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

2. 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.

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

4. 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

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

6. 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

7. 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?
------

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

9. 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

10. 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

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

12. 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.

13. 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).

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

15. 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:

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

17. 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.