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Q fever transmission suspected among hospitalized pregnant women
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Physicians at Tel Aviv Sourasky Medical Center in Israel have reported a suspected case of person-to-person transmission of Q fever among hospitalized pregnant women.
“We strongly suspect Q fever cross infection by sharing a living space and a toilet with an infective patient via transfer of aerosolized infectious particles, possibly vaginally excreted placental products,” they wrote in The Journal of Infectious Diseases. “We speculate that toilet flushing may have promoted infectivity by aerosolization of secretion as described for other pathogens.”
A healthy pregnant woman aged 32 years was admitted to the high-risk pregnancy unit at 23 weeks gestation because of repeated episodes of vaginal bleeding. Because she had impaired liver function tests, she underwent serologic analysis for Q fever and the results were consistent with recently acquired Q fever.
The patient’s history indicated she had participated in the delivery of her domestic dog 1 month prior, and the dog was later found positive for Q fever. She began treatment with trimethoprim-sulfamethoxazole. At 28 weeks gestation, after 5 weeks of intermittent vaginal bleeding, she gave birth to a baby boy weighing 1,200 g. She had near-complete placental abruption and severe placentitis. The placental tissue and breast milk were positive for Q fever, but the baby tested negative.
Another woman aged 32 years at 26 weeks gestation with a twin pregnancy was admitted during this time and housed with the other patient before the knowledge of her infection. She developed severe preeclampsia and had an uneventful emergency cesarean section at 32 weeks gestation. The baby boys weight 1,500 g and 1,150 g.
She was readmitted to the hospital 1 week postpartum due to fever and mild cough, and physical examination found minimal crackles at lung bases. Because of the hospital staff’s knowledge of her previous roommate and infection, she underwent serology for Q fever. The results were consistent with acute Q fever, and she had no known risk factors for the infection. Her hospitalization for 6 weeks before giving birth made pre-admission infection highly unlikely because the time exceeds the usual incubation period of Q fever.
“In order to minimize chances of cross infection, we suggest that in Q fever endemic areas, hospitalized pregnant women with repeated episodes of vaginal bleeding should be specifically inquired regarding environmental, behavioral and occupational risk factors for Q fever infection,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.
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