Bioterrorist Agents: Brucellosis. Learning Objectives Become familiar with the following aspects of...
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Bioterrorist Bioterrorist Agents: Agents:
BrucellosisBrucellosis
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Learning ObjectivesLearning Objectives
Become familiar with the following Become familiar with the following aspects of Brucellosis:aspects of Brucellosis: Epidemiology Epidemiology TransmissionTransmission Clinical featuresClinical features Diagnosis Diagnosis TreatmentTreatment PreventionPrevention
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BackgroundBackground
Brucella melitensisBrucella melitensis discovered by discovered by Bruce in 1887Bruce in 1887
Types: Types: B. melitensis, abortus, suis, B. melitensis, abortus, suis, neotomae, ovis, canisneotomae, ovis, canis, and types , and types infecting marine mammals infecting marine mammals
Pathogenic types in humans - Pathogenic types in humans - B. B. melitensismelitensis, , abortusabortus, , canis canis and and suissuis
Zoonotic diseaseZoonotic disease
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Brucellosis- definitionBrucellosis- definition
A multisystem disease with a broad A multisystem disease with a broad range of symptoms including acute range of symptoms including acute or insidious onset of fever, night or insidious onset of fever, night sweats, undue fatigue, anorexia, sweats, undue fatigue, anorexia, weight loss, headache and arthralgiaweight loss, headache and arthralgia
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EpidemiologyEpidemiology
Incidence in US: <0.5 cases per Incidence in US: <0.5 cases per 100,000 100,000 primarily primarily B. melitensis B. melitensis
Most cases in the US are reported Most cases in the US are reported from California, Florida, Texas and from California, Florida, Texas and VirginiaVirginia
High risk areas: High risk areas: Mediterranean Mediterranean Basin, South and Central America, Basin, South and Central America, Eastern Europe, Asia, Africa , the Eastern Europe, Asia, Africa , the Caribbean and the Middle East. Caribbean and the Middle East.
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TransmissionTransmission
Three methods of transmission:Three methods of transmission:1.1. Ingestion –unpasteurized milk or dairy Ingestion –unpasteurized milk or dairy
products. Ingestion is most common products. Ingestion is most common method of transmission.method of transmission.
2.2. Inhalation – breathing in the Inhalation – breathing in the organism. Lab workers are high risk.organism. Lab workers are high risk.
3.3. Wound contamination –high risk Wound contamination –high risk occupations include hunters, occupations include hunters, slaughterhouse workers, meat packing slaughterhouse workers, meat packing plant workers and veterinariansplant workers and veterinarians
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Potential For Intentional Potential For Intentional Harm?Harm?
CDC Category B agentCDC Category B agent Most likely route of intentional exposure: Most likely route of intentional exposure:
Respiratory Respiratory Could also happen via contamination of Could also happen via contamination of
food/drinkfood/drink Identify intentional exposures as any BT Identify intentional exposures as any BT
agent:agent: Common SourceCommon Source Unlikely patientsUnlikely patients Unlikely SeasonUnlikely Season Multiple PatientsMultiple Patients Geographic correlationGeographic correlation
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Case DefinitionCase Definition Clinical illness with fever, night sweats, fatigue, Clinical illness with fever, night sweats, fatigue,
anorexia, weight loss, headache and arthralgiaanorexia, weight loss, headache and arthralgia Laboratory criteria for diagnosis:Laboratory criteria for diagnosis:
Isolation of Isolation of BrucellaBrucella sp. from a clinical sp. from a clinical specimen, or specimen, or
Fourfold or greater rise in Fourfold or greater rise in BrucellaBrucella agglutination titer between acute- and agglutination titer between acute- and convalescent-phase serum specimens convalescent-phase serum specimens obtained greater than or equal to 2 weeks obtained greater than or equal to 2 weeks apart and studied at the same laboratory, or apart and studied at the same laboratory, or
Demonstration by immunofluorescence of Demonstration by immunofluorescence of BrucellaBrucella sp. in a clinical specimen sp. in a clinical specimen
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Case classificationCase classification
Probable:Probable: clinically compatible case clinically compatible case with an epidemiologic link with an epidemiologic link
Confirmed:Confirmed: clinically compatible case clinically compatible case that is laboratory confirmedthat is laboratory confirmed
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Clinical FeaturesClinical Features
Flu-like symptoms:"undulant" fever, Flu-like symptoms:"undulant" fever, headache, chills, myalgias, arthralgias, headache, chills, myalgias, arthralgias, weakness and malaise weakness and malaise
Most recover entirely within 3 to 12 Most recover entirely within 3 to 12 months months
Some develop ill-defined chronic Some develop ill-defined chronic syndromesyndrome
Possible complications: arthritis, uveitis, Possible complications: arthritis, uveitis, sacroiliitis, spondylitis (10% of cases), sacroiliitis, spondylitis (10% of cases), meningitis (5%), and epididymoorchitismeningitis (5%), and epididymoorchitis
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TreatmentTreatment
Six week course of a combination of Six week course of a combination of antibiotics. antibiotics.
Doxycycline and rifampin or Doxycycline and rifampin or doxycyclin and streptomycin doxycyclin and streptomycin
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Prevention/Infection Prevention/Infection ControlControl
Pasteurizing milk and dairy productsPasteurizing milk and dairy products Eradicating infection from herds and Eradicating infection from herds and
flocksflocks Observing safety precautions for Observing safety precautions for
occupational exposures includingoccupational exposures including rubber bootsrubber boots wearing impermeable clothing, wearing impermeable clothing, gloves and face masks gloves and face masks practicing good personal hygiene practicing good personal hygiene
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Case ReportsCase Reports
Suspected Brucellosis Case Prompts Investigation of Possible Bioterrorism-Related Activity
MMWR Morb Mortal Wkly Rep MMWR Morb Mortal Wkly Rep 2000: 49(23)2000: 49(23)http://www.http://www.cdccdc..govgov//mmwrmmwr/PDF/wk/mm4923./PDF/wk/mm4923.pdfpdf
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ResourcesResources
CDC CDC Emergency Preparedness and Emergency Preparedness and ResponseResponse
www.bt.cdc.gov/agent/brucellosis/index.aspwww.bt.cdc.gov/agent/brucellosis/index.asp
USDA, APHIS, Veterinary ServicesUSDA, APHIS, Veterinary Services
www.aphis.usda.gov/vs/nahps/brucellosiswww.aphis.usda.gov/vs/nahps/brucellosis
Special thanks to Altoon Dweck, MD, MPH, Johns Hopkins Preventive Medicine Resident