1. Brucella

2. Brucella spp. Gram negative, coccobacilli bacteria
Facultative, intracellular organism
Environmental persistence
Temperature, pH, humidity
Frozen and aborted materials
Multiple species

3. Species Biovar/Serovar Natural Host Human Pathogen B. abortus 1-6, 9
cattle
yes
B.melitensis
1-3
goats, sheep
B. suis
1, 3
swine 2
hares 4
reindeer, caribou 5
rodents
B. canis
none
dogs, other canids
B. ovis
sheep no
B. neotomae
Desert wood rat
B. maris (?)
marine mammals ?

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. History of Malta Fever 450 BC: Described by Hippocrates
1905: Introduction into the U.S.
1914: B. suis Indiana, United States
1953: B. ovis New Zealand, Australia
1966: B. canis in dogs, caribou, and reindeer

6. History Alice Evans, American bacteriologist
Credited with linking the organisms
Similar morphology and pathology between:
Bang’s Bacterium abortus
Bruce’s Micrococcus melitensis
Nomenclature today credited to Sir David Bruce
Brucella abortus and Brucella melitensis

7. Transmission to Humans
Conjunctiva or broken skin contacting infected tissues
Blood, urine, vaginal discharges, aborted fetuses, placentas
Ingestion
Raw milk & unpasteurized dairy products
Rarely through undercooked meat
Incubation varies
5-21 days to three months

8. Who is at Risk? Occupational Disease Hunters Travelers
Cattle ranchers/dairy farmers
Veterinarians
Abattoir workers
Meat inspectors
Lab workers
Hunters
Travelers
Consumers of unpasteurized dairy products

9. B. melitensis
Latin America, Middle East, Mediterranean, eastern Europe, Asia, and parts of Africa
Accounts for most human cases
In the Mediterranean and Middle East
Up to 78 cases/100,000 people/year
Arabic Peninsula 20% seroprevalence
Recent emergence in cattle on Middle Eastern intensive dairy farms

10. B. abortus Worldwide Some countries have eradicated it
Notifiable disease in many countries
Poor surveillance and reporting due to lack of recognition
Fever of Unknown Origin (FUO)

11. Brucellosis in U.S.:

12. Human Disease Can affect any organ or organ system
All patients have a cyclical fever
Variability in clinical signs
Headache, weakness, arthralgia, depression, weight loss, fatigue, liver dysfunction

13. Human Disease 20-60% of cases Hepatomegaly may occur
Osteoarticular complications
Arthritis, spondylitis, osteomyelitis
Hepatomegaly may occur
Gastrointestinal complications
2-20% of cases
Genitourinary involvement
Orchitis and epididymitis most common

14. Human Disease Neurological Cardiovascular
Depression, mental fatigue
Cardiovascular
Endocarditis resulting in death
Chronic brucellosis is hard to define
Length, type and response to treatment variable
Localized infection
Blood donations of infected persons should not be accepted

15. Human Disease Congenitally infected infants Low birth weight
Failure to thrive
Jaundice
Hepatomegaly
Splenomegaly
Respiratory difficulty
General signs of sepsis (fever, vomiting)
Asymptomatic

16. Diagnosis in Humans Isolation of organism Serum agglutination test
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

17. Treatment of Choice Combination therapy has the best efficacy
Doxycycline for six weeks in combination with streptomycin for 2-3 weeks or rifampin for 6 weeks
CNS cases treat 6-9 months
Same for endocarditis cases plus surgical replacement of valves

18. Yersinia pestis

19. Yersinia pestis
Yersinia originally classified in Pasteurellaceae family
Based on DNA similarities with E. coli, Y. pestis is now part of Enterobacteriaceae family
11 named species in genus  3 are human pathogens
Y. pestis, Y. pseudotuberculosis, Y. enterocolitica
Y. pestis and Y. pseudotuberculosis rarely infect humans
Y. enterocolitica is the cause of 1 – 3% of diarrhea cases caused by bacteria

20. Yersinia pestis Gram-negative bacteria Can grow with or without oxygen
Most commonly found in rats but also found in:
Mice, squirrels, fleas, cats, dogs, lice, prairie dogs, wood rats, chipmunks

21. Types of Plague Bubonic Plague Pneumonic Plague Septicemic Plague
Most common
Infection of the lymph system (attacks immune system)
Pneumonic Plague
Most serious type of plague
Infection of the lungs leading to pneumonia
Primary and Secondary
Septicemic Plague
Bacteria reproduces in the blood
Can be contracted like bubonic plague but is most often seen as a complication of untreated bubonic or pneumonic plague

22. Diagnosis and Treatment Symptoms
Most cases of plague are diagnosed initially from presented symptoms, especially Bubonic plague. If plague is suspected, blood work is completed to determine how far the plague has progressed and to determine antibiotic resistances.
Since no major antibiotic resistances have developed, plague is usually treated with Streptomycin. Other antibiotics that can be used are: tetracyclines, fluoroquinolones and other aminoglycosides.
Antibiotics are administered to the patient as well as to those who are believed to have been exposed.
Symptoms
Bubonic
Fever, headache, chills, weakness, swollen and tender lymph glands
Pneumonic
Fever, headache, weakness, rapid onset of pneumonia (usually accompanied by: shortness of breath, chest pain, cough, bloody or watery sputum)
Septicemic
Fever, chills, weakness, abdominal pain, shock, bleeding underneath skin or other organs

23. http://rarediseases. about

24. Transmission
Bubonic and Septicemic can not be transferred human to human. They can only be contracted if bitten by an infected rodent or flea.
Pneumonic can be transferred through exposure to infected particles. This usually occurs when in close contact with someone who is infected and is exposed to sputum that is coughed up.

26. History There have been three major pandemics of the plague.
Mid 6th century, mid 14th century, early 20th century
The most well known plague pandemic was in the mid 14th century in Europe known as the Black Death
The plague came from Asia and spread through Europe in two years.
In the two years, it killed more than half of the population.
People didn’t understand how the plague worked which allowed it to spread .
Benefits.

27. Sedlec Ossuary in Kutna Hora

28. Incidence Considered a re-emerging disease.
Incidence is on the rise: 2,000 to 3,000 cases a year worldwide.