(Undulant, Malta – Mediterranean – or Gibraltar fever)
A brucellosis is Brucella sp. caused. The symptoms begin as acute febrile illness with few or no local symptoms and can progress to a chronic stage with fever recurrences, weakness, sweating and unclear severe pain. The diagnosis is made by culture of the organism, mostly from the blood. Optimal treatment usually requires two antibiotics – doxycycline or trimethoprim / sulfamethoxazole plus gentamicin, streptomycin or rifampicin.
The causative agent of human brucellosis are B. abortus (cattle), B. melitensis (sheep and goats) and B. suis (pigs). B. canis (dogs) led to sporadic infections. General B. melitensis and B. suis are more pathogenic than other Brucella sp.
A brucellosis is Brucella sp. caused. The symptoms begin as acute febrile illness with few or no local symptoms and can progress to a chronic stage with fever recurrences, weakness, sweating and unclear severe pain. The diagnosis is made by culture of the organism, mostly from the blood. Optimal treatment usually requires two antibiotics – doxycycline or trimethoprim / sulfamethoxazole plus gentamicin, streptomycin or rifampicin. The causative agent of human brucellosis are B. abortus (cattle), B. melitensis (sheep and goats) and B. suis (pigs). B. canis (dogs) led to sporadic infections. General B. melitensis and B. suis are more pathogenic than other Brucella sp. The most common sources of infection livestock and raw milk products are deer, bison, horses, moose, caribou, rabbits, chickens and desert rats may also be infected. People can acquire the infection about these animals as well. Brucellosis is acquired by direct contact with secretions and excretions from infected animals intake of uncooked meat, raw milk or dairy products that use living organisms contain inhaling aerolisiertem infectious material Rarely, human-to-human transmission, the highest prevalence is found in rural areas, brucellosis an occupational disease in butchers, butchers, veterinarians, hunters, farmers, ranchers and technicians in microbiology laboratories. Brucellosis come in the US, Europe and Canada only rarely, the Middle East, however, Mediterranean countries, Mexico and Central America there is sporadic diseases. Since very few organisms (perhaps only 10 to 100) can cause an infection via aerosol exposure, are Brucella sp potential agent for biological terrorism. Patients with acute uncomplicated brucellosis usually recover in two to three weeks time, even without treatment. but some also occurs in sub-acute, intermittent or chronic illness. Complications at a brucellosis are rare, but it can occur (particularly sakroillakal or vertebral) subacute bacterial endocarditis, meningitis, encephalitis, neuritis, orchitis, cholecystitis, hepatic abscesses and osteomyelitis. Symptoms and signs The incubation period of brucellosis varies from 5 days to several months and is an average of 2 weeks. The onset can be sudden, with chills and fever, severe headache, joint and lumbar back pain, malaise, and occasionally diarrhea. The onset can be insidious, with a slight prodromal malaise, muscle pain, headaches, neck pain, followed by a rise in evening temperature. With progressive disease, the temperature rises to 40-41 ° C, then gradually decreases again to normal or near normal values ??with excessive sweating morgendlichem. Characteristically, persists the intermittent fever for 1-5 weeks followed by a 2- to 14-day remission with largely reduced or no symptoms. In some patients, the fever can also run transient. For others, the fever phase occurs once or repeatedly in waves (undulating) again and disappears during the course of months or years and can manifest as FUU. After the initial febrile phase, you might notice of anorexia, weight loss abdominal and joint pain, headache, back pain, weakness, irritability, insomnia, depression and emotional instability coming. A pronounced constipation occurs. There is a splenomegaly and lymph nodes may be enlarged slightly to moderately. Up to 50% of patients have hepatomegaly. Brucellosis is fatal at <5% of patients, usually as a result of endocarditis or severe CNS complications. Diagnostic blood cultures Serological tests during the acute phase and the recovery time should be taken off blood cultures; the growth may take> 7 days and subcultures that use special media, possibly for up to 3 to 4 weeks must be kept; Therefore, the laboratory should be informed of the suspected brucellosis. Acute and Verlaufsseren should be examined at intervals of 3 weeks. A four-fold increase in titer, or a Akuttiter of 1: 160 or higher considered diagnostically conclusive, especially when a positive exposure history and typical clinical findings are present. The white blood cell count is normal or lowered with a relative or absolute lymphocytosis during the acute phase. Therapy doxycycline plus either rifampicin, an aminoglycoside (streptomycin or gentamicin) or ciprofloxacin In acute cases, the patients should take care of himself, bed rest is recommended during episodes of fever. Severe pain of the musculoskeletal system, especially on the spine can make analgesics required. The Brucella endocarditis often requires surgery in addition to treatment with antibiotics. When antibiotics are given a combination therapy is preferred because the relapse rates are high in monotherapy. The recurrence rate can be obtained by doxycycline 100 mg p.o. 2 times a day for 6 weeks plus streptomycin 1 g i.m. every 12-24 h (or gentamicin 3 mg / kg i.v. 1 time / day) for 14 days reduced. For uncomplicated cases can rifampin 600 to 900 mg po 2 times / are used daily for 6 weeks instead of an aminoglycoside. Therapy with ciprofloxacin 500 mg p.o. 2 times / day for 14 to 42 days plus. Rifampin or doxycycline instead of an aminoglycoside have proven to be equally effective. In children <8 years, trimethoprim-sulfamethoxazole (TMP / SMX) and rifampicin p.o. applied over 4-6 weeks. Even with antibiotic treatment about 5 to 15% of patients are relapsed, so should all be observed clinically and with repeated serological titers for 1 year. Prevention Pasteurization of milk contributes to the prevention of brucellosis. made from unpasteurized milk cheese may be contaminated if it is <3 months old. People who handle potentially infected animals or carcasses, safety goggles and rubber gloves should carry and protect skin injuries from exposure. In the U.S. and several other countries control programs to the discovery of infection in animals, elimination of infected animals and vaccination of seronegative young cattle and pigs are mandatory. There is no human vaccine; the use of the veterinary vaccine (a live vaccine) in humans can cause an infection. Immunity after infection in humans is of short duration and lasts about 2 years. Antibiotic prophylaxis after exposure is recommended for high-risk patients (eg. As those who have unprotected contact with infected animals or laboratory samples, or see the animal vaccine). The therapies include doxycycline 100 mg p.o. 2 times / day plus rifampin 600 mg po 1 time / day for 3 weeks; Rifampin is not used for the exposure to the B. abortus (strain RB51) vaccine, which is resistant to rifampicin. Key points A brucellosis is transmitted by direct contact with secretions and excretions from infected animals. The infection usually causes fever and general symptoms, but certain organs (eg., Brain, meningitis, heart, liver, bones) are rarely affected. Most patients recover in 2 to 3 weeks again, even without treatment, but in some there is a sub-acute, intermittent or chronic illness. The diagnosis is made with blood cultures and serological tests during the acute phase and convalescence time. Most patients are treated with two antibiotics, typically doxycycline plus either rifampicin, an aminoglycoside or ciprofloxacin; Patients are monitored for up to 1 year relapse.