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Many Names of Brucellosis

Genus BRUCELLA Dr.P.Sreenivasulu Reddy MD., Professor of Microbiology NARAYANA MEDICAL COLLEGE Nellore-1 Andhra Pradesh INDIA. Human Disease Malta Fever Undulant Fever Mediterranean Fever Rock Fever of Gibraltar Gastric Fever. Animal Disease Bang’s Disease Enzootic Abortion

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Many Names of Brucellosis

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  1. Genus BRUCELLADr.P.Sreenivasulu Reddy MD.,Professor of MicrobiologyNARAYANA MEDICAL COLLEGENellore-1Andhra Pradesh INDIA

  2. 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 Many Names of Brucellosis

  3. Sir William Burnett (1779-1861) • Physician General to the British Navy • Differentiated the various fevers affecting soldiers

  4. Jeffery Allen Marston • Contracted Malta fever. • Described his own case in great detail.

  5. Sir David Bruce (1855-1931) • British Army physician and microbiologist • Discovered Micrococcus melitensis (July 9, 1887)

  6. Bernhard Bang (1848-1932) • Danish physician and veterinarian • Discovered Bacterium abortus (1897) could infect cattle, horses, sheep and goats.

  7. Alice Evans, American bacteriologist • Credited with linking the organisms • Similar morphology and pathology between: • Bang’s Bacterium abortus • Bruce’s Micrococcus melitensis • Nomenclature today credited to Sir David Bruce • Brucella abortus and Brucella melitensis.

  8. Morphological Profile Brucella spp. are small, Gram-negative, non-motile, non-spore-forming, coccobacilli . Intracellular microbes causing chronic disease.

  9. Cultural characters Aerobe. Best medium is Trypticase Soya Agar with selective agents (Polymyxin,Cyclohexamide).Small,moist,translucent and glistening colonies after 3 or more days of incubation.

  10. Biochemical reactionsCatalase and Oxidase positive.Nitrates are reduced.Rapidly positive for urease. Negative for IMViC reactions. Susceptibility • Killed at 600 C in 10 minutes • Pasteurization of milk . • Survival is long in refrigerated milk, • ice creams and cheese.

  11. Transmission to Humans • Conjunctiva or broken skin on contact with infected tissues • Blood, urine, vaginal discharges, aborted fetuses, placentas • Ingestion • Raw milk & unpasteurized dairy products (Cheese) • Rarely through undercooked meat

  12. Transmission to Humans • Inhalation of infectious aerosols • Pens, stables, slaughter houses • Inoculation with vaccines • B. abortus strain 19, RB-51 • B. melitensis Rev-1 • Conjunctival splashes, injection • Person-to-person transmission is rare • Incubation varies • 5 days to three months

  13. Transmission in Animals • Ingestion / contact with infected tissues or body fluids • Mucous membranes, injections • Venereal • Swine, sheep, goats, dogs • Fomites

  14. Who is at Risk? • Occupational Disease • Cattle ranchers/dairy farmers • Veterinarians • Abattoir workers • Meat inspectors • Lab workers • Hunters • Travelers • Consumers of unpasteurized dairy products

  15. Pathogenecity and Immunity Followed by Entry Ingested by PMN and not killed (super oxide dismutase ,LPS and nucleotide substance).Spread to local LN, multiply and spread to blood. Reaches to RES (Spleen,Liver,BM,LN).Resist phagocytosis (production of AMP/GMP and TNF Inhibits the phagolysosome fusion).Spread (CNS,Heart,Joints,Respiratory,Skin,GU system)Host response leads to granuloma formation and necrosis.

  16. B. abortus (Contagious/ Infectious abortion) • Worldwide • Some countries have eradicated it • Notifiable diseasein many countries • abortions, arthritic joints. • Fever of Unknown Origin (FUO) Main causes for spontaneous abortion in animals are erythritol, which can promote infections in the fetus and placenta and lack of anti-Brucella antibody in amniotic fluid.

  17. B. canis • Poorly understood • 1-19% prevalence in United States • contact with aborted fetuses and semen. • Rarely causes disease in humans.

