بسم الله الرحمن الرحيم

1. بسم الله الرحمن الرحيم Brucellosis

2. ZOONOSIS A disease, primarily of animals, that can be transmitted to humans as a result of direct or indirect contact with the infected animal population

3. Brucella are Ideal Biological Warfare Agents • They are highly infectious • They can be easily aerosolized • They are stable in production, storage, & delivery • They are sensitive to sunlight • They cause high morbidity, but low mortality • There are no human vaccines against brucellosis • There is high economic loss to animal agriculture

4. 2- عامل يا عوامل اتيولوژيك • Fastidious & aerobic • Facultative intracellular • Gram negative non motile cocobacilli

5. Etiologic agents

7. Isolated species in Iran

8. Pathogenesis • Skin abrasion, conjunctivae, inhalation or ingestion • Engulfed by neutrophils and monocytes (resistant to killing) • Localize regional lymph nodes • Infect phagocytic cells in the RE system and form granulomas

9. 1 ـ دوره نهفتگي • 5-60 days (1-2 month)

10. 3 ـ انتشار جغرافيائي • Occurs worldwide • Endemic areas - Africa, Asia • True incidence not known

11. Seasonal distribution in Iran

12. Effect of Gender • Men aged 15-45 years are affected twice as often as women of the same age • Male predominance seem to be a factor in some cases • The man is more likely than the woman to be exposed to the heaviest concentration of organisms

13. Effect of Gender • In Iran both sexes are nearly always equally contacted with contaminated animals and dairy products • There is not a significant predominance of male to female brucellosis in Iran

14. Sex distribution in Iran Male 56% Female 44%

15. Age distribution • Children are affected very much less than adults • The odd low incidence in children is unexplained • It may be that gastric acidity is less often deficient than in adult • Occupational exposure is much more important

16. توزيع سني 56000 بيمار ايراني در سال 1370 0-4 5-9 10-14 20-24 30-34 40-44 50-54 + 60

17. Occupational hazards • Farmers • Shepherds, goatherds • Veterinarians • Abattoir workers • Laboratory workers • Butchers

18. موقعيت اجتماعي و شغلي 56000 مورد بروسلوز گزارش شده در ايران در سال 1370 %

19. 6 ـ تاثير عوامل مساعد كننده • عوامل فرهنگي و عقيدتي • زمينه هائي نظير ضعف ايمني ، ابتلاء به بيماريهاي سركوبگر ايمني ، مصرف داروهاي مضعف سيستم ايمني • استرس هاي مختلف • فقر و بي خانماني

20. 7 ـ حساسيت و مقاومت در مقابل بيماري • مقاومت طبيعي • مصونيت اكتسابي بعد از ابتلاء • مصونيت اكتسابي بعد از واكسيناسيون • - در انسان ؟ • - در حيوانات ؟

21. Brucellosis in animals • Transmitted by contact with infected tissue or milk (oral, aerosol or abrasion) • Predilection for erythritol rich organs (breast, uterus, epididymis, ect.) • Abortions, mastitis and sterility

22. Transmission of brucellosis • Farmers / Ranchers • Veterinarians (food animal practice) • Brucellosis eradication personnel • Meat inspection personnel • Abattoir workers • Laboratory personnel

23. Transmission of brucellosis Brucellosis as a Food Borne Disease • Is not occupation related • Often no history of animalcontact • May occur outside brucellosis enzootic areas • Often occurs in outbreaks • May involve women & children • May involve travelers to brucellosis enzootic areas

24. Reservoirs • Natural Human Species HostPathogen • Brucella abortus Cattle * • Brucella suis Swine * • Brucella melitensis Goats/Sheep * • Brucella ovis Sheep • Brucella canis Dogs * • Brucella neotomae Desert wood rat7

25. Occurrence in Wildlife

26. Reservoir • Mammalian parasite • Host specificity is not exclusive • Horse is occasionally infected • Serum from camels have proved positive • Have been isolated from foxes, buffaloes, elk, moose, deer, polecats • Rabbits have been infected • Infection of hares have proved

