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Infectious Diseases Research Center, Babol Medical University, Babol, 4717641367 Iran
Department of Gynecology, Rohani Teaching Hospital, Babol Medical University, Babol, Iran
a r t i c l e
i n f o
Article history:
Received 20 August 2010
Received in revised form 2 June 2011
Accepted 10 June 2011
Available online 13 July 2011
Keywords:
Brucellosis
Pregnancy
Abortion
Recurrent abortion
Treatment
a b s t r a c t
From April 2000 to March 2010, 19 pregnant women with brucellosis were evaluated,
treated and followed up. Ten (53%) pregnant women had spontaneous abortions. Six of
eleven (55%) women infected in the rst trimester had a spontaneous abortion. After
treatment, all subsequently became pregnant and gave birth to normal babies. Among 13
patients who received cotrimoxazole plus rifampin, only four (31%) aborted and nine mothers had normal term deliveries. Two patients with recurrent abortions had brucellosis and
became pregnant and gave birth after treatment. The brucellosis screening program for
pregnant women and those with spontaneous abortion is necessary in brucellosis endemic
regions.
2011 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd.
All rights reserved.
1. Introduction
0035-9203/$ see front matter 2011 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.trstmh.2011.06.003
M.R.H. Roushan et al. / Transactions of the Royal Society of Tropical Medicine and Hygiene 105 (2011) 540542
541
Table 1
Clinical manifestations, STA or 2ME tests and outcome of pregnancy in 19 pregnant women with brucellosis
Case no.
Age
Weeks of
pregnancy
STA
2ME
Treatment
regimen
Outcome of pregnancy
1
2
3
4
5
6
7
8
30
28
20
22
27
23
26
20
3
4
21
4
6
20
28
21
1/160
1/320
1/1280
1/320
1/320
1/640
1/320
1/640
1/80
1/160
1/640
1/160
1/80
1/160
1/80
1/160
Cotri/Rif
Cotri/Rif
Cotri/Rif
Doxy/Rif
Cotri/Doxy
Gen/Doxy
Cotr/Rif
Gen/Doxy
Term delivery
Term delivery
Term delivery
Spontaneous abortion
Spontaneous abortion
Spontaneous abortion
Term delivery
Spontaneous abortion
9
10
26
21
4
16
1/640
1/320
1/160
1/160
Gen/Doxy
Cotr/Rif
Spontaneous abortion
Term delivery
11
12
13
25
36
18
12
26
8
1/1280
1/1280
1/320
1/640
1/160
1/160
Cotr/Rif
Cotr/Rif
Cotr/Rif
Term delivery
Spontaneous abortion
Spontaneous abortion
14
15
16
17
18
19
30
21
23
21
30
28
12
25
7
8
12
20
1/2560
1/320
1/320
1/320
1/640
1/320
1/640
1/160
1/80
1/160
1/160
1/80
Cotr/Rif
Gen/Doxy
Cotr/Rif
Cotr/Rif
Cotr/Rif
Cotr/Rif
Spontaneous abortion
Spontaneous abortion
Term delivery
Spontaneous abortion
Term delivery
Term delivery
STA: standard tube agglutination titer; 2ME: 2-Mercaptoethanol titer; Cotr: cotrimoxazole; Rif: rifampin; Doxy: doxycycline; Gen: gentamicin.
3. Results
4. Discussion
The mean age of these patients was 25 4.62 years. Brucellosis occurred in two (11%) patients during spring, seven
(37%) in summer, nine (47%) in autumn and one (5%) in
winter. Consumption of fresh cheese (12 cases) and animal husbandry (three cases) were the main risk factors for
brucellosis.
Brucella melitensis was isolated in blood cultures of four
patients (patients no. 6, 12, 15, 19). Repeated spontaneous abortions had been noted in two patients: patient
no. 2 had aborted twice and patient no. 5 four times;
in both patients subsequent pregnancies occurred 57
months after abortion. After successful treatment one
of them aborted again and the other had a normal
delivery. One year after treatment the patient who had
aborted became pregnant and subsequently had a normal
birth. Only ve patients were hospitalized due to vaginal bleeding and fever with brucellosis being diagnosed
as the cause; all spontaneously aborted (patients no. 4,
6, 8, 9 and 15). Active toxoplasmosis, cytomegalovirus
and listeria monocytogen infections were not detected
in patients who had spontaneously aborted; six to nine
months after successful treatment all became pregnant
again.
During treatment with cotrimoxazole plus rifampin in
13 cases, four (31%) spontaneously aborted and nine (69%)
mothers had term deliveries (Table 1). In total, ten (53%)
patients had spontaneous abortions and six (55%) of 11
patients infected in the rst trimester also had spontaneous
In this study 10 (53%) pregnant women with brucellosis had spontaneous abortions. The rate of abortion was
higher than that reported by Lulu et al.9 (31% of 35 patients)
and Khan et al.5 (46% of 92 patients) and was much higher
than that reported by Sharif et al.7 (18% of 30 patients) and
Elshamy and Ahmed (27% of 55 patients).8
Brucellosis causes fewer spontaneous abortions in
humans than in animals because of the absence of erythritol in the human placenta.4 In human maternal bactremia,
toxemia, acute febrile reaction, disseminated intravascular coagulation (DIC) and placentitis may be the cause
of spontaneous abortion and IUFD. In this study, 55% of
patients infected in the rst trimester had spontaneous
abortions and half aborted before treatment. Of the 13
patients who received cotrimoxazole plus rifampin, only
four (31%) aborted and nine (69%) had full term deliveries
(Table 1). Investigators have shown that prompt treatment
of brucellosis may cure the mother and protect the fetus.5,6
We did not nd any association between incidence of
spontaneous abortion and the magnitude of serum agglutination titer as showed by others.6 The weakness of this
study was the lack of isolation of brucella infection of fetus
and placenta. This issue is an important point and needs to
be investigated.
Interestingly, we observed two patients with recurrent
abortions most probably related to brucellosis; we believe
they had chronic brucellosis. Both became pregnant and
had normal deliveries after treatment. These observations
542
M.R.H. Roushan et al. / Transactions of the Royal Society of Tropical Medicine and Hygiene 105 (2011) 540542
emphasize the need to perform brucella serologic tests during pregnancy in endemic regions.
In summary, the brucellosis screening program for pregnant women and spontaneous abortion cases is necessary
in endemic regions.
Authors contributions: MRHR conceived and designed
the study; MRHR and MB treated and followed up all the
patients; MRHR, MB and FS collected, analysed and interpreted the data; NA was the gynecologic consultant and
participated in the interpretation of the data; MRHR wrote
the draft of the paper which was revised by all authors;
MRHR wrote the nal version of the manuscript which was
read and approved by all authors. MRHR is guarantor of the
paper.
Funding: This work was supported by Infectious Diseases
Research Center of Babol Medical University, Babol, Iran
(GR015-1389).
Conicts of interest: None declared.