BRUCELLOSIS Sorokhan V.D., MD, PhD.
Definition <ul><li>Brucellosis, also called undulant fever, or Malta fever, is a highly contagious  zoonosis  caused by in...
Etiology <ul><li>Brucellosis is caused by the bacterial genus Brucella.  Brucella spp. are small,  gram-negative , non-mot...
Classification The traditional classification of Brucella species is based largely on the preferred hosts. South America, ...
Classification Geographic Distribution Animal Reservoir Organism Recent case reports describing some human cases (mainly n...
Epidemiology <ul><li>Ingestion of unpasteurized goat milk and related dairy products is the main route of B .  melitensis ...
Pathology <ul><li>Fig. 1.  Well-formed hepatic granuloma from a patient with brucellosis. </li></ul><ul><li>Histologic fin...
Mortality/Morbidity <ul><li>Human brucellosis carries a low mortality rate (<5%), mostly secondary to endocarditis, which ...
History <ul><li>Symptoms of brucellosis are protean in nature, and none is specific enough to support the diagnosis. </li>...
Physical <ul><li>Physical findings in patients with brucellosis are variable and nonspecific for the disease. </li></ul><u...
Differential Diagnoses <ul><li>The diseases most frequently confused with brucellosis are a nkylosing  s pondylitis and  u...
Workup <ul><li>Bone marrow culture  </li></ul><ul><li>Serology </li></ul><ul><li>ELISA </li></ul><ul><li>Polymerase chain ...
Medical Care <ul><li>The goal of medical therapy is to control patient symptoms as quickly as possible to prevent complica...
Diet <ul><li>No special diet is required for the treatment of brucellosis. </li></ul>
Medication <ul><li>Doxycycline  - a dult  dose: 100 mg PO/IV q12h. </li></ul><ul><li>Streptomycin  - a dult  dose:  1 g IM...
Prevention <ul><li>Inform persons with occupational risk about the use of protective devices (masks, gloves) to avoid expo...
Prognosis <ul><li>Although initial symptoms may be debilitating, if the symptoms are treated appropriately and within the ...
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Lecture brucellosis 5

