brucellosis n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
BRUCELLOSIS PowerPoint Presentation
Download Presentation
BRUCELLOSIS

Loading in 2 Seconds...

play fullscreen
1 / 37

BRUCELLOSIS - PowerPoint PPT Presentation


  • 260 Views
  • Uploaded on

BRUCELLOSIS. Dr. Indumathi Consultant Microbiologist Gokula Metropolis Clinical Laboratory. GRAM NEGATIVE COCCOBACILLI (PARVO BACTERIA). BORDETELLA, BRUCELLA, YERSENIA, PASTEURELLA, FRANCESELLA HAEMOPHILUS, MORAXELLA, GARDENERELLA HACEK. Historical Background. Malta Fever

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'BRUCELLOSIS' - halil


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
brucellosis
BRUCELLOSIS

Dr. Indumathi

Consultant Microbiologist

Gokula Metropolis Clinical Laboratory

gram negative coccobacilli parvo bacteria
GRAM NEGATIVE COCCOBACILLI(PARVO BACTERIA)
  • BORDETELLA, BRUCELLA, YERSENIA, PASTEURELLA, FRANCESELLA
  • HAEMOPHILUS, MORAXELLA, GARDENERELLA
  • HACEK
historical background
Historical Background
  • Malta Fever
    • Major health problem to British troops in Malta in the 19th and early 20th centuries.
historical background1
HISTORICAL BACKGROUND
  • MEDITERRANEAN FEVER
  • UNDULANT FEVER
  • MALTA FEVER
historical background2
Historical Background
  • 1860 J.A. Maraston; assistant surgeon in the British Army in Malta -- first accurate description “Mediterranian Gastric Remittent Fever”
  • David Bruce (1855-1931) -1883 sent to Malta to provide medical care to the troops. - 1887 isolated “micrococcus” from spleens of 4 soldiers died of the disease.
historical background3
Historical Background

What is the source?

“Mediterranean Fever Commission” 1904

historical background4
Historical Background
  • 1905 ZAMMIT;MALTESE PHYSICIAN

- GOATS: SOURCE OF INFECTION. : GOATS’ MILK

  • 1897 E. BANG;DANISH VETERINARIAN

-INTRACELULAR PATHOGEN CAUSING ABORTION IN CATTLE NAMED “BACILLUS ABORTUS”.

  • 1918 A.EVANS;AMERICAN MICROBIOLOGIST

BACILLUS ABORTUS AND MICROCOCCUS MELITENSIS & NAMED IT BACTERIACEAE.

historical background5
Historical Background
  • 1920 Meyer and Shaw suggested BRUCELLA
  • 1914 Mohler isolated organism from liver & spleen of Pigs--B.suis.
  • 1957 B. neotome, 1963 B. ovis, 1966 B. canis
epidemiology
Epidemiology
  • Worldwide zoonosis
  • Only 17 countries declared brucellosis free1986
  • Six species 1. B.abortus - mainly cattle 2. B.melitensis - sheeps & goats 3. B.suis - pigs 4. B. canis - dogs 5. B. ovis - sheep (not human pathogen) 6. B. neotomae - desert wood rat (not human pathogen)
  • B. melitensis -- most common worldwide
epidemiology1
Epidemiology
  • ENDEMIC DISEASE :Saudi Arabia, Iran, Iraq
  • MOSTLY B. MELITENSIS & B. ABORTUS.
  • NO CLEAR FIGURES ABOUT INCIDENCE & PREVALENCE.
  • INCIDENCE : 5.4 PER 1000 PER YEAR.
  • PREVALENCE : 8.6 - 38 % - SOME REGIONS.
bacteriology
Bacteriology
  • GRAM NEGATIVE COCCI, COCCOBACILLI,
  • STRICT AEROBIC, NONMOTILE, NONSPORE FORMING.
  • 3 SPECIES:
  • B.MELITENSIS : GOATS
  • B.ABORTUS : CATTLE
  • B.SUIS : PIGS
bacteriology1
BACTERIOLOGY
  • FACULTATIVE INTRACELLULAR
  • STRICT AEROBES/FASTIDIOUS
  • 5-10% CARBONDIOXIDE : FOR B.ABORTUS
  • SLOW GROWTH ON ORDINARY MEDIA
  • ENRICHED MEDIUM : GLUCOSE/SERUM/
  • TRYPTICASE SOY BROTH/AGAR
biochemical reactions
BIOCHEMICAL REACTIONS
  • NO FERMENTATION OF SUGARS
  • OXIDATIVE
  • OXIDASE AND UREASE POSITIVE
  • IMVIC : ----
transmission
Transmission
  • ZOONOSIS AFFECTING DOMESTIC ANIMALS.
  • CONCENTRATED IN MILK, URINE, GENITAL ORGANS.

