Brucellosis is a zoonotic bacterial infection transmitted from animals to humans through contact with infected fluids or consumption of unpasteurized dairy. It causes a broad range of symptoms from fever to arthritis and is a public health problem in many developing countries. Diagnosis involves culture, serology or PCR of blood, bone marrow or tissues. Treatment requires combination antibiotic therapy for at least six weeks, and up to twelve weeks for complications like spondylitis or endocarditis. Doxycycline plus rifampin or streptomycin are common regimens.

2.  is a zoonotic infection
 transmitted to humans by contact with fluids
from infected animals (sheep, cattle, goats,
pigs, or other animals) or derived food products
such as unpasteurized milk and cheese.
 one of the most widespread zoonoses
worldwide
 Brucellosis has high morbidity both for humans
and animals; it is an important cause of
economic loss and a public health problem in
many developing countries

4.  incubation period : 1-4 weeks it may be as
long as several months
 Brucella melitensis causes more severe
infection than Brucella abortus
 Brucella canis is infrequently associated with
human disease, and reported cases have
usually been mild

5.  is a systemic infection with a broad clinical
spectrum, ranging from asymptomatic disease
to severe and/or fatal illness
 Clinical and laboratory features vary widely
(table 1 and table 2)
 The main presentations are acute febrile illness,
with or without signs of localization, and chronic
infection.
 Infection among children is generally more
benign than in adults with respect to likelihood
and severity of complications and response to
treatment
 Brucellosis in pregnancy is associated with risk
of spontaneous abortion, premature delivery,
miscarriage, and intrauterine infection with fetal
death

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9.  Acute illness usually consists of the insidious
onset of fever, night sweats (with a strong,
peculiar, moldy odor), arthralgia, myalgia, low
back pain, and weight loss as well as
weakness, fatigue, malaise, headache,
dizziness, depression, and anorexia
 A significant percentage of patients may have
dyspepsia, abdominal pain, and cough.
 Physical findings are variable and nonspecific.
Hepatomegaly, splenomegaly, and/or
lymphadenopathy may be observed.
 brucellosis can affect any organ system

10.  Osteoarticular involvement is the most
common presentation
 The sacroiliac joints and large joints of the
lower limbs are most frequently involved [
 Spondylitis is a serious complication of
brucellosis; it is more prevalent in older
patients and patients with prolonged illness
prior to treatment

11.  Osteoarticular involvement is the most
common presentation
 The sacroiliac joints and large joints of the
lower limbs are most frequently involved
 Spondylitis is a serious complication of
brucellosis; it is more prevalent in older
patients and patients with prolonged illness
prior to treatment

12.  Genitourinary involvement occurs in 2 to 20 percent
of cases; orchitis and/or epididymitis are the most
common manifestations
 Pulmonary involvement occurs in up to 7 percent of
patients with
 Gastrointestinal involvement can present with
clinical hepatitis (3 to 6 percent of cases)
 Hematological abnormalities, including anemia,
leukopenia, thrombocytopenia, pancytopenia,…
 ●Neurological involvement occurs in 2 to 7 percent
of cases. Manifestations include meningitis (acute
or chronic), encephalitis, ..
 ●Cardiac involvement is relatively rare
 ●Ocular involvement
 ●Dermatologic manifestations
.

14.  The rate of relapse following treatment is about
5 to 15 percent
 Relapse usually occurs within the first six
months following completion of treatment,
although it may occur up to 12 months following
completion of treatment
 Causes of relapse include inadequate choice of
antibiotics, shortened treatment duration, lack of
adherence, or localized foci of infection
 relapse due to antibiotic resistance is rare

15.  Chronic brucellosis refers to patients with
clinical manifestations for more than one
year after the diagnosis of brucellosis is
established
 Chronic brucellosis is characterized by
localized infection (generally spondylitis,
osteomyelitis, tissue abscesses, or uveitis)
and/or relapse

16.  laboratory findings should be interpreted
together with clinical manifestations,
exposure history, occupation, and history of
past infection
 Laboratory tools for diagnosis of brucellosis
include culture, serology, and polymerase
chain reaction (PCR)

17.  Ideally, the diagnosis is made by culture of the
organism from blood or other sites such as
bone marrow or liver biopsy specimens.
 The sensitivity of culture is limited
 if standard blood cultures are negative and
brucellosis remains a consideration, Serologic
testing should also be performed;
 serum agglutination and (ELISA) are the
most common serologic tests.

