Brucellosis. Ahmad Ramadan MD June 2012. History. Malta fever Bang’s disease Crimean fever Gibraltar fever Undulant fever Mediterranean fever Milk sickness Goat fever Cyprus fever.
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Ahmad Ramadan MD
1- B.melitensis is the most prevalent worldwide . It’s the most virulent and causes the most severe and acute cases of Brucellosis . It is aquired primarily from goats , sheep and camels .
3- B.Suis , from hogs .
4- B.Canis , from dogs.
5- B.Pinnipediae .
6- B.Cetaceae .
The last two strains affect marine animals, however they were recently described to cause disease in humans mainly neubrucellosis .
Brucella are killed by boiling or pasteurization of milk and milk products .
Brucellae is transmitted most commonly through ingestion of untreated milk or milk products , raw meat , inhalation during contact with animals , specially by slaughterhouse , farm and lab workers .
Incubation period 1-3 weeks .
May be as long as several months .
1- Abrupt : 1-2 days .
One week or more . :2- Gradual
30-40% of patients have reactive asymmetric polyarthrits involving the knees , hips , shoulders and SI joints. Cultures of synovial fluid are positive in about 50 % of cases .
Osteomyelitis of the lumbar vertebrae is common .
In brucella , septic arthritis and osteomyelitis , the peripheral WBC count is typically normal .
Aortic root abscess
Thrombophlebitis with pulmomary aneurysm and PE
No place for monotherapy .
At least 8 weeks.
Doxycycline and Aminoglycosides for 4 weeks , followed by Doxycycline and Rifampicin for 4-8 weeks is the most effective regimen .
WHO recommendation : Doxycycline and Rifampicin for 8-12 weeks .
Aortic root abscess
Mycotic aortic aneurysm
Cerebral and Cerebellar abscess
Spinal or extra spinal osteomyelitis
Liver or Splenic abscess
TMP-SMZ + Rifampicin for 8-12 weeks
Ceftriaxone + Rifampicin + Doxycycline
Neurobrucellosis is uncommon , but serious.
Multiple cerebral or cerebellar abscesses
Cranial nerve lesions
Myositis and rhabdomyolysis