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== Overview ==
''[[Brucella|Brucellosis]]'' is a [[zoonotic]] disease, [[humans]] could be infected by eating undercook meat or raw [[Dairy product|dairy]] products, inhalation of the [[bacteria]] and direct contact of bacteria with [[skin]] [[wounds]] or [[Mucous membranes|mucous membranes.]] Following transmission, [[white blood cells]] phagocyte the pathogen and transports it via hematologic or [[Lymphatic system|lymphatic route]] to different organs, specially to those of the [[reticuloendothelial system]].
 
== Pathophysiology ==
''[[Brucella|Brucellosis]]'' is a [[zoonotic]] disease, [[humans]] could be infected by eating undercook meat or raw [[Dairy product|dairy]] products, inhalation of the [[bacteria]] and direct contact of bacteria with [[skin]] [[wounds]] or [[Mucous membranes|mucous membranes.]] Following transmission, [[white blood cells]] phagocyte the pathogen and transports it via hematologic or [[Lymphatic system|lymphatic route]] to different organs specially to those of the [[reticuloendothelial system]]. [[Endotoxic]] [[lipopolysaccharide]] LPS, plays an important role in: survival of bacteria inside [[Monocytic|monocytic cel]]<nowiki/>l, supressing [[Lysosome|phagosome-lysosome fusion]] and internalizing bacteria into [[endoplasmic reticulum]]. The pathophysiology of Brucellosis can be described in the following steps:<ref name="pmid15930423">{{cite journal| author=Pappas G, Akritidis N, Bosilkovski M, Tsianos E| title=Brucellosis. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 22 | pages= 2325-36 | pmid=15930423 | doi=10.1056/NEJMra050570 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15930423  }}</ref><ref name=":0">{{Cite web|url=https://www.cdc.gov/brucellosis/transmission/index.html|title=CDC|date=|access-date=|website=|publisher=|last=|first=}}</ref><ref name="pmid8698508">{{cite journal| author=Zhan Y, Liu Z, Cheers C| title=Tumor necrosis factor alpha and interleukin-12 contribute to resistance to the intracellular bacterium Brucella abortus by different mechanisms. | journal=Infect Immun | year= 1996 | volume= 64 | issue= 7 | pages= 2782-6 | pmid=8698508 | doi= | pmc=174139 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8698508  }} </ref><ref name="pmid1574477">{{cite journal| author=Larralde de Luna M, Raspa ML, Ibargoyen J| title=Oral-facial-digital type 1 syndrome of Papillon-Léage and Psaume. | journal=Pediatr Dermatol | year= 1992 | volume= 9 | issue= 1 | pages= 52-6 | pmid=1574477 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1574477  }} </ref><ref name="pmid2915152">{{cite journal| author=Gazapo E, Gonzalez Lahoz J, Subiza JL, Baquero M, Gil J, de la Concha EG| title=Changes in IgM and IgG antibody concentrations in brucellosis over time: importance for diagnosis and follow-up. | journal=J Infect Dis | year= 1989 | volume= 159 | issue= 2 | pages= 219-25 | pmid=2915152 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2915152  }} </ref><ref name="pmid10858243">{{cite journal| author=Arenas GN, Staskevich AS, Aballay A, Mayorga LS| title=Intracellular trafficking of Brucella abortus in J774 macrophages. | journal=Infect Immun | year= 2000 | volume= 68 | issue= 7 | pages= 4255-63 | pmid=10858243 | doi= | pmc=101738 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10858243  }} </ref><ref name="pmid12414154">{{cite journal| author=Boschiroli ML, Ouahrani-Bettache S, Foulongne V, Michaux-Charachon S, Bourg G, Allardet-Servent A et al.| title=Type IV secretion and Brucella virulence. | journal=Vet Microbiol | year= 2002 | volume= 90 | issue= 1-4 | pages= 341-8 | pmid=12414154 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12414154  }} </ref><ref name="pmid15694858">{{cite journal| author=Lapaque N, Moriyon I, Moreno E, Gorvel JP| title=Brucella lipopolysaccharide acts as a virulence factor. | journal=Curr Opin Microbiol | year= 2005 | volume= 8 | issue= 1 | pages= 60-6 | pmid=15694858 | doi=10.1016/j.mib.2004.12.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15694858  }} </ref><ref name="pmid12414174">{{cite journal| author=DelVecchio VG, Kapatral V, Elzer P, Patra G, Mujer CV| title=The genome of Brucella melitensis. | journal=Vet Microbiol | year= 2002 | volume= 90 | issue= 1-4 | pages= 587-92 | pmid=12414174 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12414174  }} </ref><ref name="pmid11782541">{{cite journal| author=Moreno E, Moriyon I| title=Brucella melitensis: a nasty bug with hidden credentials for virulence. | journal=Proc Natl Acad Sci U S A | year= 2002 | volume= 99 | issue= 1 | pages= 1-3 | pmid=11782541 | doi=10.1073/pnas.022622699 | pmc=117501 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11782541  }} </ref><ref name="pmid12414149">{{cite journal| author=Gorvel JP, Moreno E| title=Brucella intracellular life: from invasion to intracellular replication. | journal=Vet Microbiol | year= 2002 | volume= 90 | issue= 1-4 | pages= 281-97 | pmid=12414149 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12414149  }} </ref><ref name="pmid12525425">{{cite journal| author=Ko J, Splitter GA| title=Molecular host-pathogen interaction in brucellosis: current understanding and future approaches to vaccine development for mice and humans. | journal=Clin Microbiol Rev | year= 2003 | volume= 16 | issue= 1 | pages= 65-78 | pmid=12525425 | doi= | pmc=145300 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12525425  }} </ref><ref name="pmid12414158">{{cite journal| author=Dornand J, Gross A, Lafont V, Liautard J, Oliaro J, Liautard JP| title=The innate immune response against Brucella in humans. | journal=Vet Microbiol | year= 2002 | volume= 90 | issue= 1-4 | pages= 383-94 | pmid=12414158 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12414158  }} </ref>
 
