Brucellosis overview
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Brucellosis overview On the Web |
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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 an ancient disease. 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. Traditionally Brucella, due to its propensity for airborne transmission, low lethality, minimal mortality, and ease of manufacturing made it to be considered as a biological weapon. CDC classifies it into category B pathogen. Brucella is usually transmitted via the digestive route to the humanhost. 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. Human brucellosis is caused by four Brucellae species: B. abortus, B. canis, B. melitensis, and B. suis. Brucellosis must be differentiated from Typhoid fever, Malaria, Tuberculosis, Lymphoma, Dengue, Leptospirosis, Rheumatic disease, Epstein-barr virus, Toxoplasmosis, Cytomegalovirus, and HIV. 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. 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. There are no guidelines for brucellosis screening. However, some endemic areas screen family members of patients with brucellosis. If left untreated, patients with brucellosis may progress to develop focal infections, relapses or chronic brucellosis.[1] 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. There is no specific diagnostic criteria for Brucellosis, Diagnosis is based on history of potential exposure, presentation consistent with the disease, supporting laboratory findings. Brucellosis can present with diverse clinical presentation, which include systemic flu-like symptoms and symptoms due to focal involvement of organs. Patients with brucellosis are usually well-appearing. Physical examination usually reveal combination of several non-specific findings. The diagnosis of brucellosis can be confirmed by either a positive bacterial culture or a positive titer of anti-Brucella antibodies on serological testing. There is no specific X-ray finding associated with Brucellosis. There is no specific CT scan finding associated with Brucellosis. There is no specific MRI finding associated with Brucellosis. 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. 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. Secondary prevention strategies of Brucellosis include following the patient upto 2 years following the diagnosis of Brucellosis to monitor for relapse.