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Neonatal Bruselloz: İki Hasta-İki Farklı Bulaş

Year 2015, Volume: 13 Issue: 2, 134 - 137, 01.09.2015
https://doi.org/10.4274/jcp.29494

Abstract

Bruselloz, Orta Doğu, Asya, Doğu Avrupa, Orta ve Güney Amerika ülkeleri ile ülkemizin de dahil olduğu Akdeniz havzasında halen endemik olan sistemik bir enfeksiyon hastalığıdır. Neonatal bruselloz oldukça nadir görülür ve bebeğe bulaş yolları ile ilgili net bilgiler bulunmamaktadır. Bebeğe bulaşın, anne karnında plasentadan direkt olarak, doğum sırasında annenin genital sistemindeki sekresyonların ve kanın yutulması ya da enfekte anne sütünün içilmesi ile olabileceği düşünülmektedir. Bu raporda iki yenidoğan bebekte iki farklı bulaş yolu ve klinikleri sunulmaktadır. İlk olgu, 31. gebelik haftasında doğan solunum sıkıntısı, hepatosplenomegalisi, lökositozu olan prematüre bebekti. Hastadan doğar doğmaz alınan kan kültüründe brusella üremesinin öğrenilmesiyle değiştirilen antibiyotik tedavisi sonrasında mekanik ventilasyon desteği kesilebildi, hepatosplenomegalisi ve lökositozu düzeldi. İkinci olgu ise kardeşine bruselloz tanısı konulduğu için ailesi araştırılırken annesine doğumdan hemen önce bruselloz tanısı konan 28 günlük miadında doğan bebekti. Bebeğin doğumdaki ilk değerlendirmesi tamamen normalken, tıbbi öneriye rağmen emzirilmişti. Yaşamın 4. haftasında gelişen lökopeni ve nötropeni nedeniyle tekrar değerlendirildi ve brusella tüp aglutinasyon testinin pozitifleştiği saptandı. Hastaya verilen antibiyotik tedavisinden sonra hastanın değerleri normale dönmüştür. Her iki hastada da anne sütü annelerin tedavisi tamamlanıncaya kadar kesildi, bebekler mama ile beslendi. Her iki ailenin de kırsal kesimde yaşayan ve pastörize edilmemiş süt ürünlerini kullanan aileler olduğu görüldü. Her iki hastaya da trimetoprim sulfametoksazol ve rifampisin tedavisi 6 hafta süreyle herhangi bir komplikasyon gözlenmeksizin kullanıldı. Sonuç olarak; bruselloz ülkemiz gibi endemik ülkelerde, intrauterin ve neonatal enfeksiyonların ayırıcı tanısında mutlaka düşünülmeli ve araştırılmalıdır. Neonatal dönemdeki klinik bulgular farklı ve müphem olabileceği için ailenin geleneksel alışkanlıkları, özellikle kırsal kesimden gelen hastalarda sorgulanmalıdır