=== Transmission===
According to CDC, humans are generally infected with Brucellosis in one of the following three ways:<ref name="pmid15930423" /><ref>{{Cite web|url=CDC|title=https://www.cdc.gov/brucellosis/transmission/index.html|last=|first=|date=|website=|publisher=|access-date=}}</ref>
{| class="wikitable"
! colspan="2" |ROUTE OF TRANSMISSION
|-
|[[Gastrointestinal]]
|
Eating undercooked meat or consuming [[Unpasteurized milk|unpasteurized]]/raw dairy products
|-
|[[Inhalation]]
|
[[Breathing]] in the [[bacteria]] that cause brucellosis (inhalation)
|-
|[[Cutaneous]]
|
[[Bacteria]] entering the body through skin [[wounds]] or [[mucous membranes]]
|-
|Other modes of transmission
|
*Person-to-person spread of [[brucellosis]] is extremely rare.
*Infected mothers who are breast-feeding may transmit the infection to their infants.
*Sexual transmission has been rarely reported.
*While uncommon, [[transmission]] may also occur via [[Transplantation|tissue transplantation]] or [[blood transfusions]].
|}
 
=== '''Incubation''' ===
[[Incubation period]] of brucellosis varies from one to four weeks. But occasionally, it may be as long as several months. 


== Pathophysiology==
=== '''Dissemination''' ===
* Brucellosis is an infectious disease caused by the bacteria of the genus Brucella.
Following transmission, brucellae is ingested by [[macrophages]] and [[Polymorphonuclear cells|polymorphonuclea]]<nowiki/>r cells. On ingestion, they replicate [[Intracellular|intracellularly]] inside the lysed cells and disseminate systemically. 
* ''Brucella spp.'' are primarily passed among animals, and they cause disease in many different vertebrates.
* Various Brucella species affect sheep, goats, cattle, deer, elk, pigs, dogs, and several other animals.
* Humans become infected by coming in contact with animals or animal products that are contaminated with these bacteria.
* Humans are generally infected in one of three ways:
** Eating undercooked meat or consuming unpasteurized/raw dairy products
** Breathing in the organism (inhalation)
** Having the bacteria enter the body through skin wounds.
* The most common way to be infected is by eating or drinking contaminated milk products.  
* When sheep, goats, cows, or camels are infected, their milk is contaminated with the bacteria. If the milk is not pasteurized, these bacteria can be transmitted to persons who drink the milk or eat dairy products.


