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Bacteriology F > Brucella > Flashcards

Brucella Flashcards

1
Q

Brucellosis is endemic in which country?

A

It is endemic in Lebanon

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2
Q

Are they motile? Spore forming? Do they have a capsule?

A

They are nonmotile, non-spore forming, non encapsulated coccobacilli

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3
Q

What are the results of the catalase and oxidase test?

A

They are catalase and oxidase positive

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4
Q

Are they extracellular or intracellular bacteria?

A

They are facultative intracellular

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5
Q

To what they are sensitive?

A

They are sensitive to direct sunlight

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6
Q

How are they transmitted?

A

By ingestion of contaminated animal products like milk or cheese
By direct contact with infected animals like a splash of blood in the conjunctiva
Laboratory infection can occur

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7
Q

Who are the reservoir?

Why infected individuals do not transmit the disease?

A

Animals are the natural reservoir, humans are not, they all accidental hosts and this is why infected individuals do not transmit the disease

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8
Q

What is the clinical presentation?

A

Brucellosis which is the Malta fever or undulating fever

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9
Q

What is the characteristic of brucellosis?

A

Night sweats are a characteristic of brucellosis and sometimes they are accompanied with chills

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10
Q

What is the incubation period?

A

1 to 6 weeks

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11
Q

Where do they multiply?

How do they escape phagocytosis?

A

They multiply at the site of entry, then they multiply into macrophages
In macrophages they block the phagosome-lysosome fusion, especially the degranulation of myeloperoxidase system

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12
Q

How bacteria will pass to the blood?

A

Bacteria will go to the lymphatic channels, then to lymph nodes, to the thoracic duct and then to blood

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13
Q

Where bacteria can go?

A

They can go to all parenchymatous organs like liver, spleen, lungs, heart, kidneys etc…

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14
Q

Where bacteria are multiplying wherever they are?

What do we have in parenchymatous organs?

A

They are multiplying in macrophages.

This is why parenchymatous organs end up having granulomas

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15
Q

What is the host reaction to brucellosis?

A

The formation of caseating granulomas (caseation=form of necrosis, destruction that appears cheese-like, typical of tuberculosis)

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16
Q

From what are composed caseating granulomas?

A

A compact layer of mononuclear cells, epithelioid cells (they resemble epithelial cells, but their origin is the monocyte macrophage), giant cells (syncytium, multinucleated cells), lymphocytes and plasma cells.

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17
Q

What happens in individuals who recover?

A

That is a deposition of fibrotic tissue on the granuloma

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18
Q

To what is converted the tissue fibrous tissue in advanced cases?

A

It is converted into a calcified area which many of them can heal spontaneously, while others stay for a longer period considered as dormant granulomas where there is a risk of relapse

19
Q

Which bacteria presents a similar case?

A

Tuberculosis

20
Q

What are the three types of symptoms?

A

Depending on whether there is acute, localized or chronic brucellosis

21
Q

Why diagnosis is not easy in the acute brucellosis?

A

Because it includes general symptoms like nausea, backache, headache, fever causing night sweats which are not typical of brucellosis

22
Q

Which symptoms can help in diagnosis of acute brucellosis?

A

Hepatomegaly, splenomegaly, lymphadenopathy although they are still not specific

23
Q

What happens if it is not treated?

A

Individuals end up with localized brucellosis

24
Q

What are the manifestations of localized brucellosis?

A
  • Osteomyelitis, Lumbo sacral vertebrae
  • Disc space infection, involving adjacent vertebrae
  • septic arthritis in knees
  • splenic abscesses ending with calcification
  • prostatic or renal infection
  • pleural effusion and pneumonia which is the most difficult thing to diagnose
  • Endocarditis: Which is the worst outcome
25
Q

Why endocarditis is the worst outcome?

A

Aortic valve is involved, it can be destroyed either by granuloma, or by the LPS which is very active during the infection.
Both valves are involved, this requires immediate surgery and replacement of both valves along with antibiotics therapy

26
Q

Can we find free bacteria during the chronic brucellosis? What do we find either?

A

Free bacteria are no more found. We can find them only in granulomas

27
Q

What are the symptoms of this stage?

A

Fatigue, weakness, nonspecific aches, pain, nervousness and other psychoneurotic symptoms
Fever is still present and is undulating

28
Q

What is the vaccine? What are preventions?

A

It is live attenuated for animals

Farmers should wear protective equipment and not eat anything from an unknown origin

29
Q

What do we see during the physical examination?

A

Splenomegaly, hepatomegaly and lymphadenopathy

30
Q

In which medium does they grow?

A

The best medium is Castaneda bottles, they grow aerobically and anaerobically

31
Q

Why culture is dangerous?

A

Because it can be transmitted in the lab

32
Q

What is the best way for diagnosis?

A

Serology since culture takes a lot of time

33
Q

Which test is done in serology?

A

Wright’s test known as Coombs test in the past which is a standard agglutination test

34
Q

When IgM start to be detected? IgG and IgA?

A

IgM start to be detective the first week, peek at around three months weather IgA and IgG start to be deducted after the first week and stay for around eight weeks.
As long as the disease is active, we can detect IgM and IgG

35
Q

What means the detection of IgM? The reduction of IgG in the brucellosis?

A

During brucellosis when IgM are detected this indicates the acute active infection, but IgG detection indicates whether there is a recent acute infection or a chronic infection

36
Q

What does the mercaptoethanol test? For what purpose?

A

It destroys pentameric and dimeric IgA leaving only the monomers
This test is done to detect the agglutnating IgG which are of importance to us

37
Q

What happens to the antibodies when there is progression to a chronic stage?

A

Agglutinating ability of Ab is lost in vitro, so we will be left with those that are not agglutinating and that can be detected by ELISA or by complement fixation

38
Q

Do they give permanent immunity?

A

There is no permanent immunity

39
Q

At which stages the treatment should be? Why?

A

It should be very early, at the acute and subacute stages since it is very difficult to treat chronic stages

40
Q

What is the antibiotic treatment?

A

Doxycycline (a tetracycline) + aminoglycoside (e.g., gentamycin) for 4 weeks
Followed by doxycycline + rifampin for 4-8 weeks

41
Q

What is the treatment for CNS disease?

A

Long-term therapy with high doses of Bactrim + rifampin

42
Q

What is the treatment for children?

A

Bactrim + rifampin for 8-12 weeks

43
Q

Is there any vaccine?

A

No vaccines for humans but there is a live attenuated vaccines for animals

Bacteriology F (16 decks)

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