title: Brucellosis in pregnancy: clinical aspects and obstetric outcomes.
abstract: OBJECTIVE
  Brucellosis is a zoonosis with high morbidity in humans. This disease has gained interest recently due to its re-emergence and potential for weaponization. Pregnant women with this disease can develop severe complications. Its association with adverse obstetric outcomes is not clearly understood. The objective of this study was to describe the obstetric outcomes of brucellosis in pregnancy.
  
  
  METHODS
  Cases of pregnant women with active brucellosis seen at the Hospital Nacional Cayetano Heredia from 1970 to 2012 were reviewed. Diagnostic criteria were a positive agglutination test and/or positive blood/bone marrow culture. Presentation and outcomes data were collected. The Chi-square test was used for nominal variables. A p-value of <0.05 indicated significance.
  
  
  RESULTS
  One hundred and one cases were included; 27.7% had a threatened abortion/preterm labor, 12.8% experienced spontaneous abortion, 13.9% preterm delivery, 8.1% fetal death, and 1.1% congenital malformations. There was one maternal death secondary to severe sepsis. After delivery, neonatal death occurred in 8.1%, low birth weight in 14.5%, and congenital brucellosis in 6.4%. The most common treatment was aminoglycosides plus rifampicin (42.2% of cases). Complication rates decreased if treatment was started within 2 weeks of presentation (p < 0.001).
  
  
  CONCLUSIONS
  This is the largest series of brucellosis in pregnancy reported in the literature. Brucella presents adverse obstetric outcomes including fetal and maternal/neonatal death. Cases with unexplained spontaneous abortion should be investigated for brucellosis. Prompt treatment is paramount to decrease the devastating outcomes.
authors.affiliation: Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Obstetrics and Gynecology, Wayne State University/Detroit Medical Center, Detroit, MI, USA. Electronic address: vilchezlagosg@umkc.edu.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Vilchez
authors.affiliation: Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Miguel
authors.initials: M
authors.lastname: Espinoza
authors.affiliation: Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Guery
authors.initials: G
authors.lastname: D'Onadio
authors.affiliation: Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Obstetrics and Gynecology, Hospital Nacional Cayetano Heredia, Lima, Peru.
authors.forename: Pedro
authors.initials: P
authors.lastname: Saona
authors.affiliation: Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Infectious Diseases, Tropical Medicine and Dermatology, Hospital Nacional Cayetano Heredia, Lima, Peru.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Gotuzzo
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000818:Animals; D002006:Brucellosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D036861:Delivery, Obstetric; D005260:Female; D005313:Fetal Death; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D063130:Maternal Death; D008875:Middle Aged; D007752:Obstetric Labor, Premature / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology; D055815:Young Adult
keywords: Brucellosis; Fetal death; Maternal death; Neonatal death; Pregnancy; Preterm labor