18.  rising titers of specific serum antibodies
 The interpretation of serological tests can be
difficult, particularly in the setting of chronic
infection, reinfection, relapse, and in endemic
areas where a high proportion of the population
has antibodies against brucellosis
 Positive serological test results can persist long
after recovery in treated individuals,
 so it is not always possible to distinguish
serologically between active and past infection

20.  White blood cell counts are usually normal to
low; pancytopenia can occur.
 Minor abnormalities in hepatic enzymes are
relatively common

21.  Radiographs, bone scans, (CT), (MRI), and
echocardiography may be helpful in
evaluating focal disease but do not provide a
definitive diagnosis.

22.  TREATMENTThe goal of brucellosis therapy
is to control the illness and prevent
complications, relapses, and sequelae [
 use of antibiotics with activity in the acidic
intracellular environment (doxycycline,
rifampin),
 use of combination regimens, and
prolonged duration of treatment

23.  two major regimens for the treatment of
adults with uncomplicated brucellosis (eg,
not having spondylitis, neurobrucellosis, or
endocarditis)
 Monotherapy and regimens shorter than six
weeks are not accepted treatment strategies
for brucellosis

24.  Doxycycline 100 mg orally twice daily for six
weeks, plus streptomycin 1 g intramuscularly
once daily for the first 14 to 21 days.
 It has been suggested that gentamicin (5
mg/kg) may be substituted for streptomycin;
equal efficacy has been demonstrated
 The optimal duration of gentamicin is uncertain;
5 days to 14 days is acceptable
 ●Doxycycline 100 mg orally twice daily plus
rifampin 600 to 900 mg (15 mg/kg) orally once
daily. Both drugs are administered for six
weeks.

25.  Fluoroquinolones (ciprofloxacin 500 mg twice
daily or ofloxacin 200 mg twice daily) have good
in vitro activity against Brucella
 can be used in combination with doxycycline or
rifampin but are not appropriate first-line agents
 They may be useful in the setting of drug
resistance, antimicrobial toxicity, and some
cases of relapse
 doxycycline and trimethoprim-sulfamethoxazole
(TMP-SMX; one double-strength tablet twice a
day), since the strain is resistant to rifampin

26.  In general, longer courses of therapy (at
least 12 weeks) are warranted for treatment
of spondylitis, neurobrucellosis, endocarditis,
or localized suppurative lesions
 at least three drugs are generally warranted
in the setting of neurobrucellosis,
endocarditis, and localized suppurative
lesions

27.  two antibiotic agents for at least 12 weeks
 Patients with Brucella spondylitis appear to
respond better to doxycycline (100 mg orally
twice daily for 12 weeks) plus streptomycin
(1 g intramuscularly once daily for the first 14
to 21 days) than to doxycycline-rifampin

28.  two or three drugs that cross the blood-
brain–cerebrospinal fluid (CSF) barrier for
treatment of neurobrucellosis. Reasonable
regimens include doxycycline, rifampin, and
either ceftriaxone
 Ceftriaxone-based regimens may be more
successful and allow shorter duration of

29.  Regimens include rifampin (900 mg once
daily), with or without TMP-SMX (one
double-strength tablet twice a day) for six
weeks
 ceftriaxone is also a reasonable regimen
 Use of TMP-SMX during the last week prior
to delivery is associated with kernicterus and
should be avoided if possible

30.  with a tetracycline (for children ≥8 years) or
TMP-SMX (for children <8 years) and at
least one other agent (rifampin, gentamicin,
or streptomycin,