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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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brucellosis

Brucellosis

Ahmad Ramadan MD

June 2012

history

History

Malta fever

Bang’s disease

Crimean fever

Gibraltar fever

Undulant fever

Mediterranean fever

Milk sickness

Goat fever

Cyprus fever

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The causal relationship between organism and disease was first established in 1887 by Dr.David Bruce .
etiology

Etiology

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 .

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2- B.abortus , from cattle .

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 .

epidemiology

Epidemiology

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 .

clinical manifestations

Clinical manifestations

Incubation period 1-3 weeks .

May be as long as several months .

Onset :

1- Abrupt : 1-2 days .

One week or more . :2- Gradual

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Physical examination often reveals no abnormalities

Pallor

Lymphadenopathy

Hepatosplenomegaly

Arthritis

Spinal tenderness

Rash

Orchitis

Meningitis

Cardiac murmurs

Pneumonia

bones and joints

Bones and Joints

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 .

heart

Heart

Endocarditis

Myocarditis

Pericarditis

Aortic root abscess

Thrombophlebitis with pulmomary aneurysm and PE

treatment

Treatment

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 .

surgery

Surgery

Endocarditis

Aortic root abscess

Mycotic aortic aneurysm

Cerebral and Cerebellar abscess

Spinal or extra spinal osteomyelitis

Liver or Splenic abscess

pregnancy

Pregnancy

TMP-SMZ + Rifampicin for 8-12 weeks

Meningitis

Ceftriaxone + Rifampicin + Doxycycline

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CNS

Neurobrucellosis is uncommon , but serious.

Meningitis

Meningoencephalitis

Multiple cerebral or cerebellar abscesses

Myelitis

Guillain-Barre syndrome

Cranial nerve lesions

Hemiplegia

Sciatica

Myositis and rhabdomyolysis