miércoles, 21 de mayo de 2014

Adverse Pregnancy Outcomes and Coxiella burnetii Antibodies in Pregnant Women, Denmark - Volume 20, Number 6—June 2014 - Emerging Infectious Disease journal - CDC

full-text ►

Adverse Pregnancy Outcomes and Coxiella burnetii Antibodies in Pregnant Women, Denmark - Volume 20, Number 6—June 2014 - Emerging Infectious Disease journal - CDC

link to Volume 20, Number 6—June 2014

Volume 20, Number 6—June 2014


Adverse Pregnancy Outcomes and Coxiella burnetiiAntibodies in Pregnant Women, Denmark

Stine Yde NielsenComments to Author , 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)


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 (14). 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 (911). In contrast, population studies from northern Europe have not found an association between C. burnetii and adverse pregnancy outcomes (1215).
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.


  1. Bacci SVillumsen SValentiner-Branth PSmith BKrogfelt KAMolbak KEpidemiology and clinical features of human infection with Coxiella burnetii in Denmark during 2006–07.Zoonoses Public Health2012;59:618DOIExternal Web Site IconPubMedExternal Web Site Icon
  2. Bosnjak EHvass AMVillumsen SNielsen HEmerging evidence for Q fever in humans in Denmark: role of contact with dairy cattle. Clin Microbiol Infect2010;16:12858DOIExternal Web Site IconPubMedExternal Web Site Icon
  3. Roest HITilburg JJvan der Hoek WVellema Pvan Zijderveld FGKlaassen CHThe Q fever epidemic in the Netherlands: history, onset, response and reflection. Epidemiol Infect2011;139:112DOIExternal Web Site IconPubMedExternal Web Site Icon
  4. 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 Adobe PDF fileExternal Web Site Icon
  5. Berri MRousset EChampion JLRusso PRodolakis AGoats may experience reproductive failures and shed Coxiella burnetii at two successive parturitions after a Q fever infection. Res Vet Sci2007;83:4752DOIExternal Web Site IconPubMedExternal Web Site Icon
  6. Bildfell RJThomson GWHaines DMMcEwen BJSmart NCoxiella burnetii infection is associated with placentitis in cases of bovine abortion. J Vet Diagn Invest.2000;12:41925DOIExternal Web Site IconPubMedExternal Web Site Icon
  7. Parker NRBarralet JHBell AMQ fever. Lancet2006;367:67988DOIExternal Web Site IconPubMedExternal Web Site Icon
  8. Tissot-Dupont HVaillant VRey SRaoult DRole of sex, age, previous valve lesion, and pregnancy in the clinical expression and outcome of Q fever after a large outbreak. Clin Infect Dis2007;44:2327DOIExternal Web Site IconPubMedExternal Web Site Icon
  9. Carcopino XRaoult DBretelle FBoubli LStein AQ Fever during pregnancy: a cause of poor fetal and maternal outcome. Ann N Y Acad Sci2009;1166:7989DOIExternal Web Site IconPubMedExternal Web Site Icon
  10. Carcopino XRaoult DBretelle FBoubli LStein AManaging Q fever during pregnancy: the benefits of long-term cotrimoxazole therapy. Clin Infect Dis2007;45:54855DOIExternal Web Site IconPubMedExternal Web Site Icon
  11. Angelakis EMillion MD’Amato FRouli LRichet HStein AQ fever and pregnancy: disease, prevention, and strain specificity. Eur J Clin Microbiol Infect Dis2013;32:3618.DOIExternal Web Site IconPubMedExternal Web Site Icon
  12. Nielsen SYHjollund NHAndersen AMHenriksen TBKantso BKrogfelt KAPresence of antibodies against Coxiella burnetii and risk of spontaneous abortion: a nested case-control study. PLoS ONE2012;7:e31909DOIExternal Web Site IconPubMedExternal Web Site Icon
  13. 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.
  14. van der Hoek WMeekelenkamp JCLeenders ACWijers NNotermans DW,Hukkelhoven CWAntibodies against Coxiella burnetii and pregnancy outcome during the 2007–2008 Q fever outbreaks in the Netherlands. BMC Infect Dis2011;11:44DOIExternal Web Site IconPubMedExternal Web Site Icon
  15. Nielsen SYAndersen AMMolbak KHjollund NHKantso BKrogfelt KANo 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 Dis2013;13:87DOIExternal Web Site IconPubMedExternal Web Site Icon
  16. Agger JFChristoffersen ABRattenborg ENielsen JAgerholm JSPrevalence of Coxiella burnetii antibodies in Danish dairy herds. Acta Vet Scand2010;52:5DOIExternal Web Site IconPubMedExternal Web Site Icon
  17. Nielsen SYMolbak KNybo Andersen AMBrink Henriksen TKantso BKrogfelt KA,Prevalence of Coxiella burnetii in women exposed to livestock animals, Denmark, 1996 to 2002. Euro Surveill2013;18:20528 .PubMedExternal Web Site Icon
  18. Villumsen SJorgensen CSSmith BUldum SSchiellerup PKrogfelt KADetermination of new cutoff values for indirect immunofluorescence antibody test for Q fever diagnosis in Denmark. Diagn Microbiol Infect Dis2009;65:938DOIExternal Web Site IconPubMedExternal Web Site Icon
  19. Jensen JSBjornelius EDohn BLidbrink PComparison 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 Dis2004;31:499507DOIExternal Web Site IconPubMedExternal Web Site Icon
  20. Angen ØStahl MAgerholm JSChristoffersen ABAgger JFDynamics 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 Sci2011;94:57509DOIExternal Web Site IconPubMedExternal Web Site Icon
  21. Koch ASvendsen CBChristensen JJBundgaard HVindfeld LChristiansen CBQ fever in Greenland. Emerg Infect Dis2010;16:5113DOIExternal Web Site IconPubMedExternal Web Site Icon
  22. Kumar AYadav MPKakkar SHuman milk as a source of Q-fever infection in breast-fed babies. Indian J Med Res1981;73:5102 .PubMedExternal Web Site Icon
  23. Prasad BNChandiramani NKWagle AIsolation of Coxiella burnetii from human sources.Int J Zoonoses1986;13:1127 .PubMedExternal Web Site Icon
  24. Munster JMLeenders ACHamilton CJHak EAarnoudse JGTimmer APlacental histopathology after Coxiella burnetii infection during pregnancy. Placenta.2012;33:12831DOIExternal Web Site IconPubMedExternal Web Site Icon
  25. Langley JMMarrie TJLeblanc JCAlmudevar AResch LRaoult DCoxiella burnetiiseropositivity in parturient women is associated with adverse pregnancy outcomes. Am J Obstet Gynecol2003;189:22832DOIExternal Web Site IconPubMedExternal Web Site Icon
  26. Raoult DFenollar FStein AQ fever during pregnancy: diagnosis, treatment, and follow-up. Arch Intern Med2002;162:7014DOIExternal Web Site IconPubMedExternal Web Site Icon


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/eid2006.130584External Web Site Icon
DOI: 10.3201/eid2006.130584

No hay comentarios:

Publicar un comentario