Brucellosis

Notes

## Basic introduction

  • This is a zoonotic disease that is caused by Brucella species that may include abortus (from cattle and the least virulent), B. canis (from dogs), B. melitensis (from sheep and goats and the most virulent), and B. suis (from pigs).
  • It is one of the most common zoonoses worldwide.
  • It is also known as “undulant fever”, “Mediterranean fever” or “Malta fever”
  • The incubation period is highly variable (1 week to 2 months or longer).
  • Infection occurs after ingestion of either unpasteurized milk, undercooked infected meat or getting into close contact with secretions of an infected animal.
  • People with occupational livestock contact such as farmers, veterinarians, abattoir workers, and livestock keepers are at high risk of infection.
  • The Kenyan Zoonotic Disease Unit (a collaboration between Ministry of Agriculture, Livestock, Fisheries and the Ministry of Health) has given Brucellosis
  • a key priority in its strategy of combating of zoonotic diseases.

## Statistics

  • Globally, about 500,000 new cases are estimated to occur annually
  • The estimated national seroprevalence of brucellosis in Kenya is 3.0% (2007 data)
  • The seroprevalence of brucellosis from pastoral and agro-pastoral managed herds in Kenya range from 9.9 to 15 % in cattle, 10.3 to 38.0 % in camel, 13 to 16.1% in goats, and around 11.9% in sheep.
Symptoms

##The common triad symptoms are:

  • Undulant fevers
  • Profuse sweating
  • Migratory arthralgia and myalgia

## Other symptoms are:

  • Flu-like symptoms
  • Headache
  • Weakness
  • Loss of appetite
  • Abdominal pain
  • Constipation or diarrhea
  • Cough
  • Rash
  • Jaundice
  • CNS abnormality
  • Pneumonia
  • Hepatomegaly
  • Splenomegaly
  • Spinal tenderness
  • Malaise
  • Weight loss
  • Abortion
  • Orchitis
  • Acute renal failure
  • Endocarditis
  • Neurobrucellosis
  • Splenic abscess
  • Spondylitis
  • Arthritis
  • Encephalitis
  • Lymphadenopathy
Diagnosis
  • Diagnosis of brucellosis in Kenya and other sub-Saharan Africa countries is generally challenging due to the wide spectrum of clinical manifestations and lack of reliable diagnostic tests.
  • Rose Bengal plate test (RBT)
  • Standard agglutination test or SAT - rising titers (agglutination titre > 1:160 is significant in nonendemic areas and > 1:320 in endemic areas).
  • Blood culture in tryptose medium (that may take up to 2 months to grow and it poses biohazard risks to the laboratory personnel). It has a sensitivity of 40-70%.
  • ELISA
  • Rapid Diagnostic Tests (RDTs)
  • Validated polymerase chain reaction (PCR)
  • Milk ring test (in cattle)
Differential
  • Malaria
  • Typhoid Fever
  • Urinary Tract Infections
  • Fever of unknown origin
  • Tuberculosis
  • Meningitis
  • Osteomyelitis
  • Malignancy
  • Abortion Complications
  • Viral Hepatitis
  • Acute Epididymitis
  • Ankylosing Spondylitis
  • Collagen-vascular disease
  • Pneumonia
  • Cryptococcosis
Prevention
  • Vaccination of animals is the most effective method of prevention and control (but it is not routinely undertaken in Kenya)
  • Avoiding unpasteurized milk, undercooked meat or getting into close contact with secretions of infected animal.
Reference
  1. Hasanjani R, Mohraz M, Hajiahmadi M, Ramzani A, Valayati AA (April 2006). "Efficacy of gentamicin plus doxycycline versus streptomycin plus doxycycline in the treatment of brucellosis in humans". Clin. Infect. Dis. 42 (8): 1075–1080
  2. Kenyan Ministry of Health. Clinical guidelines for management and referral of common conditions at levels 4-6. Hospitals. 2009; 3:259-261.http://apps.who.int/medicinedocs/documents/s21000en/s21000en.pdf
  3. Ministry of Health, Kenya. Kenya Essential Medicine List (2016). http://publications.universalhealth2030.org/uploads/KEML-2016Final-1.pdf
  4. Njeru, J., Wareth, G., Melzer, F., Henning, K., Pletz, M. W., Heller, R., & Neubauer, H. (2016). Systematic review of brucellosis in Kenya: disease frequency in humans and animals and risk factors for human infection. BMC Public Health, 16(1), 853
  5. Omballa VO, Musyoka RN, Vittor AY, Wamburu KB, Wachira CM, Waiboci LW, et al. Serologic Evidence of the Geographic Distribution of Bacterial Zoonotic Agents in Kenya, 2007. Am J Trop Med Hyg. 2016;94(1):43–51.
  6. (2006). http://www.who.int/csr/resources/publications/Brucellosis.pdf
Management
  • IM streptomycin 1g OD x 2/52 PLUS Caps doxycycline 100mg BD for 45 days OR
  • IM gentamicin 5mg/kg x 1/52 PLUS Caps doxycycline 100mg BD for 45 days OR
  • Caps doxycycline 100mg BD PLUS rifampicin 600- 900mg daily for at least 6 wks.
  • Co-trimoxazole and rifampin can be used in pregnancy
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