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| ==Overview== | | ==Overview== |
| '''Brucellosis''' is a [[zoonosis]] (infectious disease transmitted from animals to humans) caused by bacteria of the genus ''[[Brucella]]''. ''[[Brucella]]'' is usually transmitted via the digestive route to the human host. Following transmission, [[white blood cells]] [[phagocyte]] the pathogen and transports it via the [[hematologic]] or [[lymphatic]] route to different organs, specially to those of the [[reticuloendothelial system]].<ref name="pmid9204307">{{cite journal| author=Corbel MJ| title=Brucellosis: an overview. | journal=Emerg Infect Dis | year= 1997 | volume= 3 | issue= 2 | pages= 213-21 | pmid=9204307 | doi=10.3201/eid0302.970219 | pmc=PMC2627605 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9204307 }} </ref><ref name="aa">Brucelosis. Wikipedia. https://es.wikipedia.org/wiki/Brucelosis. Accessed on February 2, 2016</ref> Brucellosis must be differentiated from [[typhoid fever]], [[malaria]], [[tuberculosis]], [[lymphoma]], [[dengue]], [[leptospirosis]] and [[Rheumatic disease|rheumatic diseases]].<ref name="enf">Enfermedades infecciosas: Brucelosis -Diagnóstico de Brucelosis,Guia para el Equipo de Salud. Ministerio de Salud-Argentina. http://www.msal.gob.ar/images/stories/bes/graficos/0000000304cnt-guia-medica-brucelosis.pdf. Accessed on February 2, 2016</ref> Brucellosis is not very common in the United States, but brucellosis can be very common within countries that do not have good standardized and effective public health and domestic animal health programs. Areas currently listed as high risk are the Mediterranean Basin (Portugal, Spain, Southern France, Italy, Greece, Turkey, North Africa), South and Central America, Eastern Europe, Asia, Africa, the Caribbean, and the Middle East.<ref name="c">Brucellosis. CDC. http://www.cdc.gov/brucellosis/exposure/index.html.html. Accessed on February 3, 2016</ref> Common risk factors in the development of brucellosis are consuming unpasteurized dairy products, unsafe hunting practices and occupational risks such as slaughther house workers, meat-packing employees, veterinarian and laboratory workers.<ref name="c">Brucellosis. CDC. http://www.cdc.gov/brucellosis/exposure/index.html. Accessed on February 1, 2016</ref> If left untreated, patients with brucellosis may progress to develop focal infections, relapses or chronic brucellosis.<ref name="f">Brucellosis. CDC. http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/brucellosis. Accessed on February 3, 2016</ref> Common complications of brucellosis include [[hepatitis|granulomatous hepatitis]], [[arthritis]], [[sacroiliitis]], [[meningitis]], [[orchitis]], [[epididymitis]] [[uveitis]], and [[endocarditis]]. The prognosis of brucellosis is good with adequate treatment. Relapse may occur, and symptoms may continue for years.<ref name="f">Brucellosis. Medline Plus. https://www.nlm.nih.gov/medlineplus/ency/article/000597.htm. Accessed on February 3, 2016</ref><ref name="abc">FAO/WHO/OIE Brucellosis in humans and animals. WHO (2006). http://www.who.int/csr/resources/publications/Brucellosis.pdf Accessed on February 3, 2016 </ref><ref name="a">Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on February 1, 2016</ref> Symptoms of brucellosis include [[undulant fever]], [[night sweats]] (with characteristic smell, likened to wet hay), and [[joint pain]].<ref name="a">Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on February 4, 2016</ref> Patients with brucellosis are usually well-appearing.<ref name="aa">Madkour M. Madkour's Brucellosis. Springer Science & Business Media; 2012.</ref> Common physical examination findings include hepatomegaly, splenomegaly, and lymphadenopathy.<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=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15930423 }} </ref> The mainstay of therapy for brucellosis is [[Antimicrobial drug|antimicrobial therapy]]. The preferred regimen for uncomplicated brucellosis is a combination of [[Doxycycline]] and [[Streptomycin]]. [[Rifampin]] is the drug of choice for brucellosis in pregnancy. For children less than 8 years of age, the preferred regimen is either [[Gentamycin]] or a combination of [[ Trimethoprim-sulfamethoxazole]] and [[Streptomycin]].<ref name="a">Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on February 1, 2016</ref><ref name="h">Brucellosis. CDC. http://www.cdc.gov/brucellosis/treatment/index.html. Accessed on February 5, 2016</ref> The optimal way to prevent brucellosis is by not consuming unpasteurized dairy or undercooked meat, and having safe occupational practices. There are no available vaccines for humans against brucellosis.<ref name="a">Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on February 5, 2016</ref><ref name="j">Brucellosis. CDC. http://www.cdc.gov/brucellosis/prevention/index.html. Accessed on February 5, 2016</ref>
