Brucellosis
May 23, 2019

GENERAL INFORMATION

What is Brucellosis?
Zoonotic disease

What are the highest are affected by the disease ?

  • Mediterranean basin
  • Middle East
  • Central Asia
  • Africa
  • Mexico Central/South America

Is the incidence rate decreasing in KSA ?
Yes ( from 22 in 2004 to 12.5 in 2012 )

Highest area affected in KSA ?
Al-Qassim
Aser ,
Hail


possibility of brucellosis in patient with previous Hx of brucellosis?

  • parial treatment
  • re-infection
  • relapse 5-16%

MICROBIOLOGY:

What is the causative Organism ?
Brucella

  • G-VE COCCOBACILI( intracellular )
  • intracellular ( including Macrophage >> RES >> liver/spleen/Bone marrow )
  • incubation period 2 – 6 weeks

What are the Types of brucella ( causing human disease ) ?
4 types goes human infectioin

  • melitinsus : MC AND MOST SEVERE
  • abortus ( cattle )
  • canis ( dogs )
  • suits ( pigs ) ( severe )

How long it can Survive ?
Milk at 8C > 2days
Frozen meat > 3 week
goat cheese > up to 3 month
Animal excretion for more than 40days


TRANSMISSION:

What are possible route of Transmission ?

  • Animal to Human
  • Human to Human

How it can be Transmitted from Animal to Human ?

  • Food/ Fluid ingestion (MCC) ( milk/ meet product )
  • Direct contact with infected Animal ( with skin and mucosa , Conjunctival )
  • Inhalation ( ESP. In Labs )

Can it be transmitted from Human to Human? And can be transmitted by Breast feeding ?
Yes

How it can be Transmitted from Human to Human ?

  • infected blood
  • Sexual Contact
  • Trans- Placental , during Delivery or Breast Feeding

NB: Highly infectious ( only needs 10 organism)


CLINICAL MANIFESTATIONS:

How long is the incubation Period ?
1-4 week

What are the main presentation :
acute / chronic
localized ( 30% ) , and generalized

What are the common Presenting Symptoms ?

  • Fever , Night Sweeting
  • WT loss and Loss of Appetite
  • arthralgiamyalgia and Low Back Pain

What are possible Physical findings ?

  • Hepatosplenomegally
  • LAP

What are the possible Localized infection Presentation ?

  • Sacroiliits ( MC )
  • Genitourinary 20% ( orchitis , epididmytitis )
  • Pulmonary 7%
  • GIT (mainly Liver )
  • Hematology: usually it causes Pancytopenia
  • Neurological: meninigitis
  • Heart: Endocariditis 1-2%
  • Eye ( uveitis)
  • skin ( Rash )

When Chronic brucellosis is considered ?
Presence of clinical manifestations for more than 1 year after diagnosis of brucellosis with Localized infection or Relapse


INVESTIGATIONS:

  • there is PCR
  • Culture
  • blood ( in acute cases )
  • BM ( more for Chronic , More sensitive 80-90%)

Serology :

  1. serum Agllutination test
    1/80 in non endemic area
    1/160 in endemic

2.ELIZA

  • igM , igG , IgA

3.Other

  • Rose Bengal Agllutination
  • more sensative
  • rapid screening test
  • Coombs test ( Brucellacapt )
  • in relapsing and persistent active infection

What can Cause F+ result for Serology investigation ?
Other infections

What can Cause F+ result for Serology investigation ?
Early course of infection
Immunosuppression

follow up should be

  • igG measures ,and clinically

What is Prozone phenomenon:
very high titer gives false -ve ( large no. Of Ab excess the available Ag for the test )
Ocurs in Endocrine and ID (including Syphilis )

How can we overcome Prozone phenomenon if suspected ?

  • ask the labs to make it more diuluted
  • should start Treatment , then repeat Antibody titer again

What is the best imaging modality for spine involvement ?
MRI

What is the only specific imaging finding that can distinguish Brucellosis from other disease ?
Localized Snoflake calcification in CT with hepatosplenic


TREATMENT:

  • Doxy + Strep is the best
  • Doxy + Genta

doxy / Cipro ( قبرص )

in CSF:until CSFparameter have returns to normal

What can be used in Pregnant patient ?

  • Rifampin +/- Bactrim
  • Rifampin + CTX

When bactrim should be avoided in pregnant patient ? And why ?
Last week prior to delivery
Associated with kernicterus


relapse occurs from 6-5 month
why
parial treatment ( non-compliance , resistance , wrong treatment , localized infection , unappropriate treatment)