1. Brucellosis, Tetanus & PlagueBy
Dr. Riaz Ahmed

2. Brucellosis
Also known as undulant fever / malta fever / mediterranean fever.
Bacterial zoonosis which is transmitted to man by direct / indirect contact with animals.
Caused by different species of brucella- group of organisms and characterized by:
Intermittent / irregular febrile attacks
Arthritis / enlarged spleen etc.

3. Epidemiology Agent factors:
Brucella abortus – in bovine – abortus fever
B.Suis – Pigs – Swine – F or Porcine
B.Canis – Canines – Canine fever
B.Melitensis – Goats – Caprine fever
Host factors: predominantly disease of males.
Farmers
Shepherds
Butchers
Slaughter house men
Veterinarians
Lab-workers – are at special risk because of occupational exposure.

4. Environmental factors:
Most prevalent under conditions of advanced domestication in the absence of corresponding advanced S.O. Hygiene (+) where there is
Overcrowding of herds
Increased rain fall
Lack of exposure to sunlight
Unhygienic practice of milking/ heat production

5. M.O.T:
Ingestion – milk / milk products
- meat even of camel
Contact – absorption from skin
Inhalation
Inoculation 02mm – throat or oral cavity
Source / Reservoir:
S – milk, lochial secretions, placenta, urine, feces & meat.
R – farm animals e.g., cattle, goats, swine etc.
I.P: highly variable usually 1-3 weeks.

6. Lab diagnosis:
Bacteriological
Serological / allergic test
Control:
in animals:
Test / slaughter
Vacc – B.Abortus strain – 19
Hygienic measures
In humans:
At individual level
At community level

7. Tetanus
An acute disease caused by exotoxins of clostridium tetani clinically characterized by :
Muscular rigidity
Painful paraoxysmal spasms of voluntary muscles esp.
Masseters ( trismus / lock-jaw )
Facial (risus sardonicus)
Back / neck (opisthotonus)
And those of lower limbs and abdomen
Mortality : 40-80%

8. Agent factors:
Clostridium tetani
Reservoir of infection
Source – soil / dust
Exotoxin
P.O.C – None
Host factors:
Age / sex
Occupation
Rural / urban differences
Immunity
Environmental factors:
Tetanus is a positive environmental hazard.
M.O.T: contamination of wounds with tetanus spores.

9. I.P: 6 – 10 days
Types:
Traumatic
Puerperal
Otogenic
Idopathic
Tetanus Neonatorum (8th day syndrome)
Prevention:
Active immunization – DPT
Passive – ATS
Both
Antibiotics
Observe tetanus schedule for pregnant women

10. Plague (Black Death)
Basically & primarily a zoonotic disease caused by Yersinia pestis involving rodents & fleas.
It exists in natural foci & is transmitted by infected flea bites to humans living or intruding into the same ecological environment.
Occurrence: many forms e.g.,
Epizootic
Enzootic
Sporadic
And in epidemics of all forms including anthroporotic primarily pnemonic.

11. History Epidemics of plague are mentioned in Bible
Association of plague with rats is known to be ancient.
1st out-break – 1320 B.C.
1st Pandemic – 542 A.D. called Justinian plague, which lasted for 50 years & estimated mortality was 100 deaths.
2nd Pandemic – 1346 B.C. lasted for 30 years & claimed one forth world mortality.
In 1840 B.C. – Pandemic of pneumonic type
In 1930 – 6 million deaths in India.
In out-break in India, then subsided gradually.

12. Plague
Def: Highly fatal disease characterized by high fever, progressive heart failure & nervous symptoms.
Conjunctiva is injected with reddish appearance.
Skin – hemorrhage & pustular eruptions.
Clinical forms:
Bubonic
Pnemonic
Septicemic
sylvatic

13. Bubonic plague Onset sudden, most common type
High temperature, prostration
Painful buboos
Vesicular / pustular skin lesions
Complications:
secondary terminal pneumonia

14. Pneumonic plague
Primary P. Plague is rare. Generally follows as a complication of bubonic - septicemic plague.
Incidence decreased 1%
Highly infectious
Symptoms – acute bacterial infection
Sputum – hemorrhagic
Most deadly form of plague

15. Septicemic :
Rare
Buboes absent
Fever – low
Hemorrhages into skin
Sylvatic :
Endemic in rodents in jungles
Man is affected accidentally while doing activities like hunting etc.

16. Source of infection:
In bubonic plague : by bite of inf. Rat – fleas
Xenophsylla cheopis
Xenophsylla actia
Xenophsylla braziliensis
In pneumonic plague:
exhaled droplets of saliva
sputum of patients
Reservoir : rats & wild rodents, out of 1700 species 200 associated with plague.

17. I.P:
Bubonic : 2-7 days
Septicemic : 2-7 days
Pneumonic : 1-3 days
P.O.C: pneumonic is very communicable from person to person, bubonic if terminal inf. is there.
M.O.T:
Bubonic plague – bite of infected rat flea
Pneumonic plague – droplets

18. Epidemiology
Agent factors: yersinia pestis, occur in blood, buboes, spleen, liver, other viscera of infected persons.
Host factors:
Age / sex – all ages & both sexes
Activities of man e.g., hunting, cultivation, grazing, harvesting, construction etc.
Movements – ship, land, cargo
Immunity – no natural immunity
Environmental factors:
Season : september – May
Temp : C
Humidity less than 60%, Rain fall
Rural / urban, Human dwellings

19. Population at risk:
Geologists, Biologists
Anthropologists
Hunters, agriculturists etc.
Vector of plague: Pulex irritants (human fleas)
Blocked / Partially blocked flea
Flea Indices:
Total flea index
Specific index – if >1
Sp.% of fleas
Burrow index

20. Prevention & Control Control of cases: Early diagnosis Notification
Isolation
Treatment
Disinfection
Control of fleas/ rodents:
Application of insecticides, rodenticides and other preventive measures to be adopted.
Vaccination: ml SC after 7-10 days.

21. Chemoprophylaxis:
Surveillance
Health education

22. Thank You