Brucellosis
Classification & external resources

ICD-10	A23.
ICD-9	023
DiseasesDB	1716
MedlinePlus	000597
eMedicine	med/248

Brucellosis, also called undulant fever or Malta fever, is a zoonosis (infectious disease transmitted from animals to humans) caused by bacteria of the genus Brucella. It is primarily a disease of domestic animals (goats, pigs, cattle, dogs, etc) and humans and has a worldwide distribution, mostly now in developing countries. Image File history File links No higher resolution available. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // A00-A79 - Bacterial infections, and other intestinal infectious diseases, and STDs (A00-A09) Intestinal infectious diseases (A00) Cholera (A01) Typhoid and paratyphoid fevers (A010) Typhoid fever (A02) Other Salmonella infections (A03) Shigellosis (A04) Other bacterial intestinal infections (A040) Enteropathogenic Escherichia coli infection (A045) Campylobacter enteritis (A046) Enteritis due to Yersinia... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Zoonosis (pronounced ) is any infectious disease that may be transmitted from other animals, both wild and domestic, to humans or from humans to animals (the latter is sometimes called reverse zoonosis). ... This false-colored electron micrograph shows a malaria sporozoite migrating through the midgut epithelia. ... Phyla Actinobacteria Aquificae Chlamydiae Bacteroidetes/Chlorobi Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Lentisphaerae Nitrospirae Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Verrucomicrobia Bacteria (singular: bacterium) are unicellular microorganisms. ... Species B. abortus B. melitensis Brucella is a genus of Gram-negative bacteria. ...

History and nomenclature

The disease now called brucellosis, under the name "Mediterranean fever", first came to the attention of British medical officers in Malta during the Crimean War in the 1850s. The causal relationship between organism and disease was first established by Dr. David Bruce in 1887. ^[1] Combatants Allies: Second French Empire British Empire Ottoman Empire Kingdom of Sardinia Russian Empire Bulgarian volunteers Casualties 90,000 French 35,000 Turkish 17,500 British 2,194 Sardinian killed, wounded and died of disease ~134,000 killed, wounded and died of disease The Crimean War (1853–1856) was fought... Sir David Bruce (May 29, 1855, Melbourne - November 27, 1931) was a Scottish pathologist and microbiologist who investigated the Malta-fever and trypanosomes, identifying the cause of sleeping sickness. ...

In 1897 Danish veterinarian Bernhard Bang isolated Brucella abortus as the agent and the additional name Bang's disease was assigned. In modern usage "Bang's disease" is often shortened to just "bangs" when ranchers discuss the disease or vaccine. 1897 (MDCCCXCVII) was a common year starting on Friday (see link for calendar). ... Look up veterinarian in Wiktionary, the free dictionary. ... Bernhard Lauritz Frederik Bang (June 7, 1848 Sorø - June 22, 1932 Copenhagen), was a Danish veterinarian. ... Brucellosis (Undulant fever or Malta fever) is an infectious disease caused by the Brucella bacteria. ... Ranching is the raising of cattle or sheep on rangeland, although one might also speak of ranching with regard to less common livestock such as elk, bison or emu. ... A vaccine is an antigenic preparation used to establish immunity to a disease. ...

Maltese doctor and archaeologist Sir Temi Zammit identified unpasteurized milk as the major source of the pathogen in 1905, and it has since become known as Malta Fever, or deni rqiq locally. In cattle this disease is also known as contagious abortion and infectious abortion. Sir Themistocles (Temi) Zammit (1864-1935) stands out as a personality who enriched Maltas national identity and achieved international recognition through his scientific research. ... For other uses, see 1905 (disambiguation). ...

The popular name "undulant fever" originates from the characteristic undulance (or "wave-like" nature) of the fever which rises and falls over weeks in untreated patients. In the 20th Century, this name, along with "brucellosis" (after Brucella, named for Dr Bruce), gradually replaced the 19th Century names "Mediterranean fever" and "Malta fever". Species B. abortus B. melitensis Brucella is a genus of Gram-negative bacteria. ...

