Chronic Q Fever of Pregnancy Presenting as Coxiella burnetii Placentitis: Successful Outcome Following Therapy with Erythromycin and Rifampin

Bental, Tamir; Fejgin, Moshe D.; Keysary, Avi; Rzotkiewicz, Sabine; Oron, Chaya; Nachum, R; Beyth, Yoram; Lang, Ruth

doi:10.1093/clinids/21.5.1318

Cited by 37 publications

(23 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Because C. burnetii is found in the placenta of aborted fetuses [11], [19], we investigated the ability of C. burnetii organisms to infect BeWo trophoblasts. We extended the previously described procedure for establishing macrophage infection by C. burnetii [20] to BeWo trophoblasts.…”

Section: Resultsmentioning

confidence: 99%

Coxiella burnetii, the Agent of Q Fever, Replicates within Trophoblasts and Induces a Unique Transcriptional Response

et al. 2010

View full text Add to dashboard Cite

Q fever is a zoonosis caused by Coxiella burnetii, an obligate intracellular bacterium typically found in myeloid cells. The infection is a source of severe obstetrical complications in humans and cattle and can undergo chronic evolution in a minority of pregnant women. Because C. burnetii is found in the placentas of aborted fetuses, we investigated the possibility that it could infect trophoblasts. Here, we show that C. burnetii infected and replicated in BeWo trophoblasts within phagolysosomes. Using pangenomic microarrays, we found that C. burnetii induced a specific transcriptomic program. This program was associated with the modulation of inflammatory responses that were shared with inflammatory agonists, such as TNF, and more specific responses involving genes related to pregnancy development, including EGR-1 and NDGR1. In addition, C. burnetii stimulated gene networks organized around the IL-6 and IL-13 pathways, which both modulate STAT3. Taken together, these results revealed that trophoblasts represent a protective niche for C. burnetii. The activation program induced by C. burnetii in trophoblasts may allow bacterial replication but seems unable to interfere with the development of normal pregnancy. Such pathophysiologocal processes should require the activation of immune placental cells associated with trophoblasts.

show abstract

Section: Resultsmentioning

confidence: 99%

Coxiella burnetii, the Agent of Q Fever, Replicates within Trophoblasts and Induces a Unique Transcriptional Response

et al. 2010

View full text Add to dashboard Cite

show abstract

“…Before the common usage of hydroxychloroquine, a combination of rifampin plus doxycycline was sometimes used for the treatment of Q fever endocarditis [28,29]. Rifampin has also been used to treat Q fever during pregnancy [58,59]. A combination of rifampin and erythromycin has resulted in a successful delivery and recovery from a human placental infection [58].…”

Section: Alternatives For Q Fever Treatmentmentioning

confidence: 99%

“…Rifampin has also been used to treat Q fever during pregnancy [58,59]. A combination of rifampin and erythromycin has resulted in a successful delivery and recovery from a human placental infection [58]. Rifampin is placed in pregnancy category C by the US FDA.…”

Section: Alternatives For Q Fever Treatmentmentioning

confidence: 99%

Antimicrobial therapies for Q fever

Kersh¹

2013

Expert Review of Anti-infective Therapy

View full text Add to dashboard Cite

Summary Q fever is caused by the bacterium Coxiella burnetii and has both acute and chronic forms. The acute disease is a febrile illness often with headache and myalgia that can be self-limiting whereas the chronic disease typically presents as endocarditis and can be life threatening. The normal therapy for the acute disease is a two week course of doxycycline, whereas chronic disease requires 18-24 months of doxycycline in combination with hydroxychloroquine. Alternative treatments are used for pregnant women, young children, and those who cannot tolerate doxycycline. Doxycycline resistance is rare but has been reported. Co-trimoxazole is a currently recommended alternative treatment, but quinolones, rifampin, and newer macrolides may also provide some benefit.

show abstract

“…Findings of Sarkar et al suggest that gestational exposure to azithromycin is not associated with an increase in the rate of major malformations above the baseline of 1-3%, supporting earlier research showing that macrolide antibiotics are generally safe in pregnancy [20]. Bental et al reported a case of chronic Q fever due to placentitis in which treatment with erythromycin and rifampin contributed to the delivery of a healthy baby [21].…”

Section: Discussionmentioning

confidence: 80%

Azithromycin for acute Q fever in pregnancy

Cerar

Karner

Avšič-Županc

et al. 2009

Wien Klin Wochenschr

View full text Add to dashboard Cite

Q fever is a zoonosis caused by Coxiella burnetii. Although data on Q fever during pregnancy are limited, they indicate that infection with C. burnetii is associated with high morbidity and mortality. The infection is usually asymptomatic in pregnant women but may result in obstetric complications such as spontaneous abortion, intrauterine growth retardation, intrauterine fetal death and premature delivery; in addition, pregnant women are at higher risk of developing chronic Q fever. Treatment of Q fever during pregnancy is challenging not only because C. burnetii is an intracellular bacterium but also because of safety restrictions and limited information on the efficacy of treatment. We report a case of acute Q fever in pregnancy with a successful outcome for mother and child, describe our therapeutic approach to the management of this case, and suggest that treatment with azithromycin may have prevented possible obstetric complications and evolution toward a chronic serologic profile in our patient.

show abstract

Chronic Q Fever of Pregnancy Presenting as Coxiella burnetii Placentitis: Successful Outcome Following Therapy with Erythromycin and Rifampin

Cited by 37 publications

References 10 publications

Coxiella burnetii, the Agent of Q Fever, Replicates within Trophoblasts and Induces a Unique Transcriptional Response

Coxiella burnetii, the Agent of Q Fever, Replicates within Trophoblasts and Induces a Unique Transcriptional Response

Antimicrobial therapies for Q fever

Azithromycin for acute Q fever in pregnancy

Contact Info

Product

Resources

About