References

  • 1. Yumuk Z, O’Callaghan D. Brucellosis in Turkey: an overview. Int J Infect Dis 2012;16:228-35.
  • 2. Young EJ. Brucella Species. In: Mandell GL, Benett JE, Dolin R, (eds). Principles and Practice of Infectious diseases. 5th edition. New York: Churchill Livingstone; 2000;2386-93.
  • 3. Ruben B, Band JD, Wong P, Colville J. Person-to-person transmission of Brucella melitensis. Lancet 1991;337:14-5.
  • 4. Ertem M, Kürekci AE, Aysev D, Unal E, Ikinciogullari A. Brucellosis transmitted by bone marrow transplantation. Bone Marrow Transplant 2000;26:225-6.
  • 5. Giannacopoulos I, Eliopoulou MI, Ziambaras T, Papanastasiou DA. Transplacentally transmitted congenital brucellosis due to Brucella abortus. J Infect 2002;45:209-10.
  • 6. Al-Eissa YA, al-Mofada SM. Congenital brucellosis. Pediatr Infect Dis J 1992;11:667-71.
  • 7. Singer R, Amitai Y, Geist M, Shimonovitz S, Herzog N, Reiss A, et al. Neonatal brucellosis possibly transmitted during delivery. Lancet 1991;338:127-8.
  • 8. Lubani MM, Dudin KI, Sharda DC, Abu Sinna NM, Al-Shab T, Al-Refe’ai AA, et al. Neonatal brucellosis. Eur J Pediatr 1988;147:520-2.
  • 9. Lubani M, Sharda D, Helin I. Probable transmission of brucellosis from breast milk to a newborn. Trop Geogr Med 1988;40:151-2.
  • 10. Mosayebi Z, Movahedian AH, Ghayomi A, Kazemi B. Congenital brucellosis in a preterm neonate. Indian Pediatr 2005;42:599- 601.
  • 11. Ceylan A, Köstü M, Tuncer O, Peker E, Kırımi E. Neonatal brucellosis and breast milk. Indian J Pediatr 2012;79:389-91.
  • 12. Koklu E, Buyukkayhan D, Akcakus M, Kurtoglu S, Koklu S, Gunes T. Brucellosis with pulmonary involvement in a premature infant. Ann Trop Paediatr 2006;26:367-70.
  • 13. Wood EE. Brucellosis as a hazard of blood transfusion. Br Med J 1995;1:27-8.
  • 14. Mesner O, Riesenberg K, Biliar N, Borstein E, Bouhnik L, Peled N, et al. The many faces of human-to-human transmission of brucellosis: congenital infection and outbreak of nosocomial disease related to an unrecognized clinical case. Clin Infect Dis 2007;45:135-40.
  • 15. Akçakuş M, Esel D, Cetin N, Kisaarslan AP, Kurtoğlu S. Brucella melitensis in blood cultures of two newborns due to exchange transfusion. Turk J Pediatr 2005;47:272-4.
  • 16. Hatipoglu CA, Bilgin G, Tulek N, Kosar U. Pulmonary involvement in brucellosis. J Infect 2005;51:116-9.
  • 17. Cacace ML, Claros EA, Erazu KA, Escobar GI, Lucero NE. Congenital brucellosis in an infant. Vector Borne Zoonotic Dis 2013;13:513-5.
  • 18. Solera J. Update on brucellosis: therapeutic challenges. Int J Antimicrob Agents 2010;36(Suppl 1):18-20.
  • 19. Khuri-Bulos NA, Daoud AH, Azab SM. Treatment of childhood brucellosis: results of a prospective trial on 113 children. Ped Infect Dis J 1993;12:377-83.
  • 20. Apa H, Keskin S, Gülfidan G, Yaman Y, Devrim I. An infant with acute brucellosis presenting with Coombs-positive autoimmune hemolytic anemia: is breastfeeding guilty for transmission? Vector Borne Zoonotic Dis 2013;13:509-12.

Neonatal Brucellosis: Two Cases with Two Different Transmissions

Year 2015, Volume: 13 Issue: 2, 134 - 137, 01.09.2015
https://doi.org/10.4274/jcp.29494