Transmission and incubation

American Bison involved in a brucellosis vaccine study

The disease is transmitted either through contaminated or untreated milk (and its derivates) or through direct contact with infected animals, which may include dogs, pigs, camels and ruminants, primarily sheep, goats, cattle, bison. This also includes contact with their carcasses. Leftovers from parturition are also extremely rich in highly virulent brucellae . Brucellae, along with leptospira have the unique property of being able to penetrate through intact human skin, so infection by mere hand contact with infectious material is likely to occur. Image File history File links Agricultural Research Service scientists are helping users of American rangelands meet the challenge of managing multiple uses sustainably. ... Image File history File links Agricultural Research Service scientists are helping users of American rangelands meet the challenge of managing multiple uses sustainably. ... Binomial name (Linnaeus, 1758) Subspecies B. b. ... A glass of cows milk. ... Trinomial name Canis lupus familiaris The dog (Canis lupus familiaris) is a domestic subspecies of the wolf, a mammal of the Canidae family of the order Carnivora. ... For other uses, see Pig (disambiguation). ... For other uses, see Camel (disambiguation). ... A ruminant is any hooved animal that digests its food in two steps, first by eating the raw material and regurgitating a semi-digested form known as cud, then eating the cud. ... Species See text. ... This article is about the domestic species. ... For general information about the genus, including other species of cattle, see Bos. ... Binomial name (Linnaeus, 1758) Subspecies B. b. ... Carcass of a chicken after cooking Carcass may refer to: A carcass (or carcase) is a term for a dead body, typically that of an animal. ... Species Leptospira is a genus of spirochaete bacteria, including a small number of pathogenic and saprotrophic microorganisms. ...

The disease is now usually associated with the consumption of unpasteurized milk and soft cheeses made from the milk of infected animals and with occupational exposure of veterinarians and slaughterhouse workers. Some vaccines used in livestock, most notably B. abortus strain 19 also cause disease in humans if accidentally injected. Problems with vaccine induced cases in the United States declined after the release of the RB-51 strain developed in the 1990s and the relaxation of laws requiring vaccination of cattle in many states.

The incubation period of brucellosis is, usually, of one to three weeks, but some rare instances may take several months to surface. Incubation period, also called the latent period or latency period, is the time elapsed between exposure to a pathogenic organism, or chemical or radiation, and when symptoms and signs are first apparent. ...

Brucellosis in animals

Species infecting domestic livestock are B. melitensis (goats and sheep), B. suis (pigs, see Swine brucellosis), B. abortus (cattle and bison), B. ovis (sheep), and B. canis (dogs). B. abortus also infects bison and elk in North America and B. suis is endemic in caribou. Brucella species have also been isolated from several marine mammal species (pinnipeds and cetaceans). Brucellosis in pigs is an infectious and contagious disease caused by the bacteria, Brucella suis. ...

Brucellosis in cattle

Cattle affected with Brucella abortus have high incidences of abortions, or calve weak offspring, arthritic joints, and retention of after-birth, known as retained placenta. There are two main causes for spontaneous abortion in animals. The first is due to erythrotol, which can promote infections in the fetus and placenta. Second is due to the lack of anti-Brucella activity in the amniotic fluid. Males can also harbor the bacteria in their reproductive tracts, namely seminal vesicles, ampullae, testicles, and epididymides. The placenta is an ephemeral (temporary) organ present in female placental vertebrates, such as some mammals and sharks during gestation (pregnancy). ... Categories: Stub | Andrology | Exocrine system | Reproductive system ... The ampulla of Vater is a sphincter (a small muscle) where the common bile duct enters the duodenum. ... Human male anatomy The testicles, known medically as testes (singular testis), are the male generative glands in animals. ... Epididymides, in anatomy, describe the tubar structure within the testes that contains and stores sperm, and connects to the vas deferens. ...

Dairy herds in the USA are tested at least once a year with the Brucella Milk Ring Test^[2] (BRT). Cows that are confirmed to be infected are often killed. In the United States, veterinarians are required to vaccinate all young stock, thereby further reducing the chance of zoonotic transmission. In American and Canadian English, a veterinarian (from Latin veterinae, draught animals) is an animal doctor, a practitioner of veterinary medicine. ... A vial of the vaccine against influenza. ... Zoonosis is any infectious disease that can be transmitted from animals, both wild and domestic, to humans. ...

Canada declared their cattle herd brucellosis-free on September 19, 1985. Brucellosis ring testing of milk and cream, as well as testing of slaughter cattle, ended April 1, 1999. Monitoring continues through auction market testing, standard disease reporting mechanisms, and testing of cattle being qualified for export to countries other than the USA.^[3]

