Brucellosis
Encyclopedia
Brucellosis, also called Bang's disease, Crimean fever, Gibraltar fever, Malta fever, Maltese fever, Mediterranean fever, rock fever, or undulant fever, is a highly contagious zoonosis
caused by ingestion of unsterilized
milk
or meat
from infected animals or close contact with their secretions. Transmission from human to human, through sexual contact or from mother to child, is rare but possible. Brucella
spp. are small, Gram-negative
, non-motile, non-spore-forming, rod shaped (coccobacilli
) bacteria. They function as facultative
intracellular parasites causing chronic disease, which usually persists for life. Symptoms include profuse sweating and joint and muscle pain. Brucellosis has been recognized in animals including humans since the 20th century.
medical officers in the 1850s in Malta during the Crimean War
. The causal relationship between organism and disease was first established in 1887 by Dr. David Bruce
.
In 1897, Danish
veterinarian
Bernhard Bang
isolated Brucella abortus as the agent; and the additional name Bang's disease was assigned.
Maltese
doctor and archaeologist Sir Themistocles Zammit
earned a knighthood for identifying unpasteurized milk as the major source of the pathogen in 1905, and it has since become known as Malta Fever. In cattle, this disease is also known as contagious abortion and infectious abortion.
The popular name undulant fever originates from the characteristic undulance (or "wave-like" nature) of the fever, which rises and falls over weeks in untreated patients. In the 20th century, this name, along with brucellosis (after Brucella
, named for Dr Bruce), gradually replaced the 19th century names Mediterranean fever and Malta fever.
In 1989, neurologists in Saudi Arabia discovered neurobrucellosis, a neurological involvement in brucellosis.
The following obsolete names have previously been applied to brucellosis:
), B. suis (pigs, see Swine brucellosis
), B. abortus (cattle and bison), B. ovis
(sheep), and B. canis (dogs). B. abortus also infects bison and elk in North America and B. suis is endemic in caribou. Brucella species have also been isolated from several marine mammal species (pinnipeds and cetaceans).
. There are two main causes for spontaneous abortion in animals. The first is due to erythritol
, which can promote infections in the fetus and placenta. The second is due to the lack of anti-Brucella activity in the amniotic fluid. Males can also harbor the bacteria in their reproductive tracts, namely seminal vesicle
s, ampullae
, testicle
s, and epididymides
.
s is Brucella canis
. It is transmitted to other dogs through breeding and contact with aborted fetuses. Brucellosis can occur in humans that come in contact with infected aborted tissue or semen. The bacteria in dogs normally infect the genitals and lymphatic system
, but can also spread to the eye
, kidney
, and intervertebral disc
(causing discospondylitis). Symptoms of brucellosis in dogs include abortion in female dogs and scrotal
inflammation and orchitis
(inflammation of the testicles) in males. Fever is uncommon. Infection of the eye can cause uveitis
, and infection of the intervertebral disc can cause pain or weakness. Blood testing of the dogs prior to breeding can prevent the spread of this disease. It is treated with antibiotics, as with humans, but it is difficult to cure.
Brucellosis in humans is usually associated with the consumption of unpasteurized milk and soft cheeses made from the milk of infected animals, primarily goats, infected with Brucella melitensis and with occupational exposure of laboratory workers, veterinarians and slaughterhouse workers. Some vaccines used in livestock, most notably B. abortus strain 19, also cause disease in humans if accidentally injected. Brucellosis induces inconstant fever
s, sweating, weakness, anaemia, headache
s, depression
and muscular and bodily pain.
The symptoms are like those associated with many other febrile
diseases, but with emphasis on muscular pain and sweating. The duration of the disease can vary from a few weeks to many months or even years. In the first stage of the disease, septicaemia occurs and leads to the classic triad of undulant fevers, sweating (often with characteristic smell, likened to wet hay) and migratory arthralgia
and myalgia
. Blood tests characteristically reveal leukopenia and anemia, show some elevation of AST and ALT, and demonstrate positive Bengal Rose and Huddleston reactions. This complex is, at least in Portugal, known as the Malta fever. During episodes of Malta fever, melitococcemia (presence of brucellae in blood) can usually be demonstrated by means of blood culture in tryptose medium or Albini medium. If untreated, the disease can give origin to focalizations or become chronic. The focalizations of brucellosis occur usually in bones and joints and spondylodiscitis of lumbar spine accompanied by sacroiliitis
is very characteristic of this disease. Orchitis
is also frequent in men.
