Brucellosis overview

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Overview
Historical Perspective
Pathophysiology
Causes
Differentiating Brucellosis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Principles of diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2] Danitza Lukac Vishal Devarkonda, M.B.B.S[1]

Overview

Brucellosis is an ancient Zoonotic disease, it is caused by bacteria of the genus Brucella. It is usually acquired by consuming unpasteurized dairy or undercooked meat products. Patients with brucellosis usually present with undulant fever, night sweats, and joint pain. Brucellosis can be easily treated with antibiotics. If left, untreated patients with brucellosis may progress to develop focal infections, relapses or chronic brucellosis. Prognosis is good with treatment.

Historial Perspective

According to some studies, there is evidence that Brucellosis occurred in animals 60 million years ago and 3 million years ago in human beings. In 450 BC, Hippocrates described a disease similar to Brucellosis.

Pathophysiology

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.

Causes

Human brucellosis is caused by four Brucellae species: B. abortus, B. canis, B. melitensis, and B. suis.

Differentiating Brucellosis from other Diseases

Brucellosis must be differentiated from Typhoid fever, Malaria, Tuberculosis, Lymphoma, Dengue, Leptospirosis, Rheumatic disease, Epstein-barr virus, Toxoplasmosis, Cytomegalovirus, and HIV.

Epidemiology and Demographics

Worldwide, the incidence of Brucellosis ranges from a low of 0.01 per 100,000 to high of 200 per 100,000 individuals. Case fatality rate is less than 2% when untreated. Brucellosis most commonly affects men in age group between 20 to 45 years old. 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

Risk Factors

Common risk factors in the development of brucellosis are: 1) consuming unpasteurized dairy products or raw meat products, 2) unsafe hunting practices, and 3) occupational risks.

Screening

There are no guidelines for brucellosis screening. Some endemic areas screen family members of patients with brucellosis.

Natural history, Complications and Prognosis

If left untreated, patients with brucellosis may progress to develop focal infections, relapses or chronic brucellosis. Common complications of brucellosis include: granulomatous hepatitis, arthritis, sacroiliitis, meningitis, orchitis, epididymitis uveitis, and endocarditis. The prognosis of brucellosis is good with adequate treatment.

Diagnosis

Principles of Diagnosis

Diagnosis is based on history of potential exposure, presentation consistent with the disease, and supporting laboratory findings.

History and Symptoms

Brucellosis can present with diverse clinical presentation, which include systemic flu-like symptoms and symptoms due to focal involvement of organs.

Physical Examination

Patients with brucellosis are usually well-appearing. Common physical examination findings include hepatomegaly, splenomegaly, and lymphadenopathy.

Laboratory Findings

The diagnosis of brucellosis can be confirmed by either a positive bacterial culture or a positive titre of anti-Brucella antibodies on serological testing.

Other Diagnostic Studies

There is no specific X-ray, CT or MRI finding associated with Brucellosis.

Treatment

Medical Therapy

The mainstay of therapy for brucellosis is antimicrobial therapy. The preferred regimen for uncomplicated brucellosis is a combination of Doxycycline and Streptomycin. Rifampicin 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.

Prevention

Brucellosis can be prevented by not consuming unpasteurized dairy or undercooked meat, and

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="a">Brucellosis. Wikipedia.

References

1. ↑ ^{Jump up to:1.0 1.1} 
2. ↑ ^{Jump up to:2.0 2.1 2.2 2.3} Brucelosis. Wikipedia. https://es.wikipedia.org/wiki/Brucelosis. Accessed on February 2, 2016 Cite error: Invalid <ref> tag; name "aa" defined multiple times with different content Cite error: Invalid <ref> tag; name "aa" defined multiple times with different content Cite error: Invalid <ref> tag; name "aa" defined multiple times with different content
3. ↑ ^{Jump up to:3.0 3.1} 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
4. ↑ ^{Jump up to:4.0 4.1 4.2 4.3} Brucellosis. CDC. http://www.cdc.gov/brucellosis/exposure/index.html.html. Accessed on February 3, 2016 Cite error: Invalid <ref> tag; name "c" defined multiple times with different content Cite error: Invalid <ref>tag; name "c" defined multiple times with different contentCite error: Invalid <ref> tag; name "c" defined multiple times with different content
5. ↑ ^{Jump up to:5.0 5.1 5.2 5.3} Brucellosis. CDC. http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/brucellosis. Accessed on February 3, 2016 Cite error: Invalid<ref> tag; name "f" defined multiple times with different content Cite error: Invalid <ref> tag; name "f" defined multiple times with different content Cite error: Invalid <ref>tag; name "f" defined multiple times with different content
6. ↑ ^{Jump up to:6.0 6.1} FAO/WHO/OIE Brucellosis in humans and animals. WHO (2006). http://www.who.int/csr/resources/publications/Brucellosis.pdf Accessed on February 3, 2016
7. ↑ ^{Jump up to:7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8} Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on February 1, 2016 Cite error: Invalid <ref> tag; name "a" defined multiple times with different content Cite error: Invalid <ref> tag; name "a" defined multiple times with different content Cite error: Invalid<ref> tag; name "a" defined multiple times with different content Cite error: Invalid <ref> tag; name "a" defined multiple times with different content Cite error: Invalid <ref>tag; name "a" defined multiple times with different contentCite error: Invalid <ref> tag; name "a" defined multiple times with different content Cite error: Invalid <ref> tag; name "a" defined multiple times with different content Cite error: Invalid<ref> tag; name "a" defined multiple times with different content
8. ↑ ^{Jump up to:8.0 8.1} 
9. ↑ ^{Jump up to:9.0 9.1} Brucellosis. CDC. http://www.cdc.gov/brucellosis/treatment/index.html. Accessed on February 5, 2016
10. ↑ ^{Jump up to:10.0 10.1} Brucellosis. CDC. http://www.cdc.gov/brucellosis/prevention/index.html. Accessed on February 5, 2016
11. Jump up↑ Brucella. Wikipedia. https://en.wikipedia.org/wiki/Brucella#Characteristics. Accessed on February 2, 2016
12. Jump up↑ 
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14. ↑ ^{Jump up to:14.0 14.1} Brucellosis 2010 Case Definition. CDC. http://wwwn.cdc.gov/nndss/conditions/brucellosis/case-definition/2010/. Accessed on February 2, 2016
15. Jump up↑ Pourbagher A, Pourbagher MA, Savas L, Turunc T, Demiroglu YZ, Erol I; et al. (2006). "Epidemiologic, clinical, and imaging findings in brucellosis patients with osteoarticular involvement.". AJR Am J Roentgenol. 187 (4): 873–80. PMID 16985128. doi:10.2214/AJR.05.1088.