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| ==Historial Perspective==
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| In 1887, [[David Bruce (microbiologist)|David Bruce]], a Scottish pathologist and microbiologist, was the first to discover the association between [[Brucella|''Brucella'']] and the development of brucellosis.<ref name="a">Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on February 1, 2016</ref>
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| ==Pathophysiology==
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| ''[[Brucella]]'' is usually transmitted via the digestive route to the human host. Following transmission, [[white blood cells]] [[phagocyte]] the pathogen and transport it via the [[hematologic]] or [[lymphatic]] route to different organs, specially those of the [[reticuloendothelial system]].<ref name="pmid9204307">{{cite journal| author=Corbel MJ| title=Brucellosis: an overview. | journal=Emerg Infect Dis | year= 1997 | volume= 3 | issue= 2 | pages= 213-21 | pmid=9204307 | doi=10.3201/eid0302.970219 | pmc=PMC2627605 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9204307 }} </ref><ref name="aa">Brucelosis. Wikipedia. https://es.wikipedia.org/wiki/Brucelosis. Accessed on February 2, 2016</ref>
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| ==Causes==
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| [[Human]] brucellosis is caused by four [[Brucella|Brucellae]] species: [[Brucella abortus|''B. abortus'']], [[Brucella canis|''B. canis'']], [[Brucella melitensis|''B. melitensis'']], and ''B. suis''.<ref name="aba">Brucella. Wikipedia. https://en.wikipedia.org/wiki/Brucella#Characteristics. Accessed on February 2, 2016</ref>
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| ==Differentiating Brucellosis from other Diseases==
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| Brucellosis must be differentiated from [[typhoid fever]], [[malaria]], [[tuberculosis]], [[lymphoma]], [[dengue]], [[leptospirosis]] and [[Rheumatic disease|rheumatic diseases]].<ref name="enf">Enfermedades infecciosas: Brucelosis -Diagnóstico de Brucelosis,Guia para el Equipo de Salud. Ministerio de Salud-Argentina. http://www.msal.gob.ar/images/stories/bes/graficos/0000000304cnt-guia-medica-brucelosis.pdf. Accessed on February 2, 2016</ref>
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| ==Epidemiology and Demographics==
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| Brucellosis is not very common in the United States, but brucellosis can be very common within countries that do not have good standardized and effective public health and domestic animal health programs. Areas currently listed as high risk are the Mediterranean Basin (Portugal, Spain, Southern France, Italy, Greece, Turkey, North Africa), South and Central America, Eastern Europe, Asia, Africa, the Caribbean, and the Middle East.<ref name="c">Brucellosis. CDC. http://www.cdc.gov/brucellosis/exposure/index.html.html. Accessed on February 3, 2016</ref>
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| ==Risk Factors==
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| Common risk factors in the development of brucellosis are consuming unpasteurized dairy products, unsafe hunting practices and occupational risks such as slaughther house workers, meat-packing employees, veterinarian, and laboratory workers.<ref name="c">Brucellosis. CDC. http://www.cdc.gov/brucellosis/exposure/index.html. Accessed on February 1, 2016</ref>
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| ==Screening==
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| There are no guidelines for brucellosis screening. Some [[Endemic (epidemiology)|endemic]] areas screen family members of patients with brucellosis. <ref name="pmid25934639">{{cite journal| author=Sanodze L, Bautista CT, Garuchava N, Chubinidze S, Tsertsvadze E, Broladze M et al.| title=Expansion of brucellosis detection in the country of Georgia by screening household members of cases and neighboring community members. | journal=BMC Public Health | year= 2015 | volume= 15 | issue= | pages= 459 | pmid=25934639 | doi=10.1186/s12889-015-1761-y | pmc=PMC4432945 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25934639 }} </ref> <ref name="pmid19011744">{{cite journal| author=Tabak F, Hakko E, Mete B, Ozaras R, Mert A, Ozturk R| title=Is family screening necessary in brucellosis? | journal=Infection | year= 2008 | volume= 36 | issue= 6 | pages= 575-7 | pmid=19011744 | doi=10.1007/s15010-008-7022-6 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19011744 }} </ref>
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| ==Natural history, Complications and Prognosis ==
