Is Maternal Brucellosis compatible with breastfeeding? Do we have alternatives for Maternal Brucellosis?

Maternal Brucellosis

October 20, 2016 (Low Risk)

Infection caused by several species of Brucella (B. melitensis, B. abortus and B. suis, rarely B. canis) by consumption of fresh milk products from infected animals or close contact to them. Apart from the transplacental and perinatal transmission, inter-human transmission is extremely rare (Nemenqani 2009).

There are very few publications on transmission through breast milk being not able several of them to state it categorically since they could not exclude a transplacental transmission or from other sources of infection (supplementation to infants with non-human fresh milk is frequent in endemic areas (al- Nahedh 1994), failure to have a positive culture for Brucella in the breastmilk (Lubani 1988, al-Eissa 1990, Varon 1990, Barroso 1998, Palanduz 2000, Palanduz 2005, Arroyo 2006, Ceylan 2012, Calik 2012). Others found that transmission was transplacental or at delivery (Lubani 1988, Aydın 2013, Ozturk 2015). Some others commented that the infant was weaned, but did not point out to whether the child was infected or not. (Nemenqani 2009, Ozturk 2015).

The only one reported case of Brucella infection of a 11-mo-old infant, Brucella melitensis was isolated from a breastmilk culture (Tikare 2008).
Also, in rare cases of breast abscess due to Brucella infection, breastmilk cultures were positive for Brucella melitensis; two mothers breastfed their infants, but the author failed to mention the clinical condition or evolution of infants (Nemenqani 2009).

Any way, the fact is that the incubation period lasts from 3 to 4 weeks (range 1 week to several months) and then until the first symptoms appear that again is followed by a time period to get a diagnosis which is often delayed, it is probably worthless withdrawing breastfeeding. Hence, it seems operationally more effective the initiation of treatment to the mother, test the infection status of the infant, follow him up and treat the child if indicated (al-Eissa 1990).

Treatment of Brucellosis, which can include Doxycycline, TMP-SMX, Rifampicin, Streptomycin and Gentamicin, is compatible with breastfeeding (See specific info on these antimicrobials).

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Synonyms

  • Maternal Bang's disease
  • Maternal Cyprus fever
  • Maternal Gibraltar fever
  • Maternal infection by Brucella spp.
  • Maternal Malta Fever
  • Maternal Mediterranean fever
  • Maternal Undulant fever; Gibraltar fever; Malta fever; Mediterranean fever

References

  1. Ozturk M, Yavuz F, Altun D, Ulubay M, Firatligil FB. Postpartum Bilateral Sacroiliitis caused by Brucella Infection. J Clin Diagn Res. 2015Abstract Full text (link to original source) Full text (in our servers)
  2. Aydın B, Beken S, Akansel R, Dilli D, Okumuş N, Zenciroğlu A, Tanır G. Prematurity due to maternal brucella infection and review of the literature. Turk J Pediatr. 2013Abstract Full text (link to original source) Full text (in our servers)
  3. Ceylan A, Köstü M, Tuncer O, Peker E, Kırımi E. Neonatal brucellosis and breast milk. Indian J Pediatr. 2012Abstract
  4. Calik M, Iscan A, Gul M, Derme T, Cece H, Torun MF. Severe neurobrucellosis in a young infant. Clin Neurol Neurosurg. 2012Abstract
  5. Red Book. Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: 2012 Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, Red Book 2012
  6. Nemenqani D, Yaqoob N, Khoja H. Breast brucellosis in Taif, Saudi Arabia: cluster of six cases with emphasis on FNA evaluation. J Infect Dev Ctries. 2009Abstract Full text (link to original source) Full text (in our servers)
  7. Tikare NV, Mantur BG, Bidari LH. Brucellar meningitis in an infant--evidence for human breast milk transmission. J Trop Pediatr. 2008Abstract
  8. Arroyo Carrera I, López Rodríguez MJ, Sapiña AM, López Lafuente A, Sacristán AR. Probable transmission of brucellosis by breast milk. J Trop Pediatr. 2006Abstract
  9. Palanduz A, Telhan L, Yildirmak Y, Memioğlu N, Arapoğlu M, Kayaalp N. Brucellar arthritis of knee in a child. J Paediatr Child Health. 2005Abstract
  10. Palanduz A, Palanduz S, Güler K, Güler N. Brucellosis in a mother and her young infant: probable transmission by breast milk. Int J Infect Dis. 2000Abstract Full text (link to original source) Full text (in our servers)
  11. Barroso Espadero D, Arroyo Carrera I, López Rodríguez MJ, Lozano Rodríguez JA, López Lafuente A. Transmisión de brucelosis por lactancia materna. Presentación de dos casos. [The transmission of brucellosis via breast feeding. A report of 2 cases]. An Esp Pediatr. 1998Abstract Full text (link to original source) Full text (in our servers)
  12. Barroso Espadero D, Arroyo Carrera I, López Rodríguez MJ, Lozano Rodríguez JA, López Lafuente A. [The transmission of brucellosis via breast feeding. A report of 2 cases]. An Esp Pediatr. 1998Abstract
  13. Casalinuovo F, Di Sarno A, Caparello G, Saladino A. [Isolation of Brucella melitensis biovar 2 from the human milk]. Ann Ig. 1995Abstract
  14. al-Nahedh NN, Morley DC. Infant feeding practices and the decline of breast feeding in Saudi Arabia. Nutr Health. 1994Abstract
  15. al-Mafada SM, al-Eissa YA, Saeed ES, Kambal AM. Isolation of Brucella melitensis from human milk. J Infect. 1993Abstract
  16. Varon E, Cohen R, Bouhanna CA, Canet J, Janaud JC, Geslin P. [Brucellosis in a 3 month-old infant]. Arch Fr Pediatr. 1990Abstract
  17. al-Eissa YA. Probable breast-milk borne brucellosis in a young infant. Ann Trop Paediatr. 1990Abstract
  18. Lubani M, Sharda D, Helin I. Probable transmission of brucellosis from breast milk to a newborn. Trop Geogr Med. 1988Abstract
  19. Lubani MM, Dudin KI, Sharda DC, Abu Sinna NM, Al-Shab T, Al-Refe'ai AA, Labani SM, Nasrallah A. Neonatal brucellosis. Eur J Pediatr. 1988Abstract