Archive for August 23, 2008

Q Fever During Pregnancy: A Public Health Problem in Southern France

Clinical Infectious Diseases  Sept 1998  V.27  N.3  p.592–596

Andreas Stein – Didier Raoult

From the Unite des Rickettsies, Faculte de Medecine, Universite de la Mediterranee, Marseille, France

We describe five cases of Q fever in pregnant women that were diagnosed during the last 3 years in the town of Martigues in Southern France. Analysis of our cases and the 18 other published cases shows that Q fever is a significant cause of morbidity and mortality in pregnancy. The disease may present as an acute or chronic infection and can be reactivated during subsequent pregnancies, as is seen with other mammals. In Martigues, Q fever is present in at least one per 540 pregnancies and constitutes the most significant public health problem related to intrauterine infections.
abstract
http://www.journals.uchicago.edu/doi/abs/10.1086/514698

PDF
http://www.journals.uchicago.edu/doi/pdf/10.1086/514698

August 23, 2008 at 7:08 pm Leave a comment

Risks Factors and Prevention of Q Fever Endocarditis

Clinical Infectious Diseases  1 Aug 2001  V.33  N.3  p.312–316

Florence Fenollar,1 Pierre-Edouard Fournier,1 M. Patrizia Carrieri,2 Gilbert Habib,3 Thierry Messana,4 and Didier Raoult1

1Unité des Rickettsies, Centre Nationale de Recherche Scientifique: Unité Mixte de Recherche 6020, Faculté de Médecine, Université de la Méditerranée, 2Institut Nationale de Santé et de Recherche Médicale Unité 379, and 3Service de Cardiologie and 4Service de Chirurgie Cardiaque, Hôpital de La Timone, Marseille, France

Coxiella burnetii causes acute and chronic Q fever. To evaluate the risk factors of development of chronic endocarditis following Q fever and to assess the best preventive therapy, a retrospective study of patients diagnosed as having Q fever during 1985–2000 was conducted. Twelve patients with acute Q fever who developed endocarditis and 102 patients with Q fever endocarditis were included in the study. When compared to 200 control patients with acute Q fever, preexisting valvular disease, especially a prosthetic valve, were encountered more often among patients with endocarditis. Among patients with valvular defects, we estimate the risk of developing endocarditis to be 39%. A combination of doxycycline plus hydroxychloroquine was better at preventing the development of endocarditis than doxycycline alone ( ). Our results should encourage physicians to detect valvular lesions in patients with acute Q fever and to search for acute Q fever in patients with a valvulopathy and unexplained fever. A proper treatment for such patients and a scheduled follow-up should reduce the risk of developing endocarditis.
abstract
http://www.journals.uchicago.edu/doi/abs/10.1086/321889

PDF
http://www.journals.uchicago.edu/doi/pdf/10.1086/321889

August 23, 2008 at 7:06 pm Leave a comment

Newer Macrolides as Empiric Treatment for Acute Q Fever Infection

Antimicrobial Agents and Chemotherapy  Dec 2001  V.45  N.12  p.3644-3646

Achilleas Gikas,* Diamantis P. Kofteridis, Andreas Manios, John Pediaditis, and Yiannis Tselentis

Zoonoses and Clinical Bacteriology, Parasitology, Geographical Medicine, and Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Greece

The effectiveness of newer macrolides in acute Q fever for 113 patients was recorded. The mean times to defervescence were 2.9 days for doxycycline and 3.3, 3.9, 3.9, and 6.4 days for clarithromycin, roxithromycin, erythromycin, and -lactams, respectively (P < 0.01 for macrolides versus -lactams). We conclude that macrolides may be an adequate empirical antibiotic therapy for acute Q fever.

abstract
http://aac.asm.org/cgi/content/abstract/45/12/3644

PDF
http://aac.asm.org/cgi/reprint/45/12/3644

August 23, 2008 at 7:03 pm Leave a comment

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

N Engl J of Medicine  Feb.3, 1994  V.330  N.5  p.371

Correspondence

Didier Raoult, M.D., Ph.D. – Andreas Stein, M.D.

