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Volume 32, Number 1—January 2026

Synopsis

Two Cases of Q Fever in Pregnancy, including Management of the Newborn, Australia

Robyn SilcockComments to Author , Robert Horvath, Su May Chew, and Clare Nourse
Author affiliation: Pathology Queensland, Herston, Queensland, Australia (R. Silcock, R. Horvath); Queensland Children’s Hospital, Brisbane, Queensland, Australia (R. Silcock, C. Nourse); University of Queensland, Brisbane (R. Silcock, C. Nourse); Q Fever Interest Group, Brisbane (R. Silcock, R. Horvath, S.M. Chew, C. Nourse); Prince Charles Hospital, Brisbane (R. Horvath); Toowoomba Hospital, Toowoomba, Queensland, Australia (S.M. Chew)

Main Article

Table 3

​Table 3. Published cases of Q fever infection in pregnancy reviewed for study of Q fever in pregnancy, including management of the newborn, Australia*

Mother’s age, country (reference) Gestation Treatment Outcome
42 y, the Netherlands (22)
 Shortly before conception; steep increase in IgG phase I and IgG phase II and PCR serum positive at 25 weeks’
 Cotrimoxazole (allergy so changed to erythromycin)
 Induction of labor at 38 weeks; healthy baby, birth weight 3,850 g; amniotic fluid and placenta PCR positive; newborn blood PCR negative
29 y, Slovenia (3)
 Seroconversion found at 9 weeks; febrile illness 10 days before conception
 Azithromycin for 6 d at 9 weeks’ gestation
 Spontaneous vaginal delivery at term; birth weight 3,500 g; amniotic fluid and placenta PCR negative
39 y, Australia (4)
 Fever at 7 weeks; seroconversion at 9 weeks
 Cotrimoxazole from 9 to 36 weeks’ gestation
 Spontaneous vaginal delivery at term; birth weight 3,600 g; placenta, blood, breastmilk PCR negative
27 y, Germany (23)
Acute Q fever at 7 weeks; retrospective diagnosis at 19 weeks
 Erythromycin from 25 to 26 weeks’ gestation; rifampin + clarithromycin from 26 weeks through delivery
 Delivery at 30 weeks; birth weight 3,900 g
28 y, Spain (5)
 14 weeks
 No treatment
 Delivery at 36 weeks; healthy baby, birth weight 2,125 g
26 y, United Kingdom (24)
 14 weeks
 No treatment
 Intrauterine fetal demise at 25 weeks; C. burnetii detected on placental stains
28 y, Israel (25)
 22 weeks’ gestation; fever since 16 weeks; acute Q fever on serology
 Erythromycin and rifampin from 22 to 30 weeks’ gestation
 Premature labor at 30 weeks; birth weight 1,300 g; baby treated for 14 d with rifampin + erythromycin; complete recovery
29 y, Israel (26)
 21 weeks’ gestation; fevers since 17 weeks; chronic Q fever on serology
 Erythromycin at 21 weeks’ gestation, then tetracycline from 22 weeks gestation until induction at 28 weeks
 Induced at 28 weeks; birth weight 1,000 g; placenta necrotic; C. burnetii isolated; baby not infected; yellow teeth
34 y, Spain (27)
 21 weeks’ gestation; febrile; acute Q fever on serology
 Cotrimoxazole from 21 weeks’ gestation until term
 Delivery at 40 weeks; healthy baby, birth weight 2,930 g; formula fed
18 y, Spain (28)
 Fevers at 19 weeks’ gestation; seropositive 1 month later
 Clarithromycin commenced at 20 weeks’ gestation; duration not specified
 Delivery at 40 weeks; healthy baby
34 y, Israel (29)
 Pyrexia of unknown origin at 24 weeks’ gestation; 26 weeks abruption
 No treatment
 Viable baby delivered; birth weight 967 g; PCR Q fever positive
27 y, Israel (30)
 26 weeks’ gestation; 3-week history of fevers
 Doxycycline commenced at 26 weeks’ gestation, continued until IUFD at 27 weeks
 Intrauterine fetal demise at 27 weeks
29 y, Australia (7)
29 weeks’ gestation
 Cotrimoxazole from 29 to 30 weeks’ gestation; clarithromycin from 31 weeks until term (rash with cotrimoxazole)
 Medical induction at 39 weeks; healthy baby; amniotic fluid, fetal blood, and placenta PCR negative
26 y, United Kingdom (31)
28 weeks’ gestation (acute Q fever seroconversion between 16 and 29 weeks)
 Ciprofloxacin from 29 weeks’ gestation until induction at 32 weeks
 Induced at 32 weeks; healthy baby
34 y, Israel (29)
Fevers at 29 weeks’ gestation
 No treatment
 Placental abruption; delivered at 31 weeks; healthy baby; birth weight 1,514 g; placenta PCR positive
22 y, Australia (6) Fevers at 28 weeks’ gestation; acute Q fever on serology Cotrimoxazole from 29 weeks’ gestation until term Spontaneous vaginal delivery at 40 weeks; C. burnetti detected on PCR of placenta, not detected in breastmilk; patient well

