Brucellosis

communicable disease course, master of community medicine university of Khartoum

1. Brucellosis
Presented by
Mahmoud Aboud

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

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

6. Clinical manifestation
Triad: Fever, Arthralgia/Arthritis,Hepatosplenomegaly
•+ 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

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. Treatment
> 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
Meningitis,Osteomyelitis,Endocarditis:
Doxy + Genta +/- Rifampin

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. Complications
•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

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

36. Typhoid

37. Diagnosis & Differential diagnosis

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

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

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