Brucellosis
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Brucellosis. Sung Chul Hwang, M.D. Dept of Pulmonary and Critical Care Medicine Ajou University School of Medicine. Introduction. Also called undulant, Mediteranean , or Malta fever Zoonotic infection Four species : abortus(cattle) melitensis (goats and sheep) suis(swine)

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Brucellosis

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Brucellosis

Brucellosis

Sung Chul Hwang, M.D.

Dept of Pulmonary and Critical Care Medicine

Ajou University School of Medicine


Introduction

Introduction

  • Also called undulant, Mediteranean , or Malta fever

  • Zoonotic infection

  • Four species :

    abortus(cattle)

    melitensis (goats and sheep)

    suis(swine)

    canis(dogs)


Febrile patterns of brucellosis undulant fever

Febrile patterns of Brucellosis(Undulant fever)


Epidemiology

Epidemiology

  • Direct inoculation through cuts and abrasions

  • Via conjunctiva

  • Inhalation of aerosols

  • Ingestion of contaminated food

  • Venereal transmission has been suggested


Pathogenesis

Pathogenesis

  • Invasion of bodyphagocytized by PMN or Macrophages spread to regional L/Ns Blood stream formation of granulomas with epitheloid cells, giant cells, lymphocytes and plasma cells in liver and RES


Acute brucellosis

Acute Brucellosis

  • Incubation 7 to 21 days to months

  • Insidious onset of low grade fever, and no localizing complaints

  • Anorexia, sweats, chills, weight loss, headache, backache, arthralgia

  • Multiple complaints but a few physical findings

  • Splenomegally (10-20%), lymphadenopathy(15%), hepatomegaly(10%)


Localized brucellosis

Localized Brucellosis

  • Any anatomic locations

  • Osteomyelitis, splenic abscess, GU tract infections, pulmonary infection, endocarditis(most common cause of mortality)


Chronic brucellosis

Chronic Brucellosis

  • Malaise asthenia, depression, chronic fatigue syndrome- like presentation

  • Ill health of more than 1 year of following onset Brucellosis

  • Mixed manifestations:

  • relapsing illness with or without localizing infection,

  • patients with no objective signs of infections,

  • no evidence of active Brucellosis by serology or culture


Diagnosis

Diagnosis

  • Clinical suspicion in chronic fever and non-specific complaints

  • Routine Lab. and X-rays : non-specific

  • Cultures: Blood, Bone Marrow, or liver biopsy in initial stage , but only 15 to 20% positive slow growth biphasic media

  • (Ruiz-Castaneda) : 7 – 21 days to 35 days but usually Bactec culture system only grow it for 7 days then discard


Serologic tests for brucellosis

Serologic Tests for Brucellosis

  • Serum Agglutination ( Standard Tube Assay) : > 1: 160 or 4 fold increased titer

  • Complement fixation

  • Rose Bengal Agglutination

  • Antibrucella Coombs

  • ELISA


Treatment of brucellosis

Treatment of Brucellosis

  • Choice : Tetracycline 30 mg/kg/day gor 3 to 6 weeks + SM 15mg/kg q 12hrs for first 2 weeks

  • Alternative : Tetracycline (or doxycycline plus GM or Rifampin

  • Endocarditis : Antibiotics + Valve replacement


Prognosis

Prognosis

  • Mortality < 5 %

    < 2 % with antibiotics

  • Endocarditis is the most common cause of Mortality


Prevention

Prevention

  • Immunization of animals with live attenuated vaccine

  • No vaccine available for human

  • Pasteurization of the milk products

  • Avoid contacts and exposure by protective garments and gloves


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