Managing Q Fever during Pregnancy: The Benefits of Long-Term Cotrimoxazole Therapy
Identifieur interne : 001A67 ( Main/Exploration ); précédent : 001A66; suivant : 001A68Managing Q Fever during Pregnancy: The Benefits of Long-Term Cotrimoxazole Therapy
Auteurs : Xavier Carcopino [France, Irlande (pays)] ; Didier Raoult [France] ; Florence Bretelle [France] ; Léon Boubli [France] ; Andreas Stein [France]Source :
- Clinical Infectious Diseases [ 1058-4838 ] ; 2007.
Abstract
Background. Q fever is a zoonosis caused by Coxiella burnetii. During pregnancy, it may result in obstetric complications, such as spontaneous abortion, intrauterine growth retardation, intrauterine fetal death, and premature delivery. Pregnant women are exposed to the risk of chronic Q fever. Methods. We included 53 pregnant women who received a diagnosis of Q fever. We compared the incidence of obstetric and maternal Q fever complications for women who received long-term cotrimoxazole treatment (n = 16) with that for women who did not receive long-term cotrimoxazole treatment (n = 37); long-term cotrimoxazole treatment was defined as oral administration of trimethoprim-sulfamethoxazole during at least 5 weeks of pregnancy. Results. Obstetric complications were observed in 81.1% of pregnant women who did not receive long-term cotrimoxazole therapy: 5 (13.5%) women experienced spontaneous abortions, 10 (27%) experienced intrauterine growth retardation, 10 (27%) experienced intrauterine fetal death, and 10 (27%) experienced premature delivery. Oligoamnios was observed in 4 patients (10.8%). Obstetric complications were found to occur significantly more often in patients infected during their first trimester of pregnancy than in those infected later (P = .032). The outcome of the pregnancy was found to depend on placental infection by C. burnetii (P = .013). Long-term cotrimoxazole treatment protected against maternal chronic Q fever (P = .001), placental infection (P = .038), and obstetric complications (P = .009), especially intrauterine fetal death (P = .018), which was found to be related to placental infection (P = .008). Conclusions. Q fever during pregnancy results in severe obstetric complications, including oligoamnios. Because of its ability to protect against placental infection, intrauterine fetal death, and maternal chronic Q fever, long-term cotrimoxazole treatment should be used to treat pregnant women with Q fever.
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DOI: 10.1086/520661
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wicri:rule="url">France</country><wicri:regionArea>Reprints or correspondence: Dr. Xavier Carcopino, Dept. of Obstetrics and Gynaecology, Hôpital Nord, Chemin des Bourrely, 13915 Cedex 20</wicri:regionArea><placeName><region type="region" nuts="2">Provence-Alpes-Côte d'Azur</region><settlement type="city">Cedex 20</settlement></placeName></affiliation></author><author><name sortKey="Raoult, Didier" sort="Raoult, Didier" uniqKey="Raoult D" first="Didier" last="Raoult">Didier Raoult</name><affiliation wicri:level="4"><country xml:lang="fr">France</country><wicri:regionArea>Unité des Rickettsies, Unité Mixte de Recherche 6020, Université de la Méditerranée, Faculté de Médecine, Marseille</wicri:regionArea><placeName><region type="region">Provence-Alpes-Côte d'Azur</region><region type="old region">Provence-Alpes-Côte d'Azur</region><settlement type="city">Marseille</settlement></placeName><orgName type="university">Université de la Méditerranée</orgName></affiliation></author><author><name sortKey="Bretelle, Florence" sort="Bretelle, Florence" uniqKey="Bretelle F" first="Florence" last="Bretelle">Florence Bretelle</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Service de Gynécologie Obstétrique, Hôpital Nord, Chemin des Bourrely, Marseille</wicri:regionArea><placeName><region type="region">Provence-Alpes-Côte d'Azur</region><region type="old region">Provence-Alpes-Côte d'Azur</region><settlement type="city">Marseille</settlement></placeName></affiliation></author><author><name sortKey="Boubli, Leon" sort="Boubli, Leon" uniqKey="Boubli L" first="Léon" last="Boubli">Léon Boubli</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>Service