Professional Documents
Culture Documents
Brucella species occasionally cause spontaneous human abortion, but theories regarding whether they do so
more frequently than do other infectious pathogens remain controversial. We reviewed 92 pregnant women
who presented with acute brucellosis at a Saudi Arabian hospital. From 1983 through 1995, the cumulative
incidence of pregnancy and brucellosis was 1.3 cases per 1000 delivered obstetrical discharges. The incidence
of spontaneous abortion in the first and second trimesters was 43%, and the incidence of intrauterine fetal
death in the third trimester was 2%. Antepartum antimicrobial therapy with cotrimoxazole or cotrimoxazole/
rifampin was protective against spontaneous abortion (relative risk, 0.14; 95% confidence interval, 0.060.37;
P ! .0001). The beneficial effect of treatment occurred in women with febrile illness; vaginal bleeding at
presentation usually led to spontaneous abortion. This study demonstrated that the incidence of spontaneous
abortion among pregnant women with brucellosis is high and that these women should receive prompt therapy
with antimicrobial agents when they present for medical care.
Brucellosis, a zoonotic disease of global importance [1],
is endemic in Saudi Arabia (national seroprevalence,
15%) [2]. Endemicity in this region results from the
persistence of domestic animal reservoirs for Brucella
species and the human consumption of unpasteurized
dairy products [3, 4].
Various Brucella species are well-known causes of contagious abortion in cattle, sheep, goats, swine, and dogs
[5]. There is also evidence that brucellosis can produce
spontaneous abortion in humans, which has been demonstrated by rare cases in which Brucella species were
isolated from fetal or placental tissues, but it has not
been demonstrated that brucellosis causes abortions
more frequently than do other bacterial infections [6].
a
Current affiliation: Department of Medicine, Maricopa Medical Center,
Phoenix, Arizona.
Characteristic
No. (%)
of patients
14 (15)
2125
32 (35)
2630
19 (21)
3135
15 (16)
3642
10 (11)
4347
2 (2)
4 (4)
6 (7)
7 (8)
71 (81)
62 (72)
16 (18)
4 (5)
4 (5)
RESULTS
From 1983 through 1995, there were 545 cases of brucellosis
at the hospital, of which 92 (17%) occurred in pregnant women
23 (25)
44 (48)
25 (27)
No. of
patients
No. (%) of
spontaneous
abortions
First
23
12 (52)
Second
44
28 (64)
Third
25
2 (8)
92
42 (46)
Trimester of pregnancy
Total
a
a
DISCUSSION
We found that the incidence of spontaneous abortion and
intrauterine death among a retrospective cohort of 92 pregnant
women with acute brucellosis due primarily to B. melitensis
was 46%. As shown in the Results section, the rates of spontaneous abortion and intrauterine death among women with
active brucellosis substantially exceeded the rates of spontaneous abortion and intrauterine death among the general population of pregnant women at our institution during the corresponding trimesters. The frequency of fetal loss among
patients with brucellosis was comparable in the first and second
trimesters, but intrauterine fetal death during the third trimester was uncommon. Most of these women were older than
20 years of age, were not primigravid, and most had not had
a spontaneous abortion prior to the study period. Our rate of
incidence exceeds the 10% rate reported by Criscuolo and di
Treated
Had spontaneous
abortion
12
11
Total
First
Vaginal bleeding with or without febrile illness
Predominantly febrile illness
12
11
Second
Vaginal bleeding with or without febrile illness
28c
28
16d
16
14e
1f
11
11
92
41
42
Third
Febrile illness at term or postpartum
Preterm febrile illness
Total
a
b
c
d
e
f
g
Treatment
Treated
Had normal
deliveries
Had spontaneous
abortion or
fetal death
3
CMZ
23
19
CMZ Rif
17
16
41
36
Rif
Total
Acknowledgments
References
1. Matyas Z, Fujikura T. Brucellosis as a world problem. Dev Biol Stand
1984; 56:320.
2. Al Sekait MA. Seroepidemiological survey of brucellosis antibodies in
Saudi Arabia. Annals of Saudi Medicine 1999; 19:21922.
3. Kiel FW, Khan MY. Brucellosis in Saudi Arabia. Soc Sci Med 1989;
29:9991001.
4. Cooper CW. Risk factors in transmission of brucellosis from animals
to humans in Saudi Arabia. Trans R Soc Trop Med Hyg 1992; 86:2069.
5. Young EJ. Brucella species. In: Mandell GL, Bennett JE, Dolin R, eds.
Mandell, Douglas and Bennetts principles and practice of infectious
diseases. 4th ed. New York: Churchill Livingstone, 1995:205360.
6. Young EJ. Human brucellosis. Rev Infect Dis 1983; 5:82142.
7. Poole PM, Whitehouse DB, Gilchrist MM. A case of abortion consequent upon infection with Brucella abortus biotype 2. J Clin Pathol
1972; 25:8824.
8. Seoud M, Saade G, Awar G, Uwaydah M. Brucellosis in pregnancy. J
Reprod Med 1991; 36:4415.
9. Memish Z, Mah MW, Al Mahmoud S, Al Shaalan M, Khan MY. Brucella
bacteremia: clinical and laboratory observations in 160 patients. J Infect
2000; 40:5963.
10. Kiel FW, Khan MY. Analysis of 506 consecutive positive serologic tests
for brucellosis in Saudi Arabia. J Clin Microbiol 1987; 25:13847.
11. Bannatyne RM, Jackson MC, Memish Z. Rapid diagnosis of Brucella
bacteremia by using the BACTEC 9240 system. J Clin Microbiol
1997; 35:26734.
12. Criscuolo E, di Carlo FC. El aborto y ostras manifestaciones ginecobstetricas en el curso de la brucelosis humana. Rev Fac Cien Med Univ
Nac Cordoba 1954; 12:32130.
13. Lulu AR, Araj GF, Khateeb MI, Mustafa MY, Yusuf AR, Fenech FF.
Human brucellosis in Kuwait: a prospective study of 400 cases. Q J
Med 1988; 66:3954.
14. Madkour MM. Pregnancy and brucellosis. In: Madkour MM, ed. Brucellosis. London: Butterworth, 1989:197204.
15. Sarram M, Feiz J, Foruzandeh M, Gazanfarpour P. Intrauterine fetal
infection with Brucella melitensis as a possible cause of second-trimester
abortion. Am J Obstet Gynecol 1974; 119:65760.
16. Makhseed M, Harouny A, Araj G, Moussa MA, Sharma P. Obstetric
and gynecologic implication of brucellosis in Kuwait. J Perinatol
1998; 18:1969.