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Overview
Brucellosis
Dr Debasis Biswas
Occupational risk
Overview
Slaughterhouse workers
Farmers and shepherds
Veterinarians
Laboratory workers
Virulence attributes
Invade circulating PMNs and macrophages
LPS coat: facilitates intracellular survival
Production of AMP & GMP, which inhibit phagosomal
fusion and oxidative burst activity.
Poor inducers of inflammatory cytokines like TNF & IFNs
Do not activate the alternative complement system
Inhibit programmed cell death
Pathogenesis
Entry thru wound/ conj mucosa/ inhalation/ ingestion
Intracellular survival in phagocytes
Transported via lymphatics to local LNs . Replication
Hematogenous dissemination Distant organs
Predilection for placenta . Erythritol
May also replicate in: Kidney; Liver; Spleen; Breast;
Joints
After replication in the ER, brucellae are released with
the help of hemolysins and induce cell necrosis.
Localized and Systemic infection.
Can involve:
CNS, Heart, Joints,
Genitourinary system,
Lungs & Skin
Fever
Sweat
Fatigue
4/5/2015
Immune Response
Acute
Prolonged Bacteremia
Irregular Fever
Systemic manifestations:
fatigue, anorexia,
drenching sweats,
musculo-skeletal pain
Complications: Articular,
Osseous, Visceral,
Neurological
Host response:
B abortus:
Granulomas
B melitensis & B suis: Visceral microabscesses
(commonly)
[1]
Species-wise pathogenicity
Highest
pathogenicity
High
pathogenicity
B. abortus
Moderate
pathogenicity
B. canis
Moderate
pathogenicity
Mild-to-moderate
sporadic disease;
complications rare
Insidious onset, frequent
relapses, does not
commonly cause chronic
brucellosis.
B. melitensis
[1]
B. suis
[1]
Prognosis
Diagnostic Approach
Isolation
Blood
Tissues (e.g. bone marrow biopsy or liver aspiration)
Body fluids (Synovial/ Pleural/ CSF): Low yield
Serology
Slide Agglutination
Tube Agglutination
ELISA
4/5/2015
[1]
[1]
CBC in Brucellosis
CSF in Brucellosis
Anaemia
Leukopenia
Neutropenia with relative Lymphocytosis
Thrombocytopenia is reported in 40% (secondary to
hepatosplenomegaly or from immune thrombocytopenia)
Culture
Biochemical reactions
[1]
Strict aerobes
6-8 weeks: To declare -ve
Speciation
CO2 Requirement (B. abortus is capnophilic)
H2S production (Most strains of B. abortus are H2S +ve)
Sensitivity to dyes (Basic fuchsin and Thionin)
Lysis by Tblisi phage (B. melitensis is resistant)
(B. abortus is sensitive)
Antigenic structure (B. melitensis: M= 20 x A)
(B. abortus: A= 20 x M)
Serology
Tube Agglutination test: SAT
Detects Anti- LPS antibodies
2- Mercapto ethanol test
Detects IgG class of Anti- LPS antibodies
Titers higher than 1:80 define active infection
Endemic Areas: Titers > 1:320 are more specific
Persistent infection/ Relapse:
A high IgG antibody titer
Titer that is higher after treatment
Potential cross-reactivity with other organisms, e.g.
Francisella tularensis
Yersinia enterocolitica serotype O9
Vibrio cholerae
Escherichia coli 0:116; 0:157
4/5/2015
Prozone Phenomenon
ELISA
PCR
Histopathology
Mixed inflammatory
infiltrates with
lymphocytic
predominance
and granulomas
with necrosis
Brucella species are poorly staining, small Gramnegative coccobacilli and are seen mostly as single
cells with an appearance resembling "fine sand."