The Many Faces of Human-to-Human Transmission of Brucellosis: Congenital Infection and Outbreak of Nosocomial Disease Related to an Unrecognized Clinical Case

Because person-to-person transmission of brucellosis is exceptional, physicians who care for patients with this disease are not considered to be at increased risk. A woman in her 24th week of pregnancy who had received a diagnosis of placenta previa presented to the hospital with massive vaginal bleeding and hypovolemic shock, requiring performance of an emergency Cesarean delivery. Two physicians who assisted the surgical delivery developed culture-proven Brucella melitensis infection. The organism was also recovered from cultures of blood samples obtained from the mother and the premature newborn. The mother had been observed since early pregnancy because of an undiagnosed febrile hepatitis, but no specific tests for brucellosis had been performed. Retrospective testing of serum samples obtained at the onset of disease were positive for Brucella antibodies, indicating that the disease could have been diagnosed earlier.