* Direct person-to-person spread of brucellosis is extremely rare.
===Seeding===
* Mothers who are breast-feeding may transmit the infection to their infants.
* On [[transmission]], [[bacteria]] is actively [[phagocytosed]]  by neurophilic [[granulocytes]] and [[monocytes]].
* Sexual transmission has also been reported.
* For both sexual and breast-feeding transmission, if the infant or person at risk is treated for brucellosis, their risk of becoming infected will probably be eliminated within 3 days.
* Although uncommon, transmission may also occur via contaminated tissue transplantation. <ref>http://www.cdc.gov/brucellosis/
</ref>


===Transmission and Incubation===
*On entry into the body, [[Brucella|brucellae]] multiply in the [[Neutrophil|neutrophilic]] [[granulocytes]] and [[monocytes]], initially in [[lymph nodes]], which is followed by systemic hematogenous spread resulting in multiple localizing [[infection]]
[[Image:American Bison.jpg|thumb|left|American Bison involved in a brucellosis vaccine study]]
* The disease is transmitted either through contaminated or untreated [[milk]] (and its derivates) or through direct contact with infected animals, which may include dogs, pigs, camels and ruminants, primarily sheep, goats, cattle, American Bison. This also includes contact with their carcasses.  Parturition rests are extremely rich in highy virulent brucellae . Brucellae, along with [[leptospira]] have the unique property of penetrate through intact human skin, so infection by mere hand contact with infectious material is likely to occur.
The disease is now usually associated with the consumption of unpasteurized milk and soft cheeses made from the milk of infected animals and with occupational exposures of veterinarians and slaughterhouse workers.  Some vaccines used in livestock, most notably ''B. abortus'' strain 19 also cause disease in humans if accidentally injected.  Problems with vaccine induced cases in the United States declined after the release of the RB-51 strain developed in the 1990s and the relaxation of laws requiring vaccination of cattle in many states.


The [[incubation period]] of brucellosis is, usually, of one to three weeks, but some rare instances may take several months to surface.
===Immune response===
Brucellosis elicits both [[Humoral immunity|humoral]] and [[Cell-mediated immunity|cell-mediated]] [[immune]] responses:<ref name="pmid15930423" /><ref name=":0" /><ref name="pmid8698508" /><ref name="pmid1574477" /><ref name="pmid2915152" /><ref name="pmid10858243" /><ref name="pmid12414154" /><ref name="pmid15694858" /><ref name="pmid12414174" /><ref name="pmid27672085">{{cite journal| author=Khan M, Harms JS, Marim FM, Armon L, Hall CL, Liu YP et al.| title=The Bacterial Second Messenger Cyclic di-GMP Regulates Brucella Pathogenesis and Leads to Altered Host Immune Response. | journal=Infect Immun | year= 2016 | volume= 84 | issue= 12 | pages= 3458-3470 | pmid=27672085 | doi=10.1128/IAI.00531-16 | pmc=5116723 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27672085  }}</ref><ref name="pmid159304233">{{cite journal| author=Pappas G, Akritidis N, Bosilkovski M, Tsianos E| title=Brucellosis. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 22 | pages= 2325-36 | pmid=15930423 | doi=10.1056/NEJMra050570 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15930423  }}</ref>
====Humoral immune response====
* [[Humoral immune system|Humoral]] response has a limited role in protecting host from [[Brucellosis|Brucellae]].
* On activation, [[Chronic lymphocytic leukemia|B-cell]] produce [[IgM]] class [[antibody]], which is followed by [[IgG]] antibodies .
* [[Antibodies]] promote clearance of extracellular [[bacteria]] and facilitate [[phagocytosis]] of the Brucellae.


