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1 Brucellosis Dr. Zahoor 2 Brucellosis • Brucellosis also called Mediterranean fever or Malta fever or Undulant fever • It is called Brucellosis after its bacterial cause. • It is called Undulant fever because of its rising and falling like a wave. 3 Brucellosis • Brucellosis is Zoonosis infection (endemic in animals). It is infectious disease. 4 Brucellosis • Brucella is gram negative bacilli, four types are important to human 1. Brucella abortus – reservoir cattle 2. Brucella melitensis – sheep, goat , camel 3. Brucella suis – reservoir pigs 4. Brucella canis – reservoir dogs 5 Brucellosis • Brucella infection is transmitted to human mainly by ingestion of unpasteurized (raw) milk from infected animals • Brucellosis has world wide distribution, although it is almost eliminated from cattle in UK, USA 6 Brucellosis • Highest incidence of Brucellosis is in the Mediterranean countries, Middle East and Tropics • There are about 500,000 new cases diagnosed per year world wide 7 Brucellosis How the organism gets entry into the human body? By ingestion of infected milk, uncooked meat, less frequently via respiratory tract, abraded skin, animal urine, faeces may act as source of infection • Occupational exposure can occur 8 Brucellosis • In human, bacilli travel in the lymphatics and infect lymph node, this is followed by haematogenous spread with localization in reticulo – endothelial system 9 Brucellosis Clinical Features • Incubation period 1-3 weeks ( 5- 60 days ) • Acute infection is characterized by undulant fever (high swinging temperature), rigors, lethargy, headache, joint and muscle pain • Onset may be insidious, with malaise, headache, weakness, generalized myalgia and night sweats 10 Brucellosis Clinical Features (cont) • Lymphadenopathy - is common • Hepatosplenomegaly – is common • Pancytopenia • Arthritis, Sacroilitis, Osteomyelitis • Endocarditis can occur 11 Brucellosis • Brucellosis acute infection lasts few days to few months • After acute Brucellosis , infection , symptoms persist in some patients for more than one year , such patients are defined as having Chronic brucellosis. 12 Focal Manifestation of Brucellosis 13 Brucellosis Diagnosis Definitive diagnosis depend on isolation of organism • Blood or bone marrow cultures are positive during acute phase of illness in 80% of patients caused by B.melitensis • Serological test – Brucella agglutination test, 4 fold or more rise in titre over a 4 week period 14 Brucellosis Diagnosis (cont) • Increased serum IgG signifies recent infection • Neurobrucellosis-CSF culture is Positive in 30% 15 Brucellosis Management • Anti biotic - Doxycycline - Rifampicin - Gentamicin - Streptomycin • Combination of these drugs can be used. Treatment is given for 6 weeks • Neurobrucellosis is treated for 3-6 months 16 Brucellosis Management ( cont ) • Doxycycline 100 mg 12hrly for 6 weeks with Streptomycin 1 gm i/m daily for first 02 weeks. ALTERNATE Oral REGIMEN • Doxycycline 100 mg 12- hrly plus Rifampicin 900 mg (15mg/kg ) daily for 6 weeks. 17 Brucellosis Prevention & Control • Careful attention to hygiene when handling infected animals • Vaccination of animals • Pasteurization of milk Note – No vaccine is available for use in humans 18 Thank you