1. BRUCELLOSIS DR. AREEJ M. N.

2. EPIDEMIOLOGY

3. Epidemiology Worldwide zoonosisWorldwide zoonosis Only 17 countries declared brucellosis free1986Only 17 countries declared brucellosis free1986 Six speciesSix species 1. B.abortus - mainly cattle 2. B.melitensis - sheeps & goats 3. B.suis - pigs 4. B. canis - dogs 5. B. ovis - sheep (not human pathogen) 6. B. neotomae - desert wood rat (not human pathogen) B. melitensis -- most common worldwide B. melitensis -- most common worldwide

4. Populations at Risk Occupational disease –Cattle ranchers/dairy farmers –Veterinarians –Meat inspectors –Lab workers Hunters Travelers Consumers –Unpasteurized dairy products Center for Food Security and Public Health, Iowa State University, 2012

5. Brucella melitensis Distribution –Mediterranean, Middle East, Central Asia, Central America Incidence –Mediterranean, Middle East 78 cases/100,000 people/yr –Arabic Peninsula 20% seroprevalence; 2% active cases 100 to 200 U.S. cases annually –Unpasteurized cheeses Center for Food Security and Public Health, Iowa State University, 2012

6. Epidemiology in Saudi Arabia Endemic diseaseEndemic disease Mostly B. melitensis & b. abortus.Mostly B. melitensis & b. abortus. No clear figures about incidence & prevalence.No clear figures about incidence & prevalence. Incidence : 5.4 per 1000 per year.Incidence : 5.4 per 1000 per year. Prevalence : 8.6 - 38 % - some regions.Prevalence : 8.6 - 38 % - some regions.

7. TRANSMISSION

8. Transmission Zoonosis affecting domestic animals. Concentrated in milk, urine, genital organs.Concentrated in milk, urine, genital organs. ROUTES OF TRANSMISSION Oral : unpasteurised milk & products raw milk or meat.Oral : unpasteurised milk & products raw milk or meat. Respiratory: lab workers.Respiratory: lab workers. Skin: accidental penetration or abrasionSkin: accidental penetration or abrasion –- at risk farmers & veterinarians. Other routes:Other routes: Conjunctival, Blood transfusion, Transplacental, ? person to person.

9. Clinical Manifestations Incubation period: variable 2- 8 wks.Incubation period: variable 2- 8 wks. Presentation: acute 50% & insidious 50%Presentation: acute 50% & insidious 50% Sx & signs not specific.Sx & signs not specific. Can affect any organ.Can affect any organ. Common nonspecific Sx:Common nonspecific Sx: - fever with rigors. - fever with rigors. - sweats, malaise, anorexia. - sweats, malaise, anorexia. - headache, back pain. - headache, back pain.

10. Diagnosis in Humans Isolation of organism –Blood, bone marrow, other tissues Serum agglutination test –Four-fold or greater rise in titer –Samples 2 weeks apart Immunofluorescence –Organism in clinical specimens PCR Center for Food Security and Public Health, Iowa State University, 2012

11. Treatment Drugs against Brucella TetracyclinesTetracyclines AminoglycosidesAminoglycosides –Streptomycin since 1947 –Gentamicin –Netilmicin RifampicinRifampicin Quinolones - ciprofloxacinQuinolones - ciprofloxacin ?3rd generation cephalosporins?3rd generation cephalosporins

12. Treatment Drugs against Brucella Treatment for uncomplicated Brucellosis –Stremptomycin + Doxycycline for 6 weeks »? TMP/SMX + Doxycycline for 6 weeks –WHO recommendation 1986 »Rifampicin + Doxycycline for 6 weeks Treatment of complicated BrucellosisTreatment of complicated Brucellosis –Endocarditis, meningitis –No uniform agreement –Usually 3 antibrucella drugs for 3 months

13. Complications of Brucellosis Most common –Arthritis, spondylitis, epididymo-orchitis, chronic fatigue Neurological –5% of cases Other –Ocular, cardiovascular, additional organs and tissues Center for Food Security and Public Health, Iowa State University, 2012

14. Congenital Brucellosis Variable symptoms –Premature delivery –Low birth weight –Fever –Failure to thrive –Jaundice –Hepatomegaly –Splenomegaly Abortion risk unclear Center for Food Security and Public Health, Iowa State University, 2012

15. –Control of disease in domestic animals »immunization using B. abortus strain 19 and B. melitensis strain Rev 1 –Routine pasteurization of milk –In labs strict biosafety precautions Prevention