{"id":367,"date":"2023-09-16T22:07:08","date_gmt":"2023-09-16T21:07:08","guid":{"rendered":"https:\/\/microregistrar.com\/?p=367"},"modified":"2023-09-16T22:07:08","modified_gmt":"2023-09-16T21:07:08","slug":"brucella","status":"publish","type":"post","link":"https:\/\/microregistrar.com\/?p=367","title":{"rendered":"Brucella"},"content":{"rendered":"\n<h4 class=\"wp-block-heading\" id=\"h.v1dgkvhfsyv_l\">Bacteria<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Gram stain \u2013 Very small, faintly stained Gram-negative coccobacilli. They tend not to cluster.<\/li>\n\n\n\n<li>Colonies \u2013 Punctate, non-pigmented, and non-haemolytic colonies.<\/li>\n\n\n\n<li>Brucella grows on blood agar, chocolate agar but not on MacConkey agar.<\/li>\n\n\n\n<li>Strict aerobe, some strains require carbon dioxide on primary isolation.<\/li>\n\n\n\n<li>Brucella is non-motile, oxidase-positive, catalase-positive and urease-positive.<\/li>\n<\/ul>\n\n\n\n<p>There are many Brucella species \u2013 not all known to cause human disease. Those known to cause human disease are \u2013 B melitensis, B abortus, B suis, B canis and B ceti. Brucella infection is a zoonosis \u2013 each Brucella sp is associated with some animal host \u2013<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>B melitensis: Sheep, goat, Camel (the commonest cause of Brucellosis).<\/li>\n\n\n\n<li>B abortus: Cattle, Buffalo, Yaks, camels<\/li>\n\n\n\n<li>B suis: pigs, boar, caribou, rodents<\/li>\n\n\n\n<li>B canis: canines<\/li>\n\n\n\n<li>B ceti: Dolphin, whales, porpoise<\/li>\n<\/ul>\n\n\n\n<p>Brucella survives in the environment for a long time \u2013 water (weeks), soil (months).<\/p>\n\n\n\n<p>In animals, they show a predilection for reproductive organs. Brucella is rare in the UK. Most cases are associated with travel to the Mediterranean or Middle Eastern countries.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"h.80oeh2rai0ep_l\"><a href=\"https:\/\/www.microregistrar.app\/bacteria\/brucella#h.80oeh2rai0ep\"><\/a><a href=\"https:\/\/www.microregistrar.app\/bacteria\/brucella#h.80oeh2rai0ep\"><\/a>Transmission<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Contact with raw infected tissue (calving\/Dealing with cattle stillbirths) or ingesting undercooked meat.<\/li>\n\n\n\n<li>Ingestion of unpasteurized dairy products (milk, fresh cheese, cream\/ice cream, yoghurt). Refrigeration does not inhibit Brucella&#8217;s survival; on the contrary, it lengthens it.<\/li>\n\n\n\n<li>Inhalation of infected aerosol \u2013 protection necessary during aerosol-generating procedures in the laboratory)<\/li>\n\n\n\n<li>Transmission via blood transmission, transplant, congenital transmission etc (rare).<\/li>\n<\/ul>\n\n\n\n<p>The infective dose varies based on the species \u2013 lowest for B melitensis (1-10) and highest in B canis (approx 10^6).<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h.67qkvxtyf9go_l\"><a href=\"https:\/\/www.microregistrar.app\/bacteria\/brucella#h.67qkvxtyf9go\"><\/a><a href=\"https:\/\/www.microregistrar.app\/bacteria\/brucella#h.67qkvxtyf9go\"><\/a>Test for Brucella<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h.r81j34xp75q4_l\"><a href=\"https:\/\/www.microregistrar.app\/bacteria\/brucella#h.r81j34xp75q4\"><\/a><a href=\"https:\/\/www.microregistrar.app\/bacteria\/brucella#h.r81j34xp75q4\"><\/a>Culture<\/h3>\n\n\n\n<p>All recent Brucella cases in the UK were identified from blood culture. If clinically suspected of Brucella or the blood culture grows small gram-negative bacilli, oxidase and\/or urease +ve, it should be processed in a containment level 3 facility using a Class I biosafety cabinet.