Neonatal brucellosis possibly transmitted during delivery

Infection by Brucella melitensis or Brucella papionis modifies essential physiological functions of human trophoblasts

Brucellosis is a zoonosis caused by bacteria of the Brucella genus. In ruminants, brucellosis causes abortion, followed by chronic infection and secretion of bacteria in milk. In humans, it usually presents as flu-like symptoms, with serious complications if untreated. Epidemiological studies have only recently established that brucellosis can also cause pregnancy complications in women, but the pathogenic mechanisms are unknown. Pioneering studies in ruminants showed that Brucella infect trophoblasts and then colonise the placenta where they grow to high density. A recent study showed that the main zoonotic Brucella species can infect human cytotrophoblasts (CTB) and extravillous trophoblasts (EVT). In this work, we show that Brucella papionis (associated with stillbirth in primates) also infects human trophoblasts. However, it replicates actively in CTB, whereas its replication is very restricted within EVT. We also observed alteration of several trophoblastic functions upon infection by B. papionis or Brucella melitensis (the most prevalent species in human brucellosis). Infection altered the production of hormones, the ability of CTB to form syncytiotrophoblasts, and the invasion capacity of EVT. We also found that infection can spread between different types of trophoblasts. These findings constitute a new step in understanding how Brucella infection causes adverse pregnancy outcomes.

Congenital Brucellosis: A Systematic Review of the Literature

BACKGROUND

Knowledge of the spectrum of presentations and the outcome of congenital brucellosis should expedite diagnosis and improve prognostication.

METHODS

A systematic review of literature of cases of congenital brucellosis was performed on October 10, 2017 (registered as PROSPERO CRD42017072061).

RESULTS

A case seen by the authors was added to the review, yielding 44 reported cases of which 22 (50%) were from Turkey, Saudi Arabia, or Kuwait. For cases with the gestational age reported, 23 of 37 (62%) were preterm. The species was Brucella melitensis in 35 cases, Brucella abortus in 3 cases and not documented in 6 cases. The diagnosis was based on a positive blood culture from the first day of life in 20 cases (45%). Presentation was usually typical for a bacteremic infant of that GA, but two infants were asymptomatic at diagnosis. There were two recurrences and seven deaths (six in preterm infants), but the role of Brucella infection in the deaths was not clear.

CONCLUSION

Brucellosis remains a concern in endemic countries, adversely affecting pregnancy and very rarely causing neonatal infection. Prematurity appeared to be the prime cause of death in neonates with congenital brucellosis.

Potential risk of blood transfusion-transmitted brucellosis in an endemic area of China

BACKGROUND

Brucellosis is a severe zoonotic disease that is increasingly prevalent in north China. A study evaluating Brucella infection in blood donors was conducted at Kashi central blood station, Xinjiang, China.

STUDY DESIGN AND METHODS

Four serologic and two molecular methods of detection of Brucella infection were used in plasma samples from blood donations collected from Kashi in northwest China, considered a brucellosis-endemic area. Blood donor samples collected in Shenzhen, southern China, a brucellosis-nonendemic area, were tested as a negative control group.

RESULTS

In 3896 plasma samples collected from Kashi central blood station, 135 (3.5%) plasma samples were reactive by the Rose Bengal plate test (RBPT), and 120 (3.1%) of the 135 RBPT-reactive sample were also reactive with the standard tube agglutination test (SAT), respectively. All samples of the control group of 399 blood samples from Shenzhen blood center tested negative with RBPT and SAT. Of 135 seroreactive plasma samples, 39 (1.0%) reacted with B. melitensis membrane protein extracts by enzyme-linked immunosorbent assay and 25 were reactive to either rBP26 or rOMP31 by Western blot. Thirteen plasma samples and two follow-up blood samples were identified as carrying Brucella DNA by quantitative polymerase chain reaction (PCR) and nested PCR. Overall 15 (1:300) Kashi blood donations were found positive by nucleic acid testing, confirmed specific by DNA sequencing.

CONCLUSIONS

The data indicate a probable high rate of Brucella bacteremia, suggesting a potential risk of transfusion-transmitted brucellosis. Blood donation screening for Brucella infection may be considered in the high Brucella-endemic areas of China.

Increasing threat of brucellosis to low-risk persons in urban settings, China

Cases of brucellosis were diagnosed in 3-month-old twins and their mother. An epidemiologic survey suggested that raw sheep or goat meat might be the source of Brucella melitensis infection. This finding implies that the increasing threat of brucellosis might affect low-risk persons in urban settings in China.

Brucellosis with pulmonary involvement in a premature infant

Congenital brucellosis is rare. A premature infant with transplacentally acquired congenital brucellosis and pulmonary involvement is described.