ROUTES OF TRANSMISSION

  • ORAL: UNPASTEURISED MILK & PRODUCTS RAW MILK OR MEET.
  • RESPIRATORY: LAB WORKERS.
  • SKIN: ACCIDENTAL PENETRATION OR ABRASION
    • - AT RISK FARMERS & VETERINARIANS.
  • OTHER ROUTES:

CONJUNCTIVAL, BLOOD TRANSFUSION, TRANSPLACENTAL, ? PERSON TO PERSON.

pathogenesis
Pathogenesis

Entry to the body

Macrophage activation

Polymorph migration & Phagocytosis

Intracelluar multiplication

Lymphatics

RES organs

Blood

Any organ

virulence factors
VIRULENCE FACTORS
  • RESISTS PHAGOCYTOSIS :
  • LOW M.W. MOLECULES INHIBIT FUSION OF LYSOSOMES/PHAGOSOMES
  • ABILITY TO SURVIVE INTRACELLULARLY : PROLONGED PERSISTANCE
pathogenesis1
Pathogenesis
  • CELL MEDIATED IMMUNITY ALSO ACTIVATED WITH GRANULOMA FORMATION (MAINLY WITH B. ABORTUS)
  • HUMORAL ANTIBODY RESPONSE OF LITTLE IMPORTANCE
  • MAIN WAY OF BODY CONTROL OF THE INFECTION IS THROUGH COMMITTED T-LYMPHOCYTES PRODUCING LYMPHOKINES (- INTERFERON) WHICH ACTIVATE MACROPHAGE KILLING
  • PYOGENIC INFECTION MORE WITH B. MELITENSIS AND B. SUIS
clinical manifestations
Clinical Manifestations
  • INCUBATION PERIOD: VARIABLE 2- 8 WKS.
  • PRESENTATION: ACUTE 50% & INSIDIOUS 50%
  • SX & SIGNS NOT SPECIFIC.
  • CAN AFFECT ANY ORGAN.
  • COMMON NONSPECIFIC SX: - FEVER WITH RIGORS. - SWEATS, MALAISE, ANOREXIA. - HEADACHE, BACK PAIN.
clinical manifestations1
Clinical Manifestations
  • GIT 70% : ANOREXIA, ABD. PAIN, VOMITING, DIARRHEA,CONTIPATION, HEPATOSPLENOMEGALY.
  • LIVER : INVOLVED IN MOST CASES BUT LFTS NORMAL OR MILDLY ABNORMAL.
    • GRANULOMAS (B. ABORTUS).
    • HEPATITIS (B.MELITENSIS).
    • ABSCESSES (B.SUIS).
clinical manifestations2
Clinical Manifestations
  • SKELETAL 20-60% :
  • ARTHRITIS, SPONDYLITIS, OSTEOMYELITIS.
  • SACROILIITIS - MOST COMMON.
  • ATHRITIS - OLIGOARTICULAR : HIP, KNEE & ANKLES.

