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BRUCELLOSIS
AL- Abbasi A.M.,
MD, PhD, FRCP DCN, DTM&H
Professor of Infectious Diseases& Clinical
Immunology
Transmission from animals and their
products
syndrome from geographical regions:
Mediterranean fever, Malta fever,
Gibraltar fever, Cyprus fever.
• Global incidence is not known
• True incidence even developed nations exceeds
26 times the reported ones.
• Many countries in Europe are free from the
disease.
• Consumption of imported cheese, cottage cheese travel
aboard
• Occupation – related exposure
Inhalation
Trans conjunctiva
Skin abrasions , autoinoculation
occasionally: placenta, breast milk, sexual, Biological
warfare by aerosolized B.melitensis.
Pathogenesis
Ingestion by PMNS & macrophage
• Cytokines for
defense:
IL1
IL12
TNF
Smooth & Rough
LPS
IgM, IgG, IgA, Abs
Resistance for intracellular killing
Suppression of
myeloperoxidase – H2 O2 halide
system
 Production of superoxide
dismutase.
 Inhibition of phagosomeliposome fusion escapes &
multiply in cytoplasm
Pathogenesis
• Brucella bacteria survive intracellularly by
avoiding the immune system in several ways:
• Poor inducers of inflammatory cytokines (i.e.
TNF/interferon)
• Don’t activate the complement system
• Inhibit programmed cell death.
Inflammatory responses by non caseating
granuloma, caseation & abscesses
• Classification of acute, sub acute, serologic, bacterial & mixed
types serves no purpose for diagnosis & management
• Brucellosis is systemic disease & protean manifestations IP 13/52 & more
• Onset abrupt or gradual, family history, fever, chills, sweating,
mayalqia, joints, anorexia, dreadfulness & depression
• Osteomyelitis of lumbar vertebrae
• Pallor
• Heart, NS, Genitourinary, pulmonary, GIT, skin & endocrine.
AL- Abbasi, Brucellosis in Iraq, 1993.
AL- Abbasi, Reem Shanshal, Brucellosis in AL-Anbar Governorate
AL- Abbasi, Brucella meningitis, Iraqi Med. J.;1993
AL- Abbasi, Brucellosis of the CNS, Int. Congr. For Tropical Dis., Cairo, 2009.
(A): MRI of lumbar spine in a patient with brucellosis showing evidence of
paravertebral and epidural abscess
(B): MRI of thoracic spine in a patient with brucellosis showing evidence of
multifocal spondylodiskitis
(C): MRI of tibia in a patient with brucellosis showing evidence of osteomyelitis.
Potential exposure + consistent
clinical picture
Culture
PCR
Serology: interpretation
Doxycycline + amino glycoside X 4 weeks followed by
Doxycycline +Rifampicin X 4 – 8 weeks
Quinolones
Third generation Cephalosporin's
TMP- SMZ
Follow up of clinically cured patient by serology & blood
culture every 3-6/12 for 2 years .
Sequel
Biological warfare
In 1954, B. suis became the first agent
weaponized by the United States at its
Pine Bluff Arsenal near Pine Bluff, Arkansas.
Brucella species survive well in aerosols and
resist drying.