Brucellosis

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pathogen

• Brucella aboutus
  • cattle
  • Africa, temperate zone
• B. melitensis
  • goats, sheep, camels
  • Mediterranean, Middle East, Americas
• B. suis
  • pigs, reindeer, rodents
  • USA and everywhere
• B. canis
  • dogs

• gram negative cocco-bacilli
• facultative intracellular bacteria
  • prefers macrophage and reticuloendothelial system cells
    • reason why brucellosis shows undulating long period course as well as potential of relapse
  • also infectable in various cells including bones and joints

epidemiology

• estimated > 500,000 human cases per year

clinical features

• transmission
  • ingestion of contaminated unpasteurised milk, soft cheese, natural cheese
  • aspiration of infected dust
    • farmers and vets higher risk
  • animal contact
  • human-to-human extremely rare
• incubation 1 week to weeks to months
• HIV not risk factor
• flu-like illness
  • fever undulating and lasts for weeks
  • night sweats
  • dry cough
• myalgia and arthralgia
  • difficulty walking
• depressive, anorexic, lethargy
• hepatosplenomegaly

• septic arthritis
• muscle abscess - psoas etc.
• orchitis
• low grade meningoencephalitis
• endocarditis (1%)

difference in spp.

• B. abortus
  • insidious slow onset
  • axial skelton
• B. melitensis
  • acute onset
  • peripheral joints
  • single joint in children
• B. suis
  • acute onset
  • deep tissue abscess

diagnosis

• blood culture
  • in short time to 3 weeks
  • quite low sensitivity
• bone marrow culture more sensitive
• standard agglutination test (SAT)
• microagglutination test (MAT)

treatment

• relapse possible
• combination of 2 antibiotics for 3 months needed
• doxycycline + gentamycin/rifampcin

prevention

• one health approach
• pasteurization of milk
• animal vaccination