Correspondence

Q Fever during Pregnancy -- A Risk for Women, Fetuses, and Obstetricians

N Engl J Med 1994; 330:371February 3, 1994

Article

To the Editor:

The pathogenic role of Coxiella burnetii during pregnancy is controversial. In cattle, sheep, and goats it has been suspected of causing abortion, low birth weight, and prematurity. Cases of Q fever have occasionally been reported during pregnancy in humans1. We report a case of infection during pregnancy, which was followed by fetal infection and death.

A 26-year-old nurse who was eight weeks pregnant and worked in an intensive care unit presented with fever and cough. A diagnosis of acute Q fever was made on the basis of seroconversion, and she received co-trimoxazole for 21 days. She had no risk factors for exposure to Q fever, such as contact with domestic animals or raw milk. At 24 weeks of pregnancy she was hospitalized for abnormal uterine contractions; the fetus was subsequently aborted. The placenta had multiple foci of necrosis in which C. burnetii was identified by immunofluorescence. Microscopical examination of the fetus showed nonspecific inflammatory lesions of the lung. C. burnetii was identified in the spleen and kidney, but not the lung of the fetus and was isolated from both the placenta and fetal kidney2.

The mother's serum contained high levels of antibody against C. burnetii, typical of chronic infection3. She was treated with doxycycline and became asymptomatic. Seven days after the abortion, the obstetrician who delivered the fetus and placenta presented with pneumonia, and shortly thereafter antibodies against C. burnetii were detected in his serum. He was treated with doxycycline and recovered.

C. burnetii has been isolated from the placentas of asymptomatic women,4 and the organism has been reported to cause abortion and stillbirth5. Among 15 published cases of Q fever during pregnancy, C. burnetii was isolated from 6 of 11 placentas; the outcome of the pregnancy was normal in 5 cases, prematurity and low birth weight were noted in 7 cases, and fetal death in utero occured in 3 cases1. Fetal death has been attributed to placental insufficiency due to vasculitis, but it may be due to fetal infection. The infection in the obstetrician in this case may have resulted from aerosolization of organisms in the infected placenta.

Didier Raoult, M.D., Ph.D.
Andreas Stein, M.D.
World Health Organization Collaborative Center for Rickettsial Reference and Research, Marseille, 13385, France

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   J.M. Munster, A.C.A.P. Leenders, C.J.C.M. Hamilton, E. Hak, J.G. Aarnoudse, A. Timmer. (2011) Placental histopathology after Coxiella burnetii infection during pregnancy. Placenta
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    A. Téllez, J. Sanz Moreno, D. Valkova, C. Domingo, P. Anda, F. de Ory, F. Albarrán, D. Raoult. (1998) Q fever in pregnancy: case report after a 2-year follow-up. Journal of Infection 37:1, 79-81
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