Does brucellosis in human pregnancy increase abortion risk? Presentation of two cases and review of literature

Brucellosis is one of the most common zoonotic diseases that can be encountered during pregnancy. We present two pregnant women with brucellosis. One of them delivered normally and the other patient had an abortion. We reviewed the literature regarding the clinical course of brucellosis in pregnant women. Brucellosis during pregnancy can be associated with abortion, congenital and neonatal infections and infection of the delivery team. Therefore treatment with a combination of rifampicin and trimethoprim-sulfamethoxazole should be started as soon as it is diagnosed to prevent possible complications.

A rare case of Brucella melitensis infection in an obstetrician during the delivery of a transplacentally infected infant

We report a case of Brucella melitensis infection in an obstetrician who was infected during the delivery of an infant suffering from congenital brucellosis. The obstetrician was treated with doxycycline and rifampin and fully recovered. This is the first reported case of Brucella infection transmitted through infectious secretions at the delivery of a transplacentally infected newborn and emphasizes that, especially in endemic areas educational and technical measures are needed in order the obstetricians to avoid ingestion of secretions during clearance of the newborn's respiratory tract from saliva and amniotic fluid.

Epidemiology and control of brucellosis in China

The paper describes the history and evolvement of brucellosis in China. It presents the variation of epidemic situation, epidemiological characteristics, application of vaccines and control in brief. Before 1980s, human and animal brucellosis was quite severe; during 1980s, the incidence of human and animal brucellosis was relatively low, and seemed to decrease during the decade. During 1990s, there were no obvious changes in the incidence of animal brucellosis, but the incidence of human brucellosis increased, especially from 1995 to 2001. There are not only some common characteristics but also some differences in brucellosis epidemiology relative to that reported in the rest of the world. For the entire country, B. melitensis was the predominant strain associated with outbreaks, and the epidemic peak is from February to June. Several Brucella vaccines have been used in China for prevention and control of brucellosis. such as B. abortus 104 M in humans, B. suis S2 in animals. The introduction of comprehensive measures has allowed great progress in the prevention and control of brucellosis in China. Surveillance points were set-up countrywide to estimate the epidemic situation. In addition, we discussed the new characteristics of brucellosis in China, the influence of the El Nino phenomenon on brucellosis epidemic situation, the phenomenon of antigenic interference between Brucella species and some disadvantages of live Brucella vaccines.

Neonatal brucellosis and blood transfusion: case report and review of the literature

Neonatal brucellosis following blood transfusion has not previously been reported. A premature male infant born at 24 weeks gestation developed low grade fever and decreased activity and showed poor weight gain at 45 weeks post-menstrual age. Blood culture grew Brucella melitensis and the brucella antibody titre was positive. He received a 6-week course of septrin and rifampicin and made a full recovery. The infant had received a blood transfusion 5 days prior to his illness. The blood donor had symptoms suggestive of brucellosis, and it was suspected that the blood transfusion was the source of infection but this could not be confirmed as the donor was not traceable. It is suggested that, in areas endemic for brucellosis, prospective blood donors should be questioned about symptoms of brucellosis, and serological tests to screen for brucellosis might be indicated.

Brucellosis in a mother and her young infant: probable transmission by breast milk

Brucellosis, although primarily a zoonotic infection, is also a threat for human health. Infection can be transmitted to humans through direct contact with infected animals, products of conception, or animal discharges, and through consumption of potentially infected milk, milk products, or meat. Human-to-human transmission is rare. There have been case reports of transmission via blood transfusion and bone marrow transplantation from infected donors. Sexual intercourse is a possible means of transmission. Neonatal infection can be acquired transplacentally or during delivery. This report describes a mother with brucellosis who probably transmitted the infection to her 3-month-old baby by breast milk.

Antimicrobial factors and microbial contaminants in human milk: recent studies

An overview of recent studies of antimicrobial factors and microbial contaminants found in human milk is presented. The incidence of gastrointestinal and respiratory infections in infants receiving human milk continues to be lower than in those not breast-fed due to the presence of specific antibody and possibly anti-adhesion factors in the milk. Whether the many other antimicrobial factors, which have been shown to be active in vitro or in animal model systems, have any influence on infant infections is still not clear. Microbial contaminants in human milk are rare, as are associated infant infections from the milk. However, some contaminants such as cytomegalovirus are commonly transferred to infants from the milk of seropositive mothers, fortunately without any adverse effects in the infants. Human T-lymphotropic virus type 1 is transferred via human milk in endemic areas, human milk being the main source of mother-to-infant transmission. While some reports suggest human immunodeficiency virus type 1 transfer may occur through human milk, this is not the predominant mode of transmission to infants.