Abstract
The etiologies of undifferentiated fever in pregnant women have not been studied thoroughly. Because of its non-specific presentation but severe prognosis, listeriosis is often suspected in this setting, but in most cases not confirmed. We studied the causes of undifferentiated fever in pregnant women who received preemptive listeriosis treatment. We conducted from November 1, 2011, to June 30, 2013, a prospective multicentric observational cohort study of pregnant women referred to obstetrical wards with undifferentiated fever and who received listeriosis preemptive treatment. Clinical and biological features, treatment, outcome, and final diagnosis were collected. We enrolled 103 febrile pregnant women. A cause was identified in 77/103 (75%): viral infection in 52/103 (50%, influenza in 21 (20%)), bacterial infection in 22 (21%, including 16 pyelonephritis (16%) and 3 pneumonias (3%)), and TORCH infection in 3 (3%, varicella, toxoplasmosis, and cytomegalovirus primo-infections, n=1, each). Viral infections collected during influenza outbreaks (December–March) accounted for 43/57 (75%) cases. Two fetal losses were reported in the context of febrile pneumonia. Final diagnoses required adapting medical care in 46/77 (60%) of cases, for bacterial, influenza, or TORCH infections. A large array of benign to potentially severe infections manifests as acute undifferentiated fever in pregnant women, requiring careful repeated evaluation.
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References
Surgers L, Bleibtreu A, Burdet C, Clermont O, Laouenan C, Lefort A, Mentre F, Carbonne B, Bingen E, Meynard JL, Denamur E (2014) Escherichia coli bacteraemia in pregnant women is life-threatening for foetuses. Clin Microbiol Infect 20(12):O1035–O1041. https://doi.org/10.1111/1469-0691.12742
Le Gouez A, Benachi A, Mercier FJ (2016) Fever and pregnancy. Anaesth Crit Care Pain Med 35(Suppl 1):S5–S12. https://doi.org/10.1016/j.accpm.2016.06.007
Mallart E, Charlier C (2018) Main complications of pregnancy. Fever and pregnancy. Rev Prat 68(7):e277–e282
Charlier C, Perrodeau E, Leclercq A, Cazenave B, Pilmis B, Henry B, Lopes A, Maury MM, Moura A, Goffinet F, Dieye HB, Thouvenot P, Ungeheuer MN, Tourdjman M, Goulet V, de Valk H, Lortholary O, Ravaud P, Lecuit M (2017) Clinical features and prognostic factors of listeriosis: the MONALISA national prospective cohort study. Lancet Infect Dis 17(5):510–519. https://doi.org/10.1016/S1473-3099(16)30521-7
Mylonakis E, Paliou M, Hohmann EL, Calderwood SB, Wing EJ (2002) Listeriosis during pregnancy: a case series and review of 222 cases. Medicine 81(4):260–269
Elinav H, Hershko-Klement A, Solt I, Glikman D, Nir-Paz R (2015) Pregnancy-associated listeriosis: many beliefs, few facts. Lancet Infect Dis 15(10):1128–1130. https://doi.org/10.1016/S1473-3099(15)00302-3
Elinav H, Hershko-Klement A, Valinsky L, Jaffe J, Wiseman A, Shimon H, Braun E, Paitan Y, Block C, Sorek R, Nir-Paz R (2014) Pregnancy-associated listeriosis: clinical characteristics and geospatial analysis of a 10-year period in Israel. Clin Infect Dis 59(7):953–961. https://doi.org/10.1093/cid/ciu504
Janakiraman V (2008) Listeriosis in pregnancy: diagnosis, treatment, and prevention. Rev Obstet Gynecol 1(4):179–185
Charlier C, Goffinet F, Azria E, Leclercq A, Lecuit M (2013) Inadequate management of pregnancy-associated listeriosis: lessons from four case reports. Clin Microbiol Infect. https://doi.org/10.1111/1469-0691.12281
Benshushan A, Tsafrir A, Arbel R, Rahav G, Ariel I, Rojansky N (2002) Listeria infection during pregnancy: a 10 year experience. Isr Med Assoc J 4(10):776–780
Committee on Obstetric Practice ACoO, Gynecologists (2014) Committee opinion no. 614: management of pregnant women with presumptive exposure to Listeria monocytogenes. Obstet Gynecol 124(6):1241–1244. https://doi.org/10.1097/01.AOG.0000457501.73326.6c
de Valk H, Tourdjman M, Leclercq A, Maury M, Moura A, Laurent E, Chenal-Francisque V, Goulet V, Brisse S, Lecuit M (2016) Changes in epidemiology and surveillance of listeriosis in France. In: International Symposium On Problems of Listeriosis. Institut Pasteur, Paris
Caron F, Galperine T, Flateau C, Azria R, Bonacorsi S, Bruyere F, Cariou G, Clouqueur E, Cohen R, Doco-Lecompte T, Elefant E, Faure K, Gauzit R, Gavazzi G, Lemaitre L, Raymond J, Senneville E, Sotto A, Subtil D, Trivalle C, Merens A, Etienne M (2018) Practice guidelines for the management of adult community-acquired urinary tract infections. Med Mal Infect 48(5):327–358. https://doi.org/10.1016/j.medmal.2018.03.005
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This study received funding from Programme hospitalier de recherche clinique, Institut Pasteur, Inserm, Santé Publique France.
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In accordance with French legislation, the study received Institutional Review Board approval by an ethical committee (Comité de Protection des Personnes Ile-de-France 3, November 6, 2009).
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Charlier, C., Perrodeau, E., Levallois, C. et al. Causes of fever in pregnant women with acute undifferentiated fever: a prospective multicentric study. Eur J Clin Microbiol Infect Dis 39, 999–1002 (2020). https://doi.org/10.1007/s10096-019-03809-3
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DOI: https://doi.org/10.1007/s10096-019-03809-3