+ All Categories
Home > Documents > Brucellosis M.Karimi. Etiology Brucella: Abortus(Cattle),Melitensis (Sheep,Goat)Suis(Swin),...

Brucellosis M.Karimi. Etiology Brucella: Abortus(Cattle),Melitensis (Sheep,Goat)Suis(Swin),...

Date post: 22-Dec-2015
Category:
Upload: sheila-hill
View: 227 times
Download: 1 times
Share this document with a friend
Popular Tags:
40
Brucellosis M.Karimi
Transcript

Brucellosis

M.Karimi

Etiology

• Brucella: Abortus(Cattle),Melitensis (Sheep,Goat)Suis(Swin),Canis(Dog)

• G- Coccobacil• Aerobic, Non-spore

forming• Non motile• Blood or Choclate agar

Epidemiology

• Unpasteurized milk• Occupational events

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

Pathogenesis

• Survive& Replicate within phagocytes&Monocytes• Infected macrophages localized within reticuloendothelial

system(Granuloma formation in spleen,liver,bone marrow)

Clinical manifestationTriad: 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

• Fever

• Hepatosplenomegally

• Arthralgia/Arthritis

Sacroiliac,Hip,Ankle,

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

• False positive SAT

Yersinia entrocolitica

Vibrio cholerae

Francislla tularensis

• False negative SAT

Prozen effect

Differential diagnosis

• Car-Scratch disease

• Typhoid fever

• TB

• Fungal infections

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

calcified brucellomas in both kidneys calcified brucellomas in the spleen

Salmonellae Infections

M.Karimi

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’..)

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

Pathogenesis

• Ingestion

• Attached to “M” cells

• Phagocytosed by macrophages

• Replication

• Bacteremia

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

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

Complications

• Dehydration’Shock• Localized infection: Pneumonia Empyema Abscesses Osteomyelitis Septic arthritis Postinfectious arthritis Pyelonephritis meningitis

Diagnosis

• Cultures (Stool’ Blood’ Urine’ Bone marrow’ CSF’…)

Treatment

• Correction of shock’ dehydration’…

• Antibiotics:

1-Infants < 3 mo.

2-Child with immunodeficiency’ Malnutrition

Malignancy’ Intravascular catheter or

other foreign material

Treatment

• Ceftriaxone or Cefotaxime Septicemia’ Enteric fever’ Metastatic site of infection

• Amoxicillin• Co-trimaxozole• Fluroqinolones• Chloramphenicol

Typhoid fever

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

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

Salmonella Typhi

Clinical manifestation

• Infant:

mild GE to severe septicemia without diarrhea

Fever’ hepatomegaly ’ jaundice’ anorexia’ lethargy’ weight loss

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)

Rose spot

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

Dense chronic bone reaction due to typhoid

osteomyelitis.There is a central sequestrum

Typhoid

Diagnosis & Differential diagnosis

• Diagnosis

Cultures:

Blood’ Urine’ Stool’ Bone marrow’ Lymph nodes’ Deudenal fluied’

Reticuloendothelial tissue’

• Differential diagnosis

Bronchitis

Bronchopneumonia

Gastroenteritis

Influenza

Treatment

Drugs:• Ceftriaxone• Ampicillin• Chloramphenicol• Co-Trimoxozole• Ciprofloxacin• Azithromycin

Surgery• Cholecystectomy

Prognosis

• With treatment : Mortality <1%

• Without treatment : Relapse up to 10%

• Chronic carrier: Excrete S.typhi for more than 3 mo.


Recommended