Brucellosis is caused by bacteria of the genus Brucella that can infect both animals and humans. It is a zoonotic disease transmitted through contact with infected animals or consumption of unpasteurized dairy products. In humans, it causes non-specific symptoms like fever, joint pain, and fatigue. Diagnosis involves blood cultures and serology. Treatment consists of a combination of doxycycline and rifampin or streptomycin for 6 weeks to prevent relapse. Vaccination of animals and pasteurization of dairy products are important for prevention.

1. DRSHAWKY EL-EMAM
MEDICAL SPECIALIST(GIT &LIVER)
MEDICAL DIRECTOR, BAISH HOSPITAL
2020
Brucellosis
Updates for the diagnosis,treatment
and prevention of brucellosis

2. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬‫بسم‬
”‫العليم‬ ‫أنت‬ ‫إنك‬ ‫علمتنا‬ ‫ما‬ ‫إال‬ ‫لنا‬ ‫علم‬ ‫ال‬‫سبحانك‬
‫الحكيم‬”‫اآلية‬ ‫البقرة‬ ‫سورة‬32

3. Center for Food Security and Public Health, Iowa
State University, 2012

4. The Many Names of Brucellosis
•Human Disease
•Malta Fever
•Undulant Fever
•Mediterranean Fever
•Rock Fever of Gibraltar
•Gastric Fever
Animal Disease
•Bang’s Disease
•Enzootic Abortion
•Epizootic Abortion
•Slinking of Calves
•Ram Epididymitis
•Contagious Abortion
Center for Food Security and Public Health, Iowa
State University, 2012

5. Contents
1. Introduction
Causative organism
2. Epidemiology
3. Transmission to human
4. Clinical Manifestation
5. Investigations
6. Treatment
7. Prevention

7. History of Brucellosis
•450 BC: Described by Hippocrates
•1905: Introduced to the U.S.
•1914: B. suis
–Indiana, United States
•1953: B. ovis
–New Zealand, Australia
•1966: B. canis
–Dogs, caribou, and reindeer
Center for Food Security and Public Health, Iowa
State University, 2012

9. History of Brucellosis
•Jeffery Allen Marston
–British Army surgeon
–Contracted Malta fever
–Described his own
case in great
detail
Center for Food Security and Public Health, Iowa
State University, 2012

10. History of Brucellosis
•Sir William Burnett
(1779-1861)
–Physician General to
the British Navy
–Differentiated among
the various fevers
affecting soldiers
Center for Food Security and Public Health, Iowa
State University, 2012
Professor FEG Cox. The Wellcome Trust, Illustrated History of Tropical Diseases

11. The annual number of reported cases in United
States (now approximately 100 cases) has dropped
significantly because of aggressive animal
vaccination programs and milk pasteurization.
Human brucellosis carries a low mortality rate
(<5%), mostly secondary to endocarditis, which is a
rare complication of brucellosis.

12. History of Brucellosis
•Sir David Bruce (1855-
1931)
–British Army physician
and microbiologist
–Discovered
Micrococcus melitensis
Center for Food Security and Public Health, Iowa
State University, 2012
Professor FEG Cox. The Wellcome Trust, Illustrated History of Tropical Diseases

13. The annual number of reported cases in United
States (now approximately 100 cases) has dropped
significantly because of aggressive animal
vaccination programs and milk pasteurization.
Human brucellosis carries a low mortality rate
(<5%), mostly secondary to endocarditis, which is a
rare complication of brucellosis.

14. Congenital Brucellosis
•Variable symptoms
–Premature delivery
–Low birth weight
–Fever
–Failure to thrive
–Jaundice
–Hepatomegaly
–Splenomegaly
•Abortion risk unclear
Center for Food Security and Public Health, Iowa
State University, 2012

15. History of Brucellosis
•Bernhard Bang (1848-
1932)
–Danish physician and
veterinarian
–Discovered Bacterium
abortus could infect
cattle, horses, sheep,
and goats
Center for Food Security and Public Health, Iowa
State University, 2012
Professor FEG Cox. The Wellcome Trust, Illustrated History of Tropical Diseases

16. The annual number of reported cases in United
States (now approximately 100 cases) has dropped
significantly because of aggressive animal
vaccination programs and milk pasteurization.
Human brucellosis carries a low mortality rate
(<5%), mostly secondary to endocarditis, which is a
rare complication of brucellosis.

