Dr Abdulqaharmominzada666@gmail.com

1. Brucellosis
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‫فیضی‬ ‫هللا‬ ‫ذبیح‬ ‫دوکتور‬ ‫پوهنوال‬
‫الرحیم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬

2. CONTENTS
1. Introduction
2. Etiology
3. Epidemiology
4. Pathogenesis
5. Clinical features
6. Organ systems involvement (complications)
7. Diagnosis
8. Differential diagnosis
9. Treatment
10. Prognosis
11. prevention

3. INTRODUCTION
Genus brucella
Alpha-2 subgroup of protobacteria
Chronic granulomatous infection
 Zoonotic disease

4. ETIOLOGY
 Brucella abortus (cattle)
 Brucella melitensis ( goat and sheep )
 Brucella suis ( Swine )
 Brucella canis ( Dog )
gram ( - )
Aerobic
None spore forming
None motile

5. ETIOLOGY…
B.ovis
B.neotomae
B.ceti
B.pinnipedialis
B.microti
B.inopinata

6. EPIDEMIOLOGY
Brucella exist world wide ( rare in industrialized countries)
Mediterranean , India , Mexico , central and south America
Risk factor :
1. exposure to infected animals and animal’s product
2. Inhalation of infected aerosols

7. PATHOGENESIS
Rout of infection:
1. Skin ( cut and abrasions )
2. Inhalation ( infected aerosol )
3. Ingestion ( meat and dairy products )
4. Inoculation ( conjunctival sac of the eye )

8. PATHOGENESIS……..
Risk for infection depend on:
1. Nutritional status
2. Immune status
More virulent species
1. Brucella melitensis
2. Brucella suis
Smooth lipopolysaccharide
of cell wall

9. PATHOGENESIS……
This organism is Facultative intracellular and can:
1. Survive and replicate in monocyte and macrophage
2. Ingested by macrophage and localize within RES
3. Granuloma formation

10. PATHOGENESIS…..
The major factor in recovery:
1. Antibody against lipopolysaccharide and cell wall
2. Cell mediated response (macrophage activation enhance
intracellular killing)
3. Sensitized T lymphocyte (interferon gamma ,TNF alpha)

11. CLINICAL FEATURES
Brucellosis is a systemic illness and can be:
1. Acute ( < 2months )
2. Subacute ( 2 – 12 months )
3. Chronic ( > 1 years )
Incubation period : 7days – 3months
Symptoms generally beginning 2-4 weeks after exposure

12. CLINICAL FEATURES…..
Most patient have classic triad:
1. fever ( FUO ) : continues or intermittent and persist for several months.
2. arthralgia / arthritis: particularly knee , hip , ankle (child) sacroiliac ( adult )
3. hepatosplenomegaly
 Less common lymphadenopathy

13. CLINICAL FEATURES….
Other symptoms include:
1. Refuse to bear weight on an extremity + fever = typical presentation
2. Headache
3. Pharyngitis
4. Cough
5. vomiting
6. Abdominal pain
7. Diarrhea
8. Rashes
9. Night sweats
10. Weakness

14. CLINICAL FEATURES….
Invasion of nervous system can cause: 1%
1. Headache
2. Mental change
3. Depression
4. Symptom of meningitis

15. CLINICAL FEATURES….
Neonatal and congenital infection resulting from :
1. Transplacentally
2. Breast milk
3. Blood transfusion

16. ORGAN SYSTEMS OF
INVOLVEMENT
Skeletal system :
1. Arthritis
2. Movement limitation , swelling and tenderness of affected joint
3. Disclosing hip
4. Vertebral involvement
1. MRI
2. Radionuclide bone
scan
3. ultrasound

17. CENTRAL NERVOUS SYSTEM
1. Meningitis
2. encephalitis
3. Myelitis
4. Neuritis
5. Mycotic aneurysm
6. Brain abscess

18. ALIMENTARY TRACT
1. Nausea
2. Vomiting
3. Anorexia
4. Weight loss
5. Abdominal discomfort
Rare case of:
1. Cholecystitis
2. Ileitis
3. Colitis
4. pancreatitis

19. RETICULOENDOTHELIAL
SYSTEM
 Liver ( elevated liver enzyme or normal )
1. B.Abortus (noncaseating granuloma)
2. B.suis (suppurative abscess)
3. B.melitensis (hepatic lesion and nonspecific reactive hepatitis)
4. Rarely chronic hepatospleenic abscess (surgery)

20. CARDIOVASCULAR SYSTEM
1. Endocarditis (common)
2. Arterial and venous thrombosis
3. Cutaneous Vasculitis
4. Endarteritis
5. Myocarditis
6. Pericarditis
Peripheral and
cerebrovascular aneurysm

21. GENITOURINARY TRACT
1. Orchitis and epididymitis (adult)
2. Nephritis
3. Glomerulonephritis

22. RESPIRATORY TRACT
1. Cough ( common)
2. Respiratory tract lesion <5%
3. pneumonia
4. Pulmonary nodule
5. Empyema

23. HEMATOLOGIC SYSTEM
Mild hematologic abnormalities are
1. Anemia
2. Lymphocytosis
3. Thrombocytopenia
Rare life threatening complications are:
1. Pancytopenia
2. Thrombocytopenic purpura
3. Mucosal bleeding

24. DIAGNOSIS
1. History of exposure
2. Laboratory findings :
•Blood culture (gold standard) : prior to antibiotic therapy
•Bone marrow culture when organism is in RES (even after antibiotic)
•Serum agglutination test ( =>1:160 or =>1:320 ) except of B.canis
•ELISA (IgG and IgM)

25. DIAGNOSIS….
• Enzyme immunoassay indication:
1. Complicated cases
2. Suspected chronic brucellosis
3. Reinfection

26. DIFFERENTIAL DIAGNOSIS
1) Tularemia
2) Cat scratch disease
3) Typhoid fever
4) Chronic malaria
5) HIV
6) Sarcoidosis
7) Histoplasmosis
8) Blastomycosis
9) M.Tuberculosis infection
10) Atypical mycobacteria infection
11) Rickettsia infection
12) Yersinia infection

27. TREATMENT
1. Doxycycline
2. Aminoglycosides
3. Cephalosporin ( ceftriaxone )
4. Rifampicin
5. Streptomycin

28. TREATMENT

29. PROGNOSIS
 With specific antimicrobial therapy ( good outcome )
 Most of deaths are result of organ system involvement

30. PREVENTION
1. Prevent from exposure to infected animals
2. Use Pasteurized milk and dairy product
3. No vaccine currently exist

31. REFERENCES ….
GHAI 8th
Nelson
Pediatrics infectious disease 5th

32. ‫جهان‬ ‫یک‬ ‫تان‬ ‫توجه‬ ‫از‬
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