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Bioterrorist Agents: Brucellosis

Learning Objectives. Become familiar with the following aspects of Brucellosis:Epidemiology TransmissionClinical featuresDiagnosis TreatmentPrevention. Background. Brucella melitensis discovered by Bruce in 1887Types: B. melitensis, abortus, suis, neotomae, ovis, canis, and types infecting marine mammals Pathogenic types in humans - B. melitensis, abortus, canis and suisZoonotic disease.

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Bioterrorist Agents: Brucellosis

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    1. Bioterrorist Agents: Brucellosis

    2. Learning Objectives Become familiar with the following aspects of Brucellosis: Epidemiology Transmission Clinical features Diagnosis Treatment Prevention

    3. Background Brucella melitensis discovered by Bruce in 1887 Types: B. melitensis, abortus, suis, neotomae, ovis, canis, and types infecting marine mammals Pathogenic types in humans - B. melitensis, abortus, canis and suis Zoonotic disease

    4. Brucellosis- definition A multisystem disease with a broad range of symptoms including acute or insidious onset of fever, night sweats, undue fatigue, anorexia, weight loss, headache and arthralgia

    5. Epidemiology Incidence in US: <0.5 cases per 100,000 primarily B. melitensis Most cases in the US are reported from California, Florida, Texas and Virginia High risk areas: Mediterranean Basin, South and Central America, Eastern Europe, Asia, Africa , the Caribbean and the Middle East.

    6. Transmission Three methods of transmission: Ingestion unpasteurized milk or dairy products. Ingestion is most common method of transmission. Inhalation breathing in the organism. Lab workers are high risk. Wound contamination high risk occupations include hunters, slaughterhouse workers, meat packing plant workers and veterinarians

    7. Potential For Intentional Harm? CDC Category B agent Most likely route of intentional exposure: Respiratory Could also happen via contamination of food/drink Identify intentional exposures as any BT agent: Common Source Unlikely patients Unlikely Season Multiple Patients Geographic correlation

    8. Case Definition Clinical illness with fever, night sweats, fatigue, anorexia, weight loss, headache and arthralgia Laboratory criteria for diagnosis: Isolation of Brucella sp. from a clinical specimen, or Fourfold or greater rise in Brucella agglutination titer between acute- and convalescent-phase serum specimens obtained greater than or equal to 2 weeks apart and studied at the same laboratory, or Demonstration by immunofluorescence of Brucella sp. in a clinical specimen

    9. Case classification Probable: clinically compatible case with an epidemiologic link Confirmed: clinically compatible case that is laboratory confirmed

    10. Clinical Features Flu-like symptoms:"undulant" fever, headache, chills, myalgias, arthralgias, weakness and malaise Most recover entirely within 3 to 12 months Some develop ill-defined chronic syndrome Possible complications: arthritis, uveitis, sacroiliitis, spondylitis (10% of cases), meningitis (5%), and epididymoorchitis

    11. Treatment Six week course of a combination of antibiotics. Doxycycline and rifampin or doxycyclin and streptomycin

    12. Prevention/Infection Control Pasteurizing milk and dairy products Eradicating infection from herds and flocks Observing safety precautions for occupational exposures including rubber boots wearing impermeable clothing, gloves and face masks practicing good personal hygiene

    13. Case Reports Suspected Brucellosis Case Prompts Investigation of Possible Bioterrorism-Related Activity MMWR Morb Mortal Wkly Rep 2000: 49(23) http://www.cdc.gov/mmwr/PDF/wk/mm4923.pdf

    14. Resources CDC Emergency Preparedness and Response www.bt.cdc.gov/agent/brucellosis/index.asp USDA, APHIS, Veterinary Services www.aphis.usda.gov/vs/nahps/brucellosis Special thanks to Altoon Dweck, MD, MPH, Johns Hopkins Preventive Medicine Resident

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