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Brucellosis and pregnancy

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Brucellosis and pregnancy

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Brucellosis and pregnancy

  1. 1. Brucellosis and Pregnancy Prof. Aboubakr Elnashar Benha University Hospital, Egypt Aboubakr Elnashar
  2. 2. Other names for Brucellosis  Undulant fever  Malta fever  Mediterranean fever. Aboubakr Elnashar
  3. 3. CONTENTS 1. Causative organism 2. Epidemiology 3. Transmission to human 4. Clinical Manifestation 5. Investigations 6. Treatment 7. Prevention Aboubakr Elnashar
  4. 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 Aboubakr Elnashar
  5. 5. 2. Epidemiology  Major zoonotic disease.  Worldwide  Major endemic areas: Mediterranean basin Arabian Gulf Indian subcontinent, Parts of Mexico Central and South America Aboubakr Elnashar
  6. 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 Aboubakr Elnashar
  7. 7. Brucellosis in Saudi Arabia Endemic National prevalence: 15% 1. Persistence of domestic animal reservoirs for Brucella species 2. Human consumption of unpasteurized products Aboubakr Elnashar
  8. 8. Brucellosis in Egypt: Incidence: common. Among pregnant women 3.5% {Sherif et al.2003] 12 .2 % (Alshamy and Ahmed, 2008) Aboubakr Elnashar
  9. 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 Aboubakr Elnashar
  10. 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. Aboubakr Elnashar
  11. 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 Aboubakr Elnashar
  12. 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. 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. Aboubakr Elnashar
  14. 14. Fever 1. Acute stages: high 2. undulant stages: low grade and intermittent 3. Chronic stages: low grade or absent Aboubakr Elnashar
  15. 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. Aboubakr Elnashar
  16. 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. Aboubakr Elnashar
  17. 17. The disease may persist as  Relapse  Chronic localized infection  Delayed convalescence Aboubakr Elnashar
  18. 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 Aboubakr Elnashar
  19. 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. Aboubakr Elnashar
  20. 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. Aboubakr Elnashar
  21. 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) Aboubakr Elnashar
  22. 22.  Serum agglutination test  most widely used  measures agglutination for IgG, IgM, IgA  Diagnostic level: 1 : 160: non endemic area 1 : 320: endemic area Aboubakr Elnashar
  23. 23. Aboubakr Elnashar
  24. 24. 6. Treatment Drugs against Brucella  Tetracycline's  Aminoglycosides  Streptomycin since 1947  Gentamicin  Netilmicin  Rifampicin  Quinolones - ciprofloxacin  ?3rd generation cephalosporins Aboubakr Elnashar
  25. 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 Aboubakr Elnashar
  26. 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 Aboubakr Elnashar
  27. 27. Prevention Aboubakr Elnashar
  28. 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 Aboubakr Elnashar
  29. 29. 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 3.elnashar53@hotmail.com 4.My clinic: Elthwara St. Mansura

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