Adverse Pregnancy Outcomes and Coxiella burnetii Antibodies in Pregnant Women, Denmark - Volume 20, Number 6—June 2014 - Emerging Infectious Disease journal - CDC
Volume 20, Number 6—June 2014
CME ACTIVITY
Adverse Pregnancy Outcomes and Coxiella burnetiiAntibodies in Pregnant Women, Denmark
Stine Yde Nielsen
, Kåre Mølbak, Tine Brink Henriksen, Karen Angeliki Krogfelt, Carsten Schade Larsen, and Steen Villumsen
Author affiliations: Aarhus University Hospital, Aarhus, Denmark (S.Y. Nielsen, T.B. Henriksen, C.S. Larsen); Statens Serum Institut, Copenhagen, Denmark (K. Mølbak, K.A. Krogfelt, S. Villumsen)
Abstract
A high risk for obstetric complications has been reported among women infected withCoxiella burnetii, the causative agent of Q fever, but recent studies have failed to confirm these findings. We reviewed national data collected in Denmark during 2007–2011 and found 19 pregnancies in 12 women during which the mother had a positive or equivocal test for antibodies to C. burnetii (IgM phase I and II titers >64, IgG phase I and II titers >128). Of these 12 women, 4 experienced obstetric complications (miscarriage, preterm delivery, infant small for gestational age, oligohydramnion, fetal growth restriction, or perinatal death); these complications occurred in 9 pregnancies (47% of the 19 total pregnancies identified). Our findings suggest an association between Q fever and adverse pregnancy outcomes, but complications were identified in only 9 pregnancies during the study’s 5-year period, indicating that the overall risk is low.
Q fever is a zoonotic infection caused by Coxiella burnetii. Findings of adverse pregnancy outcome in infected women, high seroprevalence in animal studies, and large human outbreaks have placed increasing focus on Q fever in several European countries, including Denmark (1–4). In ruminants, infection with C. burnetii is associated with high numbers of bacteria in the placenta, and the infection is known to cause abortion, retained placenta, endometritis, and infertility (5,6). Humans are infected with C. burnetii predominantly by inhalation of contaminated aerosols, and persons who have contact with livestock are at highest risk for exposure (7). Among pregnant women, >90% of those who show antibodies for C. burnetii that suggest recent infection may remain asymptomatic (8). Case series from France have associated symptomatic and asymptomatic C. burnetii infection during pregnancy with obstetric complications, including miscarriage, preterm delivery, and fetal death (9–11). In contrast, population studies from northern Europe have not found an association between C. burnetii and adverse pregnancy outcomes (12–15).
Cattle are the main reservoir for C. burnetii in Denmark. A recent study of the seroprevalence ofC. burnetii in cattle found that bulk-tank milk samples tested positive for C. burnetii at 59 of 100 randomly selected farms (16). In addition, the reported prevalence of antibodies to C. burnetiiamong veterinarians in Denmark ranges from 36% to 47% (1,2,17). These findings show that exposure to C. burnetii is common in this country in the animal reservoir and in those who are occupationally exposed to livestock or who live in rural areas with livestock contact. However, the risk for and implications of infection with C. burnetii among pregnant women have not been exhaustively described (12,15). Because of this, and because findings from the case series in France conflict with results from population-based studies from the Netherlands and Denmark, we reviewed national data from Aarhus University Hospital, Aalborg University Hospital, Hospital of Southwest Jutland, Viborg Regional Hospital, Regional Hospital West Jutland, and Hilleroed Hospital in Denmark to identify women who had elevated antibodies to C. burnetii during pregnancy. We evaluated the course of infection, effects of treatment with cotrimoxazole (trimethoprim-sulfamethoxazole), and pregnancy outcomes for these women.
Dr Nielsen is a physician in the Department of Clinical Microbiology, Aarhus University Hospital, and a postdoctoral scholar at the Department of Occupational Medicine, Hospital Region West, Herning, Denmark. Her research interests include infections, obstetrics, pediatrics, and microbiology.