Brucellosis in dogs

The causative agent of brucellosis in dogs is Brucella canis. It is transmitted to other dogs through breeding and contact with aborted fetuses. Brucellosis can occur in humans that come in contact with infected aborted tissue or semen. The bacteria in dogs normally infect the genitals and lymphatic system, but can also spread to the eye, kidney, and intervertebral disc (causing discospondylitis). Symptoms of brucellosis in dogs include abortion in bitches and scrotal inflammation and orchitis (inflammation of the testicles) in males. Fever is uncommon. Infection of the eye can cause uveitis, and infection of the intervertebral disc can cause pain or weakness. Blood testing of the dogs prior to breeding can prevent the spread of this disease. It is treated with antibiotics as with humans, but it is difficult to cure.^[4] Trinomial name Canis lupus familiaris The dog (Canis lupus familiaris) is a domestic subspecies of the wolf, a mammal of the Canidae family of the order Carnivora. ... Related to the crippling Brucella abortus, which affects humans, cows and other species alike through feeding, close contact, and contaminated products. ... The human lymphatic system The lymphatic system is a complex network of lymphoid organs, lymph nodes, lymph ducts, lymphatic tissues, lymph capillaries and lymph vessels that produce and transport lymph fluid from tissues to the circulatory system. ... For other uses, see Eye (disambiguation). ... The kidneys are organs that filter wastes (such as urea) from the blood and excrete them, along with water, as urine. ... Intervertebral discs lie in between adjacent vertebrae in the spine. ... In some male mammals, the scrotum is a protuberance of skin and muscle containing the testicles. ... Orchitis is an often very painful condition of the testicles involving inflammation, swelling and frequently infection. ... Uveitis specifically refers to inflammation of the middle layer of the eye, termed the uvea but in common usage may refer to any inflammatory process involving the interior of the eye. ...

Brucellosis in humans

Symptoms

Granuloma and necrosis in the liver of a guinea pig infected with Brucella suis

Brucellosis induces inconstant fevers, sweating, weakness, anemia, headaches, depression and muscular and bodily pain. Image File history File links No higher resolution available. ... Image File history File links No higher resolution available. ... H&E section of non-caseasting granuloma seen in the colon of a patient with Crohns disease In medicine (anatomical pathology), a granuloma is a group of epithelioid macrophages surrounded by a lymphocyte cuff. ... Necrosis (in Greek Νεκρός = Dead) is the name given to accidental death of cells and living tissue. ... An analogue medical thermometer showing the temperature of 38. ... This article discusses the medical condition. ... A headache (cephalalgia in medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ... On the Threshold of Eternity. ...

The symptoms are like those associated with many other febrile diseases, but with emphasis on muscular pain and sweating. The duration of the disease can vary from a few weeks to many months or even years. In first stage of the disease, septicaemia occurs and leads to the classic triad of undulant fevers, sweating (often with characteristic smell, likened to wet hay) and migratory arthralgia and myalgia. In blood tests, is characteristic the leukopenia and anemia, some elevation of AST and ALT and positivity of classic Bengal Rose and Huddleson reactions. This complex is, at least in Portugal, known as the Malta fever. During episodes of Malta fever, melitococcemia (presence of brucellae in blood) can usually be demonstrated by means of blood culture in tryptose medium or Albini medium. If untreated, the disease can give origin to focalizations or become chronic. The focalizations of brucellosis occur usually in bones and joints and spondylodisciitis of lumbar spine accompanied by sacroiliitis is very characteristic of this disease. Orchitis is also frequent in men. An analogue medical thermometer showing the temperature of 38. ... This article does not cite any references or sources. ... Myalgia means muscle pain and is a symptom of many diseases and disorders. ... In medicine, sacroiliitis is an inflammation of the sacroiliac joint. ... Orchitis is an often very painful condition of the testicles involving inflammation, swelling and frequently infection. ...

Diagnosis of brucellosis relies on:

1. Demonstration of the agent: blood cultures in tryptose broth, bone marrow cultures. The growth of brucellae is extremely slow (they can take until 2 months to grow) and the culture poses a risk to laboratory personnel due to high infectivity of brucellae.
2. Demonstration of antibodies against the agent either with the classic Huddleson, Wright and/or Bengal Rose reactions, either with ELISA or the 2-mercaptoethanol assay for IgM antibodies associated with chronic disease
3. Histologic evidence of granulomatous hepatitis (hepatic biopsy)
4. Radiologic alterations in infected vertebrae : the Pedro Pons sign (preferential erosion of antero-superior corner of lumbar vertebrae) and marked osteophytosis are suspicious of brucellic spondylitis.