JOINT ASP. - MONOCYTOSIS, CULTURE +VE IN 50 %

clinical manifestations3
CLINICAL MANIFESTATIONS
  • NEUROLOGIC
    • MENINGITIS, ENCEPHALITIS, RADICULOPATHY & PERIPHERAL NEUROPATHY, INTRACEREBRAL ABSCESSES
    • MENINGITIS
      • ACUTE OR CHRONIC
      • NECK RIGIDITY < 50%
      • CSF
        • LYMPHOCYTIC PLEOCYTOSIS
        • (N) OR LOW SUGAR
        • INCREASE PROTEIN
        • CULTURE +VE < 50%
        • AGGLUTINATION +VE IN >95%
clinical manifestations4
CLINICAL MANIFESTATIONS
  • CARDIOVASCULAR
    • ENDOCARDITIS 2% (MAJOR CAUSE OF MORTALITY)
    • RX: VALVE REPLACEMENT AND ANTIBIOTICS
    • PERICARDITIS & MYOCARDITIS
  • PULMONARY
    • INHALATION OR HEMATOGENOUS
    • CAUSE ANY CHEST SYNDROME
    • RARELY BRUCELLA ISOLATED FROM SPUTUM
clinical manifestations5
Clinical Manifestations
  • GENITOURINARY
    • EPIDYDEMOORCHITIS
    • PYONEPHROSIS (RARE)
  • CUTANEOUS
    • NONSPECIFIC
  • HEMATOLOGIC
    • ANEMIA
    • LEUKOPENIA
    • THROMBOCYTOPENIA
diagnosis
DIAGNOSIS
  • HISTORY OF ANIMAL CONTACT IS PIVOTAL
  • IN ENDEMIC AREA, IT SHOULD BE IN THE DD OF ANY NONSPECIFIC FEBRILE ILLNESS
diagnosis1
Diagnosis
  • LABORATORY
    • WBC (N) OR . MONOCYTOSIS
    • SPECIMENS: BLOOD
    • BONE MARROW
    • BLOOD CULTURES : CASTANEDA’S
      • SLOW GROWTH = 4 WEEKS
      • NEW AUTOMATED SYSTEM BATEC IDENTIFIES HE ORGANISM 4-8 DAYS
      • MORE RECENT (BACT/ALERT) - 2.8 DAYS
  • PCR
diagnosis2
Diagnosis
  • SEROLOGY
    • STANDARD AGGLUTINATION TEST – (SAT

DIAGNOSTIC ??

1 : 160 - NON ENDEMIC

1 : 320 - ENDEMIC AREA

      • SAT - FALSE NEGATIVE
        • PROZONE
        • BLOCKING ANTIBODIES
    • OTHER TESTS: COOMBS, ELISA, CFT,
brucella antibodies
Brucella Antibodies
  • AGG = IgG + IgM
  • 2ME = IgG
  • DETECTING INFECTED ANIMALS:
  • MILK RING TEST ; MILK + BACTERIAL SUSPENSION (STAINED) : BLUE RING ABOVE CREAM LINE
prognosis
Prognosis
  • Preantibiotic era
    • Mortality 2% mainly endocarditis
  • Morbidity
    • High with B. melitensis
    • Nerve deafness
    • Spinal cord damage
prevention
Prevention
  • CONTROL OF DISEASE IN DOMESTIC ANIMALS
    • IMMUNIZATION USING
    • B. ABORTUS STRAIN S19
    • ROUTINE PASTEURIZATION OF MILK
  • IN LABS STRICT BIOSAFETY PRECAUTIONS
treatment
Treatment

DRUGS AGAINST BRUCELLA

  • TETRACYCLINES
  • AMINOGLYCOSIDES
    • STREPTOMYCIN SINCE 1947
    • GENTAMICIN
    • NETILMICIN
  • RIFAMPICIN
  • QUINOLONES - CIPROFLOXACIN
treatment1
Treatment

Drugs against Brucella

  • Treatment for uncomplicated Brucellosis
    • Stremptomycin + Doxycycline for 6 weeks
      • ? TMP/SMX + Doxycycline for 6 weeks
    • WHO recommendation 1986
      • Rifampicin + Doxycycline for 6 weeks
  • Treatment of complicated Brucellosis
    • Endocarditis, meningitis
    • No uniform agreement
    • Usually 3 antibrucella drugs for 3 months
slide37

Relapse

PREDICTORS OF RELAPSE

MALE SEX

INADEQUATE ANTIBIOTIC THERAPY.

POSITIVE CULTURE ON INITIAL DISEASE

THROMBOCYTOPENIA

Ariza, et al: CID 20:1241, 1995