References
- Bacci S, Villumsen S, Valentiner-Branth P, Smith B, Krogfelt KA, Molbak K. Epidemiology and clinical features of human infection with Coxiella burnetii in Denmark during 2006–07.Zoonoses Public Health. 2012;59:61–8. DOI
PubMed
- Bosnjak E, Hvass AM, Villumsen S, Nielsen H. Emerging evidence for Q fever in humans in Denmark: role of contact with dairy cattle. Clin Microbiol Infect. 2010;16:1285–8. DOI
PubMed
- Roest HI, Tilburg JJ, van der Hoek W, Vellema P, van Zijderveld FG, Klaassen CH, The Q fever epidemic in the Netherlands: history, onset, response and reflection. Epidemiol Infect. 2011;139:1–12. DOI
PubMed
- European Centre for Disease Prevention and Control. Annual epidemiological report on communicable diseases in Europe 2010 [cited 2012 Dec 4].http://www.ecdc.europa.eu/en/publications/Publications/1011_SUR_Annual_Epidemiological_Report_on_Communicable_Diseases_in_Europe.pdf
- Berri M, Rousset E, Champion JL, Russo P, Rodolakis A. Goats may experience reproductive failures and shed Coxiella burnetii at two successive parturitions after a Q fever infection. Res Vet Sci. 2007;83:47–52. DOI
PubMed
- Bildfell RJ, Thomson GW, Haines DM, McEwen BJ, Smart N. Coxiella burnetii infection is associated with placentitis in cases of bovine abortion. J Vet Diagn Invest.2000;12:419–25. DOI
PubMed
- Parker NR, Barralet JH, Bell AM. Q fever. Lancet. 2006;367:679–88. DOI
PubMed
- Tissot-Dupont H, Vaillant V, Rey S, Raoult D. Role of sex, age, previous valve lesion, and pregnancy in the clinical expression and outcome of Q fever after a large outbreak. Clin Infect Dis. 2007;44:232–7. DOI
PubMed
- Carcopino X, Raoult D, Bretelle F, Boubli L, Stein A. Q Fever during pregnancy: a cause of poor fetal and maternal outcome. Ann N Y Acad Sci. 2009;1166:79–89. DOI
PubMed
- Carcopino X, Raoult D, Bretelle F, Boubli L, Stein A. Managing Q fever during pregnancy: the benefits of long-term cotrimoxazole therapy. Clin Infect Dis. 2007;45:548–55. DOI
PubMed
- Angelakis E, Million M, D’Amato F, Rouli L, Richet H, Stein A, Q fever and pregnancy: disease, prevention, and strain specificity. Eur J Clin Microbiol Infect Dis. 2013;32:361–8.DOI
PubMed
- Nielsen SY, Hjollund NH, Andersen AM, Henriksen TB, Kantso B, Krogfelt KA, Presence of antibodies against Coxiella burnetii and risk of spontaneous abortion: a nested case-control study. PLoS ONE. 2012;7:e31909. DOI
PubMed
- Munster JM. Effectiveness of a screening program for Q fever during pregnancy: a clustered randomised controlled trial. Presented at: European Scientific Conference on Applied Infectious Disease Epidemiology; Stockholm, Sweden; 2011 Nov 6–8.