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| If left untreated, patients with brucellosis may progress to develop focal infections, relapses or chronic brucellosis.<ref name="f">Brucellosis. CDC. http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/brucellosis. Accessed on February 3, 2016</ref> Common [[Complication (medicine)|complications]] of brucellosis include [[hepatitis|granulomatous hepatitis]], [[arthritis]], [[sacroiliitis]], [[meningitis]], [[orchitis]], [[epididymitis]] [[uveitis]], and [[endocarditis]]. The [[prognosis]] of brucellosis is good with adequate treatment. Relapse may occur, and symptoms may continue for years.<ref name="f">Brucellosis. Medline Plus. https://www.nlm.nih.gov/medlineplus/ency/article/000597.htm. Accessed on February 3, 2016</ref><ref name="abc">FAO/WHO/OIE Brucellosis in humans and animals. WHO (2006). http://www.who.int/csr/resources/publications/Brucellosis.pdf Accessed on February 3, 2016 </ref><ref name="a">Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on February 1, 2016</ref>
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| ==Diagnosis ==
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| ===Criteria===
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| The diagnosis of brucellosis is based on clinical and laboratory criteria.<ref name="e">Brucellosis 2010 Case Definition. CDC. http://wwwn.cdc.gov/nndss/conditions/brucellosis/case-definition/2010/. Accessed on February 2, 2016</ref>
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| ===History and Symptoms===
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| Symptoms of brucellosis include [[undulant fever]], [[night sweats]] (with characteristic smell, likened to wet hay), and [[joint pain]].<ref name="a">Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on February 4, 2016</ref>
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| ===Physical Examination===
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| Patients with brucellosis are usually well-appearing.<ref name="aa">Madkour M. Madkour's Brucellosis. Springer Science & Business Media; 2012.</ref> Common physical examination findings include hepatomegaly, splenomegaly, and lymphadenopathy.<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=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15930423 }} </ref>
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| ===Laboratory Findings===
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| A positive culture or presence of [[Brucella|''Brucella'']] antibody in [[Serological testing|serological tests]] are diagnostic of brucellosis.<ref name="e">Brucellosis 2010 Case Definition. CDC. http://wwwn.cdc.gov/nndss/conditions/brucellosis/case-definition/2010/. Accessed on February 2, 2016</ref>
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| ===Other Diagnostic Studies===
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| Spine x-ray, CT o MRI may be helpful in the diagnosis of focal brucellosis infection. Findings of Pedro Pons sign can be suggestive of brucellic [[spondylitis]].<ref name="pmid16985128">{{cite journal| author=Pourbagher A, Pourbagher MA, Savas L, Turunc T, Demiroglu YZ, Erol I et al.| title=Epidemiologic, clinical, and imaging findings in brucellosis patients with osteoarticular involvement. | journal=AJR Am J Roentgenol | year= 2006 | volume= 187 | issue= 4 | pages= 873-80 | pmid=16985128 | doi=10.2214/AJR.05.1088 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16985128 }} </ref>
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| ==Treatment==
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| ===Medical Therapy===
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| The mainstay of therapy for brucellosis is [[Antimicrobial drug|antimicrobial therapy]]. The preferred regimen for uncomplicated brucellosis is a combination of [[Doxycycline]] and [[Streptomycin]]. [[Rifampin]] is the drug of choice for brucellosis in pregnancy. For children less than 8 years of age, the preferred regimen is either [[Gentamycin]] or a combination of [[ Trimethoprim-sulfamethoxazole]] and [[Streptomycin]].<ref name="a">Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on February 1, 2016</ref><ref name="h">Brucellosis. CDC. http://www.cdc.gov/brucellosis/treatment/index.html. Accessed on February 5, 2016</ref>
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| ===Prevention===
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| Effective measures for the [[primary prevention]] of brucellosis include not consuming unpasteurized dairy or undercooked meat, and having safe occupational practices. There are no available vaccines for humans against brucellosis.<ref name="j">Brucellosis. CDC. http://www.cdc.gov/brucellosis/prevention/index.html. Accessed on February 5, 2016</ref><ref name="a">Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on February 5, 2016</ref>
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| ==References== | | ==References== |