1 / 23

Brucellosis

Brucellosis. Prepared by: Dr Mostafavy SN Department of Pediatric Infectious Disease Isfahan University of Medical science. Etiology. Brucella spp. Melitensis : severe disease Abortus Suis Canis: infrequent Gram negative coccobacilli Intracellular

adave
Download Presentation

Brucellosis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Brucellosis Prepared by: Dr Mostafavy SN Department of Pediatric Infectious Disease Isfahan University of Medical science

  2. Etiology • Brucella spp. • Melitensis : severe disease • Abortus • Suis • Canis: infrequent • Gram negative coccobacilli • Intracellular • Zoonosis: lives in breast, genitourinary, and blood of the host( humans accidental host)

  3. Transmission • Conjunctiva or broken skin • Farmers • Ranchers • Abattoir workers • Veterinarians • Slaughters • Ingestion of unpasteurized dairy products • Inhalation • Stables • Laboratories

  4. Pathogenesis • Inoculation to susceptible host • Ingestion by phagocytic cells • Multiply within PMNs • Disseminationto RES and joints • Replicationin organs • Cell mediated immunity( humoral) • Recovery+/- ABs

  5. Clinical manifestations • Incubation period: 1-4wk( to several mo.) • Insidious onset, more benign in children • Classic triad • Fever, arthritis( sacroilliac and large lower limbs), (hepato)splenomegaly • Nonspecific complaints • Anorexia, sweats, fatigue, weight loss • Occasional complications • Neurobrucellosis, osteomyelitis, endocarditis • Relapse within 6-12 mo

  6. Diagnosis • Medical history • Nonspecific tests • Culture • Serological tests • PCR

  7. Medical history • Occupation • Consumption of unpasteurized dairy product • Family history • Affected animals • Travel to endemic area

  8. Nonspecific tests • WBC/ diff (usually normal to low) • ALT/ AST( minor disturbances is common) • CSF analysis: lymphocytic pleocytosis, increased protein, decreased glucose • Synovial analysis: WBC< 15,000, Lymphocytic predominance

  9. Culture • Definite diagnosis • Any fluid: blood, bone marrow, liver biopsy, synovial, CSF • The sensitivity in blood is lower( 15-70%) than bone marrow(80-90%) • Bone marrow in pts with severe cytopenia, FUO, or negative serology • Time consuming( 7th-21st day), shorter in Bactec system • Inform lab personnel

  10. Humoral responses in brucellosis • IgM appear earlier than IgG • But IgM persists for months to years after therapy • IgG decline to low levels after therapy • Rising IgG suggest relapse, reinfection, or complication

  11. Serological tests • Agglutination tests: • Wright test( slide, tube) • Coombs Wright test • 2 Mercapto-Ethanol test • ELISA tests

  12. Wright test • Two types: • Standard: (in tubes), report titers • Rose Bengal: on plates, rapid screening test, sensitivity> 99% • Measures antibodies against LPS (no B. canis) • The mainstay diagnosis of acute brucellosis: simple, low cost, and reliable (90% sensitive)

  13. Wright test • Seroconversion or 4 fold increase of the titers over >2 weeks is the definite test • Titers >1:160 in endemic and >1:80 in non-endemic areas is highly suggestive • False positive: cross-reaction with other bacteria • False-negative: early infection , immuno suppression, prozone phenomenon, blocking antibodies, complicated cases

  14. Slide Agglutination Test

  15. Coombs Wright Test • Addition of anti-human globulin to SAT tubes • Titers > 1/320 considered as positive • Can detect blocking antibodies • Helpful in highly suspected cases with negative SAT • 7% false-negative results

  16. Coombs Wright Test

  17. 2 Mercapto Ethanol test • Addition of 2ME to brucella SAT tubes • 2ME makes IgM inactive • Positive test( >1/80 ) is evidence of active infection

  18. ELISA tests • Simple, rapid, and reliable but expensive • Measures IgM, IgG, and IgA • Useful in complicated, relapsed or reinfection cases

  19. Treatment • Disease: • Doxycycline(Cotrimoxazole in < 8yr) for 6 wk+ • Gentamicine for 14 days or rifampine for 6 wk • Complications: • Doxycycline(Cotrimoxazole in < 8yr) for 6 mo+ • Gentamicin for 14 days+ • Rifampin for 6 mo in adults and chidren< 8 year

  20. Prevention • Education • Wearing gloves, masks, goggles if dealing with infected animals/ tissues • Avoiding consumption of raw dairy products • Immunization of animals • Eradicate reservoir

More Related