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78 Cards in this Set
- Front
- Back
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SPECIES OF BRUCELLA AND ANIMAL RESERVOIRS
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Brucella melitensis -
Reservoir - Gat, Sheep Other Host - Cattle/Antelope Human Cases (worldwide) +++++ Brucella abortus - Reservoir - CAttle, Water Buffalo, Jackal/Hyena Other Host - Horse Human Cases (worldwide) +++ Brucella suis- Reservoir - Pig, Wolf/fox Other Host - Cattle/Caribou Human Cases (worldwide) ++ Brucella ovis- Reservoir - Sheep Other Host - -- Human Cases (worldwide) NO Brucella canis- Reservoir - Dog Other Host --- Human Cases (worldwide) Few |
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BRUCELLOSIS Hyperendemic areas (>5000cases/year)
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EUROPE
Greece, Spain, Italy, Portugal LATIN AMERICA Peru, Argentina, Mexico ARABIAN COUNTRIES Irak, Kuwait, Iran |
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Br. abortus
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Br. abortus
USA, Argentina, Europe Produces acute forms: Low mortality Rare chronic forms Male adults Attack rate/Familiar infection: 1/10 |
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Br. suis
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Br. suis
Argentina, Europe Produces supuration Labor disease: Male adults Low mortality |
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BRUCELLOSIS: Br. melitensis
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Associated to dairy products, goat cheese
Not a professional disease Men and women 1:1/Children 20%-25% Severe forms Occasional mortality Chronic state (5%-10%) Rate of familiar infection attack: =50% |
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BRUCELLOSIS CONTROL
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Brucellosis is a zoonosis with a high impact in the economy and public
Implementation of vaccination programs in cattle and pasteurization of milk eradicated the disease in Uruguay and Japan and reduced in France, Chile and USA “Goat Brucellosis” eradication is still a problem that has not been solved |
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ROUTES OF TRANSMISSION
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Ingestion of unpasteurized dairy products
(milk goat cheese) Direct contact with animals and their secretions --> veterinarians & abattoir workers Inhaled aerosols --> Laboratory Rarely: Bone marrow transplantation (2) Not proven but reported: Human-to-Human transmission |
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What is the leading cause of laboratory personne transmitted disease?
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Brucellosis is the leading cause of laboratory personnel transmitted infection worldwide, especially Brucella melitensis
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Where do you find BRUCELLOSIS: Br. melitensis?
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Europe: Greece, Spain, Italy, Portugal
Latin America: Peru, Argentina, Mexico Arabian Contries: Irak, Kuwait, Iran |
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What is BRUCELLOSIS: Br. melitensis mostly associated with?
Is it a professional disease? |
Associated to dairy products, goat cheese
Not a professional disease |
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What is BRUCELLOSIS: Br. melitensis rate of familiar infection attack rate?
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Rate of familiar infection attack: =50%
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Which BRUCELLOSIS causes a severe form of disease?
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Br. melitensis
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Which BRUCELLOSIS causes acute forms of disease?
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Br. abortus
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Which BRUCELLOSIS causes supuration?
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Br. suis
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Which BRUCELLOSIS causes low mortality?>
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Br. abortus and B. suis and b. melitensis - all three
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Which BRUCELLOSIS causes a chronic form?
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B. abortus - Rare
B. melitensis - 5-10% |
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Which BRUCELLOSIS is a labor disease?
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B. suis, poss B. abortus - both effect males more
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B. abortus vs. B. melitensis - name the differences in reservoirs?
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B. abortus - cattle
B. melitensis - goats |
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B. abortus vs. B. melitensis - name the differences in transmission
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B. abortus - Workers’disease: veterinarians, farmers, butchers
B. melitensis - Consumption of nonpasteurized goat cheese |
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B. abortus vs. B. melitensis - name the differences in age
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B. abortus - Adults 20 - 45 years
B. melitensis - All ages, 25% children |
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B. abortus vs. B. melitensis - name the differences in sex
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B. abortus - > 95% male
B. melitensis - 50% female |
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B. abortus vs. B. melitensis - name the differences in Geographic location
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B. abortus - United States
Wider distribution B. melitensis - Arabic countries, Latin America: Peru, Mexico, Argentina; Mediterranean countries: Spain, Italy, Greece |
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B. abortus vs. B. melitensis - name the differences in Pathogenicity
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B. abortus - Pathogenicity Low
B. melitensis - High |
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B. abortus vs. B. melitensis - name the differences in Ratio Sub-clinical: clinical case
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B. abortus - 8:1
B. melitensis - <1:1 |
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B. abortus vs. B. melitensis - name the differences in clinical pattern
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B. abortus - Mild disease
No chronic form Mortality <0.1% B. melitensis - More severe form, frequent relapses Chronic form 1-5% Mortality = 1% |
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B. abortus vs. B. melitensis - name the differences in acute outbreaks
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B. abortus - Rare
B. melitensis - Frequent in the United States with important dairy products |
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B. abortus vs. B. melitensis - name the differences in family cases
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B. abortus - Rare
B. melitensis - Occasional |
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Brucelosis: Clinical Pattern of Acute Disease
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Malaise
Fever (mainly at nights) Extensive sweating (generalized, in patches) Back pain Arthralgias Myalgias **Constipation (some cases, especially tourists had diarrhea) **Weight loss(10-20 pounds in 1-2 weeks) |
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Clinical differences between various forms (acute, undulant, chronic) of brucellosis which age group has chronic form?