Diagnosis of brucellosis relies on:
The disease's sequelae are highly variable and may include granulomatous hepatitis
, arthritis
, spondylitis
, anaemia, leukopenia
, thrombocytopenia
, meningitis
, uveitis
, optic neuritis
, endocarditis
and various neurological disorders collectively known as neurobrucellosis.
s like tetracyclines, rifampicin
, and the aminoglycoside
s streptomycin
and gentamicin
are effective against Brucella bacteria. However, the use of more than one antibiotic is needed for several weeks, because the bacteria incubate within cell
s.
The gold standard treatment for adults is daily intramuscular injections of streptomycin
1 g for 14 days and oral doxycycline
100 mg twice daily for 45 days (concurrently). Gentamicin
5 mg/kg by intramuscular injection
once daily for seven days is an acceptable substitute when streptomycin is not available or difficult to obtain. Another widely used regimen is doxycycline plus rifampin twice daily for at least six weeks. This regimen has the advantage of oral administration. A triple therapy of doxycycline, with rifampin and cotrimoxazole, has been used successfully to treat neurobrucellosis. Doxycycline is able to cross the blood–brain barrier, but requires the addition of two other drugs to prevent relapse. Ciprofloxacin and cotrimoxazole therapy is associated with an unacceptably high rate of relapse. In brucellic endocarditis, surgery is required for an optimal outcome. Even with optimal antibrucellic therapy, relapses still occur in 5–10 percent of patients with Malta fever.
The main way of preventing brucellosis is by using fastidious hygiene in producing raw milk products, or by pasteurizing
all milk that is to be ingested by human beings, either in its unaltered form or as a derivate, such as cheese
. Experiments have shown that cotrimoxazol and rifampin are both safe drugs to use in treatment of pregnant women who have brucellosis.
by the United States at its Pine Bluff Arsenal
in Arkansas. Brucella species survive well in aerosols and resist drying. Brucella and all other remaining biological weapons in the U.S. arsenal were destroyed in 1971–72 when the U.S. offensive biological weapons (BW) program was discontinued.
The United States BW program focused on three agents of the Brucella group:
Agent US was in advanced development by the end of World War II
. When the U.S. Air Force (USAF) wanted a biological warfare capability, the Chemical Corps offered Agent US in the M114 bomblet, based after the 4-pound bursting bomblet developed for anthrax
in World War II. Though the capability was developed, operational testing indicated that the weapon was less than desirable, and the USAF termed it an interim capability until replaced by a more effective biological weapon. The main drawbacks of the M114 with Agent US was that it was incapacitating (the USAF wanted "killer" agents), the storage stability was too low to allow for storing at forward air bases, and the logistical requirements to neutralize a target were far higher than originally anticipated, requiring unreasonable logistical air support.
Agents US and AB had a median infective dose of 500 org/person, and AM was 300 org/person. The rate-of-action was believed to be 2 weeks, with a duration of action of several months. The lethality estimate was based on epidemiological information at 1–2%. AM was always believed to be a more virulent disease, and a 3% fatality rate was expected.
s are required to vaccinate
all young stock, thereby further reducing the chance of zoonotic
transmission. This vaccination is usually referred to as a "calfhood" vaccination. Most cattle receive a tattoo in their ear serving as proof of their vaccination status. This tattoo also includes the last digit of the year they were born.
The first state–federal cooperative efforts towards eradication of brucellosis caused by Brucella abortus in the U.S. began in 1934.
and elk
in the Greater Yellowstone Area (GYA) are the last remaining reservoir of Brucella abortus in the U.S. The recent transmission of brucellosis from elk to cattle in Idaho and Wyoming illustrates how the GYA is the last remaining reservoir in the United States, adversely affecting the livestock industry. Eliminating brucellosis from this area is a challenge, as there are many viewpoints on how to manage diseased wildlife.
declared their cattle herd brucellosis-free on September 19, 1985. Brucellosis ring testing of milk and cream, as well as testing of slaughter cattle, ended April 1, 1999. Monitoring continues through auction market testing, standard disease reporting mechanisms, and testing of cattle being qualified for export to countries other than the USA.
in Malta to the point of it being referred to as "the Maltese fever". The link between the illness and unpasteurised milk was established by Temi Zammit. Today thanks to a strict regime of certification of milk animals and widespread use of pasturisation the illness has been eradicated from Malta.
was declared free of brucellosis on 1 July 2009. The disease had troubled the country's farmers and veterinarians for several decades. The Irish government submitted an application to the European Commission
, which verified that Ireland had been liberated. Brendan Smith
, Ireland's Minister for Agriculture, Fisheries and Food, said the elimination of brucellosis was "a landmark in the history of disease eradication in Ireland". Ireland's Department of Agriculture, Fisheries and Food intends to reduce its brucellosis eradication programme now that eradication has been confirmed.
is at present free of cattle brucelosis, although it occurred in the past. Brucellosis of sheep or goats has never been reported. Brucellosis of pigs does occur. Feral pigs are the typical source of human infections.
is limited to sheep (Brucella ovis). The country is free of all other species of Brucella.
