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Q fever and pregnancy: disease, prevention, and strain specificity

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Abstract

The link between fetal morbidity and Q fever and the necessity of long-term antibiotics for Coxiella burnetii infection during pregnancy have been recently questioned in the Netherlands, where the clone responsible for the Q fever outbreak harbors the QpH1 plasmid. In this context, we assessed pregnancy outcomes according to antibiotic administration in a new series and compared the plasmid type between isolates associated with abortion and other clinical isolates to determine if there is a link between genotype and abortion in humans. All French patients who received a diagnosis of Q fever during pregnancy at the French National Referral Centre for Q Fever from 2006 through July 2011 were included. On the other hand, the plasmid types of 160 clinical isolates, including seven isolates from patients who experienced an abortion, were compared. The differences between the QpDV and QpH1 plasmid sequences were analyzed. Acute Q fever was a cause of fetal morbidity, and the absence of long-term cotrimoxazole therapy was associated with fetal death (p < 0.0001). Genotypic analysis showed that the QpDV plasmid was more frequent in isolates associated with abortion (p = 0.03). A comparison of the plasmid sequences revealed that four QpDV proteins had no direct counterparts in QpH1, with two whose functions were not present in QpH1. The different obstetrical morbidity of C. burnetii relative to different geographical areas could be related to strain specificity, possibly based on differences in plasmid sequences, or to a failure of public health authorities to detect early miscarriages.

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Acknowledgments

We thank Patrizia Carrieri for her precious help with the statistical analyses.

Funding

This work was supported by the French National Referral Centre for Q Fever.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculté de Médecine, CNRS UMR 7278, IRD 198, Aix-Marseille Université, 27 Bd. Jean Moulin, 13005, Marseille, France

    E. Angelakis, M. Million, F. D’Amato, L. Rouli, H. Richet, A. Stein, J.-M. Rolain & D. Raoult

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  1. E. Angelakis
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  2. M. Million
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  3. F. D’Amato
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  4. L. Rouli
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  5. H. Richet
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  6. A. Stein
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  7. J.-M. Rolain
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  8. D. Raoult
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Corresponding author

Correspondence to D. Raoult.

Additional information

E. Angelakis and M. Million contributed equally to this work.

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Supplementary information

Clinical and geographical characteristics, multi-spacer sequence typing (MST) genotyping, and plasmid type associated with 160 Coxiella burnetii isolates. The C. burnetii plasmid type has been determined in 160 human isolates: 35 isolates in this study and 125 isolates in previous reports [13, 14, 26, 27]. The clinical manifestation, including acute Q fever, endocarditis, vascular infection, or abortion, was identified for 144 strains. All seven strains isolated from placenta corresponded to abortion. (XLS 154 kb)

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Angelakis, E., Million, M., D’Amato, F. et al. Q fever and pregnancy: disease, prevention, and strain specificity. Eur J Clin Microbiol Infect Dis 32, 361–368 (2013). https://doi.org/10.1007/s10096-012-1750-3

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  • DOI: https://doi.org/10.1007/s10096-012-1750-3

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