Brucellosis in pregnancy: results of multicenter ID-IRI study
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Brucellosis in pregnant women is reported to be associated with obstetric complications (OCs), and adequate data for human brucellosis during pregnancy are largely lacking. We performed this multicenter retrospective cross-sectional study to evaluate the epidemiology, clinical course, treatment responses, and outcomes of brucellosis among pregnant women. The study period comprised a 14-year period from January 2002 to December 2015. All consecutive pregnant women diagnosed with brucellosis in 23 participating hospitals were included. Epidemiological, clinical, laboratory, therapeutic, and outcome data along with the assessment data of the neonate were collected using a standardized questionnaire. Data of 242 patients were analyzed. The OC rate was 14.0% (34/242) in the cohort. Of the 242 women, 219 (90.5%) delivered at term, 3 (1.2%) had preterm delivery, 15 (6.2%) aborted, and 5 (2.1%) had intrauterine fetal demise. Seventeen (7.0%) of the newborns were considered as low birth weight. Spontaneous abortion (6.1%) was the commonest complication. There were no maternal or neonatal deaths and pertinent sequelae or complications were not detected in the newborns. Splenomegaly (p = 0.019), nausea and/or vomiting (p < 0.001), vaginal bleeding (p < 0.001), anemia (blood hemoglobin < 11 g/dL; p < 0.001), high level of serum aspartate aminotransferase (> 41 IU/L; p = 0.025), oligohydramnios on ultrasonography (p = 0.0002), history of taking medication other than Brucella treatment during pregnancy (p = 0.027), and Brucella bacteremia (p = 0.029) were the significant factors associated with OCs. We recommend that pregnant women with OC or with fever should be investigated for brucellosis if they live in or have traveled to an endemic area.
KeywordsPregnancy Brucellosis Obstetrics Abortus Intrauterine fetal demise Risk factors
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest. NJB is affiliated to the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), in collaboration with Liverpool School of Tropical Medicine. NJB is based at the Liverpool School of Tropical Medicine. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England.
Ethics Committee of the Fatih Sultan Mehmet Training and Research Hospital Review Board, Istanbul, Turkey.
Not applicable. The study has a retrospective design.
- 1.Gul HC, Erdem H (2015) Brucellosis. In: Bennett J, Dolin R, Blaser M (eds) Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 8th Edition. Elsevier Co, Philadelphia, pp 2584–2589Google Scholar
- 3.Ozturk-Engin D, Erdem H, Gencer S, Kaya S, Baran AI, Batirel A et al (2014) Liver involvement in patients with brucellosis: results of the Marmara study. Eur J Clin Microbiol Infect Dis 33:1253–1262. https://doi.org/10.1007/s10096-014-2064-4
- 4.Erdem H, Elaldi N, Ak O, Gulsun S, Tekin R, Ulug M et al (2014) Genitourinary brucellosis: results of a multicentric study. Clin Microbiol Infect 20:O847–O853. https://doi.org/10.1111/1469-0691.12680
- 5.Erdem H, Inan A, Elaldi N, Tekin R, Gulsun S, Ataman-Hatipoglu C et al (2014) Respiratory system involvement in brucellosis: the results of the Kardelen Study. Chest 145:87–94. https://doi.org/10.1378/chest.13-0240
- 6.Ulu-Kilic A, Karakas A, Erdem H, Turker T, Inal AS, Ak O et al (2014) Update on treatment options for spinal brucellosis. Clin Microbiol Infect 2020:O75–O82 https://doi.org/10.1111/1469-0691.12351