In the first stage of the disease, septicaemia occurs and leads to the classic triad of undulant fevers, sweating (often with characteristic smell, likened to wet hay) and migratory [[arthralgia]] and [[myalgia]]. In blood tests, is characteristic the leukopenia and anemia, some elevation of AST and ALT and positivity of classic Bengal Rose and Huddleson reactions. This complex is, at least in Portugal known as the Malta fever.
====Cell mediates immune response====
During episodes of Malta fever, melitococcemia (presence of brucellae in blood) can usually be demonstrated by means of blood culture in tryptose medium or Albini medium.
*Tumor necrosis factor α ([[TNF-α]]) produces on activation of [[cell mediated immunity]], stimulates [[T lymphocytes]] and [[macrophages]], which help in eliminating intracellular [[brucellae]]. Virulent brucellae tend to suppress the activity of tumor necrosis factor α (TNF-α) and [[IFN|IFN-gamma]].
If untreated, the disease can give origin to focalizations or become chronic.
*[[Cytokines]] such as [[Interleukin 12|interleukin (IL) 12]] promote production of Interferon γ ([[Interferon|IFN-γ]]) responses. IFN-γ, which drives [[TH1]]-type responses and stimulates [[macrophage]] activation. [[Cytokines]], which include , [[IL-6]], [[IL-4]]<nowiki/>and [[IL-10]], down-regulate the protective response.
The focalizations of brucellosis occur usually in bones and joints and spondylodisciitis of lumbar spine accompanied by [[sacroiliitis]] is very characteristic of this disease. [[Orchitis]] is also frequent in men.
 
==Pathogenesis==
The pathogenesis of brucellosis is complex and not fully understood:<ref name="pmid15930423" /><ref name=":0" /><ref name="pmid8698508" /><ref name="pmid1574477" /><ref name="pmid2915152" /><ref name="pmid10858243" /><ref name="pmid12414154" /><ref name="pmid15694858" /><ref name="pmid12414174" /><ref>Barquero-Calvo E, Chaves-Olarte E, Weiss DS, et al. Brucella abortus uses a stealthy strategy to avoid activation of the innate immune system during the onset of infection. PLoS One 2007; 2:e631.</ref><ref>Gorvel JP, Moreno E. Brucella intracellular life: from invasion to intracellular replication. Vet Microbiol 2002; 90:281.</ref><ref name="pmid159304234">{{cite journal| author=Pappas G, Akritidis N, Bosilkovski M, Tsianos E| title=Brucellosis. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 22 | pages= 2325-36 | pmid=15930423 | doi=10.1056/NEJMra050570 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15930423  }}</ref>
 
By avoiding [[innate immunity]], [[Brucella infection|brucella]] survive with in [[Monocytic|monocytic cells]].
*Endotoxic [[lipopolysaccharide]] (LPS), plays a key role in survival of bacteria inside [[monocytic]] cell.
*[[LPS]] helps in survival of the [[bacteria]] inside the [[monocytic]] cell, by suppressing [[phagosome]]–[[lysosome]] fusion, internalizing bacteria into [[endoplasmic reticulum]] and inhibiting [[apoptosis]] of [[infected]] cell.
*Type IV secretion system (VirB) and  type III secretion system, that regulates [[intracellular]] survival and trafficking has been identified, although type 3 not yet confirmed. Secretion system plays an important role in [[intracellular]] transport of the bacteria acid-stable [[proteins]] produced by brucella, facilitates the survival in [[phagosomes]]
*Cu-Zn [[superoxide dismutase]], produced by brucellae, gives them resistance from [[reactive oxygen]] intermediates.
*Two component BvrS/BvrR system, codes for [[histidine]] [[kinase]] [[sensor]]. Histidine kinase sensor plays an important role in controlling the expression of [[molecular]] determinants which are necessary for cell invasion.<ref name="pmid159304232">{{cite journal| author=Pappas G, Akritidis N, Bosilkovski M, Tsianos E| title=Brucellosis. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 22 | pages= 2325-36 | pmid=15930423 | doi=10.1056/NEJMra050570 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15930423  }}</ref>
*[[Hemolysin|Hemolysins]] help the [[bacteria]] to be realeased from a [[cell]] and induce cell [[necrosis]].
==Genetics==
There is no known genetic association to Brucellosis.
 