Zoonosis
A zoonosis or zoonoseis any infectious disease that can be transmitted from non-human animals to humans or from humans to non-human animals . In a study of 1415 pathogens known to affect humans, 61% were zoonotic...
caused by ingestion of unsterilized
Sterilization (microbiology)
Sterilization is a term referring to any process that eliminates or kills all forms of microbial life, including transmissible agents present on a surface, contained in a fluid, in medication, or in a compound such as biological culture media...
milk
Milk
Milk is a white liquid produced by the mammary glands of mammals. It is the primary source of nutrition for young mammals before they are able to digest other types of food. Early-lactation milk contains colostrum, which carries the mother's antibodies to the baby and can reduce the risk of many...
or meat
Meat
Meat is animal flesh that is used as food. Most often, this means the skeletal muscle and associated fat and other tissues, but it may also describe other edible tissues such as organs and offal...
from infected animals or close contact with their secretions. Transmission from human to human, through sexual contact or from mother to child, is rare but possible. Brucella
Brucella
Brucella is a genus of Gram-negative bacteria. They are small , non-motile, non-encapsulated coccobacilli, which function as facultative intracellular parasites....
spp. are small, Gram-negative
Gram-negative
Gram-negative bacteria are bacteria that do not retain crystal violet dye in the Gram staining protocol. In a Gram stain test, a counterstain is added after the crystal violet, coloring all Gram-negative bacteria with a red or pink color...
, non-motile, non-spore-forming, rod shaped (coccobacilli
Coccobacillus
A coccobacillus is a type of rod-shaped bacteria. The word coccobacillus reflects an intermediate shape between coccus and bacillus . Coccobacilli rods are so short and wide that they resemble cocci. Haemophilus influenzae and Chlamydia trachomatis are coccobacilli...
) bacteria. They function as facultative
Parasitic plant
A parasitic plant is one that derives some or all of its sustenance from another plant. About 4,100 species in approximately 19 families of flowering plants are known. Parasitic plants have a modified root, the haustorium, that penetrates the host plant and connects to the xylem, phloem, or...
intracellular parasites causing chronic disease, which usually persists for life. Symptoms include profuse sweating and joint and muscle pain. Brucellosis has been recognized in animals including humans since the 20th century.
History and nomenclature
Under the name Malta fever, the disease now called brucellosis first came to the attention of BritishUnited Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
medical officers in the 1850s in Malta during the Crimean War
Crimean War
The Crimean War was a conflict fought between the Russian Empire and an alliance of the French Empire, the British Empire, the Ottoman Empire, and the Kingdom of Sardinia. The war was part of a long-running contest between the major European powers for influence over territories of the declining...
. The causal relationship between organism and disease was first established in 1887 by Dr. David Bruce
David Bruce (microbiologist)
Major-General Sir David Bruce KCB FRS FRSE was a Scottish pathologist and microbiologist who investigated the Malta-fever and trypanosomes, identifying the cause of sleeping sickness....
.
In 1897, Danish
Denmark
Denmark is a Scandinavian country in Northern Europe. The countries of Denmark and Greenland, as well as the Faroe Islands, constitute the Kingdom of Denmark . It is the southernmost of the Nordic countries, southwest of Sweden and south of Norway, and bordered to the south by Germany. Denmark...
veterinarian
Veterinarian
A veterinary physician, colloquially called a vet, shortened from veterinarian or veterinary surgeon , is a professional who treats disease, disorder and injury in animals....
Bernhard Bang
Bernhard Lauritz Frederik Bang
- External links :*...
isolated Brucella abortus as the agent; and the additional name Bang's disease was assigned.
Maltese
Maltese people
The Maltese are an ethnic group indigenous to the Southern European nation of Malta, and identified with the Maltese language. Malta is an island in the middle of the Mediterranean Sea...
doctor and archaeologist Sir Themistocles Zammit
Themistocles Zammit
Sir Themistocles Zammit was a Maltese archaeologist and historian, professor of chemistry, medical doctor, researcher and writer, serving as Rector of the Royal University of Malta and first Director of the National Museum of Archaeology in Valletta.-Career:After graduating in medicine from the...
earned a knighthood for identifying unpasteurized milk as the major source of the pathogen in 1905, and it has since become known as Malta Fever. In cattle, this disease is also known as contagious abortion and infectious abortion.