<\/p>\n\n\n\n<p>Standard identification methods like API, MALDI-ToF etc., may misidentify Brucella, and it is recommended to send suspected cultures to the APHA reference laboratory.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h.9welil3r62wn_l\"><a href=\"https:\/\/www.microregistrar.app\/bacteria\/brucella#h.9welil3r62wn\"><\/a><a href=\"https:\/\/www.microregistrar.app\/bacteria\/brucella#h.9welil3r62wn\"><\/a>Serology<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Screening \u2013 Total brucella antibody assay and specific IgG\/IgM enzyme immunoassays.<\/li>\n\n\n\n<li>Micro-agglutination assay<br>(B canis is less immunogenic; hence standard screening may not identify B canis infection).<\/li>\n\n\n\n<li>Serology is to be interpreted based on the clinical information, as there are possibilities of false-negative results (in early infection) or false-positive results (due to prior exposure). Repeat serology in 4-6 weeks.<\/li>\n\n\n\n<li>Brucella PCR also helps in diagnosis.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"h.zc91mdnmiv6g_l\"><a href=\"https:\/\/www.microregistrar.app\/bacteria\/brucella#h.zc91mdnmiv6g\"><\/a><a href=\"https:\/\/www.microregistrar.app\/bacteria\/brucella#h.zc91mdnmiv6g\"><\/a>Monitoring<\/h4>\n\n\n\n<p>Monitoring by serology or PCR is difficult as they remain positive despite treatment. Clinical correlation is required.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"h.qrttffnkr3ye_l\"><a href=\"https:\/\/www.microregistrar.app\/bacteria\/brucella#h.qrttffnkr3ye\"><\/a><a href=\"https:\/\/www.microregistrar.app\/bacteria\/brucella#h.qrttffnkr3ye\"><\/a>Brucella clinical picture<\/h4>\n\n\n\n<p>Incubation period \u2013 weeks to months (usually 1-4 weeks)<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Brucella can cause many different signs\/symptoms and has been called the \u2018great imitator\u2019.<\/li>\n\n\n\n<li>It can present as acute or chronic infection and, in some cases, asymptomatic infection.<\/li>\n\n\n\n<li>Common features are \u2013 fever, fatigue and arthralgia.<\/li>\n\n\n\n<li>Brucellosis was previously called undulant fever due to the waxing and waning nature of the fever.<\/li>\n\n\n\n<li>Other features \u2013 Mouldy smelling perspiration, myalgia, anorexia, back pain<\/li>\n\n\n\n<li>Hepatomegaly, splenomegaly and lymphadenopathy can be seen.<\/li>\n\n\n\n<li>Haematological features \u2013 anaemia, leucopenia\/leucocytosis, thrombocytopenia\/thrombocytosis, pancytopenia.<\/li>\n<\/ul>\n\n\n\n<p>Relapse \u2013 usually due to non-compliance in up to 15% of cases.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"h.shp1ooxiqt25_l\"><a href=\"https:\/\/www.microregistrar.app\/bacteria\/brucella#h.shp1ooxiqt25\"><\/a><a href=\"https:\/\/www.microregistrar.app\/bacteria\/brucella#h.shp1ooxiqt25\"><\/a>Complications<\/h4>\n\n\n\n<p>(Focal Brucellosis \u2013 organ-related complication)<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>CNS infection \u2013 meningoencephalitis, radiculoneuropathy, cranial nerve palsy<\/li>\n\n\n\n<li>Endocarditis, myocarditis, pericarditis, mycotic aneurysm<\/li>\n\n\n\n<li>Pneumonia, pleural effusion<\/li>\n\n\n\n<li>Suppurative infection \u2013 spleen, liver, lung<\/li>\n\n\n\n<li>Bone\/joint Involvement \u2013 sacroiliitis, discitis, arthritis (large joint)<\/li>\n\n\n\n<li>Pyelonephritis<\/li>\n\n\n\n<li>Epididymoorchitis.