Brucellosis

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Obesity, Sleep & Internal medicine
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Brucellosis
File:Brucella spp.JPG
Synonyms	Undulant fever, Malta fever, Mediterranean fever
Pronounce	N/A
Specialty	N/A
Symptoms	Fever, sweats, malaise, anorexia, headache, muscle pain
Complications	Endocarditis, arthritis, hepatitis, splenomegaly
Onset	1-3 weeks after exposure
Duration	Weeks to months
Types	N/A
Causes	Brucella species (B. abortus, B. melitensis, B. suis, B. canis)
Risks	Occupational exposure, consumption of unpasteurized dairy products
Diagnosis	Blood culture, serology, PCR
Differential diagnosis	Malaria, typhoid fever, tuberculosis, rheumatic fever
Prevention	Avoiding unpasteurized dairy, occupational safety measures
Treatment	Antibiotics such as doxycycline and rifampin
Medication	N/A
Prognosis	Generally good with treatment, but relapses can occur
Frequency	500,000 cases per year worldwide
Deaths	Rare with treatment

Brucellosis is an infectious disease caused by bacteria. People can get the disease when they are in contact with infected animals or animal products contaminated with the bacteria. Animals that are most commonly infected include sheep, cattle, goats, pigs, and dogs, among others.

Cause

• Eating undercooked meat or consuming unpasteurized/raw dairy products
• The most common way to be infected is by eating or drinking unpasteurized/raw dairy products. When sheep, goats, cows, or camels are infected, their milk becomes contaminated with the bacteria.
• If the milk from infected animals is not pasteurized, the infection will be transmitted to people who consume the milk and/or cheese products.

Transmission

• Breathing in the bacteria that cause brucellosis (inhalation)
• Breathing in the bacteria that causes brucellosis may also lead to infection. This risk is generally greater for people in laboratories that work with the bacteria. In addition, slaughterhouse and meat-packing employees have also been known to be exposed to the bacteria and ultimately become infected.
• Bacteria entering the body through skin wounds or mucous membranes
• Bacteria can also enter wounds in the skin/mucous membranes through contact with infected animals.

Occupational Risks

• People in certain occupations or settings may face increased exposure to the bacteria that cause brucellosis.
• These can include:
• slaughterhouse workers
• meat-packing employees
• veterinarians
• laboratory workers

Risks from Unpasteurized Dairy Products

• Raw milk and milk products are those that have not undergone a process called pasteurization that kills disease-causing germs. These types of products are common outside the United States and are increasingly being sold in mainstream supermarkets in the United States as well.
• Consumption of raw milk containing Brucella can cause brucellosis. Most cases of brucellosis associated with raw milk are caused by a strain called Brucella melitensis or Brucella abortus in people who traveled to countries where these strains are common and drank contaminated cow, sheep or goat milk. In rare cases, brucellosis cases associated with other strains, including RB51 and Brucella suis, are reported.
• RB51 is resistant to certain antibiotics that would normally be used to prevent or treat Brucella infections. CDC recommends that anyone exposed to RB51 receive antibiotics to prevent an infection.

Areas at Risk

• Although brucellosis can be found worldwide, it is more common in countries that do not have effective public health and domestic animal health programs. Areas currently listed as high risk are:
• the Mediterranean Basin (Portugal, Spain, Southern France, Italy, Greece, Turkey, North Africa)
• Mexico, South and Central America
• Eastern Europe
• Asia
• Africa
• The Caribbean
• The Middle East

Prevention

• The best way to prevent brucellosis infection is to be sure you do not consume:
• undercooked meat
• unpasteurized dairy products, including:
• milk
• cheese
• ice cream
• Pasteurization is when raw milk is heated to a high temperature for a short period of time. This heating process destroys harmful bacteria that may make the milk unsafe to consume.
• People who handle animal tissues (such as hunters and animal herdsman) should protect themselves by using:
• rubber gloves
• goggles
• gowns or aprons
• This will help ensure that bacteria from potentially infected animals do not get into eyes or inside a cut or abrasion on the skin.
• Signs and Symptoms
• Brucellosis can cause of range of signs and symptoms, some of which may present for prolonged periods of time.

Initial symptoms can include:

• fever
• sweats
• malaise
• anorexia
• headache
• pain in muscles, joint, and/or back
• fatigue

Some signs and symptoms may persist for longer periods of time. Others may never go away or reoccur.

• These can include:
• recurrent fevers
• arthritis
• swelling of the testicle and scrotum area
• swelling of the heart (endocarditis)
• neurologic symptoms (in up to 5% of all cases)
• chronic fatigue
• depression
• swelling of the liver and/or spleen

Treatment

• Before treatment begins, a diagnosis of brucellosis infection must be made by a doctor.
• Tests will be performed to look for bacteria in samples of blood, bone marrow, or other body fluids. In addition, a blood test can be performed to detect antibodies against the bacteria.
• Once a diagnosis is made, a doctor can prescribe antibiotics.
• Depending on the timing of treatment and severity of illness, recovery may take a few weeks to several months. Death from brucellosis is rare, occurring in no more than 2% of all cases.

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