Brucilla.pdf

Brucellosis Definition Brucellosis(alsoknownas"undulantfever,""Mediterraneanfever,"or"Maltafever")isazoonoticinfectiontransmittedtohuma nsfrom infectedanimals (cattle, sheep, goats, camels, pigs, orother animals) by ingestionof foodproducts (suchasunpasteurizeddairy products) or bycontact with tis...

Brucellosis Definition Brucellosis(alsoknownas"undulantfever,""Mediterraneanfever,"or"Maltafever")isazoonoticinfectiontransmittedtohuma nsfrom infectedanimals (cattle, sheep, goats, camels, pigs, orother animals) by ingestionof foodproducts (suchasunpasteurizeddairy products) or bycontact with tissue or fluids. Microbiology Brucella:l Gram-negative coccobacilli, normal flora of the genitourinary tract of cows, goats, sheep, pigs, and dogs. nonmotile, facultative intracellular aerobic rods There are 4 Brucella species that produce disease in humans: The most common mechanisms of transmission are: 1. Consumption of infected,unpasteurized animal products 2. Contact of skin or mucous membranes with infected animal tissue(such as placenta) or infected animal fluids (such as blood, urine, or milk) 3. Inhalation of infected aerosolized particles Food sources: Unpasteurized dairy products (especially raw milk, soft cheese, butter, and ice cream)most common Hard cheese, yogurt, and sour milk areless hazardous,since fermentation takes place Consumption of raw or undercooked muscle tissue or organ meat (such as liver and spleen)are less commonmodes of transmission Occupations at high risk: Shepherds, veterinarians, dairy-industry professionals, and laboratory personnel (including laboratory workers handling Brucella cultures and workers preparing brucellosis vaccines for animal use( Clinical Manifestations Taken up by local tissue lymphocytes, enter the circulation viaregional lymph nodes, and seed throughout the body - Insidious onset of: Fever Weight loss Night sweats (with moldy odor) Arthralgia Headache - Physical findings: Lymphadenopathy Splenomegaly Hepatomegaly Sages of Brucellosis Complications : Can affect any organ system Diagnosis Brucellosis should be suspected in patients with relevant signs and symptoms in the setting of relevant epidemiologic exposure Definitive diagnosis: Culture of the organism from blood, body fluids (urine, CSF, synovial fluid, and pleural fluid), or tissue (such as bone marrow or liver biopsy).(time consuming and hazardous) Note:Bone marrow culture is more sensitive than blood culture (sensitivity 15-70%) and is considered the gold standard for diagnosis of brucellosis Presumptive diagnosis: Brucella total antibody titer ≥1:160 by standard tube agglutination test (SAT)(sensitivity: 95%) In brucella endemic areas of Saudi Arabia, the titer of 1:320 is considered positive Detection of Brucella DNA in a clinical specimen by PCR ELISA-IgG test (serum): reported as positive or negative(sensitivity: 45-79%) Laboratory studies: CBC & LFT Treatment Goal of therapy :control the illness and prevent complications, relapses, sequelae, and mortality General principles: Use of antibiotics with activity in acidic intracellular environments, such doxycycline rifampin Use Of Combination Therapy(given high relapse rates with monotherapy),and prolonged duration of treatment Treatment  Thank You All the best !