Brucellosis

1. Brucellosis Presented by Mahmoud Aboud

2. Etiology • Brucella: Abortus(Cattle),Melitensis (Sheep,Goat)Suis(Swin), Canis(Dog) • G- Coccobacil • Aerobic, Non-spore forming • Non motile • Blood or Choclate agar

3. Epidemiology • Unpasteurized milk • Occupational events

4. Pathogenesis • Inoculation in skin ,Eye (Through abrasion or conjunctiva) • Inhalation (Infected aerosol) • Ingestion (Meat, Dairy products) Risk of infection depends 1. Nutritional status 2. Immune status 3. Rout of inoculum 4. Species of brucella

5. Pathogenesis • Survive& Replicate within phagocytes&Monocytes • Infected macrophages localized within reticuloendothelial system(Granuloma formation in spleen,liver,bone marrow)

6. Clinical manifestation Triad: Fever, Arthralgia/Arthritis,Hepatosplenomegaly • + History of animal or food exposure • Acute or insidious symptoms(2-4 wk after inoculation) • Refusal to eat • Refusal to bear weight • Lassitude • FTT • Headache • Inattention/Depression • Abdominal pain • Headache • Diarrhea • Rash • Night sweets • Weakness • Fatigue • Cough • Vomiting • Pharyngitis

7. • Fever • Hepatosplenomegally • Arthralgia/Arthritis Sacroiliac,Hip,Ankle,

8. Diagnosis • WBC Normal or low • + History of animal or food exposure • Recovering organisms (blood’ bone marrow’..) • Serum agglutination test: >1/160 (Antibody against Abortus ,Melitensis, Suis, but not Canis) • 2ME

9. • False positive SAT Yersinia entrocolitica Vibrio cholerae Francislla tularensis • False negative SAT Prozen effect

10. Differential diagnosis • Car-Scratch disease • Typhoid fever • TB • Fungal infections

11. Treatment > or = 9 years old • 1- Doxycycline 200 mg/D PO 6 WK + Streptomycin 1 g/D IM 1-2 WK OR Gentamycin 3-5 mg/kg/d IM/IV 1-2 WK -------------------------------------------------- • 2- Doxycycline 200 mg/D PO 6 WK + Rifampin 600-900 mg/D PO 6 WK < 9 years old TMP-SMZ: po 45 days (TMP 10 mg/Kg/D) (SMZ 50 mg/KG/D) + Rifampin 15-20 mg/kg/D PO 45 days Meningitis,Osteomyelitis,Endocarditis: Doxy + Genta +/- Rifampin

12. calcified brucellomas in both kidneys calcified brucellomas in the spleen

13. Salmonellae Infections M.Karimi

14. Etiology Salmonellae (G- ‘Facultative’Bacilli) • Antigens: Flagellum(H)’ Cell wall(O)’ Envelope(Vi) • Serogroups on the basis of O antigen: A’ B’ C1’ C2’ D’ E • Serotypes: S.Typhi’ S.Paratyphi’…. • Transmission: Water’ Food(beef’poultry’milk’egg’..)

15. Salmonella Gastroentritis (Nontyphoidal) Epidemiology • Age: <4 y/o (< 1y/o) • Source of infection: Poultry’eggs’ egg product ’meats’ pet reptile • Transmission: Carrier (Human) • Incubation period: 6-72 hr. (usually less than 24 hr.) • Peak incidence: Late summer &Early fall

16. Pathogenesis • Ingestion • Attached to “M” cells • Phagocytosed by macrophages • Replication • Bacteremia

17. Clinical manifestations • Self limited diseases: 3-7 days • Onset: Abrupt • Nausea’ Vomiting’ Crampy abdominal pain • Loose watery stool • Malaise’ headache’ chills • Fever 38-38.9 c (70%) for 48 hour

18. At risk of complications • Impaired immune function(T-Cell) • HIV infection • Organ transplantation • Lymphoproliferative diseases • Hemoglobinopathies (Sickle cell disease’..) • CGD • Malaria • Very old or very young

19. Complications • Dehydration’Shock • Localized infection: Pneumonia Empyema Abscesses Osteomyelitis Septic arthritis Postinfectious arthritis Pyelonephritis meningitis

20. Diagnosis • Cultures (Stool’ Blood’ Urine’ Bone marrow’ CSF’…)

21. Treatment • Correction of shock’ dehydration’… • Antibiotics: 1-Infants < 3 mo. 2-Child with immunodeficiency’ Malnutrition Malignancy’ Intravascular catheter or other foreign material

22. Treatment • Ceftriaxone or Cefotaxime Septicemia’ Enteric fever’ Metastatic site of infection • Amoxicillin • Co-trimaxozole • Fluroqinolones • Chloramphenicol

23. Typhoid fever

24. Typhoid fever • In US:400 Cases per year &Usually under 20 y/o • Worldwide:16 million cases per year and 600’000 death • Infected only human

25. Pathogenesis • Invasions on upper small intestine • Monocyte phagocyte • Monocyte carry organism from blood to other RES • Organism proliferation • Lymph node’ liver & spleen inflammation • Secondary septicemia

26. Salmonella Typhi

27. Clinical manifestation • Infant: mild GE to severe septicemia without diarrhea Fever’ hepatomegaly ’ jaundice’ anorexia’ lethargy’ weight loss

28. Clinical manifestation • Child: High fever’ malaise ’lethargy’ myalgia’ headache’ rash’ Hepatomegaly’ abdominal pain and tenderness’ diarrhea(50%)’ constipation obtunded ’delirium’ confusion ’splenomegaly’ Macular (Rose spot) or Maculopapolar rash(30%) High T with low PR (Typically each 1 degree above 38.3° C Rise PR 10/min)

29. Rose spot

30. Complications • Intestinal perforation(0.5-3%) • Severe GI hemorrhage(1-10%) • Toxic encephalopathy • Cerebral thrombosis • Acute cerebral ataxia • Aphasia • Optic neuritis • Deafness • Transverse myelitis • Acute cholecystitis • Pneumonia • Pyelonephritic • Endocarditis • Meningitis • Osteomyelitis • Septic arthritis

31. Dense chronic bone reaction due to typhoid osteomyelitis.There is a central sequestrum

32. Typhoid

33. Diagnosis & Differential diagnosis • Diagnosis Cultures: Blood’ Urine’ Stool’ Bone marrow’ Lymph nodes’ Deudenal fluied’ Reticuloendothelial tissue’ • Differential diagnosis Bronchitis Bronchopneumonia Gastroenteritis Influenza

34. Treatment Drugs: • Ceftriaxone • Ampicillin • Chloramphenicol • Co-Trimoxozole • Ciprofloxacin • Azithromycin Surgery • Cholecystectomy

35. Prognosis • With treatment : Mortality <1% • Without treatment : Relapse up to 10% • Chronic carrier: Excrete S.typhi for more than 3 mo.

Brucellosis

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Brucellosis