1. Dr. Salwa Tayel (Brucellosis)
6/3/2011
Dr. Salwa Tayel (Brucellosis)

2. Family and Community Medicine Department
Brucellosis By
Dr. Salwa Tayel
Associate Professor
Family and Community Medicine Department
King Saud University
6/3/2011
Dr. Salwa Tayel (Brucellosis)

3. Dr. Salwa Tayel (Brucellosis)
6/3/2011

4. Dr. Salwa Tayel (Brucellosis)
Introduction
Brucellosis is primarily a disease affecting animals. It can be transmitted to humans.
Brucellosis is a major health and economic problem in many parts of the world .
It is an old disease, Sir David Bruce, isolated the causative agent from a soldier in Malta in 1886
It remains the commonest zoonotic disease worldwide.
Dr. Salwa Tayel (Brucellosis)
6/3/2011

5. Dr. Salwa Tayel (Brucellosis)
CLINICAL FEATURES:
Acute systemic disease characterized by:
- acute or insidious fever
(continuous, intermittent, or irregular)
- headache,
- weakness,
- sweating,
- arthralgia
- weight loss.
± enlarged liver and spleen
Dr. Salwa Tayel (Brucellosis)
6/3/2011

6. Dr. Salwa Tayel (Brucellosis)
Duration: days, months, years with
relapses:
<8 wks Acute
8 wks – one year undulant
> one year Chronic
Complications:
Osteoarthritis %
Genitourinary %
Dr. Salwa Tayel (Brucellosis)
6/3/2011

7. Dr. Salwa Tayel (Brucellosis)
Subclinical and unrecognized infections are more frequent than clinical one.
It is usually a self-limiting disease.
50% of cases regain their health in one year.
Untreated clinical illness may become chronic.
The death rate of untreated brucellosis is about 2%.
Death is usually due to bacterial endocarditis.
Dr. Salwa Tayel (Brucellosis)
6/3/2011

8. Magnitude of the problem
Globally:
More than new human cases of brucellosis annually
Associated with substantial residual disability
An important cause of travel-associated morbidity.
Dr. Salwa Tayel (Brucellosis)
6/3/2011

9. Dr. Salwa Tayel (Brucellosis)
The new global map of human brucellosis 2006
Dr. Salwa Tayel (Brucellosis)
6/3/2011

10. The new global map of human brucellosis
The global epidemiology of human brucellosis has drastically changed over the past decade because of:
various sanitary,
Socioeconomic,
political reasons
the evolution of international travel.
Dr. Salwa Tayel (Brucellosis)
6/3/2011

11. The new global map of human brucellosis
Countries traditionally considered to be endemic -e.g. France, Israel, and most of Latin America,
Now, they achieved control of the disease.
New foci of human brucellosis have emerged, particularly in central Asia
Dr. Salwa Tayel (Brucellosis)
6/3/2011

12. Dr. Salwa Tayel (Brucellosis)
Middle East & Asia
The situation in central and western Asia is dramatic:
Syria has the highest annual incidence worldwide reaching an alarming 1603 cases per million per year
Mongolia, is ranked second (605·9 cases per million)
***In USA the annual incidence of 0·48 cases per million for last ten years (only cases annually)
Dr. Salwa Tayel (Brucellosis)
6/3/2011

13. Incidence (annual cases per million population)
Syria ,603·4
Mongolia 605·9
Iraq 278·4
Turkey 262·2
Iran 238·6
Saudi Arabia 214·4
Dr. Salwa Tayel (Brucellosis)
6/3/2011

14. Situation in Saudi Arabia:
Distribution:
Central & Eastern regions & Asir
Regional endemicity varies in Saudi Arabia due to climatic factors:
rainy season---- increased grass growth.
Dr. Salwa Tayel (Brucellosis)
6/3/2011

15. Dr. Salwa Tayel (Brucellosis)
6/3/2011

16. Situation in Saudi Arabia:
Between 1956 and 1982
only Sporadic human cases of brucellosis.
During early 1980s:
brucellosis emerged as a major public health problem.
Dr. Salwa Tayel (Brucellosis)
6/3/2011

17. Dr. Salwa Tayel (Brucellosis)
Reasons of the surge in incidence of brucellosis:
Intensive sheep/cattle breeding projects
minimal veterinary resources
Uncontrolled importation of live animals both for Hajj periods and for commercial reasons.
They were poorly screened for infection
In addition to, prevailing local custom of drinking raw and warm milk of sheep, goats, and camels, among the population of nomadic background.
Dr. Salwa Tayel (Brucellosis)
6/3/2011

