1. د/عبد الله حــامد أبو جبــل استشــــارى الحميـــات
بســم الله الرحمــن الرحيــــم
د/عبد الله حــامد أبو جبــل
استشــــارى الحميـــات
مستشفى حميـــات امبابه
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2. Brucellosis
Common classical zoonotic disease of worldwide distribution

3. Br. Melitensis → Goats , Sheeps & camels.
Reservoir:
Br. Melitensis → Goats , Sheeps & camels.
Br. Suis → Pigs.
Br. Abortus → Cattles.
Br. Canis → Dogs

4. imbabafevers.com

5. Causative organism:
Brucella sp. A small , non motile non capsulated,non spore forming ,gram –ve coccobacilli. Aerobic , facultative i.c bacteria.
Killed by boiling, pasteurization,lactic a.& strong salts. Not killed by freezing.
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6. Uncommon routes blood transfusion&bone m.transpl.
Mode of transmission:
Orally
Inhalation
Skin
Conganctiva
Uncommon routes blood transfusion&bone m.transpl.
Unproved routes, trnsplacental,sexual&breast milk feeding

7. Portals of entry for Brucella species.
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8. imbabafevers.com

9. I.P: Onset Devided into Clinical picture: 1-3 weeks
may be sudden [1-2days] or gradual [1 week or more]
Onset
acute, chronic & complications
Devided into

10. Acute Brucellosis:
Symptoms:
Fever
Rigors
Sweating
low backache.

11. Less common
chest pain
abdominal pain
Palpitation
constipation

12. Signs: Lymphadenopathy,
May be lacking.
Temp. is always high
Hepatosplenomegaly
Lymphadenopathy,
Spondylitis,bursitis, osteomyelitis,epidydemo-orchitis, meningo-encephalitis & endocarditis may occur specilly in Br. Miletensis

13. Lassitude may be present and may continue after successful ttt.
Full recovery is likely, in spite of the severity, by proper therapy
Relapse may occurs after ttt. precipitated by new infection, trauma, surgery or stress

14. Table 2. Symptoms and Signs of Brucellosis
Symptoms Fever Constitutional symptoms* Sweats Chills Arthralgias Gastrointestinal symptoms** Headache Lumbar pain Myalgias Cough/dyspnea Weight loss Neurological symptoms*** Testicular pain
% (400) 42 (400) (400) 18 (400) 14 (400) 5
Signs Hepatosplenomegaly Hepatomegaly Splenomegaly Osteoarticular Relative bradycardia Adenopathy Neuro/CNS**** Orchitis/epididymitis Cutaneous
% 41 (400) (530) (400) 3 (530)
N= 930, unless specified in ( ).
* Anorexia, asthenia, fatigue, weakness, malaise
** Abdominal pain, constipation, diarrhea, vomiting
*** Anxiety, confusional psychosis, depression, insomnia
**** Paralysis, nuchal rigidity, papilledema
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15. Chronic brucellosis: Signs: Symptoms: Onset is insidious
recurrent flu with lassitude
headache , pain & sweat
depression.
Signs:
Temp. may be normal
Moderate Splenomegaly may be in the minority of cases

16. Skeletal system [bones&joint] Occurs in about 10% of cases.
Complications: May occur with acute or chronic &may be the presentation.
Skeletal system [bones&joint] Occurs in about 10% of cases.
a-Arthritis
Reactive
Septic
b-Spondylitis
C-Ostceomyelitis

17. Spondylitis of lumber spine 4 due to Brucellosis
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18. Spondylitis with para vertebral soft tissue mass due to Brucellosis
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19. Tuberculous Spondylitis with Psoas Abscesses
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20. Crdiovascular Endocarditis Myocarditis Pericarditis
aortic root abscess
Mycotic aneurysm
Neurobrucellosis
Meningitis
Meningo- encephalitis
multiple cerebral or cerebellar absc.
rupture mycotic aneurysm
cranial n. lesions
Transient E.A
Hemiplegia
myelitis
Genitourinary
epididymo-orchitis in children
prostatitis &seminal vesiculitis in adult
Dysmeno.,ameno. Tubo-ovarian abscess,
chr.salpingitis&cervasitis
A.nephritis

21. Acute unilateral scrotal swelling in a 27-year-old man with brucellosis.
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22. . Conjunctivitis [accidental],
G.Intestinal
hepatitis with mild jaundice
liver &splenic abscesses
Respiratory:
Rarely, hilar& paratracheal lymphadenopathy
pneumonia,
lung absces
solit.or mult. Shadows
pleural eff., empyema
mediastinitis
Ocular:
. Conjunctivitis [accidental],
. keratitis, …..

23. Hepatic Granuloma due to Brucellosis
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24. Skin(Uncommon) In pregnancy Other rare complications
contact dermatitis
maculopapular eruptions,
erythema nodosum,
purpura
In pregnancy
normal delivery.
Abortion
I.U. Fetal death
Premature delivery.
Retention of placenta
Other rare complications
Thyroiditis
adrenal insuffeciency.

25. Diagnosis: Depends on the presence of
1-Coming from or presence in endemic area
2-clinical features
3-Lab. investigations

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27. Lab. Investigations
Blood or tissue culture ve in about % of cases
PCR ve in about 70% of cases
Roose Bengal TEST
Standard aggl. Test: a titre of 1/160 in non endemic areas & 1/320 in endemic areas are significant
Compl.fixation t.,Radio-I-Assay,Coombs t., ELISA t.:
Blood picture: Non sp., but exclude pyogenic inf.&T.B.

28. Treatment: The optimum antibiotic therapy is still disputed
Treatment: The optimum antibiotic therapy is still disputed . According to WHO 4 drugs only are mainly used for treatment:
Doxycycline in adults Dose: Orally 100mg cap 12 hourly
Aminoglycoside e.g: Streptomycin 15 mg/kgm body wt. i.m . Daily Gentamicin:2-5 mg/kgm body wt. daily.
Rifampicin Dose:orally mg/kgm body wt. on empty stomach.
Co-Trimoxazole mgm/kg oral or i.v.
in 2 devided doses

29. C-Pregnency & Children
At least 6 weeks of double therapy ( Doxycycline +Rifampicin) or
Triple therapy(Doxycycline +Rifampicin +Aminoglycoside) for 2 weeks then complete wth double therapy
A: Adult, acute without complications
Triple therapy for 3 months
B-Chronic without complications
Rifampicin +Co-Trimoxazole for at least 6 weeks
In the first trimester of pregnancy mono-therapy with rifampicin can be used
C-Pregnency & Children

30. D- Bone affection & neuro-brucellosis
Triple therapy for 9-12 months.
N.B: In bone affection, Doxycycline should be always and in CNS affection Rifampicin should be always.
D- Bone affection & neuro-brucellosis
Compensated liver: Treated as usual.
Terminal stage liver failure: Ciprofloxacin 750 mg tid for one month.
E-In case of Hepatitis
Doxycycline is completely metabolized by the liver and excreted in bile and can be used in usual dose in renal impairment
F-Renal impairment