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Done by: Group one.

Sadeem A.

on 10 October 2012

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Transcript of Brucellosis

Brucella can infect:
Cattles, goats, camels, dogs, and pigs.

• People working in jobs where they often come in contact with animals or meat -- such as slaughterhouse workers, farmers, and veterinarians -- are at higher risk. References A 12-year-old boy develops progressive symptoms of fever, lassitude, arthralgias, headache and abdominal pain. Physical examination shows hepatosplenomegaly. Further questioning discovers that he and his family live in a rural area and include unpasteurized dairy products in their diet.

The most likely etiologic agent of this illness is:
a) Actinomyces.
b) Bartonella Henselae.
c) Brucella.
d) Yersinia Enterocolitica. Imaging Studies:
CT and MRI occult focus of infection.

Other Tests:
Bone marrow examination,  haemolytic anemia, thrombocytopenic purpura.
CSF elevated protein levels.
CSF culture positive in fewer than 50% of patients. CSF antibodies are present in most patients. Diagnosis 1. Drinking unpasteurized milk?
2. Animal contact?
3. Traveling to endemic area?

In children:
Mild self-limiting illness.
Less chronic than in adults.
Symptoms are nonspecific, usually occurring within 2-4 weeks of inoculation. History In animals the infection localizes in the erythritol-rich placenta; this effect is less marked in humans but can still result in abortion or miscarriage. 
 Immunity following exposure is not solid, and people may experience reinfection as well as relapse.
There is no increase in the frequency or severity of brucellosis in people with HIV infection. Epidemiology   Brucella species →

Poorly staining.
Small gram-negative coccobacilli (0.5-0.7 x 0.6-1.5 µm).
Seen mostly as single cells and appearing like "fine sand “.

B. Melitensis (goat, sheep and camels); it is the most invasive.
B. Abortus (cattle); it is the least invasive.
B. Suis, (swine); it is very invasive. What is Brucellosis?
Brucellosis is an infectious disease caused by bacteria from the genus Brucella.
The first clinical case compatible with Brucellosis was credited to JA Maston, an assistant surgeon in the Royal Army Medical Corps.
Alternative Names:
Rock fever; Cyprus fever; Undulant fever; Gibraltar fever; Malta fever and Mediterranean fever. Introduction CASE 2 Prevention! All of the following have been shown to be routes of transmission for Brucella EXCEPT:
a. Unpasteurized dairy products.
b. Contaminated meat.
c. Placentae.
d. Mosquito bite. • Human brucellosis is:
- Worldwide.
- Annual occurrence rate of more than 500,000 cases.
- More common in regions with less established animal-disease-control programs and in areas where public-health initiatives may be less effective.
- In the United States, Brucellosis is much less common, with only 100-200 human cases per year due to effective animal vaccination programs and milk pasteurization. Brucellosis Mashael Al-Zaydi
Mashael Al-Ghafees
Manal Al-Nemari
Hawazn Al-Lehaibi
Bnan Al-Matrafi
Bayan Al-Matrafi
Lamees Subahi
Kholood Al-Shareef Done By: Sadeem AlDuailej
Nada Al-Qarni
Abeer Al-Thubaiti
Sahar Al-Sa'adi
Marwa Al-Otaibi
Hana'a Juharji
Geeda Al-Harthi
Noura Al-Harthi Epidemiology Brucellosis is transmitted from animals to humans in several ways:
Consumption of raw milk or cheese from infected sheep and goats (the most common).
By blood or organ transplant.
Travel-associated disease.
Inhalation of the organism.
Direct contact with infected animal secretions.
An accidental injection with the livestock vaccine used against Brucella abortus can also lead to brucellosis in humans.
Human-to-human transmission is very rare (via sexual contact and breastfeeding). Transmition - Symptoms for more than 30 days before diagnosis is a major risk factor for developing focal disease (complication).
- Mortality rate is low (<2%) and is most frequently found in those with endocarditis. MCQ Acute Brucellosis Fever, sweats, arthralgia, malaise, fatigue, bodyache, anorexia, significant weight loss, abdominal pain, nausea, vomiting.
Arthritis, splenomegaly, hepatomegaly and lymphodenopathy. 1. Fever (fever of unknown origin “undulant fever”).
2. Excessive sweating.
3. Fatigue.
4. Headache.
5. Chills.
6. Nocturnal diaphoresis (Sweating at night).
7. Weight loss.

Arthralgia, myalgia and abdominal pain.

