical isolates, including seven isolates from patients who experienced an abortion, were compared. The differences between the QpDV and QpH1 plasmid sequences were analyzed. Acute Q fever was a cause of fetal morbidity, and the absence of long-term cotrimoxazole therapy was associated with fetal death ( p  < 0.0001). Genotypic analysis showed that the QpDV plasmid was more frequent in isolates associated with abortion ( p  = 0.03). A comparison of the plasmid sequences revealed that four QpDV proteins had no direct counterparts in QpH1, with two whose functions were not present in QpH1. The different obstetrical morbidity of C. burnetii relative to different geographical areas could be related to strain specificity, possibly based on differences in plasmid sequences, or to a failure of public health authorities to detect early miscarriages.