Acute Q fever in third trimester pregnancy.

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Microbiology

Background:

• Q fever, caused by Coxiella burnetii, poses risks during pregnancy, including chronic infection and obstetric complications.
• Acute Q fever in pregnancy is often under-diagnosed, necessitating awareness and prompt diagnostic approaches.

Observation:

• A 29-year-old pregnant woman presented with symptoms including fever, back pain, thrombocytopenia, and hepatitis at 29 weeks gestation.
• Polymerase chain reaction (PCR) and serology confirmed acute Q fever infection.

Findings:

• Empirical treatment with oral clarithromycin resulted in symptomatic and biochemical improvement.
• A switch to trimethoprim/sulphamethoxazole caused a cutaneous reaction, necessitating a return to clarithromycin.
• The patient delivered a healthy infant at 39 weeks and 3 days gestation.

Implications:

• This case suggests clarithromycin is an effective treatment option for acute Q fever in pregnancy, particularly when trimethoprim/sulphamethoxazole is contraindicated due to adverse reactions.
• Increased awareness and reporting of Q fever in pregnancy are needed to understand its full impact and optimize patient care.