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…..

abstract
http://content.nejm.org/cgi/content/full/330/5/371

August 23, 2008 at 7:01 pm Leave a comment

Q Fever During Pregnancy

Archives of Internal Medicine  March 25, 2002  V.162  N.6  p.701-704

Diagnosis, Treatment, and Follow-up

Didier Raoult, MD, PhD; Florence Fenollar, MD; Andreas Stein, MD, PhD

From the Unité des Rickettsies, Université de la Méditerranée, Faculté de Médecine, Marseille, France

Background  Q fever, caused by Coxiella burnetii, may result in abortions, premature deliveries, and stillbirths in infected pregnant women.

Objective  To evaluate the best treatment strategy for Q fever during pregnancy.

Methods  We evaluated the prognosis of 17 pregnant women who developed Q fever with and without co-trimoxazole (trimethoprim-sulfamethoxazole) treatment.

Results  The outcome of the pregnancy was found to depend on the trimester. Abortions occurred in 7 of 7 insufficiently treated patients infected during the first trimester vs 1 of 5 patients infected later. Co-trimoxazole given until delivery protected against abortion (0/4) but not against the development of chronic infections, and it did not significantly reduce the colonization of the placenta (2/4 vs 4/4).

Conclusions  Our results show that C burnetii infections cause abortion and that women who develop Q fever while pregnant should be treated with co-trimoxazole for the duration of pregnancy, specifically when infected during the first trimester.
abstract
http://archinte.ama-assn.org/cgi/content/abstract/162/6/701

PDF
http://archinte.ama-assn.org/cgi/reprint/162/6/701

August 23, 2008 at 1:42 pm Leave a comment

Q Fever

Clinical Microbiology Reviews  Oct 1999  V.12  N.4  p.518-553

M. Maurin and D. Raoult

Unité des Rickettsies, CNRS UPRES A 6020, Université de la Méditerranée, Faculté de Médecine, 13385 Marseilles Cedex 5, France

Q fever is a zoonosis with a worldwide distribution with the exception of New Zealand. The disease is caused by Coxiella burnetii, a strictly intracellular, gram-negative bacterium. Many species of mammals, birds, and ticks are reservoirs of C. burnetii in nature. C. burnetii infection is most often latent in animals, with persistent shedding of bacteria into the environment. However, in females intermittent high-level shedding occurs at the time of parturition, with millions of bacteria being released per gram of placenta. Humans are usually infected by contaminated aerosols from domestic animals, particularly after contact with parturient females and their birth products. Although often asymptomatic, Q fever may manifest in humans as an acute disease (mainly as a self-limited febrile illness, pneumonia, or hepatitis) or as a chronic disease (mainly endocarditis), especially in patients with previous valvulopathy and to a lesser extent in immunocompromised hosts and in pregnant women. Specific diagnosis of Q fever remains based upon serology. Immunoglobulin M (IgM) and IgG antiphase II antibodies are detected 2 to 3 weeks after infection with C. burnetii, whereas the presence of IgG antiphase I C. burnetii antibodies at titers of 1:800 by microimmunofluorescence is indicative of chronic Q fever. The tetracyclines are still considered the mainstay of antibiotic therapy of acute Q fever, whereas antibiotic combinations administered over prolonged periods are necessary to prevent relapses in Q fever endocarditis patients. Although the protective role of Q fever vaccination with whole-cell extracts has been established, the population which should be primarily vaccinated remains to be clearly identified. Vaccination should probably be considered in the population at high risk for Q fever endocarditis.
abstract
http://cmr.asm.org/cgi/content/abstract/12/4/518

PDF
http://cmr.asm.org/cgi/reprint/12/4/518

August 23, 2008 at 1:39 pm Leave a comment


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