Advertisement

Brucellosis in pregnancy: results of multicenter ID-IRI study

  • Asuman Inan
  • Hakan ErdemEmail author
  • Nazif Elaldi
  • Serda Gulsun
  • Mustafa K. Karahocagil
  • Abdullah U. Pekok
  • Mehmet Ulug
  • Recep Tekin
  • Mile Bosilkovski
  • Safak Kaya
  • Asli Haykir-Solay
  • Tuna Demirdal
  • Selcuk Kaya
  • Mahmut Sunnetcioglu
  • Alper Sener
  • Selma Tosun
  • Emsal Aydin
  • Serap Ural
  • Tansu Yamazhan
  • Murat Muhcu
  • Ergin Ayaslioglu
  • Seval Bilgic-Atli
  • Ayse Erbay
  • Pinar Ergen
  • Ayten Kadanali
  • Suzan Sahin
  • Elif Sahin-Horasan
  • Ali Avci
  • Yakup Cag
  • Nicholas J. Beeching
Original Article
  • 35 Downloads

Abstract

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.

Keywords

Pregnancy Brucellosis Obstetrics Abortus Intrauterine fetal demise Risk factors 

Notes

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.

Ethical approval

Ethics Committee of the Fatih Sultan Mehmet Training and Research Hospital Review Board, Istanbul, Turkey.

Informed consent

Not applicable. The study has a retrospective design.

References

  1. 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
  2. 2.
    Yumuk Z, O’Callaghan D (2012) Brucellosis in Turkey—an overview. Int J Infect Dis 16:e228–e235.  https://doi.org/10.1016/j.ijid.2011.12.011 CrossRefGoogle Scholar
  3. 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. 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. 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. 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. 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. 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 CrossRefGoogle Scholar
  9. 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. 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. 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. 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. 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. 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
  15. 15.
    Elshamy M, Ahmed AI (2008) The effects of maternal brucellosis on pregnancy outcome. J Infect Dev Ctries 2:230–234.  https://doi.org/10.3855/jidc.268 CrossRefGoogle Scholar
  16. 16.
    Kurdoglu M, Adali E, Kurdoglu Z, Karahocagil MK, Kolusari A, Yildizhan R et al (2010) Brucellosis in pregnancy: a 6-year clinical analysis. Arch Gynecol Obstet 281:201–206.  https://doi.org/10.1007/s00404-009-1106-0 CrossRefGoogle Scholar
  17. 17.
    Al-Tawfiq JA, Memish ZA (2013) Pregnancy associated brucellosis. Recent Pat Antiinfect Drug Discov 8:47–50.  https://doi.org/10.2174/157489113805290719 CrossRefGoogle Scholar
  18. 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. 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. 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. 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
  22. 22.
    Yang J, Hartmann KE, Savitz DA, Herring AH, Dole N, Olshan AF et al (2004) Vaginal bleeding during pregnancy and preterm birth. Am J Epidemiol 160:118–125.  https://doi.org/10.1093/aje/kwh180 CrossRefGoogle Scholar
  23. 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. 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. 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. 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