Abstract

Brucellosis remains as an endemic infection of humans in many parts of the world; Latin America, Asia including Middle East and Mediterranean region including Turkey. Neonatal brucellosis is very rare and clinical manifestations as well as transmission route are not well-defined. The neonate can be either infected transplacentally, or by ingestion of mother’s secretions and blood during delivery, or by ingestion of breast milk. Here, we present two cases with two different transmission route and clinical findings. First case is a premature infant born after 31 weeks of gestation and hospitalized for respiratory distress in addition to hepatosplenomegaly and leukocytosis. Brucella species were isolated from the initial blood culture obtained just after birth. Clinical and laboratory findings improved with decreased ventilatory support after replacement of antibiotherapy with trimethoprim-sulfamethoxazole TMP-SMX and rifampicin. Second case was a 28 days old, term infant. Her sibling was diagnosed as brucellosis and during evaluation of the family members, her mother was found to have brucellosis just before delivery. Initial evaluation of the baby after birth was totally normal. Beside medical advice, she was breastfed and in the 4th week of life she was found to have leucopenia and neutropenia, and brucella tube agglutination test turned to be positive. After antibiotherapy, laboratory findings were normalized. Breastfeeding was ceased during the treatment periods of both mothers. Both families were from rural regions of Turkey, who were using unpasteurized dairy products. Both patients were treated with TMP-SMX and rifampicin for 6 weeks without any complication. Brucella spp must be sought as a causative agent in the differential diagnosis of intrauterine and neonatal infections in endemic countries. Family members of patients from rural areas of the country must be questioned about traditional food consumption, as findings of neonatal brucellosis are various and vague.

References

  • 1. Yumuk Z, O’Callaghan D. Brucellosis in Turkey: an overview. Int J Infect Dis 2012;16:228-35.
  • 2. Young EJ. Brucella Species. In: Mandell GL, Benett JE, Dolin R, (eds). Principles and Practice of Infectious diseases. 5th edition. New York: Churchill Livingstone; 2000;2386-93.
  • 3. Ruben B, Band JD, Wong P, Colville J. Person-to-person transmission of Brucella melitensis. Lancet 1991;337:14-5.
  • 4. Ertem M, Kürekci AE, Aysev D, Unal E, Ikinciogullari A. Brucellosis transmitted by bone marrow transplantation. Bone Marrow Transplant 2000;26:225-6.
  • 5. Giannacopoulos I, Eliopoulou MI, Ziambaras T, Papanastasiou DA. Transplacentally transmitted congenital brucellosis due to Brucella abortus. J Infect 2002;45:209-10.
  • 6. Al-Eissa YA, al-Mofada SM. Congenital brucellosis. Pediatr Infect Dis J 1992;11:667-71.
  • 7. Singer R, Amitai Y, Geist M, Shimonovitz S, Herzog N, Reiss A, et al. Neonatal brucellosis possibly transmitted during delivery. Lancet 1991;338:127-8.
  • 8. Lubani MM, Dudin KI, Sharda DC, Abu Sinna NM, Al-Shab T, Al-Refe’ai AA, et al. Neonatal brucellosis. Eur J Pediatr 1988;147:520-2.
  • 9. Lubani M, Sharda D, Helin I. Probable transmission of brucellosis from breast milk to a newborn. Trop Geogr Med 1988;40:151-2.
  • 10. Mosayebi Z, Movahedian AH, Ghayomi A, Kazemi B. Congenital brucellosis in a preterm neonate. Indian Pediatr 2005;42:599- 601.
  • 11. Ceylan A, Köstü M, Tuncer O, Peker E, Kırımi E. Neonatal brucellosis and breast milk. Indian J Pediatr 2012;79:389-91.
  • 12. Koklu E, Buyukkayhan D, Akcakus M, Kurtoglu S, Koklu S, Gunes T. Brucellosis with pulmonary involvement in a premature infant. Ann Trop Paediatr 2006;26:367-70.
  • 13. Wood EE. Brucellosis as a hazard of blood transfusion. Br Med J 1995;1:27-8.
  • 14. Mesner O, Riesenberg K, Biliar N, Borstein E, Bouhnik L, Peled N, et al. The many faces of human-to-human transmission of brucellosis: congenital infection and outbreak of nosocomial disease related to an unrecognized clinical case. Clin Infect Dis 2007;45:135-40.
  • 15. Akçakuş M, Esel D, Cetin N, Kisaarslan AP, Kurtoğlu S. Brucella melitensis in blood cultures of two newborns due to exchange transfusion. Turk J Pediatr 2005;47:272-4.
  • 16. Hatipoglu CA, Bilgin G, Tulek N, Kosar U. Pulmonary involvement in brucellosis. J Infect 2005;51:116-9.
  • 17. Cacace ML, Claros EA, Erazu KA, Escobar GI, Lucero NE. Congenital brucellosis in an infant. Vector Borne Zoonotic Dis 2013;13:513-5.
  • 18. Solera J. Update on brucellosis: therapeutic challenges. Int J Antimicrob Agents 2010;36(Suppl 1):18-20.
  • 19. Khuri-Bulos NA, Daoud AH, Azab SM. Treatment of childhood brucellosis: results of a prospective trial on 113 children. Ped Infect Dis J 1993;12:377-83.
  • 20. Apa H, Keskin S, Gülfidan G, Yaman Y, Devrim I. An infant with acute brucellosis presenting with Coombs-positive autoimmune hemolytic anemia: is breastfeeding guilty for transmission? Vector Borne Zoonotic Dis 2013;13:509-12.
There are 20 citations in total.

