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Brucella. Brucella spp. Gram negative, coccobacilli bacteria Facultative, intracellular organism...

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  • Slide 1
  • Brucella
  • Slide 2
  • Brucella spp. Gram negative, coccobacilli bacteria Facultative, intracellular organism Environmental persistence Temperature, pH, humidity Frozen and aborted materials Multiple species
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  • SpeciesBiovar/Ser ovar Natural HostHuman Pathogen B. abortus1-6, 9cattleyes B.melitensis1-3goats, sheepyes B. suis1, 3swineyes 2haresyes 4reindeer, caribouyes 5rodentsyes B. canisnonedogs, other canidsyes B. ovisnonesheepno B. neotomaenoneDesert wood ratno B. maris (?)marine mammals?
  • Slide 4
  • The Many Names of Brucellosis Human Disease Malta Fever Undulant Fever Mediterranean Fever Rock Fever of Gibraltar Gastric Fever Animal Disease Bangs Disease Enzootic Abortion Epizootic Abortion Slinking of Calves Ram Epididymitis Contagious Abortion
  • Slide 5
  • History of Malta Fever 450 BC: Described by Hippocrates 1905: Introduction into the U.S. 1914: B. suis Indiana, United States 1953: B. ovis New Zealand, Australia 1966: B. canis in dogs, caribou, and reindeer
  • Slide 6
  • History Alice Evans, American bacteriologist Credited with linking the organisms Similar morphology and pathology between: Bangs Bacterium abortus Bruces Micrococcus melitensis Nomenclature today credited to Sir David Bruce Brucella abortus and Brucella melitensis
  • Slide 7
  • Transmission to Humans Conjunctiva or broken skin contacting infected tissues Blood, urine, vaginal discharges, aborted fetuses, placentas Ingestion Raw milk & unpasteurized dairy products Rarely through undercooked meat Incubation varies 5-21 days to three months
  • Slide 8
  • Who is at Risk? Occupational Disease Cattle ranchers/dairy farmers Veterinarians Abattoir workers Meat inspectors Lab workers Hunters Travelers Consumers of unpasteurized dairy products
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  • B. melitensis Latin America, Middle East, Mediterranean, eastern Europe, Asia, and parts of Africa Accounts for most human cases In the Mediterranean and Middle East Up to 78 cases/100,000 people/year Arabic Peninsula 20% seroprevalence Recent emergence in cattle on Middle Eastern intensive dairy farms
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  • B. abortus Worldwide Some countries have eradicated it Notifiable disease in many countries Poor surveillance and reporting due to lack of recognition Fever of Unknown Origin (FUO)
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  • Brucellosis in U.S.: 1975-2006
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  • Human Disease Can affect any organ or organ system All patients have a cyclical fever Variability in clinical signs Headache, weakness, arthralgia, depression, weight loss, fatigue, liver dysfunction
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  • Human Disease 20-60% of cases Osteoarticular complications Arthritis, spondylitis, osteomyelitis Hepatomegaly may occur Gastrointestinal complications 2-20% of cases Genitourinary involvement Orchitis and epididymitis most common
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  • Human Disease Neurological Depression, mental fatigue Cardiovascular Endocarditis resulting in death Chronic brucellosis is hard to define Length, type and response to treatment variable Localized infection Blood donations of infected persons should not be accepted
  • Slide 15
  • Human Disease Congenitally infected infants Low birth weight Failure to thrive Jaundice Hepatomegaly Splenomegaly Respiratory difficulty General signs of sepsis (fever, vomiting) Asymptomatic
  • Slide 16
  • Diagnosis in Humans Isolation of organism Blood, bone marrow, other tissues Serum agglutination test Four-fold or greater rise in titer Samples 2 weeks apart Immunofluorescence Organism in clinical specimens PCR
  • Slide 17
  • Treatment of Choice Combination therapy has the best efficacy Doxycycline for six weeks in combination with streptomycin for 2-3 weeks or rifampin for 6 weeks CNS cases treat 6-9 months Same for endocarditis cases plus surgical replacement of valves
  • Slide 18
  • Yersinia pestis
  • Slide 19
  • Yersinia originally classified in Pasteurellaceae family Based on DNA similarities with E. coli, Y. pestis is now part of Enterobacteriaceae family 11 named species in genus 3 are human pathogens Y. pestis, Y. pseudotuberculosis, Y. enterocolitica Y. pestis and Y. pseudotuberculosis rarely infect humans Y. enterocolitica is the cause of 1 3% of diarrhea cases caused by bacteria
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  • Yersinia pestis Gram-negative bacteria Can grow with or without oxygen Most commonly found in rats but also found in: Mice, squirrels, fleas, cats, dogs, lice, prairie dogs, wood rats, chipmunks
  • Slide 21
  • Types of Plague Bubonic Plague Most common Infection of the lymph system (attacks immune system) Pneumonic Plague Most serious type of plague Infection of the lungs leading to pneumonia Primary and Secondary Septicemic Plague Bacteria reproduces in the blood Can be contracted like bubonic plague but is most often seen as a complication of untreated bubonic or pneumonic plague
  • Slide 22
  • Symptoms Bubonic Fever, headache, chills, weakness, swollen and tender lymph glands Pneumonic Fever, headache, weakness, rapid onset of pneumonia (usually accompanied by: shortness of breath, chest pain, cough, bloody or watery sputum) Septicemic Fever, chills, weakness, abdominal pain, shock, bleeding underneath skin or other organs Diagnosis and Treatment Most cases of plague are diagnosed initially from presented symptoms, especially Bubonic plague. If plague is suspected, blood work is completed to determine how far the plague has progressed and to determine antibiotic resistances. Since no major antibiotic resistances have developed, plague is usually treated with Streptomycin. Other antibiotics that can be used are: tetracyclines, fluoroquinolones and other aminoglycosides. Antibiotics are administered to the patient as well as to those who are believed to have been exposed.
  • Slide 23
  • http://rarediseases.about.com/od/infectiousdiseases/ig/Pictures-of-Bubonic-Plague/hand-gangrene.htm
  • Slide 24
  • Transmission Bubonic and Septicemic can not be transferred human to human. They can only be contracted if bitten by an infected rodent or flea. Pneumonic can be transferred through exposure to infected particles. This usually occurs when in close contact with someone who is infected and is exposed to sputum that is coughed up.
  • Slide 25
  • http://www.unbc.ca/nlui/wildlife_diseases _bc/plague_cycles.gif
  • Slide 26
  • History There have been three major pandemics of the plague. Mid 6 th century, mid 14 th century, early 20 th century The most well known plague pandemic was in the mid 14 th century in Europe known as the Black Death The plague came from Asia and spread through Europe in two years. In the two years, it killed more than half of the population. People didnt understand how the plague worked which allowed it to spread. Benefits.
  • Slide 27
  • http://neatorama.cachefly.net/images/2005- 12/sedlec-ossuary.jpg Sedlec Ossuary in Kutna Hora http://www.earth-photography.com/photos/Countries/CzechRepublic/Czech_KutnaHora_Ossuary1.jpg http://z.about.com/d/goeaste urope/1/0/o/5/-/- /SedlicOssuary11.JPG
  • Slide 28
  • Incidence Considered a re-emerging disease. Incidence is on the rise: 2,000 to 3,000 cases a year worldwide. http://www.cdc.gov/ncidod/dvbid/plague/world98.htm
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