Brucellosis overview
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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
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.[1][2] Brucellosis must be differentiated from typhoid fever, malaria, tuberculosis, lymphoma, dengue, leptospirosis and rheumatic diseases.[3] 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.[4] 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.[4] If left untreated, patients with brucellosis may progress to develop focal infections, relapses or chronic brucellosis.[5] Common complications of brucellosis include 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.[5][6][7] Symptoms of brucellosis include undulant fever, night sweats (with characteristic smell, likened to wet hay), and joint pain.[7] Patients with brucellosis are usually well-appearing.[2] Common physical examination findings include hepatomegaly, splenomegaly, and lymphadenopathy.[8] The mainstay of therapy for brucellosis is 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.[7][9] 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.[7][10]
Historial Perspective
In 1887, David Bruce, a Scottish pathologist and microbiologist, was the first to discover the association between Brucella and the development of brucellosis.[7]
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.[1][2]
Causes
Human brucellosis is caused by four Brucellae species: B. abortus, B. canis, B. melitensis, and B. suis.[11]
Differentiating Brucellosis from other Diseases
Brucellosis must be differentiated from typhoid fever, malaria, tuberculosis, lymphoma, dengue, leptospirosis and rheumatic diseases.[3]
Epidemiology and Demographics
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.[4]
Risk Factors
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.[4]
Screening
There are no guidelines for brucellosis screening. Some endemic areas screen family members of patients with brucellosis. [12] [13]
Natural history, Complications and Prognosis
If left untreated, patients with brucellosis may progress to develop focal infections, relapses or chronic brucellosis.[5] Common complications of brucellosis include 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.[5][6][7]
Diagnosis
Criteria
The diagnosis of brucellosis is based on clinical and laboratory criteria.[14]
History and Symptoms
Symptoms of brucellosis include undulant fever, night sweats (with characteristic smell, likened to wet hay), and joint pain.[7]
Physical Examination
Patients with brucellosis are usually well-appearing.[2] Common physical examination findings include hepatomegaly, splenomegaly, and lymphadenopathy.[8]
Laboratory Findings
A positive culture or presence of Brucella antibody in serological tests are diagnostic of brucellosis.[14]
Other Diagnostic Studies
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.[15]
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. 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.[7][9]
Prevention
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.[10][7]
References
- ↑ 1.0 1.1 Corbel MJ (1997). "Brucellosis: an overview". Emerg Infect Dis. 3 (2): 213–21. doi:10.3201/eid0302.970219. PMC 2627605. PMID 9204307.
- ↑ 2.0 2.1 2.2 2.3 Brucelosis. Wikipedia. https://es.wikipedia.org/wiki/Brucelosis. Accessed on February 2, 2016
- ↑ 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
- ↑ 4.0 4.1 4.2 4.3 Brucellosis. CDC. http://www.cdc.gov/brucellosis/exposure/index.html.html. Accessed on February 3, 2016
- ↑ 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
- ↑ 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
- ↑ 7.0 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
- ↑ 8.0 8.1 Pappas G, Akritidis N, Bosilkovski M, Tsianos E (2005). "Brucellosis". N Engl J Med. 352 (22): 2325–36. doi:10.1056/NEJMra050570. PMID 15930423.
- ↑ 9.0 9.1 Brucellosis. CDC. http://www.cdc.gov/brucellosis/treatment/index.html. Accessed on February 5, 2016
- ↑ 10.0 10.1 Brucellosis. CDC. http://www.cdc.gov/brucellosis/prevention/index.html. Accessed on February 5, 2016
- ↑ Brucella. Wikipedia. https://en.wikipedia.org/wiki/Brucella#Characteristics. Accessed on February 2, 2016
- ↑ Sanodze L, Bautista CT, Garuchava N, Chubinidze S, Tsertsvadze E, Broladze M; et al. (2015). "Expansion of brucellosis detection in the country of Georgia by screening household members of cases and neighboring community members". BMC Public Health. 15: 459. doi:10.1186/s12889-015-1761-y. PMC 4432945. PMID 25934639.
- ↑ Tabak F, Hakko E, Mete B, Ozaras R, Mert A, Ozturk R (2008). "Is family screening necessary in brucellosis?". Infection. 36 (6): 575–7. doi:10.1007/s15010-008-7022-6. PMID 19011744.
- ↑ 14.0 14.1 Brucellosis 2010 Case Definition. CDC. http://wwwn.cdc.gov/nndss/conditions/brucellosis/case-definition/2010/. Accessed on February 2, 2016
- ↑ 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. doi:10.2214/AJR.05.1088. PMID 16985128.