Brucellosis

1. brucellosis
Prepared by:
dr/Asma shaiban

2. Causative organism
• It is enzootic infection (endemic in animals)
• Four species are important to human:
• B.melitensis( the most severe disease)
• B. abortus
• B. suis
• B. canis (from pigs)
Mode of transmission:
• As animals excreted the bacteria in their milk ,
human get infected by ingestion contaminated milk ,
cheese , yoghurt and butter.
• Uncooked meat can also spread the infection

3. Pathology
• Brucella are intracellular organisms that can
live for long periods in reticulo-endothelial
system.
• Thay can evade killing by immune system and
transported into the lymphatic system and may
replicate them locally
• They can also replicate in the kidney, liver,
spleen , breast tissue or joints.(any organ system
can be involved)

4. Clinical features
• Acute illness:
High swinging temperature
Rigor
Sweating
Lethargy
Headache
Joint and muscle pains: arthralgia may be diffused or
local, with predilection for bone ends and sacroiliac
joint.
Neuropsychiatric symptoms such as delirium,
depression and dizziness can occur.
GIT symptoms like dyspepsia, abdominal pain with
constipation can occur.
Hepatic abscess may occur.

5. signs
• Palpaple spleen which may lead to hypersplenism and thrombocytopenia
• Lymph nodes enlargement
• Musculoskeletal:
 Suppurative arthritis
 Synovitis
 Bursitis
 Osteomylitis
 Spinal spondylitis
 Paravertebral or psoas abscess.
• Meningitis
• Stroke
• Cranial nerve palsies
• Intracranial or subarachnoid heamorrhage
• Myelopathy
• Uveitis
• Retinal thrombophlebitis
• Myocarditis
• endocarditis

6. Cutaneous manifestations:
• Found in 5-10% of patient and include:
Erythema nodosum
Cutaneous ulceration
Impetigo
Macular, maculopapular rash.
Vasculitic lesions (petechiae, purpura)

7. diagnosis
• Isolation of the organism is the definitive diagnosis
• Blood culture is positive in up to 80% of B. miletensis
and 50% of B. abortus.
• Sometimes bone marrow culture can be helpful if
antibiotic have been given before sample are taken but
it should not be routinely done.
• The most commonly used is serum agglutination
although many pitfalls.
Significant titres may persist for months to years
after recovery
In endemic area a single titre of 1/320 or a fourfold
rises in titer is needed to support diagnosis.
It takes several weeks to be positive .

8. Other tests:
• Pancytopenia can be found.
• Slight elevation in liver enzymes.
• ESR is elevated in complication.

9. Management
• Combinations of aminoglycosides with
tetracyclins shows synergetic effect ,so the
standard treatment is:
doxycycline 100 mg 12 – hourly for 6 weeks with
streptomycin 1 g i.m daily for the first 2 weeks.
(relapse rate is 5%)
Or:
• Doxycycline 100 mg 12 – hourly + rifampcin
900 mg (15 mg /kg) daily for 6 weeks.( failure
rate is higher)
• Chronic illness should be treated for 3 months to
6 months depending on the patient condition.

10. THE END