The disease's sequelae are highly variable and may include granulomatous hepatitis, arthritis, spondylitis, anemia, leukopenia, thrombocytopenia, meningitis, uveitis, optic neuritis and endocarditis. Hepatitis (plural hepatitides) implies injury to liver characterised by presence of inflammatory cells in the liver tissue. ... Arthritis (from Greek arthro-, joint + -itis, inflammation; plural: arthritides) is a group of conditions where there is damage caused to the joints of the body. ... Spondylitis is an inflammation of a vertebra. ... This article discusses the medical condition. ... Leukopenia or leukocytopenia refers to a decrease in the number of circulating white blood cells (leukocytes) in the blood. ... Thrombocytopenia (or -paenia, or thrombopenia in short) is the presence of relatively few platelets in blood. ... Meningitis is the inflammation of the protective membranes covering the central nervous system, known collectively as the meninges. ... Uveitis specifically refers to inflammation of the middle layer of the eye, termed the uvea but in common usage may refer to any inflammatory process involving the interior of the eye. ... Optic neuritis, sometimes called retrobulbar neuritis, is the inflammation of the optic nerve that may cause a complete or partial loss of vision. ... Endocarditis is an inflammation of the inner layer of the heart, the endocardium. ...

Treatment and prevention

Antibiotics like tetracyclins, rifampicin and the aminoglycosides streptomycin and gentamicin are effective against Brucella bacteria. However, the use of more than one antibiotic is needed for several weeks, due to the fact that the bacteria incubates within cells. An antibiotic is a drug that kills or slows the growth of bacteria. ... Tetracycline (INN) (IPA: ) is a broad-spectrum antibiotic produced by the streptomyces bacterium, indicated for use against many bacterial infections. ... Rifampicin (INN) (IPA: ) or rifampin (USAN) is a bacteriocidal antibiotic drug of the rifamycin group. ... Aminoglycosides are a group of antibiotics that are effective against certain types of bacteria. ... Streptomycin is an antibiotic drug, the first of a class of drugs called aminoglycosides to be discovered, and was the first antibiotic remedy for tuberculosis. ... Gentamicin is an aminoglycoside antibiotic, and can treat many types of bacterial infections, particularly Gram-negative infection. ... Drawing of the structure of cork as it appeared under the microscope to Robert Hooke from Micrographia which is the origin of the word cell being used to describe the smallest unit of a living organism Cells in culture, stained for keratin (red) and DNA (green) The cell is the...

The gold standard treatment for adults is daily intramuscular injections of streptomycin 1 g for 14 days and oral doxycycline 100 mg twice daily for 45 days (concurrently). Gentamicin 5 mg/kg by intramuscular injection once daily for 7 days is an acceptable substitute when streptomycin is not available or difficult to obtain.^[5] Another widely used regimen is doxycycline plus rifampin twice daily for at least 6 weeks. This regimen has the advantage of oral administration. A triple therapy of doxycycline, together with rifampin and cotrimoxazole has been used succefully to treat neurobrucellosis. ^[6] Doxycycline is able to cross the blood-brain barrier, but requires the addition of two other drugs to prevent relapse. Ciprofloxacin and co-trimoxazole therapy is associated with an unacceptably high rate of relapse. In brucellic endocarditis surgery is required for an optimal outcome. Even with optimal antibrucellic therapy relapses still occur in 5-10 percent of patients with Malta fever. The main way of preventing brucellosis is by using fastidious hygiene in producing raw milk products, or by pasteurization of all milk that is to be ingested by human beings, either in its pure form or as a derivate, such as cheese. Experiments have shown that cotrimoxyzol and rifampin are both safe drugs to use in treatment of pregnant women who have Brucellosis. Streptomycin is an antibiotic drug, the first of a class of drugs called aminoglycosides to be discovered, and was the first antibiotic remedy for tuberculosis. ... Doxycycline (INN) (IPA: ) is a member of the tetracycline antibiotics group and is commonly used to treat a variety of infections. ... Gentamicin is an aminoglycoside antibiotic, and can treat many types of bacterial infections, particularly Gram-negative infection. ... Intramuscular injection is the injection of a substance directly into a muscle. ... Pasteurization (or pasteurisation) is the process of heating liquids for the purpose of destroying viruses and harmful organisms such as bacteria, protozoa, molds, and yeasts. ... Cheese is a solid food made from the milk of cows, goats, sheep, and other mammals. ...

Biological warfare

In 1954, B. suis became the first agent weaponized by the U.S. at its Pine Bluff Arsenal in Arkansas. Brucella species survive well in aerosols and resist drying. Brucella and all other remaining biological weapons in the US arsenal were destroyed in 1971-72 when the U.S. offensive biological weapons (BW) program was discontinued. ^[7] For the use of biological agents by terrorists, see bioterrorism. ... The Pine Bluff Arsenal is an active military arsenal, that stores 12. ...