*Cotrimoxazole, trimethoprim/sulfamethoxazole.

Main Article

References
  1. Langley  JM. Perinatal Q fever: is Coxiella burnetii a human perinatal pathogen? In: Marrie TJ, editor. Q fever, volume 1: the disease. Boca Raton (FL): CRC Press; 1990. p. 201–12.
  2. Boden  K, Brueckmann  A, Wagner-Wiening  C, Hermann  B, Henning  K, Junghanss  T, et al. Maternofetal consequences of Coxiella burnetii infection in pregnancy: a case series of two outbreaks. BMC Infect Dis. 2012;12:359.PubMedGoogle Scholar
  3. Cerar  D, Karner  P, Avsic-Zupanc  T, Strle  F. Azithromycin for acute Q fever in pregnancy. Wien Klin Wochenschr. 2009;121:469–72.PubMedGoogle Scholar
  4. Marks  S, Olenski  M. Q fever in the first trimester: a case report from northern rural New South Wales. Trop Med Infect Dis. 2019;4:90.PubMedGoogle Scholar
  5. Téllez  A, Sanz Moreno  J, Valkova  D, Domingo  C, Anda  P, de Ory  F, et al. Q fever in pregnancy: case report after a 2-year follow-up. J Infect. 1998;37:79–81.PubMedGoogle Scholar
  6. Denman  J, Woods  M. Acute Q fever in pregnancy: report and literature review. Intern Med J. 2009;39:479–81.PubMedGoogle Scholar
  7. Braddick  M, Woods  ML, Prabhaharan  S. Acute Q fever in third trimester pregnancy. BMJ Case Rep. 2021;14:e242558.PubMedGoogle Scholar
  8. Raoult  D, Fenollar  F, Stein  A. Q fever during pregnancy: diagnosis, treatment, and follow-up. Arch Intern Med. 2002;162:701–4.PubMedGoogle Scholar
  9. Coste Mazeau  P, Hantz  S, Eyraud  JL, Donadel  L, Lacorre  A, Rogez  S, et al. Q fever and pregnancy: experience from the Limoges Regional University Hospital. Arch Gynecol Obstet. 2016;294:233–8.PubMedGoogle Scholar
  10. Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 16. Melbourne: Therapeutic Guidelines Limited; 2019.
  11. Centers for Disease Control and Prevention. Clinical guidance for Q fever [cited 2025 Sep 17]. https://www.cdc.gov/q-fever/hcp/clinical-guidance/index.html
  12. Maurin  M, Raoult  D. Q fever. Clin Microbiol Rev. 1999;12:518–53.PubMedGoogle Scholar
  13. Parker  NR, Barralet  JH, Bell  AM. Q fever. Lancet. 2006;367:679–88.PubMedGoogle Scholar
  14. Anderson  A, Bijlmer  H, Fournier  P-E, Graves  S, Hartzell  J, Kersh  GJ, et al. Diagnosis and management of Q fever—United States, 2013: recommendations from CDC and the Q Fever Working Group. MMWR Recomm Rep. 2013;62(RR-03):1–30.PubMedGoogle Scholar
  15. Ghanem-Zoubi  N, Paul  M. Q fever during pregnancy: a narrative review. Clin Microbiol Infect. 2020;26:864–70.PubMedGoogle Scholar
  16. Carcopino  X, Raoult  D, Bretelle  F, Boubli  L, Stein  A. Managing Q fever during pregnancy: the benefits of long-term cotrimoxazole therapy. Clin Infect Dis. 2007;45:548–55.PubMedGoogle Scholar
  17. Munster  JM, Leenders  AC, Hamilton  CJ, Meekelenkamp  JC, Schneeberger  PM, van der Hoek  W, et al. Routine screening for Coxiella burnetii infection during pregnancy: a clustered randomised controlled trial during an outbreak, the Netherlands, 2010. Euro Surveill. 2013;18:20504.PubMedGoogle Scholar
