# Neonatal Brucellosis in an Extremely Preterm Infant: A Fatal Case Report

## TL;DR

A preterm infant died from congenital brucellosis, highlighting the difficulty in diagnosing and treating this rare neonatal infection.

## Contribution

This case report adds to the limited literature on fatal congenital brucellosis in extremely preterm infants.

## Key findings

- Congenital brucellosis can present with symptoms similar to neonatal sepsis, leading to delayed diagnosis.
- Despite antimicrobial therapy, the infant succumbed to multiple organ failure due to complications of brucellosis.
- Early recognition and targeted treatment are critical for improving outcomes in neonatal brucellosis.

## Abstract

Brucellosis is a globally significant zoonotic disease, but congenital brucellosis remains exceedingly rare. It is primarily transmitted transplacentally from an infected mother to the fetus, often presenting with nonspecific signs that mimic neonatal sepsis. The condition poses diagnostic and therapeutic challenges, particularly in endemic regions where early identification is crucial to improving neonatal outcomes.

We report the case of a 19-year-old gravida 1, para 0 female with a history of treated Brucella infection at 12 weeks of gestation. She experienced preterm premature rupture of membranes (PPROM) at 24 weeks and 2 days and delivered a female infant via spontaneous vaginal delivery. The neonate, weighing 725 g at birth, presented with cyanosis, respiratory distress, and unstable vital signs. Initial workup suggested early onset sepsis, prompting empirical antibiotic therapy. However, on Day 7, blood cultures confirmed the presence of Brucella melitensis and Brucella abortus, establishing the diagnosis of congenital brucellosis. The neonate's clinical course was complicated by intraventricular hemorrhage, necrotizing enterocolitis, multiple episodes of sepsis, and cardiac arrests. Despite intensive medical management, including antimicrobial therapy with rifampicin and gentamicin, the infant succumbed to multiple organ failure on Day 39 of life.

This case highlights the diagnostic challenges of congenital brucellosis and underscores the importance of considering Brucella infection in neonates presenting with unexplained sepsis, especially in endemic regions. Early recognition and targeted therapy are essential to improve neonatal outcomes. Enhanced screening protocols for pregnant women in high-risk areas, coupled with heightened clinical suspicion in neonates with maternal brucellosis exposure, could facilitate timely diagnosis and treatment.