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) : > 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 < 5 % < 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