Associate Professor Family and Community Medicine Department King Saud University

1. Dr. Salwa Tayel (Brucellosis)

2. Brucellosis By Dr. Salwa Tayel Associate Professor Family and Community Medicine Department King Saud University Dr. Salwa Tayel (Brucellosis)

3. Dr. Salwa Tayel (Brucellosis)

4. Introduction • Brucellosis is primarily a disease affecting animals. It can be transmitted to humans. • Brucellosis is a major health and economic problem in many parts of the world . • It is an old disease, Sir David Bruce,isolated the causative agent from a soldier inMalta in 1886 • It remains the commonest zoonotic disease worldwide. Dr. Salwa Tayel (Brucellosis)

5. CLINICAL FEATURES: • Acute systemic disease characterized by: • - acute or insidious fever • (continuous, intermittent, or irregular) • - headache, • - weakness, • - sweating, • - arthralgia • - weight loss. • ± enlarged liver and spleen Dr. Salwa Tayel (Brucellosis)

6. Duration: days, months, years with relapses: <8 wks Acute 8 wks – one year undulant > one year Chronic Complications: Osteoarthritis 20-60% Genitourinary 2-20% Dr. Salwa Tayel (Brucellosis)

7. Subclinical and unrecognized infections are more frequent than clinical one. • It is usually a self-limiting disease. • 50% of cases regain their health in one year. • Untreated clinical illness may become chronic. • The death rate of untreated brucellosis is about 2%. • Death is usually due to bacterial endocarditis. Dr. Salwa Tayel (Brucellosis)

8. Magnitude of the problem Globally: • More than 500 000 new human cases of brucellosis annually • Associated with substantial residual disability • An important cause of travel-associated morbidity. Dr. Salwa Tayel (Brucellosis)

9. The new global map of human brucellosis2006 Dr. Salwa Tayel (Brucellosis)

10. The new global map of human brucellosis The global epidemiology of human brucellosis has drastically changed over the past decade because of: • various sanitary, • Socioeconomic, • political reasons • the evolution of international travel. Dr. Salwa Tayel (Brucellosis)

11. The new global map of human brucellosis • Countries traditionally considered to be endemic -e.g. France, Israel, and most of Latin America, • Now, they achieved control of the disease. • New foci of human brucellosis have emerged, particularly in central Asia Dr. Salwa Tayel (Brucellosis)

12. Middle East & Asia The situation in central and western Asia is dramatic: • Syria has the highest annual incidence worldwide reaching an alarming 1603 cases per million per year • Mongolia, is ranked second (605·9 cases per million) ***In USA the annual incidence of 0·48 cases per million for last ten years (only 100-200 cases annually) Dr. Salwa Tayel (Brucellosis)

13. Incidence (annual cases per million population) • Syria 1,603·4 • Mongolia605·9 • Iraq 278·4 • Turkey 262·2 • Iran 238·6 • Saudi Arabia 214·4 Dr. Salwa Tayel (Brucellosis)

14. Situation in Saudi Arabia: • Distribution: Central & Eastern regions & Asir • Regional endemicity varies in Saudi Arabia due to climatic factors: • rainy season---- increased grass growth. Dr. Salwa Tayel (Brucellosis)

15. Dr. Salwa Tayel (Brucellosis)

16. Situation in Saudi Arabia: • Between 1956 and 1982 • only Sporadic human cases of brucellosis. • During early 1980s: • brucellosis emerged as a major public health problem. Dr. Salwa Tayel (Brucellosis)

17. Reasons of the surge in incidence of brucellosis: • Intensive sheep/cattle breeding projects • minimal veterinary resources • Uncontrolled importation of live animals both for Hajj periods and for commercial reasons. • They were poorly screened for infection • In addition to, prevailing local custom of drinking raw and warm milk of sheep, goats, and camels, among the population of nomadic background. Dr. Salwa Tayel (Brucellosis)

18. Voting Miss Goat Universe ملكة جمال الماعز Dr. Salwa Tayel (Brucellosis)

19. Dr. Salwa Tayel (Brucellosis)

20. Cycle of infection Agent Susceptible Host Reservoir IP PC Portal of Inlet Portal of Exit Mode of transmission Dr. Salwa Tayel (Brucellosis)

21. Agent: Brucella species;Gram negative, coccobacilli bacteria,strictly parasitic and prefer the intracellular habitat. Reservoir: Cattle, Sheep and Goat & camel, Swine, ……. 21 Dr. Salwa Tayel (Brucellosis)

22. Brucella species and main reservoirs. Dr. Salwa Tayel (Brucellosis)

23. Dr. Salwa Tayel (Brucellosis)

24. The most important route of animal to human transmission of Brucella Dr. Salwa Tayel (Brucellosis)

25. Ingestion • Consumption of potentially infected unpasteurized milk, milk products, or meat. • Unpasteurized cheese, called "village cheese," from endemic areas is a particular risk for tourists. • Rarely through undercooked meat Dr. Salwa Tayel (Brucellosis)

26. Direct contact of conjunctiva or broken skin with blood, urine, aborted fetus, the placenta and the discharge from vagina of infected animals. • Accidental self inoculation of vaccines. High Risk Groups • slaughter-house workers, meat inspectors, animal handlers and veterinarians. Dr. Salwa Tayel (Brucellosis)

27. Inhalation of aerosols containing the bacteria. • Or aerosol contamination of the conjunctiva • In the lab, transmission is via aerosolization High Risk Groups • Laboratory workers. Dr. Salwa Tayel (Brucellosis)

28. Can brucellosis be spread from person to person? • Human-to-human transmission is rare. • Bone marrow transplantation from infected donors • Blood transfusion • Sexual intercourse • Neonatal infection; trans-placental or during delivery • Or probably through breast milk. Dr. Salwa Tayel (Brucellosis)

29. Summary • In the Middle East and Africa ingestion of contaminated dairy products is an important route of infection. • In USA, Human brucellosis is primarily an occupational hazard (Lab, Vet) • Whether human beings can become infected via person-to-person spread is rare or uncertain. • Incubation period varies • 7-21 days to several months • Brucellosis is not communicable from man to man. Dr. Salwa Tayel (Brucellosis)

30. Prevention 1. Eradication of brucellosis in animals is the key to prevention in humans. • Surveillance, serologic testing, quarantine and massive immunization of animals in areas with high infection rates • Legislation to control marketing and movement of animals. Dr. Salwa Tayel (Brucellosis)

31. Prevention 2. Brucellosis acquired from milk is preventable through: • Legislation to pasteurization of milk and dairy products. • Public health education to avoid drinking untreated milk and dairy products. 3. Health education for those occupationally at risk (Use of Safety measures). Dr. Salwa Tayel (Brucellosis)

32. Vaccination?! • A humanBrucellavaccine does not exist. • For animals: all are live-attenuated. • Currently, B. abortus RB51 is used to immunize cattle • B. melitensis REV.1 is used to immunize goats and sheep. Dr. Salwa Tayel (Brucellosis)

33. Bibliotheca Alexandrina Thank you salwatayel@hotmail.com Dr. Salwa Tayel (Brucellosis)