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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

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)

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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