Podcast
Questions and Answers
Which of the following is NOT a clinical manifestation associated with neurobrucellosis?
Which of the following is NOT a clinical manifestation associated with neurobrucellosis?
- Compression myelopathy
- Pneumonia (correct)
- Meningitis
- Diplopia
Which complication of pregnancy is acknowledged as rare in association with brucellosis?
Which complication of pregnancy is acknowledged as rare in association with brucellosis?
- Multiple gestation
- Intra-uterine fetal death (correct)
- Retention of placenta
- Gestational diabetes
What is the standard laboratory technique used to confirm a diagnosis of brucellosis through bacterial isolation?
What is the standard laboratory technique used to confirm a diagnosis of brucellosis through bacterial isolation?
- Blood culture (correct)
- Serological testing for IgG antibodies
- Urinary antigen detection
- PCR amplification of Brucella DNA
Which of the following serological tests is commonly included in the evaluation for brucellosis?
Which of the following serological tests is commonly included in the evaluation for brucellosis?
In what timeframe may agglutinating antibodies typically become detectable in a patient with brucellosis after disease onset?
In what timeframe may agglutinating antibodies typically become detectable in a patient with brucellosis after disease onset?
What characterizes the Prozone phenomenon in serological testing?
What characterizes the Prozone phenomenon in serological testing?
Which test is utilized to differentiate antibody types in chronic disease diagnosis?
Which test is utilized to differentiate antibody types in chronic disease diagnosis?
What hematological change is most commonly observed in acute brucellosis?
What hematological change is most commonly observed in acute brucellosis?
Which treatment regimen is NOT appropriate for children under 8 years and during pregnancy?
Which treatment regimen is NOT appropriate for children under 8 years and during pregnancy?
Which laboratory change indicates potential portal tract granuloma in brucellosis patients?
Which laboratory change indicates potential portal tract granuloma in brucellosis patients?
What is a common complication of untreated brucellosis?
What is a common complication of untreated brucellosis?
Which prevention method is NOT recommended against brucellosis?
Which prevention method is NOT recommended against brucellosis?
In an elevation of cerebrospinal fluid protein content in brucellosis, what is typically also observed?
In an elevation of cerebrospinal fluid protein content in brucellosis, what is typically also observed?
What aspect of the immune response does the Prozone phenomenon highlight?
What aspect of the immune response does the Prozone phenomenon highlight?
In brucellosis treatment, what is the typical duration for Streptomycin therapy?
In brucellosis treatment, what is the typical duration for Streptomycin therapy?
Flashcards
Brucellosis Diagnosis (Bacterial Isolation)
Brucellosis Diagnosis (Bacterial Isolation)
Confirming brucellosis by isolating Brucella bacteria from blood, bone marrow, or other bodily fluids. Repetitive blood cultures are key.
Brucellosis Blood Culture (Method)
Brucellosis Blood Culture (Method)
Blood or bone marrow is incubated in CO2 with sulphonated broth, then subcultured on solid media. Incubation time is crucial and automated systems speed things up.
Brucellosis Diagnosis (Serology - SAT)
Brucellosis Diagnosis (Serology - SAT)
Using the Standard Agglutination Test (SAT) to detect antibodies (IgG and IgM) against Brucella in patient serum - high titers suggest infection.
Brucellosis Diagnosis (SAT - Interpretation)
Brucellosis Diagnosis (SAT - Interpretation)
A positive SAT result usually occurs 7-10 days after infection onset. High titers (1,000 or more) are significant, but a titer of 80 or greater is suggestive, and a rising titer between paired samples is a strong indicator.
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Brucellosis Differential Diagnosis
Brucellosis Differential Diagnosis
Conditions like influenza, mononucleosis, typhoid, rheumatic fever, and pulmonary tb need to be excluded before a brucellosis diagnosis.
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Prozone phenomenon
Prozone phenomenon
A phenomenon where agglutination is inhibited at low antibody titers but occurs at high titers, appearing as false negatives at low dilutions, but positive at high dilutions.
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2-Mercaptoethanol
2-Mercaptoethanol
A chemical that destroys IgM antibodies, leaving IgG for agglutination in a blood test.
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Brucellosis Diagnosis Tests
Brucellosis Diagnosis Tests
Tests like ELISA and radioimmunoassay detect Brucella specific IgM, IgG, and IgA in serum.
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Acute Brucellosis Hematological Changes
Acute Brucellosis Hematological Changes
May include normochromic, normocytic anemia, leukopenia or lymphocytosis (relative), and rarely pancytopenia. ESR may be modestly increased.
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Brucellosis Liver Function Tests
Brucellosis Liver Function Tests
Abnormal liver function tests observed in 50% of cases, with elevated aminotransferases and alkaline phosphatase, suggesting portal granulomas.
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Brucellosis CSF Changes
Brucellosis CSF Changes
CSF (Cerebrospinal Fluid) may show increased protein, lymphocytic pleocytosis (increased lymphocytes), and decreased sugar level.
