Maternal Malta Fever

Infection caused by several species of Brucella (B. melitensis, B. abortus and B. suis, rarely B. canis) by consumption of fresh milk products from infected animals or close contact to them. Apart from the transplacental and perinatal transmission, inter-human transmission is extremely rare. ^{(Nemenqani 2009)}

There are very few publications on transmission from breast milk and in several of them the authors do not state this categorically because they cannot exclude the transplacental route ^{(Dadar 2021)} or other sources of infection: frequent administration of fresh milk to infants in endemic areas ^{(al-Nahedh 1994)} and no positive culture of Brucella in breast milk. ^{(Calik 2012, Ceylan 2012, Arroyo 2006, Palanduz 2005 &2000, Barroso 1998, al-Eissa 1990, Varon 1990, Lubani 1988)}

In others, transmission was transplacental or during delivery. ^{(Ozturk 2015, Aydın 2013, al-Mafada 1993, Lubani 1988).}

In some, it is stated that the infant was weaned, but there is no reference to whether the infant had contracted the disease. ^{(Ozturk 2015, Nemenqani 2009)}

There are few published cases of positive Brucella culture in breast milk:

• An asymptomatic 40-day-old girl with positive serology and negative blood culture.^{(Dadar 2021)}
• An 11-month-old exclusively breastfed infant with Brucella menigitis. ^{(Tikare 2008)}
• A 7-month-old asymptomatic infant with negative culture and serology. ^{(Celebi 2007)}
• A premature newborn infant infected transplacetally. ^{(al-Mafada 1993)}

Also in the rare cases of breast abscess due to brucellosis, breast milk culture is positive for Brucella melitensis; two of the mothers were breastfeeding, but no mention is made of the clinical status and evolution of the infants. ^{(Nemenqani 2009)}

In any case, the fact that the incubation period is 3 to 4 weeks with a range of 1 week to 6 months ^{(Red Book 2021)} from the time of infection until the first symptoms appear and that diagnosis is often delayed, probably makes it pointless to withdraw breastfeeding, being more operative to initiate treatment in the mother, investigate the infection status of the infant, follow up and treat if necessary. ^{(al-Eissa 1990)}

Treatment of brucellosis, which may include Doxycycline, TMP-SMX, Rifampicin, Streptomycin and Gentamicin is compatible with breastfeeding.

See below the information of these related products:

• Doxycycline (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
• Gentamicin Sulfate (Safe product and/or breastfeeding is the best option.)
• Rifampicine (Safe product and/or breastfeeding is the best option.)
• Streptomycin (Safe product and/or breastfeeding is the best option.)
• Trimethoprim-Sulfamethoxazole (TMP-SMX; TMP-SMZ) (Safe product and/or breastfeeding is the best option.)