BRUCELLOSIS .pptx

Brucellosis is a bacterial disease caused by various Brucella species, which mainly infect cattle, swine, goats, sheep and dogs. Humans generally acquire the disease through direct contact with infected animals, by eating or drinking contaminated animal products or by inhaling airborne agents.

1. BRUCELLOSIS Otema Simple BNS - SOROTI UNIVERSITY

2. Objectives By the end of this lesson, learners should be able to: Define brucellosis Explain the epidemiology (spread) of the brucellosis Identify the Causes of brucellosis Outline the Signs and symptoms of brucellosis Describe Management of brucellosis Explain the Prevention and control of brucellosis

3. Introduction A zoonotic bacterial infection of acute onset caused by bacteria species Brucella abortus and Brucella melitensis . Common as an occupational disease among people working with infected livestock or associated fresh animal products, for example butchers, farmers, abattoir workers, and vendors of contaminated roasted meat ( muchomo ). Incubation is 2-4 weeks on average, but it can be from 1 to 8 weeks. Its also called Undulant fever, malta fever, abortus fever

4. Types 1. Acute brucellosis: S een in approximately 50% of patients infected with Brucella. Patients usually complain of nonspecific symptoms, such as anorexia, fatigue, weakness, malaise, or joint pain. Fever is an important symptom and is seen in almost all patients. The fever is intermittent and undulant (hence known as undulant fever) and can be associated with a relative bradycardia. 2. Chronic brucellosis: This condition develops in incompletely treated patients. This condition is associated with a low grade non bacteremic infection with periodic worsening.

5. Types cont.…. 3 . Localized infection: B. suis is more likely to cause localized and suppurative infection. Complications include infections of the heart, central nervous system (CNS), and the skin. • Brucella endocarditis is the most dangerous complication and is responsible for 80% of deaths in brucellosis. • Chronic meningoencephalitis is the usual manifestation of CNS infection.

6. Epidemiology Recent studies reveal a higher global incidence than previously estimated, with 1.6–2.1 million new human cases annually In Uganda, the prevalence of brucellosis has been reported to be 12–15.8% in cattle (Bernard et al., 2005; Mwebe et al., 2010) and 4% in goats ( Kabagambe et al., 2001). In a study carried out in 2015 in South-western Uganda, the prevalence of brucellosis seropositivity was 14% in cattle, 17% in goats, and 11% in humans  

7. Transmission to human Conjunctiva or broken skin on contact with infected tissues such as Blood, urine, vaginal discharges, aborted fetuses, placentas Ingestion of raw milk & unpasteurized dairy products (Cheese) Rarely through undercooked meat Inhalation of infectious aerosols e.g. on Pens, tables, slaughter houses Inoculation with vaccines e.g. B. abortus strain 19, RB-51, B. melitensis Rev-1 Conjunctival splashes, injection Person-to-person transmission is rare Incubation varies from 5 days to three months

8. Causes of brucellosis Brucella abortus (cattle) Brucella canis (dog) Brucella melitensis (goats and sheep) Brucella suis (pigs)

9. Risk factors 1. Occupational Disease •Cattle ranchers/dairy farmers •Veterinarians •Abattoir workers •Meat inspectors •Lab workers 2. Hunters 3. Travelers 4. Consumers of unpasteurized dairy products

10. Signs and symptoms Intermittent (fluctuating) fever Aches and pains Orchitis (inflammation of the testes) Vertebrae osteomyelitis (uncommon but characteristic) Hepatomegaly Splenomegaly

11. Diagnosis 1. Culture of urine and Milk. 2. Rapid latex agglutination test, 3. Rose Bengal card test. (Rose Bengal + B. abortus + Sodium azide ) 4. Milk Ring Test: Frequently used test. A drop of colored brucella antigen (B. abortus or B. melitensis with hematoxylin) is added to milk in a test tube, incubated in a water bath at 700C for 40-50 minutes. Positive: Blue ring at the top leaving the milk unstained. Negative: No ring. Milk remains uniformly blue. 5. Brucellin Skin test: Delayed hypersensitivity. 6. Molecular techniques: Polymerase Chain Reaction

12. Medical management Adult and child > 8 years: Doxycycline 100 mg every 12 hours for 6 weeks Child > 8 years: Doxycycline 2 mg/kg per dose Plus gentamicin 5-7 mg/kg IV daily for 2 weeks Child < 8 years: 7.5 mg/kg daily in 1-3 divided doses -Or ciprofloxacin 500 mg twice daily for 2 weeks Child < 12 years: do not use Children below 8 years Cotrimoxazole 24 mg/kg every 12 hours for 6 weeks Plus gentamicin 5-7 mg/kg IV in single or divided doses for 2 weeks

13. Cautions Treatment duration must be adhered to at all times Ciprofloxacin is contraindicated in children Doxycyline, gentamicin: Contraindicated in pregnancy

14. Prevention 1. Education about risk of transmission 2. Wear proper attire if dealing with infected animals/ tissues e.g. Gloves, masks, goggles, gumboots 3. Avoid consumption of raw dairy products 4. Immunize in areas of high prevalence (Young goats and sheep with Rev-1, Calves with RB51 however, No human vaccine) 5. Eradicate reservoir 6. Identify, segregate, and / or cull infected animals

15. Complications If the treatment of brucellosis is not successful, a patient may develop complications such; Osteomyelitis Orchitis ( the inflammation of the testicle unilaterally or bilaterally) Endocarditis Myocarditis Meningitis

16. References UCG 2023 Publication (Final PDF version). Pdf Bloom, K. S. (2001) Toohey’s Medicine; A text book for students in health care professionals. 15th Edition. Churchill .UK Brunner and suddhart medical and surgical nursing 12 th edition

17. THANKS