The popular name undulant fever originates from the characteristic undulance (or "wave-like" nature) of the fever, which rises and falls over weeks in untreated patients. In the 20th century, this name, along with brucellosis (after Brucella
Brucella
Brucella is a genus of Gram-negative bacteria. They are small , non-motile, non-encapsulated coccobacilli, which function as facultative intracellular parasites....
, named for Dr Bruce), gradually replaced the 19th century names Mediterranean fever and Malta fever.
In 1989, neurologists in Saudi Arabia discovered neurobrucellosis, a neurological involvement in brucellosis.
The following obsolete names have previously been applied to brucellosis:
Brucellosis in animals
Species infecting domestic livestock are B. melitensis (goats and sheep, see Brucella melitensisBrucella melitensis
-Introduction:Brucella melitensis is a gram negative coccobacillus bacteria from the Brucellaceae family. The bacterium causes Ovine Brucellosis, along with Brucella ovis. It can infect sheep, cattle, and sometimes humans and it can be transmitted by the stable fly...
), B. suis (pigs, see Swine brucellosis
Swine brucellosis
Swine brucellosis is a zoonosis affecting pigs, caused by the bacteria Brucella suis. The disease typically causes chronic inflammatory lesions in the reproductive organs of susceptible animals or orchitis and may even affect joints and other organs. The most common symptom is abortion in...
), B. abortus (cattle and bison), B. ovis
Brucella ovis
Brucella ovis is a gram negative coccobacillus from the Brucellaceae family. Along with Brucella melitensis, it is responsible for causing Ovine Brucellosis, which is a notifiable disease...
(sheep), and B. canis (dogs). B. abortus also infects bison and elk in North America and B. suis is endemic in caribou. Brucella species have also been isolated from several marine mammal species (pinnipeds and cetaceans).
Brucellosis in cattle
The bacterium Brucella abortus is the principal cause of brucellosis in cattle. The bacteria are shed from an infected animal at or around the time of calving or abortion. Once exposed, the likelihood of an animal becoming infected is variable, depending on age, pregnancy status, and other intrinsic factors of the animal, as well as the amount of bacteria to which the animal was exposed. The most common clinical signs of cattle infected with Brucella abortus are high incidences of abortions, arthritic joints and retained after-birthPlacenta
The placenta is an organ that connects the developing fetus to the uterine wall to allow nutrient uptake, waste elimination, and gas exchange via the mother's blood supply. "True" placentas are a defining characteristic of eutherian or "placental" mammals, but are also found in some snakes and...
. There are two main causes for spontaneous abortion in animals. The first is due to erythritol
Erythritol
Erythritol is a sugar alcohol that has been approved for use as a food additive in the United States and throughout much of the world. It was discovered in 1848 by British chemist John Stenhouse. It occurs naturally in some fruits and fermented foods...
, which can promote infections in the fetus and placenta. The second is due to the lack of anti-Brucella activity in the amniotic fluid. Males can also harbor the bacteria in their reproductive tracts, namely seminal vesicle
Seminal vesicle
The seminal vesicles or vesicular glands are a pair of simple tubular glands posteroinferior to the urinary bladder of male mammals...
s, ampullae
Ampulla of ductus deferens
At the fundus of the bladder the ductus deferens of some mammalian species becomes enlarged and sometimes tortuous. This portion is termed the ampulla....
, testicle
Testicle
The testicle is the male gonad in animals. Like the ovaries to which they are homologous, testes are components of both the reproductive system and the endocrine system...
s, and epididymides
Epididymis
The epididymis is part of the male reproductive system and is present in all male amniotes. It is a narrow, tightly-coiled tube connecting the efferent ducts from the rear of each testicle to its vas deferens. A similar, but probably non-homologous, structure is found in cartilaginous...
.
Brucellosis in dogs
The causative agent of brucellosis in dogDog
The domestic dog is a domesticated form of the gray wolf, a member of the Canidae family of the order Carnivora. The term is used for both feral and pet varieties. The dog may have been the first animal to be domesticated, and has been the most widely kept working, hunting, and companion animal in...
s is Brucella canis
Brucella canis
Brucella canis is a gram-negative proteobacterium in the family Brucellaceae that causes brucellosis in dogs and other canids. Bacteria B. canis are rod-shaped or cocci, oxidase, catalase, and urease positive. The species was firstly described in USA in 1966 where mass abortions of beagles were...