27. Reservoir • Flies, mosquitoes, ticks and other insects can be infected with all species • Ticks have transmitted to guinea pigs by biting • Dogs and cats are fairly resistant • Has not been found in monkeys

28. Infection of Cattle • In many parts of the world, cattle are heavily infected • Br. Abortus is most commonly involved • They may readily infect with Br. Melitensis and Br. suis

29. Infection of Cattle • Br. Melitensis do not cause serious symptoms in cattle • Br. Abortus may lead to death of the fetus and abortion • The aborted fetus, the placenta and the discharge from vagina are all heavily contaminated

30. Infection of Cattle • Brucella tend to lodge in mammary gland and supramammary lymph nodes • They may shed in the milk for years • The organisms tend to settle in the testicles, epididymis and seminal vesicles • Organisms may be present in the semen and may transmit sexually • Transmission by artificial insemination • In cattle is a serious economic and public health problem

31. Infection of Goats • Is always due to Br. Melitensis • Abortion is not a prominent symptoms • Reduced fertility in the herd • Br. Melitensis is passed in enormous numbers in the milk • for 6-7 month

32. Infection of Sheep • Is always due to Br. Melitensis • Is occasionally due to Br. Abortus or Br. Suis • Affecting fertility and meat and wool production

33. Infection of Swine • Br. Suis is the most common brucella in swine • Swine may infect with brucella abortus and melitensis • The semen may be teeming with brucella and the boar may disseminate infection throughout the herd

34. Transmission between animals • Milk • Meat • Trans placentally • Sexually (& artificial insemination) • Respiratory • Urine

35. Mode of transmission • Ingestion • Inhalation • Abrasion skin • Mucous membranes • Conjunctive • Sexual • Blood transfusion • Organ transplant

37. Mode of transmission در شيرخواران و كودكان روستائي 1 ) تغذيه با شير خام در دوران شيرخوارگي و بعد از آن. 2 ) مصرف لبنيات خام، نظير پنير و خامه روستايي. 3 ) خوردن دنبلان آلوده اي كه خوب پخته نشده باشد. 4 ) تماس مستقيم با نوزادان تازه متولد شده حيوانات (گوساله، بزغاله، بره) 0 5 ) تماس مستقيم با نسوج حيواني آلوده، نظير مثانه حيوانات ذبح شده. 6 ) از طريق افشانه‌هاي (آئروسل) موجود در هواي آغل و اصطبل . 7 ) به هنگام بازي با وسايل كشاورزي، از طريق پوست آسيب ديده. 8 ) از طريق پاها و دست‌هاي ترك خورده كودكان روستايي. 9 ) تغذيه با شير آلوده مادر و انتقال داخل رحمي را نيز در بروسلوز مادرزادي (Congenital)، دخيل دانسته اند.

38. ج ـ پيشگيري و كنترل بروسلوز • Primordial Prevention:“…minimize hazards to health” • Primary Prevention: • Prevention of disease in “well” individuals • Secondary Prevention: • Identification and intervention in early stages of disease • Tertiary Prevention: • Prevention of further deterioration, reduction in complications

39. كنترل بروسلوز 1 ـ مبارزه با منابع و مخازن 2 ـ قطع زنجيره انتقال 3 ـ حفظ افراد سالم

40. كنترل بروسلوز • 1 ـ مبارزه با مخازن • شناسائي حيوانات بيمار • ايزوله كردن بيماران ؟؟ • منابع محيطي ؟؟

41. كنترل بروسلوز • 2 ـ قطع زنجيره انتقال • تماس‌هاي مستقيم و غيرمستقيم • آب، غذا و . . . • پوست، مخاط، هوا، جفت . . .

42. كنترل بروسلوز • 3 ـ حفظ افراد سالم • مصونسازي اكتيو؟ • مصونسازي پاسيو ؟ • كموپروفيلاكسي ؟