Q Fever during Pregnancy A Cause of Poor Fetal and Maternal Outcome

摘要

Q fever is a worldwide zoonosis caused by Coxiella burnetii. Q fever may be present asan acute or a chronic infection and can be reactivated during subsequent pregnancies.Although its exact prevalence remains unknown, it is likely that the number of cases ofQ fever in pregnant women is underestimated. During pregnancy, the illness is likely tobe asymptomatic, and diagnosis is based on serology. Acute infection results in appear-ance of IgM and IgG antibodies mainly directed against the avirulent form of C. burnetii(phase II). Chronic Q fever results in particularly high level of IgG and IgA antibodiesdirected against both virulent (phase I) and avirulent (phase II) forms of the bacterium.Q fever may result in adverse pregnancy outcome, including spontaneous abortion,intrauterine growth retardation, oligoamnios, intrauterine fetal death (IUFD), and pre-mature delivery. Obstetric complications occur significantly more often as C. burnetiiinfects the patient at an early stage of her pregnancy. Occurrence of IUFD is correlatedwith the presence of placental infection by C. burnetii and might be the consequence ofdirect infection of the fetus. The mother is exposed to the risk of chronic Q fever andendocarditis with potential fatal evolution. Long-term cotrimoxazole therapy preventsfrom placental infection, IUFD, and maternal chronic Q fever. Such treatment shouldbe used to treat pregnant women with Q fever. Women with previous history of Qfevershould have a regular serological follow up. Obstetricians' knowledge about Q fevermust be improved.