  18. Boast  A, Curtis  N, Gwee  A. QUESTION 1: Teething issues: can doxycycline be safely used in young children? Arch Dis Child. 2016;101:772–4.PubMedGoogle Scholar
  19. Pöyhönen  H, Nurmi  M, Peltola  V, Alaluusua  S, Ruuskanen  O, Lähdesmäki  T. Dental staining after doxycycline use in children. J Antimicrob Chemother. 2017;72:2887–90.PubMedGoogle Scholar
  20. Yu  PA, Tran  EL, Parker  CM, Kim  HJ, Yee  EL, Smith  PW, et al. Safety of antimicrobials during pregnancy: a systematic review of antimicrobials considered for treatment and postexposure prophylaxis of plague. Clin Infect Dis. 2020;70(Suppl 1):S37–50.PubMedGoogle Scholar
  21. Clay  KA, Hartley  MG, Armstrong  S, Bewley  KR, Godwin  K, Rayner  E, et al. Evaluation of the efficacy of doxycycline, ciprofloxacin, levofloxacin, and co-trimoxazole using in vitro and in vivo models of Q fever. Antimicrob Agents Chemother. 2021;65:e0067321.PubMedGoogle Scholar
  22. Munster  JM. Q fever during pregnancy: lessons from the Dutch epidemic [dissertation]. Groningen: University of Groningen; 2012.
  23. Hellmeyer  L, Schmitz-Ziegler  G, Slenczka  W, Schmidt  S. [Q Fever in pregnancy: a case report and review of the literature] [in German]. Z Geburtshilfe Neonatol. 2002;206:193–8.PubMedGoogle Scholar
  24. Friedland  JS, Jeffrey  I, Griffin  GE, Booker  M, Courtenay-Evans  R. Q fever and intrauterine death. Lancet. 1994;343:288.PubMedGoogle Scholar
  25. Bental  T, Fejgin  M, Keysary  A, Rzotkiewicz  S, Oron  C, Nachum  R, et al. Chronic Q fever of pregnancy presenting as Coxiella burnetii placentitis: successful outcome following therapy with erythromycin and rifampin. Clin Infect Dis. 1995;21:1318–21.PubMedGoogle Scholar
  26. Riechman  N, Raz  R, Keysary  A, Goldwasser  R, Flatau  E. Chronic Q fever and severe thrombocytopenia in a pregnant woman. Am J Med. 1988;85:253–4.PubMedGoogle Scholar
  27. García Lavandeira  S, Blanco Pérez  S, Varillas del Río  C. Q fever and pregnancy [in Spanish]. Clin Invest Ginecol Obstet. 2013;40:127–30.
  28. Jover-Díaz  F, Robert-Gates  J, Andreu-Gimenez  L, Merino-Sanchez  J. Q fever during pregnancy: an emerging cause of prematurity and abortion. Infect Dis Obstet Gynecol. 2001;9:47–9.PubMedGoogle Scholar
  29. Shinar  S, Skornick-Rapaport  A, Rimon  E. Placental abruption remote from term associated with Q Fever infection. Obstet Gynecol. 2012;120:503–5.PubMedGoogle Scholar
  30. Levin  G, Herzberg  S, Attari  R, Abu Khatab  A, Gil  M, Rottenstreich  A. Q fever first presenting as a septic shock resulting in intrauterine fetal death. Eur J Obstet Gynecol Reprod Biol. 2018;229:204–5.PubMedGoogle Scholar
  31. Ludlam  H, Wreghitt  TG, Thornton  S, Thomson  BJ, Bishop  NJ, Coomber  S, et al. Q fever in pregnancy. J Infect. 1997;34:75–8.PubMedGoogle Scholar
  32. Racult  D, Stein  A. Q fever during pregnancy—a risk for women, fetuses, and obstetricians. N Engl J Med. 1994;330:371.PubMedGoogle Scholar
  33. Stein  A, Raoult  D. Q fever during pregnancy: a public health problem in southern France. Clin Infect Dis. 1998;27:592–6.PubMedGoogle Scholar