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Brucellosis Treatment (Streptomycin & Doxycycline)
Brucellosis Treatment (Streptomycin & Doxycycline)
Streptomycin (1g daily IM) for 14-21 days and doxycycline (200mg daily) for 6-8 weeks are common treatments.
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Brucellosis Treatment (Rifampin & Doxycycline)
Brucellosis Treatment (Rifampin & Doxycycline)
Rifampin (600mg daily) and doxycycline (200mg daily) for 6 weeks are another treatment option. Avoid in children under 8 and pregnant.
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Brucellosis Prevention (Dairy Products)
Brucellosis Prevention (Dairy Products)
Pasteurization of milk (and milk products from cows, sheep, goats) is essential. Boiling is effective too.
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Brucellosis Prevention (Public Education)
Brucellosis Prevention (Public Education)
Educate about risks of consuming unpasteurized dairy, and about handling infected animal products.
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Brucellosis (Undulant Fever or Malta Fever)
- Systemic bacterial disease, acute or insidious onset, with intermittent fever of variable duration
- Worldwide disease, prevalent in Mediterranean countries (Europe, Africa), Middle East, Americas, India, and Mexico
- Primarily occupational disease affecting farm workers, veterinarians, and abattoir workers
- Often unrecognized and unreported
Occurrence
- Cases reported from Mediterranean countries (Europe and Africa), Middle East, America, India, and Mexico
- Primarily an occupational disease impacting those working with infected animals
Cycle of Infection
- Causative Agent: Gram-negative, non-motile, round or oval short bacilli; intracellular parasites of animals and humans
- Species:
- Brucella melitensis: Affects goats and sheep (Malta fever)
- Brucella abortus: Infects cows
- Brucella suis: Infects pigs
- Brucella canis: Infects dogs
- Resistance:
- Killed at 60°C in 10 minutes (pasteurization)
- Destroyed in fresh cheese during lactic acid fermentation in a few days
- Remains viable in infected butter for several days
- Sensitive to: sulpha, streptomycin, tetracycline, and chloramphenicol
Pathogenesis & Pathology
- Facultative intracellular parasites that multiply primarily within monocyte-macrophage cells
- Organisms travel through lymphatics, then the blood stream, localizing in reticuloendothelial system leading to granulomatous nodules in liver, spleen, & bone marrow
- Chronic phase can follow acute bacteremia, lasting many years
Clinical Picture
- Incubation Period: Variable, 5 to 60 days, or even several months
- Clinical Forms:
- Subclinical: Healthy individuals in endemic areas showing positive serology but lacking infection history
- Acute: Sudden or insidious onset, characterized by fluctuating high fever (39°C to 41°C), chills, rigors, excessive sweating, headache, anorexia, lethargy, prostration, often musculoskeletal pain, arthralgia, and constipation, spleen enlargement, lymphadenopathy, and tender spines (particularly in children)
- Chronic: Recurrent bouts of headache, malaise, musculoskeletal pain, extreme fatigue, & depression; may remain undiagnosed for years
Complications
- Bones and Joints: Spondylitis (lumbosacral vertebrae), osteomyelitis affecting long bones, arthritis (hip, knee, ankle, shoulder, elbow, and small joints)
- Cardiovascular: Infective endocarditis or myocarditis (rare)
- Nervous System: Meningitis, diplopia, meningeoencephalitis, compression myelopathy, & cerebral vascular occlusion
- Pregnancy: Abortion, intra-uterine fetal death, premature delivery, placental retention
Diagnosis
- History: Occupational history, exposure to animals, travel to enzootic areas, and high-risk food ingestion
- Bacterial Isolation: Blood and bone marrow cultures (positive in ~30-50% of cases); subcultures onto solid media
- Serological Tests: Standard agglutination test (SAT) detects antibodies IgG and IgM
- Other Tests: ELISA, radioimmunoassay to detect Brucella specific IgM, IgG, and IgA; blood tests may reveal liver dysfunction, portal tract granuloma, and cerebrospinal fluid irregularities
Treatment
- Streptomycin + doxycycline (14-21 days for streptomycin, 6-8 weeks for doxycycline); adjusted for neurologic or endocarditis; combined treatment with Rifampicin + doxycycline considered for specific cases
- Quinolones for specific cases
Prevention
- Education: Public awareness on risks of unpasteurized milk & products
- Animal Handling: Awareness and safety measures in slaughterhouses and meat-processing plants
- Food Sanitation: Pasteurization of milk and dairy products
- Animal Management: Livestock screening and segregation of infected animals
- Immunization: Young goats and sheep in high-prevalence areas
Control
- Reporting: Obligatory reporting to local health authorities
- Disinfection: Concurrent disinfection of purulent discharge
- Tracing: Infection tracing from contacts and identifying the source (animals, milk, etc.)
- Animal Testing & Removal: Testing and culling of suspected animals; removing reactors
- Case Treatment: Prompt and specific treatment of identified cases
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