Brucellosis

 Brucellosis is a zoonotic infection transmitted to

human by direct or indirect contacts with
infected animals.

 Also called undulent fever , malta fever, or

mediterranean fever.

 Caused by different species of the brucella group

of organisms and characterized by intermittent
or irregular febrile attacks, with profuse
sweating, arthritis and enlarged spleen
Epidemiological determinants
Agent factors
The agents are small, gram
negative, rod shaped , non- motile, non- sporing and
intracellular coccobacilli of the genus brucella.
Four species infect humans
1. B.melitensis
2. B.abortus
3. B.suis
4. B.canis
Classifications
Host factors
 Predominantly a disease of adult males.
 Farmers, shepherds, butchers, and abattoir workers,
veterinarians and laboratory workers are particularly
at special risk because of occupational exposure.
 Immunity follows infection.
Environmental factors
 Most prevalent under conditions of advanced
domestication of animals in the absence of
correspondingly advanced standards of hygiene.
 Overcrowding of herds, high rainfall, lack of exposure
to sunlight, unhygienic practices in milk and meat
production, all favour the spread of brucellosis.
 The infection can travel long distances in milk and
dust.
 The environment of a cowshed may be heavily
infected.
 The organism can survive for weeks, or months in
favourable conditions of water, urine, faeces, damp
soil and manure
Mode of transmission
Transmission is usually from infected animals to man.
There is no evidence of transmission from man to man
The routes of spread are :
1.Contact infection: direct contact with infected tissues,
blood, urine, vaginal discharge, aborted foetuses and
especially placenta.

2.Food borne infection: Infection may occur indirectly by

ingestion of raw milk and dairy products from infected
animals. Raw vegetables, contaminated water

3.Air borne infection: Inhalation of infected dust and

aerosols
Global Scenario
 Pathogenesis
Phagocytized bacteria multiply in macrophages

Carried to liver, spleen, bone marrow, lymph node,

kidneys

Multiply in cells of the reticuloendothelial system

Formation of small granulomas and release of

bacteria in systemic circulation

Septicemia
Incubation period
 Highly variable
 Usually 1-3 weeks, but may be as long as 6 months
or more
Pattern of disease
 In Humans : vary from an acute febrile disease to a
chronic low-grade ill-defined disease, lasting for
several days, months or occasionally years
Acute phase :
Characterized by a sudden or insidious onset of illness
with
(i) Swinging pyrexia (upto 40-41˚C ), rigors and
sweating.
(ii) Arthralgia/arthritis (usually monoarticular) involving
larger joints such as hip, knee, shoulder and ankle.
(iii) Low back pain.
(iv) Headache, insomnia.
(v) Small firm splenomegaly and hepatomegaly.
(vi) Leucopenia with relative lymphocytosis
.
Other Clinical Features
 Acute gastrointestinal symptoms in B. canis
infections
 Apathetic, fatigue & nonspecific myalgia
 Lose of appetite and weight
Complications
• Relapse within 2 years of recovery
• Localized disease causing suppurative or
granulomatous lesion including arthritis, spondylitis,
bursitis, osteomyelitis, pneumonia, hepatitis
• Chronic brucellosis: low grade fever and
neuropsychiatric symptoms
Diagnosis:
 Isolation of the organism from cultures of blood,
bone marrow, exudates
 Biopsy specimens during the acute phase of the
disease
 Serological tests
 Treatment
• The gold standard for the treatment of brucellosis in
adults: IM Streptomycin (0.75–1 g daily for 14–21
days) together with doxycycline (100 mg twice daily
for 6 weeks), Relapse rate : 5–10% of cases.
• Alternative regimen (current WHO
recommendation) : Rifampin (600–900 mg/day) plus
tetracycline (500 mg, 6 hourly) for 3 weeks or
doxycycline (100 mg twice daily) for 6 weeks,
relapse/failure rate is 10% ( trial), >20% (non-trial
situations)
• Patients who can’t tolerate or receive tetracyclines
(children, pregnant women) : high-dose TMP-SMX
(Trimethoprim-Sulfamethoxazole) instead (two or
three standard-strength tablets twice daily for adults,
depending on weight).
• Increasing evidence supports the use of an
aminoglycoside such as gentamicin (5–6 mg/kg per
day for at least 2 weeks) instead of streptomycin.
Control of brucellosis
1. From animal reservoirs:
based on the combination of
the following measures
(a) Test and slaughter :
 Case finding is done by mass surveys.
 Skin tests are available.
 The complement fixation test is also recommended.
(b) Vaccination:
 Vaccine of B. abortus strain 19 is commonly used for
young animals.
 A compulsory vaccination programme for all heifers
in a given community on a yearly basis can
considerably reduce the rate of infection.
 Systematic vaccination for a period of 7 to 10 years
may result in the elimination of the disease.
 Control of the infection caused by B. melitensis in
goats and sheep has to be based mainly on
vaccination
(c) Hygienic measures:
 Comprise provision of a clean sanitary environment
for animals, sanitary disposal of urine and faeces,
veterinary care of animals and health education of all
those who are occupationally involved

2. IN THE HUMANS
(a)Early diagnosis and treatment:
 In uncomplicated cases the antibiotic of choice is
tetracycline
(b) Pasteurization of milk :
 Useful preventive measure, render milk and milk
products safe for consumption
 Boiling of milk is effective when pasteurization is not
possible
(c) Protective measures :
Aim : To prevent direct contact with infected animals.
 Persons at risk should observe high standards of
personal hygiene.
 Should exercise care in handling and disposal of
placenta, discharges and foetuses from an aborted
animal.
 Should wear protective clothing when handling
carcasses.
 Exposed areas of the skin should be washed and
soiled clothing renewed.
(d) Vaccination :
 Human live vaccine of B. abortus strain 19-BA is
available
 Brucellosis would disappear if it were eradicated
from animals.
Thank You