== Microscopic Pathology ==
[[File:Brucellosis histopathology.png|center|thumb|673x673px|Brucella spp. are poorly staining, small gram-negative coccobacilli (0.5-0.7 x 0.6-1.5 µm), and are seen mostly as single cells and appearing like “fine sand”.- By Photo Credit:Content Providers(s): CDC/Courtesy of Larry Stauffer, Oregon State Public Health Laboratory - This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #1901.Note: Not all PHIL images are public domain; be sure to check copyright status and credit authors and content providers.English | Slovenščina | +/−, Public Domain, https://commons.wikimedia.org/w/index.php?curid=723156]]
[[File:Brucella granuloma with necrosis.png|center|thumb|705x705px|Histopathology of guinea pig liver in experimental Brucella suis infection. Granuloma with necrosis. - Public Domain, https://commons.wikimedia.org/w/index.php?curid=2255655]]


==Reference==
==Reference==
{{reflist|2}}
{{reflist|2}}
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Latest revision as of 20:45, 29 July 2020


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Danitza LukacVishal Devarkonda, M.B.B.S[2]

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Overview

Brucellosis is a zoonotic disease, humans could be infected by eating undercook meat or raw dairy products, inhalation of the bacteria and direct contact of bacteria with skin wounds or mucous membranes. Following transmission, white blood cells phagocyte the pathogen and transports it via hematologic or lymphatic route to different organs, specially to those of the reticuloendothelial system.

Pathophysiology

Brucellosis is a zoonotic disease, humans could be infected by eating undercook meat or raw dairy products, inhalation of the bacteria and direct contact of bacteria with skin wounds or mucous membranes. Following transmission, white blood cells phagocyte the pathogen and transports it via hematologic or lymphatic route to different organs specially to those of the reticuloendothelial system. Endotoxic lipopolysaccharide LPS, plays an important role in: survival of bacteria inside monocytic cell, supressing phagosome-lysosome fusion and internalizing bacteria into endoplasmic reticulum. The pathophysiology of Brucellosis can be described in the following steps:[1][2][3][4][5][6][7][8][9][10][11][12][13]

Transmission

According to CDC, humans are generally infected with Brucellosis in one of the following three ways:[1][14]

ROUTE OF TRANSMISSION
Gastrointestinal

Eating undercooked meat or consuming unpasteurized/raw dairy products

Inhalation

Breathing in the bacteria that cause brucellosis (inhalation)

Cutaneous

Bacteria entering the body through skin wounds or mucous membranes

Other modes of transmission

Incubation

Incubation period of brucellosis varies from one to four weeks. But occasionally, it may be as long as several months. 

Dissemination

Following transmission, brucellae is ingested by macrophages and polymorphonuclear cells. On ingestion, they replicate intracellularly inside the lysed cells and disseminate systemically. 

Seeding

Immune response

Brucellosis elicits both humoral and cell-mediated immune responses:[1][2][3][4][5][6][7][8][9][15][16]

Humoral immune response

Cell mediates immune response

Pathogenesis

The pathogenesis of brucellosis is complex and not fully understood:[1][2][3][4][5][6][7][8][9][17][18][19]

By avoiding innate immunity, brucella survive with in monocytic cells.

Genetics

There is no known genetic association to Brucellosis.

Microscopic Pathology

+/−, Public Domain, https://commons.wikimedia.org/w/index.php?curid=723156
Histopathology of guinea pig liver in experimental Brucella suis infection. Granuloma with necrosis. - Public Domain, https://commons.wikimedia.org/w/index.php?curid=2255655