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Asuman Inan
    • 1
  • Hakan Erdem
    • 2
    Email author
  • Nazif Elaldi
    • 3
  • Serda Gulsun
    • 4
  • Mustafa K. Karahocagil
    • 5
  • Abdullah U. Pekok
    • 6
  • Mehmet Ulug
    • 7
  • Recep Tekin
    • 8
  • Mile Bosilkovski
    • 9
  • Safak Kaya
    • 4
  • Asli Haykir-Solay
    • 10
  • Tuna Demirdal
    • 11
  • Selcuk Kaya
    • 12
  • Mahmut Sunnetcioglu
    • 5
  • Alper Sener
    • 13
  • Selma Tosun
    • 14
  • Emsal Aydin
    • 15
  • Serap Ural
    • 11
  • Tansu Yamazhan
    • 16
  • Murat Muhcu
    • 17
  • Ergin Ayaslioglu
    • 18
  • Seval Bilgic-Atli
    • 4
  • Ayse Erbay
    • 19
  • Pinar Ergen
    • 20
  • Ayten Kadanali
    • 21
  • Suzan Sahin
    • 22
  • Elif Sahin-Horasan
    • 23
  • Ali Avci
    • 24
  • Yakup Cag
    • 25
  • Nicholas J. Beeching
    • 26
  1. 1.Department of Infectious Diseases and Clinical MicrobiologyHaydarpasa Numune Training and Research HospitalIstanbulTurkey
  2. 2.Department of Infectious Diseases and Clinical MicrobiologyGulhane Training and Research HospitalAnkaraTurkey
  3. 3.Department of Infectious Diseases and Clinical Microbiology, School of MedicineCumhuriyet UniversitySivasTurkey
  4. 4.Department of Infectious Diseases and Clinical MicrobiologyDiyarbakir Training and Research HospitalDiyarbakirTurkey
  5. 5.Department of Infectious Diseases and Clinical MicrobiologyYuzuncuyil University School of MedicineVanTurkey
  6. 6.Department of Infectious Diseases and Clinical MicrobiologyPendik Medical Park HospitalIstanbulTurkey
  7. 7.Department of Infectious Diseases and Clinical MicrobiologyPrivate Umut HospitalEskisehirTurkey
  8. 8.Department of Infectious Diseases and Clinical MicrobiologyDicle University School of MedicineSivasTurkey
  9. 9.Department of Infectious Diseases and Febrile ConditionsSkopje Medical FacultySkopjeRepublic of Macedonia
  10. 10.Department of Infectious Diseases and Clinical MicrobiologyDışkapı Yıldırım Beyazıt Training and Research HospitalAnkaraTurkey
  11. 11.Department of Infectious Diseases and Clinical MicrobiologyKatip Celebi University School of MedicineIzmirTurkey
  12. 12.Department of Infectious Diseases and Clinical MicrobiologyKaradeniz Technical University School of MedicineTrabzonTurkey
  13. 13.Department of Infectious Diseases and Clinical MicrobiologyOnsekiz Mart University School of MedicineCanakkaleTurkey
  14. 14.Department of Infectious diseases and Clinical MicrobiologyIzmir Bozyaka Training and Research HospitalIzmirTurkey
  15. 15.Department of Infectious Diseases and Clinical MicrobiologyKafkas University School of MedicineKarsTurkey
  16. 16.Department of Infectious Diseases and Clinical MicrobiologyEge University School of MedicineIzmirTurkey
  17. 17.Department of Obstetrics and GynecologyGATA Haydarpasa Training HospitalIstanbulTurkey
  18. 18.Department of Infectious Diseases and Clinical MicrobiologyKirikkale University School of MedicineKırıkkaleTurkey
  19. 19.Department of Infectious Diseases and Clinical MicrobiologyBozok University School of MedicineYozgatTurkey
  20. 20.Department of Infectious Diseases and Clinical MicrobiologyMedeniyet University, Goztepe Training and Research HospitalIstanbulTurkey
  21. 21.Department of RadiologyUmraniye Training and Research HospitalIstanbulTurkey
  22. 22.Department of Infectious Diseases and Clinical MicrobiologyDr. Lutfi Kirdar Training and Research HospitalIstanbulTurkey
  23. 23.Department of Infectious Diseases and Clinical MicrobiologyMersin University School of MedicineMersinTurkey
  24. 24.Department of UrologyKatip Celebi University, Ataturk Training and Research HospitalIzmirTurkey
  25. 25.Department of Infectious Diseases and Clinical MicrobiologyTurkish Health Sciences University, Dr. Lutfi Kirdar Training and Research HospitalIstanbulTurkey
  26. 26.Clinical Sciences, Liverpool School of Tropical MedicineLiverpoolUK

Personalised recommendations