17. The annual number of reported cases in United
States (now approximately 100 cases) has dropped
significantly because of aggressive animal
vaccination programs and milk pasteurization.
Human brucellosis carries a low mortality rate
(<5%), mostly secondary to endocarditis, which is a
rare complication of brucellosis.

18. 1. Causative organism
Brucella
Coccobacillus, gram negative, non-sporing
Non-motile aerobic bacterium
Hosts: mostly animals.
Four species:
Melitensis: most frequent human infection
Abortus
Suis
Canis

19. The traditional classification of
Brucella species is based largely on
the preferred hosts.

20. Classifications
The traditional classification of Brucella species
is based largely on the preferred hosts.
Geographic DistributionAnimal ReservoirOrganism
Mediterranean, Asia,
Latin America, parts of
Africa and some southern
European countries
Goats, sheep, camelsB melitensis
Worldwide
Cows, buffalo, camels,
yaks
B abortus
South America, Southeast
Asia, United States
Pigs (biotype 1-3)B suis
CosmopolitanCaninesBrucella canis

21. • Causes:
Ingestion of unpasteurized milk and related dairy
products.
Aerosolization of fluids, contamination of skin abrasions,
and splashing of mucous membranes among
slaughterhouse workers , farmers and shepherds.
Veterinarians are usually infected by inadvertent
inoculation of animal vaccines against B abortus and B
melitensis.
Laboratory workers (microbiologists) are exposed by
processing specimens (aerosols) without special

22. Clinical Presentation
* Subclinical brucellosis
* Acute or subacute brucellosis
* Chronic brucellosis
* Localized brucellosis.
* Relapsing brucellosis

23. SYMPTOMS
Fever is the most common symptom which is
associated with chills.
• Constitutional symptoms of brucellosis including
anorexia, asthenia, fatigue, weakness, and malaise
(>90% of cases).
• Bone and joint symptoms include arthralgias, low
back pain, spine and joint pain, and, rarely, joint
swelling.

24. • Symptoms
• Neuropsychiatric symptoms of brucellosis are common
including Headache, depression, and fatigue.
• Gastrointestinal symptoms include abdominal pain,
constipation, diarrhea, and vomiting.
Neurologic symptoms of brucellosis can include
weakness, dizziness, unsteadiness of gait and urinary
retention.

25. Symptoms
Cough and dyspnea develop in up to 19% of
persons with brucellosis; however, these
symptoms are rarely associated with active
pulmonary involvement.

26. *Signs:
Fever : which is associated with relative
bradycardia.
Hepatosplenomegaly (or isolated hepatomegaly
or splenomegaly).
Osteoarticular findings can include tenderness
and swelling over affected joints, bursitis,
decreased range of motion, and joint effusion
(rare).

27. - Diffuse CNS involvement - Spasticity,
hyperreflexia, clonus, extensor plantar
response, sensorineural hearing loss, cranial
nerve involvement, and cerebellar signs.
Ocular findings can include uveitis,
keratoconjunctivitis, optic neuritis or
cataract.
• Cutaneous manifestations including
erythema nodosum, papulonodular eruption,
impetigo or vasculitic lesions.

28. Neurologic findings: vary according to the
presentation of neurologic disease, as follows:
Acute meningoencephalitis (most common
neurological manifestation) - Depressed level of
consciousness, meningeal irritation, cranial nerve
involvement, coma, seizure, and respiratory
depression.
Peripheral polyradiculoneuropathy -
Hypotonia and areflexia in most cases, paraparesis,
and an absence of sensory involvement

29. Differential Diagnosis:
Ankylosing Spondylitis and Undifferentiated
Spondyloarthropathy
Cryptococcosis
Viral Hepatitis
Histoplasmosis
Infectious Mononucleosis
Infective Endocarditis
Leptospirosis

30. Tuberculosis
Influenza
Tuberculosis of the Genitourinary
System
Malaria
Typhoid Fever

31. •Work Up
• CBC shows leukopenia, relative
lymphocytosis or pancytopenia.
LFT shows slight elevation.
Blood culture has sensitivity of 60% and
subcultures are still adviced for at least 4
weeks.
Bone marrow culture has sensitivity of
80-90%.