. It is transmitted to other dogs through breeding and contact with aborted fetuses. Brucellosis can occur in humans that come in contact with infected aborted tissue or semen. The bacteria in dogs normally infect the genitals and lymphatic system
Lymphatic system
The lymphoid system is the part of the immune system comprising a network of conduits called lymphatic vessels that carry a clear fluid called lymph unidirectionally toward the heart. Lymphoid tissue is found in many organs, particularly the lymph nodes, and in the lymphoid follicles associated...
, but can also spread to the eye
Human eye
The human eye is an organ which reacts to light for several purposes. As a conscious sense organ, the eye allows vision. Rod and cone cells in the retina allow conscious light perception and vision including color differentiation and the perception of depth...
, kidney
Kidney
The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...
, and intervertebral disc
Intervertebral disc
Intervertebral discs lie between adjacent vertebrae in the spine. Each disc forms a cartilaginous joint to allow slight movement of the vertebrae, and acts as a ligament to hold the vertebrae together.-Structure:...
(causing discospondylitis). Symptoms of brucellosis in dogs include abortion in female dogs and scrotal
Scrotum
In some male mammals the scrotum is a dual-chambered protuberance of skin and muscle containing the testicles and divided by a septum. It is an extension of the perineum, and is located between the penis and anus. In humans and some other mammals, the base of the scrotum becomes covered with curly...
inflammation and orchitis
Orchitis
Orchitis or orchiditis is a condition of the testes involving inflammation. It can also involve swelling and frequent infection.-Symptoms:Symptoms of orchitis are similar to those of testicular torsion...
(inflammation of the testicles) in males. Fever is uncommon. Infection of the eye can cause uveitis
Uveitis
Uveitis specifically refers to inflammation of the middle layer of the eye, termed the "uvea" but in common usage may refer to any inflammatory process involving the interior of the eye....
, and infection of the intervertebral disc can cause pain or weakness. Blood testing of the dogs prior to breeding can prevent the spread of this disease. It is treated with antibiotics, as with humans, but it is difficult to cure.
Symptoms
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
s, sweating, weakness, anaemia, headache
Headache
A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...
s, depression
Clinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...
and muscular and bodily pain.
The symptoms are like those associated with many other febrile
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
diseases, but with emphasis on muscular pain and sweating. The duration of the disease can vary from a few weeks to many months or even years. In the first stage of the disease, septicaemia occurs and leads to the classic triad of undulant fevers, sweating (often with characteristic smell, likened to wet hay) and migratory arthralgia
Arthralgia
Arthralgia literally means joint pain; it is a symptom of injury, infection, illnesses or an allergic reaction to medication....
and myalgia
Myalgia
Myalgia means "muscle pain" and is a symptom of many diseases and disorders. The most common causes are the overuse or over-stretching of a muscle or group of muscles. Myalgia without a traumatic history is often due to viral infections...
. Blood tests characteristically reveal leukopenia and anemia, show some elevation of AST and ALT, and demonstrate positive Bengal Rose and Huddleston reactions. This complex is, at least in Portugal, known as the Malta fever. During episodes of Malta fever, melitococcemia (presence of brucellae in blood) can usually be demonstrated by means of blood culture in tryptose medium or Albini medium. If untreated, the disease can give origin to focalizations or become chronic. The focalizations of brucellosis occur usually in bones and joints and spondylodiscitis of lumbar spine accompanied by sacroiliitis
Sacroiliitis
In medicine, sacroiliitis is an inflammation of the sacroiliac joint. Sacroiliitis is a feature of spondylarthropathies .-External links:*...
is very characteristic of this disease. Orchitis
Orchitis
Orchitis or orchiditis is a condition of the testes involving inflammation. It can also involve swelling and frequent infection.-Symptoms:Symptoms of orchitis are similar to those of testicular torsion...
is also frequent in men.
Diagnosis of brucellosis relies on:
- Demonstration of the agent: blood cultures in tryptose broth, bone marrow cultures. The growth of brucellae is extremely slow (they can take until 2 months to grow) and the culture poses a risk to laboratory personnel due to high infectivity of brucellae.
- Demonstration of antibodies against the agent either with the classic Huddleson, Wright and/or Bengal Rose reactions, either with ELISA or the 2-mercaptoethanol assay for IgM antibodies associated with chronic disease
- Histologic evidence of granulomatous hepatitis (hepatic biopsy)
- Radiologic alterations in infected vertebrae: the Pedro Pons sign (preferential erosion of antero-superior corner of lumbar vertebrae) and marked osteophytosis are suspicious of brucellic spondylitis.
