Brucellosis

dr. Fajar Yuwanto

SMF Penyakit Dalam
RS Abdul Moeloek
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Brucellosis
Brucellosis, also known as “undulant fever”, “Mediterranean fever” or
“Malta fever” is a zoonosis and the infection is almost invariably
transmitted by direct or indirect contact with infected animals or their
products
 Etiolgy and
Epidemiology
 Brucella spp.
• Gram negative
coccobacillus
– Facultative,
intracellular organism
• Multiple species
– Associated with certain hosts
• Environmental persistence
– Withstands drying
– Temperature, pH, humidity
– Frozen and aborted materials, dust, soil

Center for Food Security and Public Health, Iowa

State University, 2012
Species Biovar/ Natural Host Human
Serovar Pathogen
B. abortus 1-6, 9 cattle, bison, buffalo yes
B. melitensis 1-3 goats, sheep yes
B. suis 1, 2, 3 swine yes
2 European hares yes
4* reindeer, caribou yes
5 rodents yes
B. canis none dogs, other canids yes
B. ovis none sheep no
B. neotomae none rodents no
B. maris marine mammals yes?
B. pinnipediae,
B. cetaceae(?)
Center for Food Security and Public Health, Iowa
State University, 2012
 Transmission in human
01 02 03
Ingestion Mucous Aerosol
• Raw milk,
membrane or • Laboratory,
unpasteurized abraded skin abattoirs
dairy products contact with • Pens, stables,
• Rarely through slaughter
undercooked
infected houses
meat tissues
Transmission in human
04 05
Inoculation Person-to-
with vaccines person
• B. abortus strain 19, transmission
RB-51
• B. melitensis Rev-1
• Conjunctival
splashes, injection
 Populations at Risk
• Occupational disease
– Cattle ranchers/dairy farmers
– Veterinarians
– Abattoir workers
– Meat inspectors
– Lab workers
• Hunters
• Travelers
• Consumers
– Unpasteurized dairy products

Center for Food Security and Public Health, Iowa State

University, 2012
 Sign and
Symptoms
 Symptoms
Fever Neurologic symptoms
the most common including Headache,
symptom which is depression, and fatigue,
associated with chills weakness, dizziness,
unsteadiness of gait and
Symptoms urinary retention

Bone and Joint Syndrome Gastrointestinal

symptoms
include arthralgias, low back
pain, spine and joint pain, and, abdominal pain,
rarely, joint swelling. constipation, diarrhea,
and vomiting
 Sign
Fever with relative bradycardia
01 Hepatosplenomegaly
02
Osteoarticular findings
include tenderness and swelling over affected joints, bursitis,
03 decreased range of motion, and joint effusion.

Cutaneus findings
04 including erythema nodosum, papulonodular eruption, impetigo
05 or vasculitic lesions.

Ocular findings
uveitis, keratoconjunctivitis, optic neuritis or cataract
 Sign
Neurologic findings
vary according to the presentation of neurologic disease, as
06 follows:
Acute meningoencephalitis (most common neurological
manifestation) - Depressed level of consciousness,
meningeal irritation, cranial nerve involvement, coma,
seizure, and respiratory depression
Peripheral polyradiculoneuropathy - Hypotonia and
areflexia in most cases, paraparesis, and an absence of
sensory involvement
Diffuse CNS involvement - Spasticity, hyperreflexia, clonus,
extensor plantar response, sensorineural hearing loss,
cranial nerve involvement, and cerebellar signs.
SYMPTOM AND SIGN BRUCELLOSIS
Differential
Diagnosis
 Differential Diagnosis
• Ankylosing Spondylitis and • Tuberculosis
Undifferentiated • Influenza
Spondyloarthropathy • Tuberculosis of the Genitourinary
• Cryptococcosis System
• Hepatitis, Viral • Malaria
• Histoplasmosis • Typhoid Fever
• Infectious Mononucleosis
• Infective Endocarditis
• Leptospirosis
Work Up
 Work Up
Complete Blood Liver Functional
Blood Culture Bone marrow culture
Count Test

shows leukopenia, has sensitivity 17-

relative 85 % and has sensitivity of
shows slight elevation subcultureare still
lymphocytosis or 80- 90%
pancytopenia adviced for at least
4 weeks
 Work Up
Serology test Histological Findings

1. Serum tube agglutination test it include mixed inflammatory infiltrat

2. Tray agglutination test with lymphocytic predominance and
granulomas (in up to 55% of cases)
3. ELISA with necrosis
4. PCR
 Treatment and Prognosis
• Rarely fatal if treated
– Case-fatality rate <2% (untreated)
– Antibiotics necessary
– Death usually caused by endocarditis, meningitis
• About 5% of treated cases relapse
– Failure to complete treatment
– Infections requiring surgical intervention

Center for Food Security and Public Health, Iowa State

University, 2012
The World Health Organization recommends the following for
adults and children older than 8 years:

– Doxycycline 100 mg bid and rifampin 600-900 mg/d po : Both

drugs are to be given for 6 weeks (more convenient but
probably increases the risk of relapse).

– Doxycycline 100 mg po bid for 6 weeks and streptomycin 1 g/d

IM daily for 2-3 weeks: This regimen is believed to be more
effective, mainly in preventing relapse.
 • Gentamicin can be used as a substitute for streptomycin and
has shown equal efficacy.

• Ciprofloxacin-based regimens have shown equal efficacy to

doxycycline-based regimens.

Children younger than 8 years:

The use of rifampin and trimethoprim-sulfamethoxazole (TMP-

SMX) for 6 weeks is the therapy of choice. Relapse rate appears to
be approximately 5% or less.
Surgical Care
The role of surgery in patients with brucellosis
lies in the treatment of endocarditis or
drainage of focal abscesses.
Prevention
1. The prevention of human brucellosis is based on occupational
hygiene and food hygiene.
2. Vaccination is not generally recommended.
3. All dairy products should be prepared from heat-treated milk.
4. Consumption of raw milk or products made from raw milk should be
avoided.
5. Meat should be adequately cooked.
6. Special precautions should be taken by laboratory workers.
7. Physicians and health workers should be aware of the possibility of
brucellosis.
8. Public health education should emphasize food hygiene and
occupational hygiene
Terima Kasih
 References
USDA APHIS VS Brucellosis Disease Information
www.aphis.usda.gov/animal_health/animal_diseases/brucellos
is/

WHO Fact Sheet Brucellosis

www.who.int/mediacentre/factsheets/en/

Center for Food Security and Public Health

www.cfsph.iastate.edu

BruNet Publication
www.moag.gov.il/brunet/public.htm

WHO. 2006. Brucellosis in humans and animals. World Health

Organization Press