brucella presentation clinical aspects pptx

Brucella

1. Brucellosis – Clinical Aspects and Complications

2. CLINICAL ONSET OF SYMPTOMS & NATURE Onset may be insidious or abrupt Influenza-like symptoms (38–40°C) Headache, night sweats, marked fatigue ,Anorexia, weakness , wt loss, depression, arthralgia, severe back and limb pain

3. COMPLICATIONS Musculoske leta l involvement most common (60%) – osteomyelitis,septic arthritis, vertebral destruction. Hepatomegaly and lymphadenopathy(25%) Dry cough(25%) others- lung abscess,empyema , pleural effusion. Neuro brucellosis (2-5%)- meningitis,CN +, neuropathy. Epidydimo-orchitis (10%) Endocarditis (1%)

4. DD s TB Toxoplasma Cmv HIV

5. OSTEOARTICULAR COMPLICATIONS OF BRUCELLOSIS Sacroilitis >spondylodiskitis>Bursitis>osteomyelitis. In spondylodiskitis lumbar is most commonly involved – cervical is least commonly involved Avascular necrosis is less commonly seen in brucellosis If vertebral destructions ,skip lesions, multiple vertebral bodies involvement are seen we need to differentiate it from TB.

6. NEURO BRUCELLOSIS OVERVIEW • Involves both central and peripheral nervous systems • Less common but serious complicatio n Requires prompt recognition and treatment

7. Central Nervous System Involvem ent • Meningitis – most frequent manifestation • Meningeal irritation signs (37% cases) • Meningovascular complications such as mycotic aneurysms ,ischemic strokes,SAH are also frequently described. Cranial Nerves • Cranial Nerve Vlll , VI, VII commonly affected With 8 being most common. - sensorineural hearing loss - diplopia.

8. Psychiatric & Cognitive Effects • Psychiatric symptoms: depression, euphoria, psychosis • Cognitive disorders in ~21% of patients • May mimic psychiatric illnesses

9. Spinal Cord & Peripheral Nerves Myelitis, transverse myelitis Absess , granuloma,spinal root involvement Radiculopathy and peripheral neuropathy (~7%) Limb weakness and paraesthesia

10. BRUCELLOSIS IN PREGNANCY Acute stage most common in 3 rd Trimester – premature birth Chronic and subacute in 1 st trimester – abortions Most common complication- osteoarticular disease – sacroilitis most common Renal involvement - nephritis Anemia , leukopenia,lymphopenia , thromocytopenia , leucocytosis .

11. CHRONIC BRUCELLOSIS • Occurs due to untreated or inadequately treated infection • May persist or relapse over months/years

12. Granuloma & Hepatic Involvement • Granulomatous hepatitis (non caseating ) • Hepatic microabscesses and hepatomegaly • Liver function abnormalities • Bone marrow granulomas • Hemophagocytosis in severe cases • Pancytopenia in prolonged illness

13. RELAPSE IN BRUCELLOSIS • Relapse rate: ~10% • Most relapses occur within 3–6 months after treatment • Can present with same or different symptoms

14. Factors Leading to Relapse • Inadequate or inappropriate initial therapy • Illness duration <10 days at presentation • Male gender, bacteremia, thrombocytopenia Preventing Relapse • Proper treatment regimen adherence • Monitoring for early signs of recurrence • Extended follow-up after treatment