The disease's sequelae are highly variable and may include granulomatous hepatitis
Hepatitis
Hepatitis is a medical condition defined by the inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ. The name is from the Greek hepar , the root being hepat- , meaning liver, and suffix -itis, meaning "inflammation"...
, arthritis
Arthritis
Arthritis is a form of joint disorder that involves inflammation of one or more joints....
, spondylitis
Spondylitis
Spondylitis is an inflammation of the vertebra. It is a form of spondylopathy. In many cases, spondylitis involves one or more vertebral joint as well, which itself is called spondylarthritis.-Examples:...
, anaemia, leukopenia
Leukopenia
Leukopenia is a decrease in the number of white blood cells found in the blood, which places individuals at increased risk of infection....
, thrombocytopenia
Thrombocytopenia
Thrombocytopenia is a relative decrease of platelets in blood.A normal human platelet count ranges from 150,000 to 450,000 platelets per microliter of blood. These limits are determined by the 2.5th lower and upper percentile, so values outside this range do not necessarily indicate disease...
, meningitis
Meningitis
Meningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs...
, uveitis
Uveitis
Uveitis specifically refers to inflammation of the middle layer of the eye, termed the "uvea" but in common usage may refer to any inflammatory process involving the interior of the eye....
, optic neuritis
Optic neuritis
Optic neuritis is the inflammation of the optic nerve that may cause a complete or partial loss of vision.-Causes:The optic nerve comprises axons that emerge from the retina of the eye and carry visual information to the primary visual nuclei, most of which is relayed to the occipital cortex of the...
, endocarditis
Endocarditis
Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves . Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or even on intracardiac devices...
and various neurological disorders collectively known as neurobrucellosis.
Treatment and prevention
AntibioticAntibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
s like tetracyclines, rifampicin
Rifampicin
Rifampicin or rifampin is a bactericidal antibiotic drug of the rifamycin group. It is a semisynthetic compound derived from Amycolatopsis rifamycinica ...
, and the aminoglycoside
Aminoglycoside
An aminoglycoside is a molecule or a portion of a molecule composed of amino-modifiedsugars.Several aminoglycosides function as antibiotics that are effective against certain types of bacteria...
s streptomycin
Streptomycin
Streptomycin is an antibiotic drug, the first of a class of drugs called aminoglycosides to be discovered, and was the first antibiotic remedy for tuberculosis. It is derived from the actinobacterium Streptomyces griseus. Streptomycin is a bactericidal antibiotic. Streptomycin cannot be given...
and gentamicin
Gentamicin
Gentamicin is an aminoglycoside antibiotic, used to treat many types of bacterial infections, particularly those caused by Gram-negative organisms. However, gentamicin is not used for Neisseria gonorrhoeae, Neisseria meningitidis or Legionella pneumophila...
are effective against Brucella bacteria. However, the use of more than one antibiotic is needed for several weeks, because the bacteria incubate within cell
Cell (biology)
The cell is the basic structural and functional unit of all known living organisms. It is the smallest unit of life that is classified as a living thing, and is often called the building block of life. The Alberts text discusses how the "cellular building blocks" move to shape developing embryos....
s.
The gold standard treatment for adults is daily intramuscular injections of streptomycin
Streptomycin
Streptomycin is an antibiotic drug, the first of a class of drugs called aminoglycosides to be discovered, and was the first antibiotic remedy for tuberculosis. It is derived from the actinobacterium Streptomyces griseus. Streptomycin is a bactericidal antibiotic. Streptomycin cannot be given...
1 g for 14 days and oral doxycycline
Doxycycline
Doxycycline INN is a member of the tetracycline antibiotics group, and is commonly used to treat a variety of infections. Doxycycline is a semisynthetic tetracycline invented and clinically developed in the early 1960s by Pfizer Inc. and marketed under the brand name Vibramycin. Vibramycin...
100 mg twice daily for 45 days (concurrently). Gentamicin
Gentamicin
Gentamicin is an aminoglycoside antibiotic, used to treat many types of bacterial infections, particularly those caused by Gram-negative organisms. However, gentamicin is not used for Neisseria gonorrhoeae, Neisseria meningitidis or Legionella pneumophila...