18. Dr. Salwa Tayel (Brucellosis)
Voting
Miss Goat Universe
ملكة جمال الماعز
Dr. Salwa Tayel (Brucellosis)
6/3/2011

19. Dr. Salwa Tayel (Brucellosis)
6/3/2011

20. Dr. Salwa Tayel (Brucellosis)
Cycle of infection
Agent
Susceptible Host
Reservoir IP PC
Portal of Inlet
Portal of Exit
Mode of transmission
Dr. Salwa Tayel (Brucellosis)
6/3/2011

21. Dr. Salwa Tayel (Brucellosis)
Agent:
Brucella species; Gram negative, coccobacilli bacteria, strictly parasitic and prefer the intracellular habitat.
Reservoir:
Cattle, Sheep and Goat & camel, Swine, ……. 21
Dr. Salwa Tayel (Brucellosis)
6/3/2011

22. Other animal species affected
Brucella species and main reservoirs.
Human disease
Other animal species affected
Natural
host
Species
Less severe
Wild animals,
water buffalo, camels
Cattle
Brucella abortus
Severe
Wild ruminant
cattle
Sheep and Goat & camel
Brucella melitensis
( except biovar 2)
Various wild species
Swine
Brucella suis
Benign
None
Dog
Brucella canis
Dr. Salwa Tayel (Brucellosis)
6/3/2011

23. Dr. Salwa Tayel (Brucellosis)
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 the milk turns sour)
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
Dr. Salwa Tayel (Brucellosis)
6/3/2011

24. The most important route of animal to human transmission of Brucella
Dr. Salwa Tayel (Brucellosis)
6/3/2011

25. Dr. Salwa Tayel (Brucellosis)
Ingestion
Consumption of potentially infected unpasteurized milk, milk products, or meat.
Unpasteurized cheese, called "village cheese," from endemic areas is a particular risk for tourists.
Rarely through undercooked meat
Dr. Salwa Tayel (Brucellosis)
6/3/2011

26. Dr. Salwa Tayel (Brucellosis)
Direct contact of conjunctiva or broken skin with blood, urine, aborted fetus, the placenta and the discharge from vagina of infected animals.
Accidental self inoculation of vaccines.
High Risk Groups
slaughter-house workers, meat inspectors, animal handlers and veterinarians.
Dr. Salwa Tayel (Brucellosis)
6/3/2011

27. Dr. Salwa Tayel (Brucellosis)
Inhalation of aerosols containing the bacteria.
Or aerosol contamination of the conjunctiva
In the lab, transmission is via aerosolization
High Risk Groups
Laboratory workers.
Dr. Salwa Tayel (Brucellosis)
6/3/2011

28. Can brucellosis be spread from person to person?
Human-to-human transmission is rare.
Bone marrow transplantation from infected donors
Blood transfusion
Sexual intercourse
Neonatal infection; trans-placental or during delivery
Or probably through breast milk.
Dr. Salwa Tayel (Brucellosis)
6/3/2011

29. Dr. Salwa Tayel (Brucellosis)
Summary
In the Middle East and Africa ingestion of contaminated dairy products is an important route of infection.
In USA, Human brucellosis is primarily an occupational hazard (Lab, Vet)
Whether human beings can become infected via person-to-person spread is rare or uncertain.
Incubation period varies
7-21 days to several months
Brucellosis is not communicable from man to man.
Dr. Salwa Tayel (Brucellosis)
6/3/2011

30. Dr. Salwa Tayel (Brucellosis)
Prevention
1. Eradication of brucellosis in animals is the key to prevention in humans.
Surveillance, serologic testing, quarantine and massive immunization of animals in areas with high infection rates
Legislation to control marketing and movement of animals.
Dr. Salwa Tayel (Brucellosis)
6/3/2011

31. Dr. Salwa Tayel (Brucellosis)
Prevention
2. Brucellosis acquired from milk is preventable through:
Legislation to pasteurization of milk and dairy products.
Public health education to avoid drinking untreated milk and dairy products.
3. Health education for those occupationally at risk
(Use of Safety measures).
Dr. Salwa Tayel (Brucellosis)
6/3/2011

32. Dr. Salwa Tayel (Brucellosis)
Vaccination?!
A human Brucella vaccine does not exist.
For animals: all are live-attenuated.
Currently, B. abortus RB51 is used to immunize cattle
B. melitensis REV.1 is used to immunize goats and sheep.
Dr. Salwa Tayel (Brucellosis)
6/3/2011

33. Dr. Salwa Tayel (Brucellosis)
Bibliotheca Alexandrina
Thank you
Dr. Salwa Tayel (Brucellosis)
6/3/2011