BRUCELLOSIS

BRUCELLOSIS

AL- Abbasi A.M.,
MD, PhD, FRCP DCN, DTM&H

Professor of Infectious Diseases& Clinical Immunology

Transmission from animals and their products

syndrome from geographical regions:
Mediterranean fever, Malta fever, Gibraltar fever, Cyprus fever.
• Clinically
• Remittent character: undulant fever
• Intermittent fever e.g.
• typho malarial
Clinical Zoonosis

Global incidence is not known

True incidence even developed nations exceeds 26 times the reported ones.
Many countries in Europe are free from the disease.
Epidemiology


Consumption of imported cheese, cottage cheese travel aboard

Occupation – related exposure

Inhalation
Trans conjunctiva
Skin abrasions , autoinoculation
occasionally: placenta, breast milk, sexual, Biological warfare by aerosolized B.melitensis.
Transmission

Pathogenesis

Cytokines for defense:
IL1
IL12
TNF
Smooth & Rough LPS
IgM, IgG, IgA, Abs



• Suppression of
• myeloperoxidase – H2 O2 halide system
• Production of superoxide dismutase.
• Inhibition of phagosome- liposome fusion escapes & multiply in cytoplasm

• Ingestion by PMNS & macrophage

• Resistance for intracellular killing

Brucella

serum

opsonization

Pathogenesis

Brucella bacteria survive intracellularly by avoiding the immune system in several ways:
Poor inducers of inflammatory cytokines (i.e. TNF/interferon)
Don’t activate the complement system
Inhibit programmed cell death.

Liver, spleen, bones, kidneys, lymph nodes, heart valves, nervous system & testes

Pathology
• Inflammatory responses by non caseating granuloma, caseation & abscesses
Blood stream
multiplication inside phagocytes
lymphatic's







Classification of acute, sub acute, serologic, bacterial & mixed types serves no purpose for diagnosis & management
Brucellosis is systemic disease & protean manifestations IP 1-3/52 & more
Onset abrupt or gradual, family history, fever, chills, sweating, mayalqia, joints, anorexia, dreadfulness & depression
Osteomyelitis of lumbar vertebrae
Pallor
Heart, NS, Genitourinary, pulmonary, GIT, skin & endocrine.
Clinical

AL- Abbasi, Brucellosis in Iraq, 1993.

AL- Abbasi, Reem Shanshal, Brucellosis in AL-Anbar Governorate
AL- Abbasi, Brucella meningitis, Iraqi Med. J.;1993
AL- Abbasi, Brucellosis of the CNS, Int. Congr. For Tropical Dis., Cairo, 2009.









(A): MRI of lumbar spine in a patient with brucellosis showing evidence of paravertebral and epidural abscess (B): MRI of thoracic spine in a patient with brucellosis showing evidence of multifocal spondylodiskitis (C): MRI of tibia in a patient with brucellosis showing evidence of osteomyelitis.

Potential exposure + consistent clinical picture

Diagnosis
• PCR

• Culture

• Serology: interpretation

Doxycycline + amino glycoside X 4 weeks followed by

Doxycycline +Rifampicin X 4 – 8 weeks

Quinolones

Third generation Cephalosporin's
TMP- SMZ
Follow up of clinically cured patient by serology & blood culture every 3-6/12 for 2 years .


Sequel
Treatment

Biological warfare

In 1954, B. suis became the first agent

weaponized by the United States at its

Pine Bluff Arsenal near Pine Bluff, Arkansas.

Brucella species survive well in aerosols and resist drying.

Thank You