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Bioterrorist Agents: Brucellosis

Bioterrorist Agents: Brucellosis. Learning Objectives. Become familiar with the following aspects of Brucellosis: Epidemiology Transmission Clinical features Diagnosis Treatment Prevention. Background. Brucella melitensis discovered by Bruce in 1887

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Bioterrorist Agents: Brucellosis

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  1. Bioterrorist Agents: Brucellosis

  2. Learning Objectives Become familiar with the following aspects of Brucellosis: • Epidemiology • Transmission • Clinical features • Diagnosis • Treatment • Prevention

  3. Background • Brucella melitensis discovered by Bruce in 1887 • Types: B. melitensis, abortus, suis, neotomae, ovis, canis, and types infecting marine mammals • Pathogenic types in humans - B. melitensis, abortus, canis and suis • Zoonotic disease

  4. Brucellosis- definition A multisystem disease with a broad range of symptoms including acute or insidious onset of fever, night sweats, undue fatigue, anorexia, weight loss, headache and arthralgia

  5. Epidemiology • Incidence in US: <0.5 cases per 100,000 primarily B. melitensis • Most cases in the US are reported from California, Florida, Texas and Virginia • High risk areas: Mediterranean Basin, South and Central America, Eastern Europe, Asia, Africa , the Caribbean and the Middle East.

  6. Transmission Three methods of transmission: • Ingestion –unpasteurized milk or dairy products. Ingestion is most common method of transmission. • Inhalation – breathing in the organism. Lab workers are high risk. • Wound contamination –high risk occupations include hunters, slaughterhouse workers, meat packing plant workers and veterinarians

  7. Potential For Intentional Harm? • CDC Category B agent • Most likely route of intentional exposure: Respiratory • Could also happen via contamination of food/drink • Identify intentional exposures as any BT agent: • Common Source • Unlikely patients • Unlikely Season • Multiple Patients • Geographic correlation

  8. Case Definition • Clinical illness with fever, night sweats, fatigue, anorexia, weight loss, headache and arthralgia • Laboratory criteria for diagnosis: • Isolation of Brucella sp. from a clinical specimen, or • Fourfold or greater rise in Brucella agglutination titer between acute- and convalescent-phase serum specimens obtained greater than or equal to 2 weeks apart and studied at the same laboratory, or • Demonstration by immunofluorescence of Brucella sp. in a clinical specimen

  9. Case classification • Probable: clinically compatible case with an epidemiologic link • Confirmed: clinically compatible case that is laboratory confirmed

  10. Clinical Features • Flu-like symptoms:"undulant" fever, headache, chills, myalgias, arthralgias, weakness and malaise • Most recover entirely within 3 to 12 months • Some develop ill-defined chronic syndrome • Possible complications: arthritis, uveitis, sacroiliitis, spondylitis (10% of cases), meningitis (5%), and epididymoorchitis

  11. Treatment • Six week course of a combination of antibiotics. • Doxycycline and rifampin or doxycyclin and streptomycin

  12. Prevention/Infection Control • Pasteurizing milk and dairy products • Eradicating infection from herds and flocks • Observing safety precautions for occupational exposures including • rubber boots • wearing impermeable clothing, • gloves and face masks • practicing good personal hygiene

  13. Case Reports Suspected Brucellosis Case Prompts Investigation of Possible Bioterrorism-Related Activity MMWR Morb Mortal Wkly Rep 2000: 49(23) http://www.cdc.gov/mmwr/PDF/wk/mm4923.pdf

  14. Resources CDC Emergency Preparedness and Response www.bt.cdc.gov/agent/brucellosis/index.asp USDA, APHIS, Veterinary Services www.aphis.usda.gov/vs/nahps/brucellosis Special thanks to Altoon Dweck, MD, MPH, Johns Hopkins Preventive Medicine Resident

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