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adults over 40
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Clinical differences between various forms (acute, undulant, chronic) of brucellosis which have arthralgias?
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acute and undulant
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Clinical differences between various forms (acute, undulant, chronic) of brucellosis which have high fevers?
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acute and undulalnt
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Clinical differences between various forms (acute, undulant, chronic) of brucellosis which hepatomegally
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acute and undulant
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Clinical differences between various forms (acute, undulant, chronic) of brucellosis which have splenomegally
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acute and undulant
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Clinical differences between various forms (acute, undulant, chronic) of brucellosis which have hematologic involvement?
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acute - occasionally
undulant - frequently chronic - rare |
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Clinical differences between various forms (acute, undulant, chronic) of brucellosis which have psychiatric disorders?
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chronic
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Clinical differences between various forms (acute, undulant, chronic) of brucellosis which have ocular damage (uveitis)?
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chronic
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What is the best way to test for brucellosis?
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Bone marrow (92%), followed by blood culture (70%)
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what tests do you find elevated in pts with hepatitis?
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elevated alkaline phosphate and mild increase in liver enzymes
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What is the more severe form of hepatitis?
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The more severe form (rare) is acute fulminating atrophic hepatitis
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What are the most common articular syndromes?
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Sacroiliitis
Peripheric Arthritis Mixed Arthritis Spondylitis |
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Peripheral arthritis likely involves which 2 pathogenic mechanisms?
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Reactive &. infectious arthritis
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How do you differentiate between the 2 pathogenic mechanisms?
How do you test for it? |
The clinical pattern allows the differentiation
- Monoarticular (knee/CxF)= infection - Polyarticular/symmetry= reactive Use Ruiz-Castañeda culture medium or other medium such as BACTEC |
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What is the most common Rheumatic syndromes in children
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Peripheric arthrhitis >> sacroiliitis>/= extra-articular rheumatism
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Differential diagnosis of tuberculous vs. Brucellar spondylitis compare age
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Tuberculous Spondy - young adults (20-40)
Brucellar Spondy - >40 yr |
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Differential diagnosis of tuberculous vs. Brucellar spondylitis compare sex
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Tuberculous Spondy - males
Brucellar Spondy - slightly more females |
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Differential diagnosis of tuberculous vs. Brucellar spondylitis compare main location
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Tuberculous Spondy - dorsal
Brucellar Spondy - lumbar |
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Differential diagnosis of tuberculous vs. Brucellar spondylitis compare Two or more vertebrae
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Tuberculous Spondy - 10-20%
Brucellar Spondy - 30-40% |
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Differential diagnosis of tuberculous vs. Brucellar spondylitis compare Paravertebral abscess
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Tuberculous Spondy - very common
Brucellar Spondy - 10-20% |
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Differential diagnosis of tuberculous vs. Brucellar spondylitis compare Radiography
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Tuberculous Spondy - Lytic lesion (rare, blastic)
Brucellar Spondy - Lytic and blastic |
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Differential diagnosis of tuberculous vs. Brucellar spondylitis compare Sequelae (gibbus or humpback deformity)
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Tuberculous Spondy - common
Brucellar Spondy - rare |
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Comparing <15 y/o, 15-45 y/o and >45 y/o - which one is more likely to have spondy?
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>45 y/o
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Comparing <15 y/o, 15-45 y/o and >45 y/o - which one is more likely to have sacroliitis?
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almost equally distributed, but 15-45 hightest
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Comparing <15 y/o, 15-45 y/o and >45 y/o - which one is more likely to have peripheric arthritis?
