Brucellosis Dr. Ali Jabari Senior Family Physician F.I.B.M.S-FM, M.B.Ch.B Slemani University
Identification Zoonotic world-wide highest incidence in the Mediterranean, ME and the tropics 500 000 new cases diagnosed per year. In humans, is a disease of protean manifestations biological terrorism.
Epidemiology In animals; chronic lifelong infectious abortion and sterility. Infected animals milk, urine, afterbirth. Occupational hazard farmers, ranchers, veterinarians, abattoir workers, and laboratory personnel.
• incidence varies _control in domestic animal _pasteurization• Common SE, ME, the Indian subcontinent, Africa, and Central and South America.• Infection ; ingestion of unpasteurized milk products from foreign countries.
Mode of transmission contact with infected tissues, blood, urine, vaginal discharges, aborted animal fetuses and especially placentae. ingestion of raw milk and dairy products from infected animals. inhalation of aerosols accidental self-inoculation abrasions, cuts, conjunctiva. BM transplantation recently.
Incubation periodvaries from 5-60 days;occasionally several months.
Clinical features Systemic acute or insidious Subclinical and unrecognized infections fever Localised suppurative infections Osteoarticular complications Orchitis, epididymitis, osteomyelitis and endocarditis are less common.
CFR in untreated brucellosis is 2%, mostlydue to endocarditis from B. melitensisinfections.Arthritis may occur in relapse
Diagnosis Culture blood, BM, other tissues or discharges. Serology combine a test (Rose Bengal and seroagglutination) detecting agglutinating antibodies (IgM, IgG and IgA) with others detecting nonagglutinating antibodies (Coombs-IgG or ELISA-IgG). Except in the case of B. canis, Ab to lipolysaccharide Ag.
Period ofcommunicability There is no evidence of communicability from person to person.
Susceptibility & resistance Everyone is susceptible to infection. Severity and duration of clinical illness are subject to wide variation. Duration of acquired immunity is uncertain. People at risk are farmers, hunters, and eaters of unpasteurized cheeses or other unpasteurized dairy products.
Methods of control__Preventive measures: Educate the public, particularly travellers, Educate risky group Search for and Ix livestock at risk of infection. Segregation or slaughtering of infected herd. Animal vaccination
__Control of patients, contacts and immediate environment: Report to LHA Isolation Concurrent disinfection: purulent discharge. Quarantine: none. Immunization of contacts: none. Investigation of contacts and source of infection: contact tracing S&S
Specific treatment:a) D+R, or D+G or S for 6 weeks.b) TS+R children.c) meningitis or endocarditis, D+R+TS must be continued for months or years. d) Never use a single drug (high risk of relapse). e) Relapses occur in about 5% of patients treated with D and R; re-treat with original regimen.
Outbreak measures: Trace source ofinfection such as contaminatedunpasteurised milk products and instituteappropriate control measures.International measures: Control of domesticanimals and animal products in internationaltrade and transport