- 7.Koruk ST, Erdem H, Koruk I, Erbay A, Tezer-Tekce Y, Erbay AR et al (2012) Management of Brucella endocarditis: results of the Gulhane study. Int J Antimicrob Agents 40:145–150. https://doi.org/10.1016/j.ijantimicag.2012.04.009
- 8.Erdem H, Ulu-Kilic A, Kilic S, Karahocagil M, Shehata G, Eren-Tulek N et al (2012) Efficacy and tolerability of antibiotic combinations in neurobrucellosis: results of the Istanbul study. Antimicrob Agents Chemother 56:1523–1528. https://doi.org/10.1128/AAC.05974-11 CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Mohammad KI, El Ghazaly MM, Zaalouk TKH, Morsy ATA (2011) Maternal brucellosis and human pregnancy. J Egypt Soc Parasitol 41:485–496. http://www.ncbi.nlm.nih.gov/pubmed/21980785
- 10.Gulsun S, Aslan S, Satici O, Gul T (2011) Brucellosis in pregnancy. Trop Doct 41:82–84. doi: http://www.ncbi.nlm.nih.gov/pubmed/21378061 https://doi.org/10.1258/td.2011.100386
- 11.Vilchez G, Espinoza M, D’Onadio G, Saona P, Gotuzzo E (2015) Brucellosis in pregnancy: clinical aspects and obstetric outcomes. Int. J Infect Dis 38:95–100. doi: https://linkinghub.elsevier.com/retrieve/pii/S1201971215001654 https://doi.org/10.1016/j.ijid.2015.06.027
- 12.Khan MY, Mah MW, Memish ZA (2001) Brucellosis in pregnant women. Clin Infect Dis 32:1172–1177. doi: https://doi.org/10.1086/319758
- 13.Mesner O, Riesenberg K, Biliar N, Borstein E, Bouhnik L, Peled N, et al (2007) The many faces of human-to-human transmission of brucellosis: congenital infection and outbreak of nosocomial disease related to an unrecognized clinical case. Clin Infect Dis 45:e135-40. https://doi.org/10.1086/523726 https://academic.oup.com/cid/article-lookup
- 14.World Health Organization (2018) Life expectancy and healthy life expecancy data by WHO region. WHO, Geneva [accessed 6 apr 2019]. http://apps.who.int/gho/data/view.main.SDG2016LEXREGv?lang=en
- 18.Makhseed M, Harouny A, Araj G, Moussa MA, Sharma P (1998) Obstetric and gynecologic implication of brucellosis in Kuwait. J Perinatol 18:196–9. doi: http://www.ncbi.nlm.nih.gov/pubmed/9659648
- 19.Lulu AR, Araj GF, Khateeb MI, Mustafa MY, Yusuf AR, Fenech FF (1988) Human brucellosis in Kuwait: a prospective study of 400 cases. Q J Med 66:39–54. http://www.ncbi.nlm.nih.gov/pubmed/3051080
- 20.Erdem H, Akova M (2012) Leading infectious diseases problems in Turkey. Clin Microbiol Infect 18:1056–1067. https://doi.org/10.1111/1469-0691.12000
- 21.Malone FD, Athanassiou A, Nores LA, Dalton ME (1997) Poor perinatal outcome associated with maternal Brucella abortus infection. Obstet Gynecol 90:674–676. http://www.ncbi.nlm.nih.gov/pubmed/11770592
- 23.Everett C (1997) Incidence and outcome of bleeding before the 20th week of pregnancy: prospective study from general practice. 315:32–34. https://doi.org/10.1136/bmj.315.7099.32
- 24.Firoz T, Maltepe C, Einarson A. (2010) Nausea and vomiting in pregnancy is not always nausea and vomiting of pregnancy. J Obstet Gynaecol Can 32:970–972. http://www.ncbi.nlm.nih.gov/pubmed/21176306
- 25.Romero-Gutiérrez G, Herrera-Coria J, Ruiz-Treviño AS (2014) Association of Doppler flowmetry with perinatal outcome in patients with oligohydramnios. Rev Med Inst Mex Seguro Soc 52:510–515. http://www.ncbi.nlm.nih.gov/pubmed/25301125
- 26.Arenas-Gamboa AM, Rossetti CA, Chaki SP, Garcia-Gonzalez DG, Adams LG, Ficht TA (2016) Human brucellosis and adverse pregnancy outcomes. Curr Trop Med Rep 3:164–172. https://doi.org/10.1007/s40475-016-0092-0