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
The causal relationship between organism and disease was first established in 1887 by Dr.David Bruce .
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 .
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 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 Incubation period 1-3 weeks . May be as long as several months . Onset : 1- Abrupt : 1-2 days . One week or more . :2- Gradual
Physical examination often reveals no abnormalities Pallor Lymphadenopathy Hepatosplenomegaly Arthritis Spinal tenderness Rash Orchitis Meningitis Cardiac murmurs Pneumonia
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 Endocarditis Myocarditis Pericarditis Aortic root abscess Thrombophlebitis with pulmomary aneurysm and PE
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 Endocarditis Aortic root abscess Mycotic aortic aneurysm Cerebral and Cerebellar abscess Spinal or extra spinal osteomyelitis Liver or Splenic abscess
Pregnancy TMP-SMZ + Rifampicin for 8-12 weeks Meningitis Ceftriaxone + Rifampicin + Doxycycline
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