Details

Primary Language Turkish
Journal Section Case Report
Authors

İlke Mungan Akın

Özlem Kalaycık Şengül This is me

Sibel Sevük Özümüt This is me

Asuman Kıral This is me

Derya Büyükkayhan This is me

Publication Date September 1, 2015
Published in Issue Year 2015 Volume: 13 Issue: 2

Cite

APA Akın, İ. M., Kalaycık Şengül, Ö., Sevük Özümüt, S., Kıral, A., et al. (2015). Neonatal Bruselloz: İki Hasta-İki Farklı Bulaş. Güncel Pediatri, 13(2), 134-137. https://doi.org/10.4274/jcp.29494
AMA Akın İM, Kalaycık Şengül Ö, Sevük Özümüt S, Kıral A, Büyükkayhan D. Neonatal Bruselloz: İki Hasta-İki Farklı Bulaş. Güncel Pediatri. September 2015;13(2):134-137. doi:10.4274/jcp.29494
Chicago Akın, İlke Mungan, Özlem Kalaycık Şengül, Sibel Sevük Özümüt, Asuman Kıral, and Derya Büyükkayhan. “Neonatal Bruselloz: İki Hasta-İki Farklı Bulaş”. Güncel Pediatri 13, no. 2 (September 2015): 134-37. https://doi.org/10.4274/jcp.29494.
EndNote Akın İM, Kalaycık Şengül Ö, Sevük Özümüt S, Kıral A, Büyükkayhan D (September 1, 2015) Neonatal Bruselloz: İki Hasta-İki Farklı Bulaş. Güncel Pediatri 13 2 134–137.
IEEE İ. M. Akın, Ö. Kalaycık Şengül, S. Sevük Özümüt, A. Kıral, and D. Büyükkayhan, “Neonatal Bruselloz: İki Hasta-İki Farklı Bulaş”, Güncel Pediatri, vol. 13, no. 2, pp. 134–137, 2015, doi: 10.4274/jcp.29494.
ISNAD Akın, İlke Mungan et al. “Neonatal Bruselloz: İki Hasta-İki Farklı Bulaş”. Güncel Pediatri 13/2 (September 2015), 134-137. https://doi.org/10.4274/jcp.29494.
JAMA Akın İM, Kalaycık Şengül Ö, Sevük Özümüt S, Kıral A, Büyükkayhan D. Neonatal Bruselloz: İki Hasta-İki Farklı Bulaş. Güncel Pediatri. 2015;13:134–137.
MLA Akın, İlke Mungan et al. “Neonatal Bruselloz: İki Hasta-İki Farklı Bulaş”. Güncel Pediatri, vol. 13, no. 2, 2015, pp. 134-7, doi:10.4274/jcp.29494.
Vancouver Akın İM, Kalaycık Şengül Ö, Sevük Özümüt S, Kıral A, Büyükkayhan D. Neonatal Bruselloz: İki Hasta-İki Farklı Bulaş. Güncel Pediatri. 2015;13(2):134-7.