Embark on an academic journey into the realm of brucellosis, meticulously dissecting its classifications, diagnostic methodologies, and therapeutic interventions. This scholarly presentation elucidates the taxonomy of Brucella species, elucidates the intricacies of diagnostic tests including serological assays and culture techniques, and delineates evidence-based treatment regimens to combat this challenging zoonotic infection.

1. Brucellosis, clinical classification and
clinical manifestations; principals of
diagnostics and treatment.
By Sunidhi Singh
IM 534

2. Understanding Brucellosis:
• Brucellosis, often referred to as Malta fever or
Mediterranean fever, is a zoonotic infectious disease
caused by bacteria of the genus Brucella.
• Originating in animals, particularly livestock like
cattle, goats, and sheep, the disease has a significant
impact on both animal and human health.
• As a global concern, Brucellosis affects millions of
people annually, with various species of Brucella
posing a threat.

3. Etiology
• Brucella species responsible for human action
include B. abortus, B. melitensis, B. suis, and
occasionally B. canis.
• B. Melitenitis - most virulent, severe and acute
• B. Abortus - Mild to sporadic infection
• The ability of Brucella to survive and persist within
host cells contributes to the chronic nature of the
infection.

4. Etiology
• Gram stained brucella:
• Brucella spp. are small, Gram-negative, non-motile,
non-spore-forming rods

5. Transmission:
• Reservoir: Animals like cattle, humans
• caused by ingestion of unsterilized milk or meat
from infected animals, or close contact with their
secretions
• also caused by:
• Inhalation of dust or wool from infected animals
• Accidental needle puncture by Brucella b19 vaccine
for cattles.

7. Clinical Classification:
• Acute Brucellosis:
• Onset typically characterized by sudden fever, often
accompanied by chills, sweats, and generalized
malaise.
• Symptoms may include headache, joint pain, and
muscle aches.
• Duration of this phase varies but can extend up to a
few weeks.

8. Clinical Classification
• Subacute Brucellosis:
• Gradual progression of symptoms, with persistent
fever and increasing fatigue.
• Patients may experience recurrent febrile episodes,
complicating diagnosis.
• Duration is more than 4 weeks
• Subacute cases often lead to the chronic form of
the disease.

9. Clinical Classification
• Chronic Brucellosis:
• Long-term implications affecting multiple organs
and systems.
• If left untreated, may lead to lifelong illness and
complications.
• Prolonged fever, persistent fatigue, and vague
symptoms make diagnosis challenging.
• Complications, such as endocarditis or
osteoarticular involvement, may manifest during
this phase.

10. Clinical Manifestations:
• Incubation period: 5 days to 2 weeks
• Duration may vary based on the strain of Brucella and the
route of transmission.
• Acute Phase: influenza like disease
• Symptoms:
• Rapid onset of symptoms within the incubation period.
• Fever, chills, and general malaise appear suddenly.
• Duration:
• Lasts for about 1 to 3 weeks.
• Symptoms can be severe and interfere with daily activities.

11. Clinical manifestations:
• Subacute Phase:
• Progression:
• Develops following the acute phase if the infection
is not effectively treated.
• Symptoms persist, but the intensity may vary.
• Duration:
• May extend for several weeks to a few months.
• Recurrent febrile episodes may characterize this
phase.

12. Clinical Manifestations:
• Chronic Phase:
• General Characteristics:
• Develops if the infection remains untreated or
inadequately treated.
• Persistent and often nonspecific symptoms.
• Duration:
• Can extend for months to years.
• The chronic phase is marked by complications
affecting various organs.

14. Complications
• Neurological Complications:
• Presentation:
• Neurological symptoms may manifest in the chronic
phase.
• The duration depends on the severity of
neurological involvement.
• Duration:
• Persistent if not promptly treated.
• Early intervention crucial to prevent irreversible
neurological damage.

15. Complications
• Cardiac Involvement (Endocarditis):
• Indications:
• Cardiac complications may develop during the
chronic phase.
• Symptoms may progress over time.
• Duration:
• Chronic and progressive if not detected and
managed.
• Early recognition and intervention critical for
positive outcomes.

16. Complications:
• Osteoarticular Involvement:
• Features:
• Arthritis and spondylitis may develop progressively.
• Symptoms may become chronic during this phase.
• Duration:
• Variable, with symptoms persisting over an
extended period.
• May lead to long-term joint damage if not managed
appropriately.Complications

17. Complications

18. Diagnosis
• Blood Cultures: tryptose broth and bone marrow
• Blood cultures remain a gold standard for diagnosing
Brucellosis.
• Multiple blood samples collected during febrile
episodes increase sensitivity.
• Interpretation:
• Positive cultures confirm the presence of Brucella
bacteria.
• Time-consuming, with cultures taking up to several
weeks for results.

19. Diagnosis:
• Brucella Agglutination Test:
• Detects antibodies against Brucella antigens.
• Positive titers indicate exposure or active infection.
• Enzyme-Linked Immunosorbent Assay (ELISA):
• Measures antibodies in the blood.
• Provides quantitative results for antibody levels

20. Diagnosis:
• PCR (Polymerase Chain Reaction):
• Detects Brucella DNA in clinical samples.
• Useful for rapid diagnosis, especially in early stages.
• Cerebrospinal Fluid Analysis: in suspected
neurological involvement
• X ray, MRI: to assess signs of skeletal involvement

23. Treatment
• Intramuscular streptomycin 1g for 14 days
• Oral Doxycycline 100mg twice a day for 45 days
• Combination therapy: Doxycycline 5mg/kg +
Rifampicin 20mg/kg for 6 weeks, twice a day
• Symptomatic management of complications
involving organ systems.