Journal Article

Role of Sex, Age, Previous Valve Lesion, and Pregnancy in the Clinical Expression and Outcome of Q Fever after a Large Outbreak

Hervé Tissot-Dupont, Véronique Vaillant, Sylvie Rey and Didier Raoult

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 44, issue 2, pages 232-237
Published in print January 2007 | ISSN: 1058-4838
Published online January 2007 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/510389
Role of Sex, Age, Previous Valve Lesion, and Pregnancy in the Clinical Expression and Outcome of Q Fever after a Large Outbreak

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Background. Q fever is a zoonosis caused by Coxiella burnetii. After a large outbreak occurred in the Chamonix Valley in the French Alps in 2002, an extensive surveillance was conducted, to describe the variations in the clinical expression of acute Q fever according to host factors, as well as to monitor the risk of evolution of acute Q fever to chronic Q fever in patients at risk.

Methods. Three groups of patients with risk factors for evolution of acute Q fever to chronic Q fever were considered: 376 pregnant women, 19 immunocompromised patients, and 91 patients with valvular or vascular abnormalities. A group of 578 people without risk factors for evolution of acute Q fever to chronic Q fever was also tested. Diagnosis of Q fever was based on serologic testing by immunofluorescence assay.

Results. Between 30 August 2002 and 31 July 2003, a total of 1946 serum samples obtained from 1064 persons were tested. A total of 101 patients (9.3%) had acute Q fever diagnosed, and 5 patients (0.5%) had chronic Q fever diagnosed. A diagnosis of acute Q fever was established for 11 pregnant women (2.6% of 379 pregnancies), 5 patients with valvular disease (5.5%), and 85 people without risk factors (14.7%) (71 [27.9%] of 254 symptomatic patients and 14 [4.3%] of 324 asymptomatic patients). A new pregnancy in a woman with negative results of serologic tests for Q fever exposes the woman to a new risk for acute Q fever able to evolve to chronic Q fever. The rates of clinical expression were 90.6% in adult men, 75% in adult women, and 33.3% in children, and they were significantly lower (9.1%) in pregnant women. Evolution to chronic Q fever was observed in 5 patients.

Conclusion. This study emphasizes the importance of active surveillance in postepidemic conditions, especially among patients at risk, as well as the importance of systematic serologic testing during pregnancy.

Journal Article.  4154 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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