In young children they include:
Refusal to eat, lassitude, refusal to bear weight, and failure to thrive. Laboratory Studies:
Diagnosis is definitive when Brucella organisms are recovered from blood, bone marrow, or other tissue.
1. Serum agglutination test (SAT) it uses killed B-abortus cells
2. 2-Mercaptoethanol test (IgG) titers higher than 1:80 define active infection.
3. PCR tests.
4. WBC counts  within normal range or lower.
Anemia in 75% of patients.
Thrombocytopenia in 40%.
Pancytopenia  in 6% of patients. Diagnosis Cont. Symptoms Complications Antibiotics:
Acute brucellosis in adults and children ˃8 years:
Rifampin (600-900 mg) and Doxycycline

Children ˂8 years:
Rifampin and Cotrimoxazole
((15 mg/kg/day orally) each administered for six weeks)

For pregnant women:
rifampin alone or in combination with co-trimoxazole

Treatment of complicated brucellosis:
rifampin, tetracycline and aminoglycoside. Treatment CNS:

Endocarditis, myocarditis, and pericarditis.


Hepatitis, hepatic abscess and colitis.

Bones and Joints:
Sacroiliitis, spondylitis, and osteomyelitis. Surgical intervention may be required to drain pyogenic joint effusions or paraspinal abscesses. Wear goggles and rubber gloves while handling animals.
Avoid consumption of unpasteurized milk and milk products.
Hygiene may prevent infection, especially with individuals who have close contact with animals.
Avoid unnecessary contact with animals that may be infected.  
All of the following are effective in the prevention of infection due to Brucella EXCEPT:

a. Hygiene whilst handling animals.
b. Pasteurized milk.
c. Vaccination available for cattle and humans.
d. Vaccination available for cattle but not humans. CASE 1 1. Basic Malaria Microscopy (Second Edition).
2. http://www.emedicine.com
3. http://www.medicinenet.com
4. http://www.cdc.gov 
5. http://www.who.int
6. http://www.ncbi.nlm.nih.gov
7. Textbook of Clinical Pediatrics by Prof. Abdelaziz Elzouki. Acute Brucellosis 5. Murmur infective endocarditis.
6. Pericardial rub pericarditis.
7. Increased intracranial pressure or brain abscess  papilledema, cranial nerve palsy and focal neurologic deficits. Brucellosis is an infectious disease caused by bacteria from the genus Brucella.
Brucellosis is an infection of certain animals that is transmitted to humans.
Humans acquire Brucellosis when they come in contact with contaminated animals or animal products, most commonly from the ingestion of raw milk or cheese.
The symptoms of Brucellosis may include fever, sweating, body aches, and joint pain.
Brucellosis is typically diagnosed through blood tests and by isolating the organism from blood and other body tissues.
A multi-drug antibiotic regimen is the cornerstone of treatment for Brucellosis.
The complications of Brucellosis may involve various organ systems.
Brucellosis can be prevented by animal-disease-control measures, avoidance of unpasteurized dairy products and occupational protective measures.  Presenting Symptoms After ingestion or inoculation, Brucella species invade the mucosa, where polymorphonuclear leukocytes and activated macrophages mediate immune responses to eradicate the bacteria.
Brucellae can multiply and survive intracellularly by inhibiting and counteracting bactericidal effects within the phagosome.
They are then transported intracellularly via the lymphatics to organs rich in reticuloendothelial cells, and from there travel to other organs and tissues, where they can cause inflammation, granuloma formation, necrosis, and abscess formation. Pathogenises of Brucellosis Pathogenesis of Brucellosis Clinical Presentation Physical abnormalities can be minimal. Fever and minimal lymphadenopathy are the most common physical findings.

1. Hot swollen tender joints, with limited movement in patients with arthritis (most commonly knees, ankles, and hips).
2. Tenderness and limited movement is present in patients with osteomyelitis.
3. Nuchal rigidity, Kerning sign and Brudzinski sign are seen if meningitis is the focal point.
4. Generalized tenderness, rebound tenderness, and sluggish or absent bowel sounds can be expected in patients with peritonitis. Hepatomegaly may be present. Physical Signs A 3-year-old child travels with his family to Mexico, where he dines on the local cuisine. One month after return, he develops fever, anorexia, myalgias, and abdominal pain. Serologic testing is positive for Brucella infection.

Which of the following is a common manifestation of Brucellosis in children?
a) Hepatosplenomegaly.
b) Glaucoma.
c) Meningitis.
d) Endocarditis.  MCQ Summary Case 2 Edited by: Sadeem AlDuailej
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