  18. B. suis • Biovars 1 and 3 • Worldwide problem. • Free • United Kingdom, Canada • Eradicated • Holland, Denmark • Low Incidence • Middle East, North Africa

  19. Human Disease • Can affect any organ or system • All patients have a cyclical fever • Headache, weakness, arthralgia, depression, weight loss, fatigue, liver dysfunction

  20. Human Disease • 20-60% of cases • Osteoarticular complications • Arthritis, spondylitis, osteomyelitis • Hepatomegaly may occur • Gastrointestinal complications • 2-20% of cases • Genitourinary involvement • Orchitis and epididymitis most common

  21. Human Disease Neurological Depression, mental fatigue Cardiovascular Endocarditis resulting in death Chronic brucellosis is hard to define Length, type and response to treatment variable Localized infection Blood donations of infected persons should not be accepted

  22. Human Disease • Congenitally infected infants • Low birth weight • Failure to thrive • Jaundice • Hepatomegaly • Splenomegaly • Respiratory difficulty • General signs of sepsis (fever, vomiting) • Asymptomatic

  23. Chronic brucellosis:It is hard to define- Length, type and response to treatment variableThe localized form:-Bones and joints. -Lumbar spondylodiscitis, sacroiliitis is typical.-Orchitis also frequent.

  24. Sequelae are highly variable - Granulomatous hepatitis, - Arthritis, spondylitis, - Anaemia, leukopenia,thrombocytopenia, - Meningitis, uveitis, optic neuritis, - Endocarditis. Granuloma of Liver

  25. Diagnosis in Humans • Isolation of organism • Blood, bone marrow, other tissues • Serum agglutination test • Four-fold or greater rise in titer • Samples 2 weeks apart • Immunofluorescence Method • Organisms in clinical specimens • PCR

  26. Blood cultures in trypticase soya broth (Castaneda’s method): Biphasic medium. Sample inoculated bottle has to be tilted to flow the broth over solid medium and keep it upright position at 370C. The growth of brucellae is extremely slow. Bone marrow cultures are more sensitive than blood.

  27. Demonstration of IgM , IgG and Ig A ELISA is the best method. Standard tube agglutination test:Anti -O-polysaccharide of LPS. Killed strains of B. abortus as antigen. Not useful for B.canis.Modified Tube agglutination test: 2-mercaptoethanol is added to serum before testing which causes disruption of IgM and only IgG are detected. Problems with TA test: Prozone phenomenon, Presence of blocking or non-agglutinating antibodies. False positives with cholera, tularemia,yersinia or vaccination. Contd…..

  28. Castaneda strip test: Strip with colored brucella antigen. On addition of patients serum, if antibodies are present, prevents the flow of serum. Brucellin Skin test: Delayed hypersensitivity.Molecular techniques: PCRRadiology: Alterations in infected vertebrae; Pedro Pons sign( erosion of antero-superior corner of lumbar vertebrae)and marked osteophytosis are suspecious of brucellicspondylitis.

  29. Diagnosis in Animals Culture of urine and Milk.Rapid latex agglutination test, Rose Bengalcard test. (Rose Bengal + B.abortus + Sodium azide) Contd….

  30. Milk Ring Test: Frequently used test. A drop of colored brucella antigen (B.abortus/B.melitensis with hematoxylin) is added to milk in a test tube, incubated in a water bath at 700C for 40-50 minutes. Positive: Blue ring at the top leaving the milk unstained. Negative: No ring. Milk remains uniformly blue.

  31. Treatment of Choice • Combination therapy has the best efficacy • Doxycycline for 6 weeks in combination with Streptomycin for 2-3 weeks or Rifampin for 6 weeks • CNS cases to treat for 6-9 months. • Same for endocarditis cases plus surgical replacement of valves.

  32. Prognosis • May last days, months, or years • Recovery is common • Disability is often pronounced • About 5% of treated cases relapse • Failure to complete the treatment regimen • Sequestered infection requiring surgical drainage • Case-fatality rate: <2% ( untreated) • Endocarditis caused by B. melitensis

  33. Prevention and Control • Education about risk of transmission • Farmer, veterinarian, abattoir worker, butcher, consumer, hunter, public • Wear proper attire if dealing with infected animals/ tissues • Gloves, masks, goggles • Avoid consumption of raw dairy products

  34. Prevention and Control • Immunize in areas of high prevalence • Young goats and sheep with Rev-1 • Calves with RB51 • No human vaccine • Eradicate reservoir • Identify, segregate, and / or cull infected animals

  35. References: • www.slideshare.net

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