[Undulant fever, Malta fever, Mediterranean fever] Brucellosis [Undulant fever, Malta fever, Mediterranean fever]

Objectives At the end of this lecture you suppose to know the following: - Historical overview Epidemiological occurrence and importance. Agent, reservoir, IP. Identification, diagnosis, interpretation of results. Control and prevention.

Historical overview: In 1887 ,. David Bruce in Animals. bang’s disease

The Many Names of Brucellosis Human Disease Malta Fever Undulant Fever Mediterranean Fever Rock Fever of Gibraltar Gastric Fever Animal Disease Bang’s Disease Enzootic Abortion Epizootic Abortion Slinking of Calves Ram Epididymitis Contagious Abortion

EPIDEMIOLOGY Occurrence: Most widespread zoonoses, 500,000 new case/y. Does this genuine? In Iraq: ?, in Mosul ?. sex? age? Immunity → uncertain.

Etiologic agents Reservoirs; ?? B. melitensis Brucella spp. Source Virulence Infective Dose B. melitensis Goats, sheep, Cattle, Swine camels ++++ 1 – 10 B. suis Swine, Cattle +++ 1,000 – 10,000 B. abortus Cattle ++ 100,000 B. canis Dogs + 1,000,000 Reservoirs; ?? IP; 1 week - 4 WKs .occasionally may last for several ms

Resistance of brucella Heating at 60ºC For 10 minutes Phenol 1% For 15 minutes Direct sunlight In a few hours Milk For several days till? Fresh cheese For 3 months Tap-water For 57 days Human urine For 1 week Dust For 6 weeks Damp soil For 10 weeks Animal feces For 100 days Yoghurt? ------

Identification: acute or insidious onset, swinging pyrexia ……. profuse sweating , malodorous sweat and peculiar mouth taste.

The commonest complications: The commonest complications: * Arthritis 20%-60% (causing sacroiliitis, spondylodiscitis * 2%-20%; orchitis and epidedemitis. * Localized suppurative infections. CFR: 2-5% in untreated cases.? Disability is often pronounced

Diagnosis: 1. Clinical suspicion (PUO) 2. Isolation of agent Blood culture urine culture CSF culture BM culture 3. demonstration of AB (most practical but ?): (BAT). Rose-Bengal plate test (screening). (2ME), { chronicity}. Complement fixation test. ELIZA

4. (hepatic biopsy): Histologic evidence of granulomatous hepatitis 5. X Ray.

Mode of transmission: Period of communicability: No man to man transmission. Mode of transmission: (from ?) Ingestion; raw milk or products, raw vegetables, rarely undercooked meat, Direct contact with tissues or infected animals, discharges.

Air- borne infection: inhalation of infected dust, aerosoles Pens, stables, slaughter houses, labs . 4. Accidental inoculation at laboratories and veterinarians by contaminated needles with blood or vaccine (S19 or Rev-1).

9. Method of control: the control of human brucellosis rests on the elimination of the disease among domestic animals.

A- Preventive measures: Health education of farmers Health education of public Sterilization and pasteurization of milk and its product. Elimination of disease among animals: Searching for infected animals “ring test”. Segregation and Rx till recovery, slaughter, (satisfactory solution) . Vaccination of animals:

Human vaccination: living vaccine of B Human vaccination: living vaccine of B. abortus strain [19-BA vaccine] (severe hypersensitivity, not use or limited use).

B- Control of patients, contacts and environment: Reporting: obligatory. Isolation: ? Disinfection of purulent discharges. Quarantine: ?. Immunization of contacts: not applicable. Investigation of contacts and source of infection: trace for infected domestic animal. Specific treatment: combination of streptomycin +rifampicin or and doxycycline for 6 weeks, and for 6 months in case of complications.