  34. Gaburro  D. Epidemiological and clinical consideration on a Coxiella burnetii infection in three premature twin girls [in Italian]. G Mal Infett Parassit. 1956;8:384–9.
  35. Derrick  EH. The course of infection with Coxiella burneti. Med J Aust. 1973;1:1051–7.PubMedGoogle Scholar
  36. Ellis  ME, Smith  CC, Moffat  MA. Chronic or fatal Q-fever infection: a review of 16 patients seen in North-East Scotland (1967-80). Q J Med. 1983;52:54–66.PubMedGoogle Scholar
  37. Richardus  JH, Dumas  AM, Huisman  J, Schaap  GJ. Q fever in infancy: a review of 18 cases. Pediatr Infect Dis. 1985;4:369–73.PubMedGoogle Scholar
  38. van der Hoek  W, Meekelenkamp  JC, Leenders  AC, Wijers  N, Notermans  DW, Hukkelhoven  CW. Antibodies against Coxiella burnetii and pregnancy outcome during the 2007-2008 Q fever outbreaks in The Netherlands. BMC Infect Dis. 2011;11:44.PubMedGoogle Scholar
  39. de Lange  MM, Hukkelhoven  CW, Munster  JM, Schneeberger  PM, van der Hoek  W. Nationwide registry-based ecological analysis of Q fever incidence and pregnancy outcome during an outbreak in the Netherlands. BMJ Open. 2015;5:e006821.PubMedGoogle Scholar
  40. Signs  KA, Stobierski  MG, Gandhi  TN. Q fever cluster among raw milk drinkers in Michigan, 2011. Clin Infect Dis. 2012;55:1387–9.PubMedGoogle Scholar
  41. Kumar  A, Yadav  MP, Kakkar  S. Human milk as a source of Q-fever infection in breast-fed babies. Indian J Med Res. 1981;73:510–2.PubMedGoogle Scholar
  42. Prasad  BN, Chandiramani  NK, Wagle  A. Isolation of Coxiella burnetii from human sources. Int J Zoonoses. 1986;13:112–7.PubMedGoogle Scholar
  43. Munster  JM, Hamilton  CJ, Leenders  AC, Lestrade  PJ. [Chronic Q fever during pregnancy] [in Dutch]. Ned Tijdschr Geneeskd. 2011;155:A2781.PubMedGoogle Scholar
  44. Horta  BL, Rollins  N, Dias  MS, Garcez  V, Pérez-Escamilla  R. Systematic review and meta-analysis of breastfeeding and later overweight or obesity expands on previous study for World Health Organization. Acta Paediatr. 2023;112:34–41.PubMedGoogle Scholar
  45. Pérez-Escamilla  R, Tomori  C, Hernández-Cordero  S, Baker  P, Barros  AJD, Bégin  F, et al.; 2023 Lancet Breastfeeding Series Group. Breastfeeding: crucially important, but increasingly challenged in a market-driven world. Lancet. 2023;401:472–85.PubMedGoogle Scholar
  46. Victora  CG, Horta  BL, Loret de Mola  C, Quevedo  L, Pinheiro  RT, Gigante  DP, et al. Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil. Lancet Glob Health. 2015;3:e199–205.PubMedGoogle Scholar
  47. Waitt  C, Low  N, Van de Perre  P, Lyons  F, Loutfy  M, Aebi-Popp  K. Does U=U for breastfeeding mothers and infants? Breastfeeding by mothers on effective treatment for HIV infection in high-income settings. Lancet HIV. 2018;5:e531–6.PubMedGoogle Scholar
  48. Amit  S, Shinar  S, Halutz  O, Atiya-Nasagi  Y, Giladi  M. Suspected person-to-person transmission of Q fever among hospitalized pregnant women. Clin Infect Dis. 2014;58:e146–7.PubMedGoogle Scholar

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