Brucellosis

1. Brucellosis M.Karimi

2. Etiology • Brucella: Abortus(Cattle),Melitensis (Sheep,Goat)Suis(Swin),Canis(Dog) • G- Coccobacil • Aerobic, Non-spore forming • Non motile • Blood or Choclate agar

3. Epidemiology • Unpasteurized milk • Occupational events

4. Inoculation in skin ,Eye (Through abrasion or conjunctiva) Inhalation (Infected aerosol) Ingestion (Meat, Dairy products) Risk of infection depends Nutritional status Immune status Rout of inoculum Species of brucella Pathogenesis

5. Pathogenesis • Survive& Replicate within phagocytes&Monocytes • Infected macrophages localized within reticuloendothelial system(Granuloma formation in spleen,liver,bone marrow)

6. + History of animal or food exposure Acute or insidious symptoms(2-4 wk after inoculation) Refusal to eat Refusal to bear weight Lassitude FTT Headache Inattention/Depression Abdominal pain Headache Diarrhea Rash Night sweets Weakness Fatigue Cough Vomiting Pharyngitis Clinical manifestationTriad: Fever, Arthralgia/Arthritis,Hepatosplenomegaly

7. Fever • Hepatosplenomegally • Arthralgia/Arthritis Sacroiliac,Hip,Ankle,

8. Diagnosis • WBC Normal or low • + History of animal or food exposure • Recovering organisms (blood’ bone marrow’..) • Serum agglutination test: >1/160 (Antibody against Abortus ,Melitensis, Suis, but not Canis) • 2ME

9. False positive SAT Yersinia entrocolitica Vibrio cholerae Francislla tularensis False negative SAT Prozen effect

10. Differential diagnosis • Car-Scratch disease • Typhoid fever • TB • Fungal infections

11. > or = 9 years old 1- Doxycycline 200 mg/D PO 6 WK + Streptomycin 1 g/D IM 1-2 WK OR Gentamycin 3-5 mg/kg/d IM/IV 1-2 WK -------------------------------------------------- 2- Doxycycline 200 mg/D PO 6 WK + Rifampin 600-900 mg/D PO 6 WK < 9 years old TMP-SMZ: po 45 days (TMP 10 mg/Kg/D) (SMZ 50 mg/KG/D) + Rifampin 15-20 mg/kg/D PO 45 days Treatment

12. calcified brucellomas in both kidneys calcified brucellomas in the spleen

13. Salmonellae Infections M.Karimi

14. Etiology Salmonellae (G- ‘Facultative’Bacilli) • Antigens: Flagellum(H)’ Cell wall(O)’ Envelope(Vi) • Serogroups on the basis of O antigen: A’ B’ C1’ C2’ D’ E • Serotypes: S.Typhi’ S.Paratyphi’…. • Transmission: Water’ Food(beef’poultry’milk’egg’..)

15. Salmonella Gastroentritis (Nontyphoidal) Epidemiology • Age: <4 y/o (< 1y/o) • Source of infection: Poultry’eggs’ egg product ’meats’ pet reptile • Transmission: Carrier (Human) • Incubation period: 6-72 hr. (usually less than 24 hr.) • Peak incidence: Late summer &Early fall

16. Pathogenesis • Ingestion • Attached to “M” cells • Phagocytosed by macrophages • Replication • Bacteremia

17. Clinical manifestations • Self limited diseases: 3-7 days • Onset: Abrupt • Nausea’ Vomiting’ Crampy abdominal pain • Loose watery stool • Malaise’ headache’ chills • Fever 38-38.9 c (70%) for 48 hour

18. At risk of complications • Impaired immune function(T-Cell) • HIV infection • Organ transplantation • Lymphoproliferative diseases • Hemoglobinopathies(Sickle cell disease’..) • CGD • Malaria • Very old or very young

19. Complications • Dehydration’Shock • Localized infection: Pneumonia Empyema Abscesses Osteomyelitis Septic arthritis Postinfectious arthritis Pyelonephritis meningitis

20. Diagnosis • Cultures (Stool’ Blood’ Urine’ Bone marrow’ CSF’…)

21. Treatment • Correction of shock’ dehydration’… • Antibiotics: 1-Infants < 3 mo. 2-Child with immunodeficiency’ Malnutrition Malignancy’ Intravascular catheter or other foreign material

22. Treatment • Ceftriaxone or Cefotaxime Septicemia’ Enteric fever’ Metastatic site of infection • Amoxicillin • Co-trimaxozole • Fluroqinolones • Chloramphenicol

23. Typhoid fever

26. Typhoid fever • In US:400 Cases per year &Usually under 20 y/o • Worldwide:16 million cases per year and 600’000 death • Infected only human

27. Pathogenesis • Invasions on upper small intestine • Monocyte phagocyte • Monocyte carry organism from blood to other RES • Organism proliferation • Lymph node’ liver & spleen inflammation • Secondary septicemia

28. Salmonella Typhi

30. Clinical manifestation • Infant: mild GE to severe septicemia without diarrhea Fever’ hepatomegaly ’ jaundice’ anorexia’ lethargy’ weight loss

31. Clinical manifestation • Child: High fever’ malaise ’lethargy’ myalgia’ headache’ rash’ Hepatomegaly’ abdominal pain and tenderness’ diarrhea(50%)’ constipation obtunded ’delirium’ confusion ’splenomegaly’ Macular (Rose spot) or Maculopapolar rash(30%) High T with low PR (Typically each 1 degree above 38.3° C Rise PR 10/min)

33. Rose spot

34. Intestinal perforation(0.5-3%) Severe GI hemorrhage(1-10%) Toxic encephalopathy Cerebral thrombosis Acute cerebral ataxia Aphasia Optic neuritis Deafness Transverse myelitis Acute cholecystitis Pneumonia Pyelonephritic Endocarditis Meningitis Osteomyelitis Septic arthritis Complications

35. Dense chronic bone reaction due to typhoid osteomyelitis.There is a central sequestrum

36. Typhoid

37. Diagnosis Cultures: Blood’ Urine’ Stool’ Bone marrow’ Lymph nodes’ Deudenal fluied’ Reticuloendothelial tissue’ Differential diagnosis Bronchitis Bronchopneumonia Gastroenteritis Influenza Diagnosis & Differential diagnosis

38. Drugs: Ceftriaxone Ampicillin Chloramphenicol Co-Trimoxozole Ciprofloxacin Azithromycin Surgery Cholecystectomy Treatment

39. Prognosis • With treatment : Mortality <1% • Without treatment : Relapse up to 10% • Chronic carrier: Excrete S.typhi for more than 3 mo.