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Brucellosis

Brucellosis

Diagnosis

1.
Irregular fever, HA, profound weakness, fatigue, chills, sweating, arthralgias, mylagias

2.
Depression and AMS

3.
Splenomegaly (20-30%), lymphadenopathy (10-20%)

4.
Osteoarticular findings (i.e. sacroiliitis, vertebral osteomyleitis)

5.
Blood cultures require prolonged period of incubation in acute phase

6.
Bone marrow cultures produce higher yield

7.
Confirmation requires phage-typing, oxidative metabolism, or genotyping procedures

8.
ELISA followed by Western Blot

9.
Brucella titer >1:160 or 4 fold rise in titer is presumptive evidence for infection
History

1.
Described by Marsten in British soldiers in Malta during Crimean war as “Mediterranean gastric remittent fever” or “Malta fever”

2.
Brucella suis (found in swine) weaponized in 1954 by US
Pathophysiology

1.
Brucellae are group of gram-negative, aerobic, nonmotile, cocco-baccillary organisms

2.
Brucella melitensis is most common (goats and sheep)

3.
Ingestion of unpasteurized dairy products

4.
Incubation period of 5-60 d; average of 1-2 mths

5.
Infective dose: 10-100 organisms

6.
Duration: wks to mths

7.
Low mortality rate (5% of untreated cases)
Prevention

1.
No approved human vaccine

2.
Avoid unpasteurized milk and cheese
Isolation/Decontamination

1.
Standard precautions for healthcare workers

2.
0.5% hypochlorite soln
Treatment

1.
Acute brucellosis: adults: doxycycline 200 mg/d PO plus rifampin 600-900 mg/d for 6 wks

2.
Alternative: ofloxacin 400 mg/d PO and rifampin 600 mg/d PO

3.
Rifampin, a tetracycline, and an aminoglycoside indicated for infections with complications e.g. meningoencephalitis
Disposition

1.
Admit; standard precautions

2.
Notify CDC & local health dept

* Material is taken from the PEPID database
* Copyrighted material – All Rights Reserved
* For more information visit http://www.pepid.com

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