Brucellosis and pregnancy

1. Brucellosis
and
Pregnancy
Prof. Aboubakr
Elnashar
Benha University
Hospital, Egypt
Aboubakr Elnashar

2. Other names for Brucellosis
 Undulant fever
 Malta fever
 Mediterranean fever.
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3. CONTENTS
1. Causative organism
2. Epidemiology
3. Transmission to human
4. Clinical Manifestation
5. Investigations
6. Treatment
7. Prevention
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4. 1. Causative organism
Brucella
Coccobacillus, gram negative, non-sporing
Non-motile aerobic bacterium
Hosts: mostly animals.
Four species:
Melitensis: most frequent human infection
Abortus
Suis
Canis
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5. 2. Epidemiology
 Major zoonotic disease.
 Worldwide
 Major endemic areas:
Mediterranean basin
Arabian Gulf
Indian subcontinent,
Parts of Mexico
Central and South America
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6. Risk factors:
1. Family history of brucellosis
2. Stockbreeding
3. Ingestion of non-pasteurized dairy products:
most common source of transmission.
 Occupational status and
family history of brucellosis should be
obtained during prenatal care in at-risk areas.
‫الماشيه‬ ‫تربيه‬
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7. Brucellosis in Saudi Arabia
Endemic
National prevalence: 15%
1. Persistence of domestic animal reservoirs for
Brucella species
2. Human consumption of unpasteurized products
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8. Brucellosis in Egypt:
Incidence:
common.
Among pregnant women
3.5%
{Sherif et al.2003]
12 .2 %
(Alshamy and Ahmed, 2008)
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9. 3. Methods of transmission
1. Direct
1. inoculation through cuts and skin abrasions from
handling animal carcasses, placentas, or contact
with animal vaginal secretions
2. Direct conjunctival inoculation
2. Inhalation
of infectious aerosols
3. Ingestion
of contaminated food such as raw milk, cheese
made from unpasteurized (raw) milk, or raw meat
 Venereal
has been suggested, but the data are not
conclusive
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10.  Types of transmission
1. Consumption of:
1. unpasteurized milk
2. soft cheeses made from the milk of infected
animals, primarily goats, infected with B melitensis
2. Occupational
1. laboratory workers
2. Veterinarians
3. Slaughterhouse workers.
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11. Incubation period
 Few days to a few months.
 In most patients
 2 and 6 w
 Duration depend on:
 virulence of the infecting strain
 size of the inoculum
 route of infection
 resistance of the host
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12. Portals of entry
 Oral entry
 Most common route
 Ingestion of contaminated animal products
(often raw milk or its derivatives)
 Contact with contaminated fingers
 Aerosols
 Inhalation of bacteria
 Contamination of the conjunctivae
 Per cutaneous
 through skin abrasions or by accidental
inoculation Aboubakr Elnashar

13. 4. Clinical Manifestation
Usually Acute febrile illness
accompanied by a wide array of other symptoms
 Night sweats
 Malaise
 Anorexia
 Arthralgia
 Fatigue
 Weight loss
 Depression.
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14. Fever
1. Acute stages: high
2. undulant stages: low grade and intermittent
3. Chronic stages: low grade or absent
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15.  Complications may affect any organ system
1. Osteoarticular disease
most common complication (i.e., sacroiliitis and
peripheral arthritis)
2. Genitourinary disease
second most common complication.
3. Liver disease
second most common medical complication in
brucellosis are more susceptible to develop
liver disease.
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16. 4. Hematological disease
Anaemia:
found in 72.3%
{role of iron in the biology of Brucella}
Leukopenia and lymphopenia
(the latter considered a prognostic factor)
Leukocytosis
23.1%
Thrombocytopenia:
occurs rarely
: fatal CNS bleeding.
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17. The disease may persist as
 Relapse
 Chronic localized infection
 Delayed convalescence
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18. Brucellosis and pregnancy outcome:
1. Abortion.
 The incidence : 27%
 There was a statistically significant difference in
abortion rates between patients with a titre
more than 1/160 and those with a titre less than
1/160
 Causes of spontaneous abortion and IUFD
Maternal bacteremia
Toxemia
Acute febrile reaction
DIC
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19. 2. IUFD
 More frequently than do other bacterial infections
 12%
3. Chorioamnionitis,
4. Preterm labour
 10%.
 The frequency of fetal loss among patients with
brucellosis is very high.
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20. 5. Investigations
 CBC:
Total counts:
Normal/reduced
Thrombocytopenia
 ESR/CRP:
Normal/Increased
 CSF/Body fluid analysis:
Lymphocytosis, low glucose levels, elevated ADA
 Biopsied samples of lymph node, liver:
non caveating granuloma without acid fast bacilli.
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21. Serological Tests
 Main laboratory method of diagnosis
 based on antibody detection
 include:
 Serum agglutination (standard tube agglutination)
 ELISA Rose Bengal agglutination
 Complement fixation
 Indirect Coombs
 Immunecapture-agglutination (Brucellacapt)
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22.  Serum agglutination test
 most widely used
 measures agglutination for IgG, IgM, IgA
 Diagnostic level:
1 : 160: non endemic area
1 : 320: endemic area
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23. Aboubakr Elnashar

24. 6. Treatment
Drugs against Brucella
 Tetracycline's
 Aminoglycosides
 Streptomycin since 1947
 Gentamicin
 Netilmicin
 Rifampicin
 Quinolones - ciprofloxacin
 ?3rd generation cephalosporins
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25. WHO recommends
Non pregnant:
 Regimen A:
Doxycycline 100 mg orally twice daily for 6 w +
Streptomycin 1 g IM once daily for 2-3 w
more effective, mainly in preventing relapse.
 Regimen B:
Doxycycline 100 mg orally twice daily plus
Rifampin 600 to 900 mg (15 mg/kg) orally once
daily for 6 w.
more convenient but probably increases the
risk of relapse
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26. Pregnant
 Rifampicin:
 900 mg once daily for 6 w
 mainstay of treatment of brucellosis during
pregnancy OR
 Rifampicin:
 900 mg once daily plus
Trimethoprim-Sulphmethoxazole
5 mg/kg of the trimethoprim component twice daily
for 4 w
incidence of abortion was not different among
patients who received TMP-SMX alone or received
TMPSMX and rifampicin
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27. Prevention
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28. Conclusion
1. Causative organism: Melitensis: most frequent
human infection
2. Epidemiology: Among pregnant women
3.5%-12 .2 %
3. Transmission to human: direct, inhalation, ingestion
4. Clinical Manifestation: Abortion, IUFD,
Chorioamnionitis, PTL
5. Investigations: Serum agglutination test Diagnostic
level:1 : 160: non endemic area and 1 : 320: endemic
area
6. Treatment: Rifampicin
7. Prevention: occupational and food hygiene
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29. Aboubakr Elnashar
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