Brucellosis overview
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Brucellosis Microchapters |
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Diagnosis |
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Treatment |
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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 Vishal Devarkonda, M.B.B.S[1]
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
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.[1][2]
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. [12] [13]
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 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
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
- ↑ Jump up to:1.0 1.1
- ↑ 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 - ↑ 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
- ↑ 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 - ↑ 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 - ↑ 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
- ↑ 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 - ↑ Jump up to:8.0 8.1
- ↑ Jump up to:9.0 9.1 Brucellosis. CDC. http://www.cdc.gov/brucellosis/treatment/index.html. Accessed on February 5, 2016
- ↑ Jump up to:10.0 10.1 Brucellosis. CDC. http://www.cdc.gov/brucellosis/prevention/index.html. Accessed on February 5, 2016
- Jump up↑ Brucella. Wikipedia. https://en.wikipedia.org/wiki/Brucella#Characteristics. Accessed on February 2, 2016
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- ↑ 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
- 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.