Brucellosis

1
Brucellosis

• Sung Chul Hwang, M.D.
• Dept of Pulmonary and Critical Care Medicine
• Ajou University School of Medicine

2
Introduction

• Also called undulant, Mediteranean , or Malta
  fever
• Zoonotic infection
• Four species
• abortus(cattle)
• melitensis (goats and sheep)
• suis(swine)
• canis(dogs)

3
Febrile patterns of Brucellosis(Undulant fever)
4
Epidemiology

• Direct inoculation through cuts and abrasions
• Via conjunctiva
• Inhalation of aerosols
• Ingestion of contaminated food
• Venereal transmission has been suggested

5
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

6
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)

7
Localized Brucellosis

• Any anatomic locations
• Osteomyelitis, splenic abscess, GU tract
  infections, pulmonary infection,
  endocarditis(most common cause of mortality)

8
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

9
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

10
Serologic Tests for Brucellosis

• Serum Agglutination ( Standard Tube Assay) gt 1
  160 or 4 fold increased titer
• Complement fixation
• Rose Bengal Agglutination
• Antibrucella Coombs
• ELISA

11
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

12
Prognosis

• Mortality lt 5
• lt 2 with antibiotics
• Endocarditis is the most common cause of Mortality

13
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