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<15 followed by 15-45
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___ of patients infected with Brucella melitensis develop arthritis
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1/3 of patients infected with Brucella melitensis develop arthritis
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The most frequent syndromes are ____ and ____
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The most frequent syndromes are unilateral sacroiliitis (US) and peripheric mono-arthritis (PA)
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Sacroiliitis, peripheric arthritis and mixed arthritis (SI+PA) occur in __ and __ with ___ or ____brucellosis
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Sacroiliitis, peripheric arthritis and mixed arthritis (SI+PA) occur in children and young adults with acute or undulant brucellosis
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Spondylitis is predominantly seen in ___ patients and in ___ brucellosis
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Spondylitis is predominantly seen in older patients and in chronic brucellosis
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In countries with Br. melitensis, the clinical pattern is more severe in ___
Describe Si/Sx and why |
Severe thrombocytopenia
Arthritis clinical severity Probably associated to iron deficiency since Brucella rapidly grows under this condition |
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What is another name for undulant or relapsing brucellosis?
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Malta Fever
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FETAL PROGNOSIS WITH TREATMENT in PREGNACY WITH BRUCELLOSIS - comparing treatment to no treatment with abortion
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most have abortions without treatment
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PREGNACY WITH BRUCELLOSIS - comparing treatment to no treatment with preterm labor
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4 with treatment
2 without |
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PREGNACY WITH BRUCELLOSIS - comparing treatment to no treatment with labor at term
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Most with treatment
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PREGNACY WITH BRUCELLOSIS - comparing treatment to no treatment with intra-uteral death
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most without treatment
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PREGNACY WITH BRUCELLOSIS - comparing treatment to no treatment with neonatla death
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with treatment
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PREGNACY WITH BRUCELLOSIS - comparing treatment to no treatment with congential brucellosis
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without treatment
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When were most Obstetric complications associated with time of disease
when antibiotic treatment was initiated? |
>2 weeks
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Ocular involvement is most common in which form of brucellosis? (acute, undulant, chronic)
What kind of ocular involvment? |
Chronic
Uveitis - posterior uveitis |
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What type and characterisitcs of antibiotics do you want to treat brucellosis?
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Intracellular activity, bactericidal?
Rapid decrease of fever In vivo activity for complications Combination of 2 drugs to reduce relapses Tolerance Compliance 6 weeks (4 weeks in children) |
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What drug combinations are typically used?
In pregnancy? |
tetra or doxy PLUS rifampin or
tetra or doxy PLUS streptomycin or tetra or doxy PLUS gentamycin Preggos: Rifampin (6 weeks) + Aminoglycoside (2 weeks) Rifampin (6 weeks) + Cotrimoxazole (6 weeks) Tetracyclines - Contraindication |
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what is the problem with doxy and rif?
Why? |
significant rate of relapses in comparison to streptomycin and doxycycline
Rifampin 1- Reduces serum (doxycycline) 2- Increases clearance of doxycycline 3- Reduces doxycycline half-life 4- Rapid acetilators produce more reduction of doxycycline |
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What is prefered tx of children < 7 yrs old?
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RFP (4 weeks) + STM (10-14 days)
TETRACYCLINES ARE CONTRAINDICATED |
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Why DOUBLE OR TRIPLE THERAPY WITH AN AMINOGLYCOSIDE, 6 WEEKS?
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Higher frequency of relapses recognized since the ‘80s with rif
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When do you suspect subacute brucellosis?
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Previous diagnosis of Brucellosis with incomplete treatment or Epidemiologic background:
Travel to Latin America, Mediterranean or Arab countries. Consumption of unpasteurized dairy products Laboratory personnel (bacteriology division) Veterinarians and farmers |
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When do you suspect chronic brucellosis?
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CHRONIC BRUCELLOSIS SUSPECTED (at least one)
Chronic fatigue syndrome with epidemiologic background Spondylitis with osteoblastic and osteoclastic lesions Granulomatous uveitis or panuveitis Depression with low-grade fever and arthralgias |
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Why is bruce' a category
B biological agent? |
Mild dissemination
Mild morbidity and low mortality Intensified diagnostic capacity Intensified epidemiological surveillance Brucella is highly infectious through aerosol; inhalation of only 10-100 bacterias can cause disease in humans Multiple reports document airborne acquisition in laboratories meat-packing, plants and camp sites where infected animals were slaughtered |
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When do most people present with symptoms after bruce' exposure?
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40% - 5-8 weeks
26% - 9-18 weeks 14% - 3-4 weeks |
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What is the most important risk factor for bruce'?
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family members of the patients with brucellosis have higher risk to develop brucellosis mostly because of consuming of unpasteurized dairy products
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How do you prevent bruce'?
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Pasteurization of milk products
Use of gloves and masks for by veterinaries and farmers Biosecurity measures Vacunation of goats with the vaccine for B. melitensis strain Rev-1 Diagnosis and treatment of contacts |
