Brucellosis (Malta Fever) in Pregnancy and Childbirth: A Case Report

Brucellosis is a multi-organ infectious disease that can affect people of all ages. Systemic symptoms of brucellosis include back pain, headache, fatigue, weakness, general body pain, fever and chills, anorexia, muscle pain, sweating, weight loss, joint pain, cough, neurological symptoms, abdominal pain, diarrhea, and constipation. In this report, the case of a pregnant woman suffering from Malta fever with severe signs that she could not walk is reported.

In this paper, the case of a 28-year-old G3P2 female patient (third pregnancy, two normal deliveries) with 37 weeks of pregnancy and a history of brucellosis in the last two months, being under painkiller treatment, and who has been unable to walk (sacroiliitis) for two weeks, has been reported. Previously, treatment with gentamicin 2 times a day for 6 days was started, and in May 2022, the patient was admitted to Imam Reza Hospital in Mashhad by ambulance. After consultation with an infectious disease specialist, the patient received gentamicin IV QID at a dose of 5 mg/kg, ceftriaxone BID at a dose of 1 mg and IV, and rifampin QID at a dose of 600 mg and PO. She was subjected to CBC differential test twice a week, and BUN and CR assessments were performed every other day. She has received acetaminophen 500 mg PO and Q 6 hrs in the hospital during hospitalization. Radiography of the pelvis was done to check the bilateral sacroiliac joint; it has been found to be normal and no evidence of joint effusion has been seen. After a week of hospitalization and observation in the hospital, vaginal delivery was performed without any problems and she gave birth to a baby boy with an Apgar score of 9-10.

Clinical manifestations of brucellosis in pregnant women are weakness, arthralgia, fever, fatigue, excessive night sweats, anorexia, muscle pain, chills, depression, weight loss, headache, and back pain. The most common symptoms are fever, hepatomegaly, spleen involvement, joint complications, and obstetric symptoms, including vaginal bleeding, postpartum endometritis, pelvic or groin pain, premature rupture of membranes, and chorioamnionitis. Rifampicin and trimethoprim-sulfamethoxazole for 6 to 8 weeks constitute the most common and recommended treatment.