Reference

  1. ↑ 1.0 1.1 1.2 1.3 Pappas G, Akritidis N, Bosilkovski M, Tsianos E (2005). "Brucellosis". N Engl J Med. 352 (22): 2325–36. doi:10.1056/NEJMra050570. PMID 15930423.
  2. ↑ 2.0 2.1 2.2 "CDC".
  3. ↑ 3.0 3.1 3.2 Zhan Y, Liu Z, Cheers C (1996). "Tumor necrosis factor alpha and interleukin-12 contribute to resistance to the intracellular bacterium Brucella abortus by different mechanisms". Infect Immun. 64 (7): 2782–6. PMC 174139. PMID 8698508.
  4. ↑ 4.0 4.1 4.2 Larralde de Luna M, Raspa ML, Ibargoyen J (1992). "Oral-facial-digital type 1 syndrome of Papillon-Léage and Psaume". Pediatr Dermatol. 9 (1): 52–6. PMID 1574477.
  5. ↑ 5.0 5.1 5.2 Gazapo E, Gonzalez Lahoz J, Subiza JL, Baquero M, Gil J, de la Concha EG (1989). "Changes in IgM and IgG antibody concentrations in brucellosis over time: importance for diagnosis and follow-up". J Infect Dis. 159 (2): 219–25. PMID 2915152.
  6. ↑ 6.0 6.1 6.2 Arenas GN, Staskevich AS, Aballay A, Mayorga LS (2000). "Intracellular trafficking of Brucella abortus in J774 macrophages". Infect Immun. 68 (7): 4255–63. PMC 101738. PMID 10858243.
  7. ↑ 7.0 7.1 7.2 Boschiroli ML, Ouahrani-Bettache S, Foulongne V, Michaux-Charachon S, Bourg G, Allardet-Servent A; et al. (2002). "Type IV secretion and Brucella virulence". Vet Microbiol. 90 (1–4): 341–8. PMID 12414154.
  8. ↑ 8.0 8.1 8.2 Lapaque N, Moriyon I, Moreno E, Gorvel JP (2005). "Brucella lipopolysaccharide acts as a virulence factor". Curr Opin Microbiol. 8 (1): 60–6. doi:10.1016/j.mib.2004.12.003. PMID 15694858.
  9. ↑ 9.0 9.1 9.2 DelVecchio VG, Kapatral V, Elzer P, Patra G, Mujer CV (2002). "The genome of Brucella melitensis". Vet Microbiol. 90 (1–4): 587–92. PMID 12414174.
  10. ↑ Moreno E, Moriyon I (2002). "Brucella melitensis: a nasty bug with hidden credentials for virulence". Proc Natl Acad Sci U S A. 99 (1): 1–3. doi:10.1073/pnas.022622699. PMC 117501. PMID 11782541.
  11. ↑ Gorvel JP, Moreno E (2002). "Brucella intracellular life: from invasion to intracellular replication". Vet Microbiol. 90 (1–4): 281–97. PMID 12414149.
  12. ↑ Ko J, Splitter GA (2003). "Molecular host-pathogen interaction in brucellosis: current understanding and future approaches to vaccine development for mice and humans". Clin Microbiol Rev. 16 (1): 65–78. PMC 145300. PMID 12525425.
  13. ↑ Dornand J, Gross A, Lafont V, Liautard J, Oliaro J, Liautard JP (2002). "The innate immune response against Brucella in humans". Vet Microbiol. 90 (1–4): 383–94. PMID 12414158.
  14. ↑ [CDC "https://www.cdc.gov/brucellosis/transmission/index.html"] Check |url= value (help). External link in |title= (help)
  15. ↑ Khan M, Harms JS, Marim FM, Armon L, Hall CL, Liu YP; et al. (2016). "The Bacterial Second Messenger Cyclic di-GMP Regulates Brucella Pathogenesis and Leads to Altered Host Immune Response" Check |url= value (help). Infect Immun. 84 (12): 3458–3470. doi:10.1128/IAI.00531-16. PMC 5116723. PMID 27672085.
  16. ↑ Pappas G, Akritidis N, Bosilkovski M, Tsianos E (2005). "Brucellosis". N Engl J Med. 352 (22): 2325–36. doi:10.1056/NEJMra050570. PMID 15930423.
  17. ↑ Barquero-Calvo E, Chaves-Olarte E, Weiss DS, et al. Brucella abortus uses a stealthy strategy to avoid activation of the innate immune system during the onset of infection. PLoS One 2007; 2:e631.
  18. ↑ Gorvel JP, Moreno E. Brucella intracellular life: from invasion to intracellular replication. Vet Microbiol 2002; 90:281.
  19. ↑ Pappas G, Akritidis N, Bosilkovski M, Tsianos E (2005). "Brucellosis". N Engl J Med. 352 (22): 2325–36. doi:10.1056/NEJMra050570. PMID 15930423.
  20. ↑ Pappas G, Akritidis N, Bosilkovski M, Tsianos E (2005). "Brucellosis" Check |url= value (help). N Engl J Med. 352 (22): 2325–36. doi:10.1056/NEJMra050570. PMID 15930423.
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