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

Abstract

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.

Q Fever in the United States: Summary of Case Reports from Two National Surveillance Systems, 2000–2012

“…Differences in mode of transmission or variations in geographic strain virulence may be responsible for the higher rate of hepatitis observed among military service members. 22,45,46 A higher proportion of reported cases were hospitalized among Hispanics than non-Hispanics. Furthermore, cases among blacks, Asians, and American Indians together were more likely to be hospitalized versus whites alone.…”

Comparison between Emerging Q Fever in French Guiana and Endemic Q fever in Marseille, France

“…23 Only C. burnetii strains carrying the QpH1 or the QpDV plasmid have been associated with acute Q fever in humans. 26 Because the clinical picture and severity of acute Q fever is related to the strain, the incidence of diagnosed acute Q fever does not reflect the actual incidence of Q fever. We observed a higher proportion of asymptomatic cases of acute infection in Europe than has been described in other studies.…”

Coxiella burnetii-positive PCR in febrile patients in rural and urban Africa

“…15,18 However, in the recent Q fever outbreak in the Netherlands, it appears that a single strain (genotype 33) was responsible for the epidemic. 19,20 Recently, a new C. burnetii genotype (genotype 51) was identified in an aortic valve sample from a patient with Q fever endocarditis in Saudi Arabia. 21 In a previous study, a high seroprevalence of Q fever was found in West, Central, and southern Africa.…”