32. Serology
1- Serum tube agglutination test.
1. Tray agglutination test
titers of more than 1:160 in conjunction
with compatible clinical presentation is
considered highly suggestive of infection.
Titers of more than 1:320 are considered
to be more specific, especially in endemic
areas.

33. 3. ELISA:
It measures IgM, IgG and IgA
allowing for better
interpretation.
4. PCR:
It is used for rapid and
accurate diagnosis of
brucellosis.

34. Histological findings:
It includes mixed inflammatory
infiltrates with lymphocytic
predominance and granulomas (in
up to 55% of cases) with necrosis.

35. Management
The World Health Organization recommends the
following for adults and children older than 8 years:
Doxycycline 100 mg PO bid and rifampin 600-
900 mg/d PO: Both drugs are to be given for 6
weeks (more convenient but probably increases
the risk of relapse).
Doxycycline 100 mg PO bid for 6 weeks and
streptomycin 1 g/d IM daily for 2-3 weeks: This
regimen is believed to be more effective, mainly
in preventing relapse.

36. Gentamicin can be used as a substitute for
streptomycin and has shown equal efficacy.
Ciprofloxacin-based regimens have shown
equal efficacy to doxycycline-based
regimens.

37. Children younger than 8 years:
The use of rifampin and trimethoprim-
sulfamethoxazole (TMP-SMX) for 6
weeks is the therapy of choice.
Relapse rate appears to be approximately
5% or less.

38. Surgical Care
The role of surgery in patients with
brucellosis lies in the treatment of
endocarditis or drainage of focal
abscesses.

39. Treatment of Brucellosis during Pregnancy
* Rifampicin:
900 mg once daily for 6 w
mainstay of treatment of brucellosis during pregnancy
OR
*Rifampicin:
900 mg once daily plus
* Trimethoprim-Sulphmethoxazole
5 mg/kg of the trimethoprim component twice daily
for 4 w
incidence of abortion was not different among
patients who received TMP-SMX alone or received
TMPSMX and rifampicin

40. Consultations
Infectious disease specialist
Cardiothoracic surgery specialist if
endocarditis is suspected or
documented.

41. Is there a vaccine for brucellosis?
Brucellosis vaccine is a vaccine for cattle,
sheep and goats used against brucellosis.
Currently, there is no vaccine available for
humans

42. Common side effects of rifampicin may
include:
Heartburn, gas, upset stomach, loss of appetite;
nausea, vomiting, diarrhea, stomach cramps;
headache, dizziness, drowsiness, weakness, tired
feeling;
muscle weakness, pain in your arms or legs;
vision problems;
flushing (warmth, redness, or tingly feeling);

43. Common side effects of rifampicin may
include:
Heartburn, gas, upset stomach, loss of appetite;
nausea, vomiting, diarrhea, stomach cramps;
headache, dizziness, drowsiness, weakness, tired
feeling;
muscle weakness, pain in your arms or legs;
vision problems;
flushing (warmth, redness, or tingly feeling);

44. Prevention
* The prevention of human brucellosis is based on
occupational hygiene and food hygiene.
•* Vaccination is not generally recommended.
* All dairy products should be prepared from heat treated
milk.
* Consumption of raw milk or products made from raw
milk should be avoided.
Meat should be adequately cooked.

45. Prevention
* Special precusion should be taken by laboratory workers.
* Physicians and health care workers should be aware of
the possibility of brucellosis
* Public health education should emphasize food hygiene
and occupational hygiene.

47. BRUCELLOSIS
Dr. SHAWKY El-EMAM
CBIC AMERICAN BOARD
MEDICAL SPECIALIST
HEPATOLOGIST
BAISH G HOSPITAL
TSH