1. Brucellosis
Dr. Ali Jabari
Senior Family Physician
F.I.B.M.S-FM, M.B.Ch.B
Slemani University

2. 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.

3. Infectious agent
• Brucella abortus
• Brucella melitensis
• Brucella suis
• Brucella canis

4. Epidemiology
In animals; chronic lifelong  infectious
abortion and sterility.
Infected animals  milk, urine, afterbirth.
Occupational hazard  farmers, ranchers,
veterinarians, abattoir workers, and
laboratory personnel.

5. • 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.

6. Reservoir
_Animal reservoirs

7. 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.

8. Incubation period
varies from 5-60 days;
occasionally several months.

9. Clinical features
Systemic
acute or insidious
Subclinical and unrecognized infections
fever
Localised suppurative infections
Osteoarticular complications
Orchitis, epididymitis, osteomyelitis and
endocarditis are less common.

10. CFR in untreated brucellosis is 2%, mostly
due to endocarditis from B. melitensis
infections.
Arthritis may occur in relapse

11. 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.

12. Period of
communicability
There is no evidence of communicability
from person to person.

13. 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.

14. 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

15. __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

16. 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.

17. Outbreak measures: Trace source of
infection such as contaminated
unpasteurised milk products and institute
appropriate control measures.
International measures: Control of domestic
animals and animal products in international
trade and transport