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Brucellosis
and
Pregnancy
Prof. Aboubakr
Elnashar
Benha University
Hospital, Egypt
Aboubakr Elnashar
CONTENTS
1. Causative organism
2. Epidemiology
3. Transmission to human
4. Clinical Manifestation
5. Investigations
6. Treatment
7. Prevention
Aboubakr Elnashar
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
Aboubakr Elnashar
2. Epidemiology
Major zoonotic disease.
Worldwide
Major endemic areas:
Mediterranean basin
Arabian Gulf
Indian subcontinent,
Parts of Mexico
Central and South America
Aboubakr Elnashar
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.
تربيه الماشيه
Aboubakr Elnashar
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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Brucellosis in Egypt:
Incidence:
common.
Among pregnant women
3.5%{Sherif et al.2003]
12 .2 %(Alshamy and Ahmed, 2008)
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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
Aboubakr Elnashar
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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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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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
inoculationAboubakr Elnashar
4. Clinical ManifestationUsually Acute febrile illness
accompanied by a wide array of other symptoms
Night sweats
Malaise
Anorexia
Arthralgia
Fatigue
Weight loss
Depression.
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Fever
1. Acute stages: high
2. undulant stages: low grade and intermittent
3. Chronic stages: low grade or absent
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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.
Aboubakr Elnashar
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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The disease may persist as
Relapse
Chronic localized infection
Delayed convalescence
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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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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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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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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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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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6. Treatment
Drugs against Brucella
Tetracycline's
Aminoglycosides
Streptomycin since 1947
Gentamicin
Netilmicin
Rifampicin
Quinolones - ciprofloxacin
?3rd generation cephalosporins
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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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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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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, PTL5. Investigations: Serum agglutination test Diagnostic level:1 : 160: non endemic area and 1 : 320: endemic area6. Treatment: Rifampicin7. Prevention: occupational and food hygiene
Aboubakr Elnashar
Aboubakr Elnashar
You can get this lecture from:1.My scientific page on Face book:
Aboubakr Elnashar Lectures.
https://www.facebook.com/groups/2277
44884091351/
2.Slide share web site
4.My clinic: Elthwara St. Mansura