- van der Hoek W, Meekelenkamp JC, Leenders AC, Wijers N, Notermans DW,Hukkelhoven CW. Antibodies against Coxiella burnetii and pregnancy outcome during the 2007–2008 Q fever outbreaks in the Netherlands. BMC Infect Dis. 2011;11:44. DOI
PubMed
- Nielsen SY, Andersen AM, Molbak K, Hjollund NH, Kantso B, Krogfelt KA, No excess risk of adverse pregnancy outcomes among women with serological markers of previous infection with Coxiella burnetii: evidence from the Danish national birth cohort. BMC Infect Dis. 2013;13:87. DOI
PubMed
- Agger JF, Christoffersen AB, Rattenborg E, Nielsen J, Agerholm JS. Prevalence of Coxiella burnetii antibodies in Danish dairy herds. Acta Vet Scand. 2010;52:5. DOI
PubMed
- Nielsen SY, Molbak K, Nybo Andersen AM, Brink Henriksen T, Kantso B, Krogfelt KA,Prevalence of Coxiella burnetii in women exposed to livestock animals, Denmark, 1996 to 2002. Euro Surveill. 2013;18:20528 .PubMed
- Villumsen S, Jorgensen CS, Smith B, Uldum S, Schiellerup P, Krogfelt KA. Determination of new cutoff values for indirect immunofluorescence antibody test for Q fever diagnosis in Denmark. Diagn Microbiol Infect Dis. 2009;65:93–8. DOI
PubMed
- Jensen JS, Bjornelius E, Dohn B, Lidbrink P. Comparison of first void urine and urogenital swab specimens for detection of Mycoplasma genitalium and Chlamydia trachomatis by polymerase chain reaction in patients attending a sexually transmitted disease clinic.Sex Transm Dis. 2004;31:499–507. DOI
PubMed
- Angen Ø, Stahl M, Agerholm JS, Christoffersen AB, Agger JF. Dynamics of relationship between the presence of Coxiella burnetii DNA, antibodies, and intrinsic variables in cow milk and bulk tank milk from Danish dairy cattle. J Dairy Sci. 2011;94:5750–9. DOI
PubMed
- Koch A, Svendsen CB, Christensen JJ, Bundgaard H, Vindfeld L, Christiansen CB, Q fever in Greenland. Emerg Infect Dis. 2010;16:511–3. DOI
PubMed
- Kumar A, Yadav MP, Kakkar S. Human milk as a source of Q-fever infection in breast-fed babies. Indian J Med Res. 1981;73:510–2 .PubMed
- Prasad BN, Chandiramani NK, Wagle A. Isolation of Coxiella burnetii from human sources.Int J Zoonoses. 1986;13:112–7 .PubMed
- Munster JM, Leenders AC, Hamilton CJ, Hak E, Aarnoudse JG, Timmer A. Placental histopathology after Coxiella burnetii infection during pregnancy. Placenta.2012;33:128–31. DOI
PubMed
- Langley JM, Marrie TJ, Leblanc JC, Almudevar A, Resch L, Raoult D. Coxiella burnetiiseropositivity in parturient women is associated with adverse pregnancy outcomes. Am J Obstet Gynecol. 2003;189:228–32. DOI
PubMed
- Raoult D, Fenollar F, Stein A. Q fever during pregnancy: diagnosis, treatment, and follow-up. Arch Intern Med. 2002;162:701–4. DOI
PubMed
Tables
- Table 1. Patient characteristics and pregnancy outcomes in 12 women who had positive Coxiella burnetii titers during pregnancy, Denmark
- Table 2. Results of testing for 12 women who had positive Coxiella burnetii titers during pregnancy, Denmark
Suggested citation for this article: Nielsen SY, Mølbak K, Henriksen TB, Krogfelt KA, Larsen CS, Villumsen S. Adverse pregnancy outcomes and Coxiella burnetii antibodies in pregnant women, Denmark. Emerg Infect Dis [Internet]. 2014 Jun [date cited].http://dx.doi.org/10.3201/eid2006.130584![External Web Site Icon External Web Site Icon](https://lh3.googleusercontent.com/blogger_img_proxy/AEn0k_t7Z1Gpcrt1UBQwRvg5yU084w20aUNAzKhgYPILpGPvtsJfgGMbzFa3zpF-Q5xdF4LBSN9J4l1I9ZhzU6B1uoTCk_H6mlxU_2f6Pwa8S24-I9RormnbbmCUBLM=s0-d)
DOI: 10.3201/eid2006.130584
No hay comentarios:
Publicar un comentario