Brucellosis Flashcards
Features of Brucellosis arthritis
Where it involves
Septic arthritis in brucellosis progresses slowly, starting with small pericapsular erosions
In vertebrae, anterior erosions of the superior end plate are the first features to become evident, with eventual involvement and sclerosis of the whole vertebra
Anterior osteophytes eventually develop
But vertebral destruction or impingement on the spinal cord is rare and usually suggests tuberculosis
Paraclinical findings in brucellosis
CBC and other blood indices
Hepatic Enzymes, ESR, CRP
Usually within normal limits
Hepatic enzymes and bilirubin may be elevated
Peripheral leukocyte counts are usually normal or
low, with relative lymphocytosis
Mild anemia may be documented
Thrombocytopenia and disseminated intravascular coagulation with raised levels of fibrinogen degradation products can develop
The erythrocyte sedimentation rate and C-reactive protein levels are often normal but may be raised
Antibody response to brucellosis infection
In acute infection, IgM antibodies appear early
and are followed by IgG and IgA and all are active in
agglutination tests
As disease progresses, IgM levels decline, and the
avidity and subclass distribution of IgG and IgA change
Result in reduced or undetectable agglutinin titers
Detectable by alternative tests, including the complement fixation test, Coomb’s antiglobulin test, and enzyme-linked immunosorbent assay
Cut off for wright test in endemic and non endemic
also in our guidelines
In endemic areas or in settings of potential occupational exposure, agglutinin titers of 1:320–1:640 or higher are
considered diagnostic
Nonendemic areas, a titer of > 1:160 is considered
significant
here it is > 1/80
in how long will an increase in wright observed
Repetition of tests after 2–4 weeks may demonstrate
a rising titer
what cross reaction can happen and with which organisms?
Cross-reactions also occur with the O chains of some
other gram-negative bacteria
Yersinia enterocolitica O:9, Escherichia coli O157, Francisella tularensis, Salmonella enterica group
N, Stenotrophomonas maltophilia, and Vibrio cholerae
Treatment of adults with acute nonfocal brucellosis
duration and agents
adults with acute nonfocal brucellosis (duration less than 1 month), a 6-week course of therapy incorporating at least two antimicrobial agents is required
IM streptomycin (0.75–1 g daily for 14–21 days)
Doxycycline (100 mg twice daily for 6 weeks)
how long a focal brucellosis treatment should take
Complex or focal disease necessitates > 3 months of therapy
What is the reason of brucellosis treatment failure
Poor adherence underlies almost all cases of apparent
treatment failure
Failure is rarely due to the emergence of drug resistance
Usual alternative regimen in nonfocal brucellosis from WHO
Rifampin (600–900 mg/d)
Doxycycline (100 mg twice daily) for 6 weeks
Choice of Antibiotics for brucellosis in Children and Pregnants
Rifampin (600–900 mg/d)
High-dose TMP-SMX (two or three standard-strength tablets twice daily for adults, depending on weight
Brucellosis endocarditis treatment length and choices
Aminoglycoside, tetracycline, and rifampin
many experts add ceftriaxone and/or a fluoroquinolone
to reduce the need for valve replacement
Treatment is usually given for at least 6 months
Brucellosis neurologic disease treatment length and choices
3–6 months
ceftriaxone supplementation, (streptomycin, Doxycycline ) standard regime
Prevention in Brucellosis choice and length
administration of rifampin plus doxycycline for
3 weeks after a low-risk exposure (e.g., an unspecified laboratory accident)
6 weeks after a major exposure to aerosol or injected material
how should a brucellosis patient be followed after treatment
what to do with relapses
Followed clinically for up to 2 years to detect relapse
Relapses respond to a prolonged course of the same therapy used originally
General well-being and the body weight of the patient are more useful guides than serology to lack of relapse
