title: Maternofetal consequences of Coxiella burnetii infection in pregnancy: a case series of two outbreaks.
abstract: BACKGROUND
  A high complication rate of Q fever in pregnancy is described on the basis of a limited number of cases. All pregnant women with proven Q fever regardless of clinical symptoms should therefore receive long-term cotrimoxazole therapy. But cotrimoxazole as a folic acid antagonist may cause harm to the fetus. We therefore investigated the Q fever outbreaks, Soest in 2003 and Jena in 2005, to determine the maternofetal consequences of Coxiella burnetii infection contracted during pregnancy.
  
  
  METHODS
  Different outbreak investigation strategies were employed at the two sides. Antibody screening was performed with an indirect immunofluorescence test. Medical history and clinical data were obtained and serological follow up performed at delivery. Available placental tissue, amniotic fluid and colostrum/milk were further investigated by polymerase chain reaction and by culture.
  
  
  RESULTS
  11 pregnant women from Soest (screening rate: 49%) and 82 pregnant women from Jena (screening rate: 27%) participated in the outbreak investigation. 11 pregnant women with an acute C. burnetii infection were diagnosed. Three women had symptomatic disease. Three women, who were infected in the first trimester, were put on long-term therapy. The remaining women received cotrimoxazole to a lesser extent (n=3), were treated with macrolides for three weeks (n=1) or after delivery (n=1), were given no treatment at all (n=2) or received antibiotics ineffective for Q fever (n=1). One woman and her foetus died of an underlying disease not related to Q fever. One woman delivered prematurely (35th week) and one child was born with syndactyly. We found no obvious association between C. burnetii infection and negative pregnancy outcome.
  
  
  CONCLUSIONS
  Our data do not support the general recommendation of long-term cotrimoxazole treatment for Q fever infection in pregnancy. Pregnant women with symptomatic C. burnetii infections and with chronic Q fever should be treated. The risk-benefit ratio of treatment in these patients, however, remains uncertain. If cotrimoxazole is administered, folinic acid has to be added.
authors.affiliation: Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Jena, Jena, Germany. katharina.boden@med.uni-jena.de
authors.forename: Katharina
authors.initials: K
authors.lastname: Boden
authors.forename: Andreas
authors.initials: A
authors.lastname: Brueckmann
authors.forename: Christiane
authors.initials: C
authors.lastname: Wagner-Wiening
authors.forename: Beate
authors.initials: B
authors.lastname: Hermann
authors.forename: Klaus
authors.initials: K
authors.lastname: Henning
authors.forename: Thomas
authors.initials: T
authors.lastname: Junghanss
authors.forename: Thomas
authors.initials: T
authors.lastname: Seidel
authors.forename: Michael
authors.initials: M
authors.lastname: Baier
authors.forename: Eberhard
authors.initials: E
authors.lastname: Straube
authors.forename: Dirk
authors.initials: D
authors.lastname: Theegarten
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000907:Antibodies, Bacterial / Q000097:blood; D003126:Colostrum / Q000382:microbiology; D016997:Coxiella burnetii / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D004196:Disease Outbreaks; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D007231:Infant, Newborn; D008895:Milk, Human / Q000382:microbiology; D010920:Placenta / Q000382:microbiology; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D011778:Q Fever / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D015662:Trimethoprim, Sulfamethoxazole Drug Combination