de Gynécologie Obstétrique, Hôpital Nord, Chemin des Bourrely, Marseille</wicri:regionArea><placeName><region type="region">Provence-Alpes-Côte d'Azur</region><region type="old 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type="eISSN">1537-6591</idno><imprint><publisher>The University of Chicago Press</publisher><date when="2007-09-01">2007</date><biblScope unit="vol">45</biblScope><biblScope unit="issue">5</biblScope><biblScope unit="page" from="548">548</biblScope><biblScope unit="page" to="555">555</biblScope></imprint><idno type="ISSN">1058-4838</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1058-4838</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract">Background. Q fever is a zoonosis caused by Coxiella burnetii. During pregnancy, it may result in obstetric complications, such as spontaneous abortion, intrauterine growth retardation, intrauterine fetal death, and premature delivery. Pregnant women are exposed to the risk of chronic Q fever. Methods. We included 53 pregnant women who received a diagnosis of Q fever. We compared the incidence of obstetric and maternal Q fever complications for women who received long-term cotrimoxazole treatment (n = 16) with that for women who did not receive long-term cotrimoxazole treatment (n = 37); long-term cotrimoxazole treatment was defined as oral administration of trimethoprim-sulfamethoxazole during at least 5 weeks of pregnancy. Results. Obstetric complications were observed in 81.1% of pregnant women who did not receive long-term cotrimoxazole therapy: 5 (13.5%) women experienced spontaneous abortions, 10 (27%) experienced intrauterine growth retardation, 10 (27%) experienced intrauterine fetal death, and 10 (27%) experienced premature delivery. Oligoamnios was observed in 4 patients (10.8%). Obstetric complications were found to occur significantly more often in patients infected during their first trimester of pregnancy than in those infected later (P = .032). The outcome of the pregnancy was found to depend on placental infection by C. burnetii (P = .013). Long-term cotrimoxazole treatment protected against maternal chronic Q fever (P = .001), placental infection (P = .038), and obstetric complications (P = .009), especially intrauterine fetal death (P = .018), which was found to be related to placental infection (P = .008). Conclusions. Q fever during pregnancy results in severe obstetric complications, including oligoamnios. Because of its ability to protect against placental infection, intrauterine fetal death, and maternal chronic Q fever, long-term cotrimoxazole treatment should be used to treat pregnant women with Q fever.</div></front></TEI><affiliations><list><country><li>France</li><li>Irlande (pays)</li></country><region><li>Provence-Alpes-Côte d'Azur</li></region><settlement><li>Cedex 20</li><li>Marseille</li></settlement><orgName><li>Université de la Méditerranée</li></orgName></list><tree><country name="France"><region name="Provence-Alpes-Côte d'Azur"><name sortKey="Carcopino, Xavier" sort="Carcopino, Xavier" uniqKey="Carcopino X" first="Xavier" last="Carcopino">Xavier Carcopino</name></region><name sortKey="Boubli, Leon" sort="Boubli, Leon" uniqKey="Boubli L" first="Léon" last="Boubli">Léon Boubli</name><name sortKey="Bretelle, Florence" sort="Bretelle, Florence" uniqKey="Bretelle F" first="Florence" last="Bretelle">Florence Bretelle</name><name sortKey="Carcopino, Xavier" sort="Carcopino, Xavier" uniqKey="Carcopino X" first="Xavier" last="Carcopino">Xavier Carcopino</name><name sortKey="Carcopino, Xavier" sort="Carcopino, Xavier" uniqKey="Carcopino X" first="Xavier" last="Carcopino">Xavier Carcopino</name><name sortKey="Raoult, Didier" sort="Raoult, Didier" uniqKey="Raoult D" first="Didier" last="Raoult">Didier Raoult</name><name sortKey="Stein, Andreas" sort="Stein, Andreas" uniqKey="Stein A" first="Andreas" last="Stein">Andreas Stein</name></country><country name="Irlande (pays)"><noRegion><name sortKey="Carcopino, Xavier" sort="Carcopino, Xavier" uniqKey="Carcopino X" first="Xavier" last="Carcopino">Xavier Carcopino</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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