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Lecture brucellosis 5

  1. 1. BRUCELLOSIS Sorokhan V.D., MD, PhD.
  2. 2. Definition <ul><li>Brucellosis, also called undulant fever, or Malta fever, is a highly contagious zoonosis caused by ingestion of unsterilized milk or meat from infected animals, or close contact with their secretions. The disease now called brucellosis, under the name “ Mediterranean fever ” , first came to the attention of British medical officers in Malta during the Crimean War in the 1850s. The causal relationship between organism and disease was first established by Dr. David Bruce in 1887. </li></ul>
  3. 3. Etiology <ul><li>Brucellosis is caused by the bacterial genus Brucella. Brucella spp. are small, gram-negative , non-motile, non-spore-forming rods, which function as facultative intracellular parasites that cause chronic disease, which usually persists for life. These organisms localize in the reproductive organs of host animals, causing abortions and sterility. They are shed in large numbers in the animal ’ s urine, milk, placental fluid, and other fluids. Exposure to infected animals and animal products causes the disease in humans. </li></ul>
  4. 4. Classification The traditional classification of Brucella species is based largely on the preferred hosts. South America, Southeast Asia, United States . Pigs (biotype 1-3) . B . suis Worldwide . Cows, buffalo, camels, yaks . B . abortus Mediterranean, Asia, Latin America, parts of Africa and some southern European countries . Goats, sheep, camels . B . melitensis Geographic Distribution Animal Reservoir Organism
  5. 5. Classification Geographic Distribution Animal Reservoir Organism Recent case reports describing some human cases (mainly neurobrucellosis) . Marine animals, minke whales, dolphins, seals . B . pinnipediae and B . cetaceae Not known to cause human disease . Rodents . B . neotomae No known human cases . Sheep . B . ovis Cosmopolitan . Canines . B . canis
  6. 6. Epidemiology <ul><li>Ingestion of unpasteurized goat milk and related dairy products is the main route of B . melitensis transmission to humans. </li></ul><ul><li>Brucellosis causes more than 500,000 infections per year worldwide. The heaviest disease burden lies in countries of the Mediterranean basin and Arabian Peninsula, and the disease is also common in India, Mexico, and South and Central America. </li></ul>
  7. 7. Pathology <ul><li>Fig. 1. Well-formed hepatic granuloma from a patient with brucellosis. </li></ul><ul><li>Histologic findings usually include mixed inflammatory infiltrates with lymphocytic predominance and granulomas (in up to 55% of cases) with necrosis. </li></ul>
  8. 8. Mortality/Morbidity <ul><li>Human brucellosis carries a low mortality rate (<5%), mostly secondary to endocarditis, which is a rare complication of brucellosis. However, brucellosis can cause chronic debilitating illness with extensive morbidity. </li></ul>
  9. 9. History <ul><li>Symptoms of brucellosis are protean in nature, and none is specific enough to support the diagnosis. </li></ul><ul><li>Symptoms include the following: f ever , anorexia, asthenia, fatigue, weakness, malaise , arthralgias, low back pain, spine and joint pain, joint swelling , h eadache, depression, abdominal pain, constipation, diarrhea, vomiting, dizziness, unsteadiness of gait, urinary retention , cough and dyspnea . </li></ul>
  10. 10. Physical <ul><li>Physical findings in patients with brucellosis are variable and nonspecific for the disease. </li></ul><ul><li>The most common findings are hepatosplenomegaly (or isolated hepatomegaly or splenomegaly) and osteoarticular involvement. </li></ul><ul><li>Osteoarticular findings can include tenderness and swelling over affected joints, bursitis, decreased range of motion, and joint effusion. Maneuvers that isolate the sacroiliac joint may cause pain. </li></ul><ul><li>Neurologic findings vary according to the presentation of neurologic disease </li></ul><ul><li>Cutaneous findings: e rythema nodosum, abscesses, papulonodular eruptions , i mpetigo, psoriatic, eczematous, pityriasis rosealike lesions , m acular, maculopapular, scarlatiniform rashes and v asculitic lesions . </li></ul><ul><li>Ocular findings: u veitis , k eratoconjunctivitis , Iridocyclitis , n ummular keratitis , horoiditis , o ptic neuritis , m etastatic endophthalmitis , c ataracts . </li></ul>
  11. 11. Differential Diagnoses <ul><li>The diseases most frequently confused with brucellosis are a nkylosing s pondylitis and u ndifferentiated s pondyloarthropathy , i nfluenza , c ryptococcosis , l eptospirosis , viral h epatitis, m alaria , h istoplasmosis , t uberculosis , i nfectious m ononucleosis , i nfective e ndocarditis , t yphoid f ever , c ollagen vascular disease , c hronic fatigue syndrome , m alignancy , and o steomyelitis . </li></ul>
  12. 12. Workup <ul><li>Bone marrow culture </li></ul><ul><li>Serology </li></ul><ul><li>ELISA </li></ul><ul><li>Polymerase chain reaction </li></ul>
  13. 13. Medical Care <ul><li>The goal of medical therapy is to control patient symptoms as quickly as possible to prevent complications and relapses. Multidrug antimicrobial regimens are the mainstay of therapy because of high relapse rates reported with monotherapeutic approaches. </li></ul>
  14. 14. Diet <ul><li>No special diet is required for the treatment of brucellosis. </li></ul>
  15. 15. Medication <ul><li>Doxycycline - a dult dose: 100 mg PO/IV q12h. </li></ul><ul><li>Streptomycin - a dult dose: 1 g IM q12h. </li></ul><ul><li>Gentamicin - a dult dose: 5 mg/kg/d IV/IM in divided doses. </li></ul><ul><li>Trimethoprim-sulfamethoxazole - a dult dose: 160 mg TMP-800 mg SMX PO q12h. </li></ul><ul><li>Rifampin - a dult dose: 900 mg/d PO/IV divided bid. </li></ul>
  16. 16. Prevention <ul><li>Inform persons with occupational risk about the use of protective devices (masks, gloves) to avoid exposure to aerosols, body fluids, and inadvertent vaccine exposure. Inform travelers to endemic areas about appropriate dietary hygiene. </li></ul>
  17. 17. Prognosis <ul><li>Although initial symptoms may be debilitating, if the symptoms are treated appropriately and within the first few months of onset, this disease is easily curable with a low risk of relapse or chronic disease. The prognosis is poor in persons who present with congestive heart failure due to endocarditis, with a mortality rate approaching 85%. </li></ul>

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