The United States BW program focused on three agents of the Brucella group:

• Porcine Brucellosis (Agent US)
• Bovine Brucellosis (Agent AB)
• Caprina Brucellosis (Agent AM)

Agent US was in advanced development by the end of the Second World War. When the USAF wanted a biological warfare capability, the Chemical Corps offered agent US in the M114 bomblet, based after the 4-pound bursting bomblet developed for anthrax in the Second World War. Though the capability was developed, operational testing indicated that the weapon was less than desirable, and the USAF termed it an interim capability until replaced by a more effective biological weapon. The main drawbacks of the M114 with agent US was that it was incapacitating (the USAF wanted "killer" agents), the storage stability was too low to allow for storing at forward air bases, and the logistical requirements to neutralize a target were far higher than originally anticipated, requiring unreasonable logistical air support. Mushroom cloud from the nuclear explosion over Nagasaki rising 18 km into the air. ...

Agents US and AB had a median infective dose of 500 org/person, and AM was 300 org/person. The rate-of-action was believed to be 2 weeks, with a duration of action of several months. The lethality estimate was based on epidemiological information at 1 - 2%. AM was always believed to be a more virulent disease, and a 3% fatality rate was expected.

Historical names

In addition to "Malta Fever" and "undulant fever", the following obsolete names have previously been applied to brucellosis:

• Mediterranean fever
• continued fever
• Cyprus fever
• goat fever
• Gibraltar fever
• Crimean fever
• mountain fever
• Neapolitan fever
• rock fever
• slow fever
• febris melitensis
• febris undulans
• Bruce's septicemia
• melitensis septicemia
• melitococcosis
• Brucelliasis
• Milk Sickness

Popular culture references

Trivia sections are discouraged under Wikipedia guidelines. The article could be improved by integrating relevant items and removing inappropriate ones.

• The disease was referred to in the song "Play It All Night Long" by American singer/songwriter Warren Zevon. The song is about a presumably Southern farming family going through hard times: "The cattle all have brucellosis, we'll get through somehow."
• In Flannery O'Connor's short story "The Enduring Chill," the 25 year old protagonist Asbury is diagnosed with undulant fever. In an act of defiance against what he considered his mother's overbearing ways, he violated the most absolute rule on her dairy farm and drank raw milk. As a result of the brucellosis he contracted, he was reduced to a life-long invalid permanently dependent on his mother's care.
• It was also mentioned in All Things Bright and Beautiful, one volume in the memoirs of James Herriot, a Scottish veterinarian who began practice in the 1930s.
• It was prominently featured in one of the episodes of TV show House entitled "Sex Kills".
• A Brucellosis-like disease called "calpine feaver" was mentioned in Silence of the Goats, an episode of the animated show Weird Years.
• The character Renzi in the Kydd series of novels contracts undulant fever in the book Command^[8]

Image File history File links Broom_icon. ... Warren William Zevon (January 24, 1947 – September 7, 2003) was an American rock and roll musician and songwriter. ... All Creatures Great and Small was the title given to a compilation volume first published in 1972 comprising James Herriots first two novels, If Only They Could Talk and It Shouldnt Happen to a Vet, which were considered too short to publish individually in the U.S. market. ... Herriot’s former surgery in Thirsk is now a tourist attraction. ... House, also known as House, M.D., is an American medical drama television series created by David Shore and executive produced by Shore and film director Bryan Singer. ... Sex Kills is the fourteenth episode of the second season of House, which premiered on the FOX network on March 7, 2006. ... Weird Years is an animated series about Donko Dorkovitch and his eccentric family from Kryobia as they deal with life and transition in North America. ... Kydd, first published in 2001, is a Historical sea novel by Julian Stockwin. ...

References

This article is about the city in England. ... The headquarters of the Cambridge University Press, in Trumpington Street, Cambridge. ... The American Journal of Public Health (AJPH) is a peer reviewed monthly journal of the American Public Health Association (APHA). ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 77th day of the year (78th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 77th day of the year (78th in leap years) in the Gregorian calendar. ... The U.S. Army Medical Research Institute of Infectious Diseases is based at Fort Detrick, Frederick, Maryland. ... Julian Stockwin (born in 1944 in Basingstoke, Hampshire, England) is an author of naval historical fiction. ...

See also

• Swine brucellosis
• Florence Nightingale (She may have suffered from brucellosis in the Crimea.)

Brucellosis in pigs is an infectious and contagious disease caused by the bacteria, Brucella suis. ... Embley Park, now a school, was the family home of Florence Nightingale. ...

External links

• Prevention about Brucellosis from Center for Disease Control
• synd/819 at Who Named It
• 53805059 at GPnotebook
• ID14 at FPnotebook
• Brucellosis in Dogs from The Pet Health Library
• Brucella from PATRIC
• Brucella Bioinformatics Portal