|Re: Brucellosis||L & J van Schalkwyk||06.10.99|
|brucellosis and breastfeeding||Gulnara Semenova||18.10.99|
Date: Mon, 04 Oct 1999 11:26:34 +0100
From: FRANCES MASON <fmatacf.imaginet.fr>
Can the infectious disease people on ngonut please address this question: I cannot find relevant papers on Medline for humans - thanks, Mike
Should mothers breastfeed when they have brucellosis? In Kosovo they are apparently infectious for about 1/3 of the year.
Date: Wed, 06 Oct 1999 12:38:33 +0100
From: Lara and Johan van Schalkwyk <laraatanaesthetist.com>
Subject: Re: Brucellosis
>Should mothers breastfeed when they have brucellosis?
Probably not! Two reasons:
1. Rare cases of probable mother to infant transmission have been reported [ Arch Fr Pediatr 1990 Oct;47(8):587-90; Ann Trop Paediatr 1990;10(3):305-7; Trop Geogr Med 1988 Apr;40(2):151-2 ]
2. Several of the drugs used to treat Brucella are present in significant concentrations in breast milk. This may not be an absolute contra-indication - Tran & Montakantikul [ J Hum Lact 1998 Dec;14(4):337-40 ] considers both rifampin & streptomycin to be safe, despite appearing in breast milk. For tetracycline, try [ J Hum Lact. 1991 Mar;7(1):24 ]
(PS The articles are on PubMed)
Date: Mon, 18 Oct 1999 11:45:02 +1000
From: "Nursing Mothers' Association of Australia" <lrcdiratnmaa.asn.au>
Subject: brucellosis and breastfeeding
Dear Gary, Mike, Frances and all friends in NGONUT,
Thank you for the question re Brucellosis and breastfeeding.
I made a search of the LRC database(14.000 articles related to the human lactation) and found just two articles on brucellosis. One is by Youssef A. Al-Eissa, might be for your interest- "Probable breast-milk borne brucellosis in young infant, published in Annals of tropical Paediatrics(1990)10, 305-307. He describes an infant who probably was infected through his mother breastmilk and he suggests to culture maternal milk prior to antibiotic therapy and daily thereafter before recommending maintenance of transient discontinuation of breast-feeding. Mother herself got infected after drinking raw goat milk.
No other article on brucellosis and BF is been found.
I found very practical recommendations re brucellosis and breastfeeding in 5th edition of the "Breastfeeding - a guide for the medical profession" by Ruth Lawrence, Mosby, 1999, p 566, and in Appendix E, p 871. Although it is small but practical note. I suspect you might be out of the book in the field, so I am copying the entire paragraph:
Brucella melitensis has been isolated in the milk of animals. Food and animals represent the primary sources of infection in humans. Brucellosis demonstrates a broad spectrum of illness in humans, from subclinical to subacute to chronic illness with non-specific signs of weakness, fever, malaise, body aches, sweats, arthralgia, and lymphadenitis. In areas where the disease is enzootic, childhood illness has been described more frequently. The clinical manifestations in children are similar to those in adults(111). Infection can occur during pregnancy, leading to abortion(infrequently), and can produce transplacental spread, causing neonatal infection(rarely). The transmission of B. melitensis through breastmilk has been implicated in neonatal infection, although not proved(111,112).
Interruption of breastfeeding with breast pumping and discarding the milk to continue stimulation of milk production is appropriate; breastfeeding should then continue after an initial period of 48 to 72 hours of therapy in the mother. Acceptable medications for treating the mother while continuing breastfeeding include streptomycin, tetracycline, trimethoprim-sulfamethoxazole(TMP-SMX), and rifampin(see Appendix E).
111.Lubani MM et al: Neonatal brucellosis, Eur J Pediatr 147:520, 1988
112. Lubani MM et al: A multicenter therapeutic study of 1100 children with brucellosis, Pediatr Infect Dis J, 8:75, 1989
My final note is to advise mother about the danger of drinking unboiled or unpausterised animal milk, especially during pregnancy and breastfeeding, because of the tuberculosis and brucellosis, and its implications to the mother and child health.
If brucellosis is not confirmed please do not hurry up with even short discontinuation of breastfeeding, especially during emergency. Any kind of fever in emergency situation is not necessarily indicate into brucellosis or tuberculosis.
You might like to contact Aileen Robertson, WHO-EURO Regional Adviser in Nutrition for WHO latest recommendation on brucellosis, her email is AROatwho.dk
With very best regards
Gulnara Semenova, PhD, IBCLC, Director, Lactation Resource Centre,
Nursing Mothers' Association of Australia PO Box 4000, Glen Iris 3146, Vic, Australia
Tel 61-3-9885 0855, Fax 61-3-98850866
EMAIL to lrcdiratnmaa.asn.au, Please visit NMAA website: www.nmaa.asn.au