5 mg/kg by intramuscular injection
Intramuscular injection
Intramuscular injection is the injection of a substance directly into a muscle. In medicine, it is one of several alternative methods for the administration of medications . It is used for particular forms of medication that are administered in small amounts...
once daily for seven days is an acceptable substitute when streptomycin is not available or difficult to obtain. Another widely used regimen is doxycycline plus rifampin twice daily for at least six weeks. This regimen has the advantage of oral administration. A triple therapy of doxycycline, with rifampin and cotrimoxazole, has been used successfully to treat neurobrucellosis. Doxycycline is able to cross the blood–brain barrier, but requires the addition of two other drugs to prevent relapse. Ciprofloxacin and cotrimoxazole therapy is associated with an unacceptably high rate of relapse. In brucellic endocarditis, surgery is required for an optimal outcome. Even with optimal antibrucellic therapy, relapses still occur in 5–10 percent of patients with Malta fever.
The main way of preventing brucellosis is by using fastidious hygiene in producing raw milk products, or by pasteurizing
Pasteurization
Pasteurization is a process of heating a food, usually liquid, to a specific temperature for a definite length of time, and then cooling it immediately. This process slows microbial growth in food...
all milk that is to be ingested by human beings, either in its unaltered form or as a derivate, such as cheese
Cheese
Cheese is a generic term for a diverse group of milk-based food products. Cheese is produced throughout the world in wide-ranging flavors, textures, and forms....
. Experiments have shown that cotrimoxazol and rifampin are both safe drugs to use in treatment of pregnant women who have brucellosis.
Biological warfare
In 1954, B. suis became the first agent weaponizedBiological warfare
Biological warfare is the use of biological toxins or infectious agents such as bacteria, viruses, and fungi with intent to kill or incapacitate humans, animals or plants as an act of war...
by the United States at its Pine Bluff Arsenal
Pine Bluff Arsenal
The Pine Bluff Arsenal is a US Army installation located in Jefferson County, Arkansas, just northwest of the city of Pine Bluff. PBA is one of the six Army installations in the United States that store chemical weapons...
in Arkansas. Brucella species survive well in aerosols and resist drying. Brucella and all other remaining biological weapons in the U.S. arsenal were destroyed in 1971–72 when the U.S. offensive biological weapons (BW) program was discontinued.
The United States BW program focused on three agents of the Brucella group:
- Porcine Brucellosis (Agent US)
- Bovine Brucellosis (Agent AB)
- Caprine Brucellosis (Agent AM)
Agent US was in advanced development by the end of World War II
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...
. When the U.S. Air Force (USAF) wanted a biological warfare capability, the Chemical Corps offered Agent US in the M114 bomblet, based after the 4-pound bursting bomblet developed for anthrax
Anthrax
Anthrax is an acute disease caused by the bacterium Bacillus anthracis. Most forms of the disease are lethal, and it affects both humans and other animals...
in World War II. Though the capability was developed, operational testing indicated that the weapon was less than desirable, and the USAF termed it an interim capability until replaced by a more effective biological weapon. The main drawbacks of the M114 with Agent US was that it was incapacitating (the USAF wanted "killer" agents), the storage stability was too low to allow for storing at forward air bases, and the logistical requirements to neutralize a target were far higher than originally anticipated, requiring unreasonable logistical air support.
Agents US and AB had a median infective dose of 500 org/person, and AM was 300 org/person. The rate-of-action was believed to be 2 weeks, with a duration of action of several months. The lethality estimate was based on epidemiological information at 1–2%. AM was always believed to be a more virulent disease, and a 3% fatality rate was expected.
United States
Dairy herds in the USA are tested at least once a year with the Brucella Milk Ring Test (BRT). Cows that are confirmed to be infected are often killed. In the United States, veterinarianVeterinarian
A veterinary physician, colloquially called a vet, shortened from veterinarian or veterinary surgeon , is a professional who treats disease, disorder and injury in animals....
s are required to vaccinate
Vaccination
Vaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens...
all young stock, thereby further reducing the chance of zoonotic
Zoonosis
A zoonosis or zoonoseis any infectious disease that can be transmitted from non-human animals to humans or from humans to non-human animals . In a study of 1415 pathogens known to affect humans, 61% were zoonotic...
transmission. This vaccination is usually referred to as a "calfhood" vaccination. Most cattle receive a tattoo in their ear serving as proof of their vaccination status. This tattoo also includes the last digit of the year they were born.
The first state–federal cooperative efforts towards eradication of brucellosis caused by Brucella abortus in the U.S. began in 1934.
