Brucellosis in pregnancy

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Presentation transcript:

Brucellosis in pregnancy Bosilkovski Mile, PhD University clinic for infectious diseases and febrile conditions Medical Faculty Skopje Peta školu infektologije sa međunarodnim učešćem „Infekcije trudnica i djece“ Sarajevo, 24.03.2018.

Brucellosis in pregnant animals vs. pregnant women Brucellosis causes fewer spontaneous abortions in humans than it does in animals. Kurdoglu 2015, ElShamy 2008 The reasons why adverse obstetric outcomes are less frequent in humans: Absence of erythrol in the women’s placenta. The anti brucellar activity in human amniotic fluid. Al-Tawfiq 2013, Malone 1997, Khan 2001

Reasons for unfavorable obstetric outcomes in humans Maternal bacteremia Acute febrile reaction DIC Placentitis Allergic mechanism Endotoxemia ElShamy 2008, Aydin 2013, Kurdoglu 2010

Risk factor for adverse pregnancy outcomes Group Spontaneus abortion IUFD* Preterm delivery Pregnant with brucellosis (n=55) 15 (27%) 7 (13%) 6 (11%) Healthy pregnant (n=395) 60 (15%) 15 (4%) 35 (9%) *IUFD – intrauterine fetal death ElShamy 2008

Risk factor for adverse pregnancy outcomes Group Term delivery LBW Preterm delivery Spont. abort. 40 healthy pregnant 35 (88%) 4 (10%) 1 (2%) 39 pregnant with brucellosis 21 (54%) 10 (26%) 7 (18%) 1 (2%) *LBW – low body weight Gulsun 2011

Pregnancy incidence in patients with brucellosis 19 pregnant in 1245 patients with brucellosis (1.5%). Roushan 2011 21 pregnant in 342 patients with brucellosis (6%). Kurdoglu 2010 92 pregnant in 545 cases with brucellosis (17%). Khan 2001 17 pregnant among 1739 patients with brucellosis (1%). Bosilkovski unpublished

Outcome Obstetric outcomes Term delivery 47% - 100% Abortion 3% - 54% Roushan 2011, Figueroa Damian 1995 Abortion 3% - 54% Gulsun 2011, Mouhamed 1985 IUFD 0 - 13% Roushan 2011, ElShamy 2008 Premature delivery 7% - 28% Kurdoglu 2010, Hackmon 1998

Outcome B. Outcome for INFANTS UNINFECTED INFECTED - congenital / neonatal brucellosis Favorable Death 6% (Khan 2001) 8% (Vilchez 2015) LBW 26% (Gulsun 2011) 14% (Vilchez 2015) Development delay Congenital malformations NO (Gulsun 2011, ElShamy 2008)

C. Outcome for pregnant woman No increased life-threatening risk from brucellosis. Gulsun 2011 D. Outcome for environment Delivery team infection. Karcaaltincaba 2010, Mesner 2007, Poulou 2006

Advantages of treatment Prompt diagnosis and treatment decrease the risk. Kurdoglu 2015, Roushan 2011, Karcaaltincaba 2010 Among 13 patients who were treated, four (31%) aborted and nine (69%) had normal term deliveries. All 6 untreated women aborted. Roushan 2011 Rifampin in combination with TMP-SMX for six weeks. Karcaaltincaba 2010, Bosilkovski unpublished, Roushan 2011

Control and prevention In endemic regions: Routine SCREENING for brucellosis in pregnancy. Cacache 2013, ElShamy 2008 EDUCATING women of childbearing age. Kurdoglu 2010, Roushan 2011, Ijayo 2011 TESTING suspicious cases. Ali 2016, Bosilkovski unpublished

Conclusions Brucellosis is PRESENT among pregnant women. The incidence of adverse obstetric outcomes in pregnant women with brucellosis EXCEEDS the rates among the general population. Natural history of brucellosis in pregnant women could be altered by EARLY ADMINISTRATION of antibiotics. In endemic regions screening and education of pregnant women should be compulsory prevention measures.