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"h.miath7lzh6zl_l\"><a href=\"https:\/\/www.microregistrar.app\/bacteria\/brucella#h.miath7lzh6zl\"><\/a><a href=\"https:\/\/www.microregistrar.app\/bacteria\/brucella#h.miath7lzh6zl\"><\/a>Treatment<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Doxycycline+ rifampicin or Doxycycline+aminoglycoside (Streptomycin\/gentamicin)<\/li>\n\n\n\n<li>Combination therapy is preferred.<\/li>\n\n\n\n<li>A third agent could be added if required \u2013 quinolones\/cotrimoxazole<\/li>\n\n\n\n<li>Children \u2013 cotrimoxazole+rifampicin, rifampicin+gentamicin, cotrim+ gentamicin<\/li>\n\n\n\n<li>Other active drugs \u2013 quinolones, ceftriaxone<\/li>\n<\/ul>\n\n\n\n<p>Treatment is usually 6 weeks. May need a longer course in complicated cases e.g. discitis may need 6 months of treatment.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\" id=\"h.sp6w3tbnqd7_l\"><a href=\"https:\/\/www.microregistrar.app\/bacteria\/brucella#h.sp6w3tbnqd7\"><\/a><a href=\"https:\/\/www.microregistrar.app\/bacteria\/brucella#h.sp6w3tbnqd7\"><\/a>Bioterrorism<\/h4>\n\n\n\n<p>It is a potential agent as the disease can be contracted when inhaled. However, it has low mortality and a long incubation period, which can be considered a disadvantage.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h.5l3myxyi9vs9_l\"><a href=\"https:\/\/www.microregistrar.app\/bacteria\/brucella#h.5l3myxyi9vs9\"><\/a><a href=\"https:\/\/www.microregistrar.app\/bacteria\/brucella#h.5l3myxyi9vs9\"><\/a>Question<\/h2>\n\n\n\n<p>Blood culture from a 7-year-old boy who recently returned from Italy has grown this organism \u2013 Oxidase +ve, Urease +ve. Clinical details \u2013 fever, headache, chills, myalgia, arthralgia (left knee), anaemia, thrombocytopenia.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>What would be your instruction to the lab staff?<\/li>\n\n\n\n<li>What additional history would you take?<\/li>\n\n\n\n<li>What treatment advice would you give?<\/li>\n\n\n\n<li>Whom should you contact?<\/li>\n\n\n\n<li>What additional tests would you do to get the diagnosis?<\/li>\n<\/ul>\n\n\n\n<p><strong>Other potential questions \u2013<\/strong><\/p>\n\n\n\n<p>SAQ: Brucellosis<\/p>\n\n\n\n<p>SAQ: Neurobrucellosis<\/p>\n\n\n\n<p>SAQ: Management of Brucellosis<\/p>\n\n\n\n<p>SAQ: Brucella endocarditis<\/p>\n\n\n\n<p>SAQ: Investigation of Brucella infection<\/p>\n\n\n\n<p>SAQ: Complications of Brucella<\/p>\n\n\n\n<p>SAQ: How would you manage an incident where a laboratory staff was exposed to Brucella.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Bacteria There are many Brucella species \u2013 not all known to cause human disease. Those known to cause human disease [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ngg_post_thumbnail":0,"footnotes":""},"categories":[36],"tags":[76,91],"class_list":["post-367","post","type-post","status-publish","format-standard","hentry","category-bacteria","tag-bacteria","tag-brucella"],"_links":{"self":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/367","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=367"}],"version-history":[{"count":1,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/367\/revisions"}],"predecessor-version":[{"id":368,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/367\/revisions\/368"}],"wp:attachment":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=367"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=367"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=367"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}