Greater Yellowstone area
Wild bisonBison
Members of the genus Bison are large, even-toed ungulates within the subfamily Bovinae. Two extant and four extinct species are recognized...
and elk
Elk
The Elk is the large deer, also called Cervus canadensis or wapiti, of North America and eastern Asia.Elk may also refer to:Other antlered mammals:...
in the Greater Yellowstone Area (GYA) are the last remaining reservoir of Brucella abortus in the U.S. The recent transmission of brucellosis from elk to cattle in Idaho and Wyoming illustrates how the GYA is the last remaining reservoir in the United States, adversely affecting the livestock industry. Eliminating brucellosis from this area is a challenge, as there are many viewpoints on how to manage diseased wildlife.
Canada
CanadaCanada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
declared their cattle herd brucellosis-free on September 19, 1985. Brucellosis ring testing of milk and cream, as well as testing of slaughter cattle, ended April 1, 1999. Monitoring continues through auction market testing, standard disease reporting mechanisms, and testing of cattle being qualified for export to countries other than the USA.
Europe
Malta
Until the early 20th century the disease was endemicEndemic (epidemiology)
In epidemiology, an infection is said to be endemic in a population when that infection is maintained in the population without the need for external inputs. For example, chickenpox is endemic in the UK, but malaria is not...
in Malta to the point of it being referred to as "the Maltese fever". The link between the illness and unpasteurised milk was established by Temi Zammit. Today thanks to a strict regime of certification of milk animals and widespread use of pasturisation the illness has been eradicated from Malta.
Republic of Ireland
IrelandRepublic of Ireland
Ireland , described as the Republic of Ireland , is a sovereign state in Europe occupying approximately five-sixths of the island of the same name. Its capital is Dublin. Ireland, which had a population of 4.58 million in 2011, is a constitutional republic governed as a parliamentary democracy,...
was declared free of brucellosis on 1 July 2009. The disease had troubled the country's farmers and veterinarians for several decades. The Irish government submitted an application to the European Commission
European Commission
The European Commission is the executive body of the European Union. The body is responsible for proposing legislation, implementing decisions, upholding the Union's treaties and the general day-to-day running of the Union....
, which verified that Ireland had been liberated. Brendan Smith
Brendan Smith (politician)
Brendan Smith is an Irish Fianna Fáil politician. He has been a Teachta Dála for the Cavan–Monaghan constituency since 1992. He previously served as the Minister for Agriculture, Fisheries and Food and Minister for Justice and Law Reform .Born in Cavan in 1956, Smith was educated at Bawnboy...
, Ireland's Minister for Agriculture, Fisheries and Food, said the elimination of brucellosis was "a landmark in the history of disease eradication in Ireland". Ireland's Department of Agriculture, Fisheries and Food intends to reduce its brucellosis eradication programme now that eradication has been confirmed.
Australia
AustraliaAustralia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
is at present free of cattle brucelosis, although it occurred in the past. Brucellosis of sheep or goats has never been reported. Brucellosis of pigs does occur. Feral pigs are the typical source of human infections.
New Zealand
Brucellosis in New ZealandNew Zealand
New Zealand is an island country in the south-western Pacific Ocean comprising two main landmasses and numerous smaller islands. The country is situated some east of Australia across the Tasman Sea, and roughly south of the Pacific island nations of New Caledonia, Fiji, and Tonga...
is limited to sheep (Brucella ovis). The country is free of all other species of Brucella.
See also
- Swine brucellosisSwine brucellosisSwine brucellosis is a zoonosis affecting pigs, caused by the bacteria Brucella suis. The disease typically causes chronic inflammatory lesions in the reproductive organs of susceptible animals or orchitis and may even affect joints and other organs. The most common symptom is abortion in...
- Wildlife diseaseWildlife diseaseWildlife, domestic animals and humans share a large and increasing number of infectious diseases, known as zoonoses. The continued globalization of society, human population growth, and associated landscape changes further enhances the interface between wildlife, domestic animals, and humans,...
- Andrew MoynihanAndrew MoynihanAndrew Moynihan, VC was by birth an English recipient of the Victoria Cross, the highest and most prestigious award for gallantry in the face of the enemy that can be awarded to British and Commonwealth forces....
Victoria Cross recipient who died from 'Malta Fever'.
External links
- Brucella and Brucellosis | Medchrome
- Brucella genomes and related information at PATRIC, a Bioinformatics Resource Center funded by NIAID
- Prevention about Brucellosis from Center for Disease Control – re high rate of brucellosis in humans in ancient Pompeii
- Brucellosis in Dogs from The Pet Health Library
- Brucella Bioinformatics Portal
- Brucellosis Fact Sheet