Brucellosis

Question 1

Lab worker exposed to brucella on open bench (non cat 3 lab), was >5 feet away.

What is level of risk?

How to manage?

Answer 1

Low risk

Do serology at 0 and keep in local laboratory

Only send to ref lab if becomes symptomatic

No difference between pregnant or non-pregnant people

Question 2

3 ways brucella is transmitted?

Answer 2

1. aerosol (resist drying)
2. infected animal/carcass
3. infected milk

Question 3

Focal brucella infection (articular/epididymo-orchitis).

How to treat?

Answer 3

as per uncomplicated brucella

doxy+streptomycin

OR

doxy + rifampicin

but for longer (at least 12 weeks)

Neurological/endocarditis may need 3 drug regime for even longer

Question 4

Non-pregnant laboratory worker worked with open brucella blood culture in cat 2 cabinet (instead of cat3). What is level of risk? How to manage?

Answer 4

High risk (worked with in non-cat 3 environment/sniffed/<5 feet away/aerosol generating procedure eg breakage/mouth-pipetted)

Send serology at 0, 6 weeks and 6 months.

Prophylaxis with doxy 3 weeks OR cotrim 3 weeks

Question 5

Non-pregnant patient diagnosed with brucella. how to treat?

Answer 5

doxy 6 weeks + streptomycin 3 weeks

OR

doxy 6 weeks + rifampicin 6 weeks

Question 6

Brucella symptoms?

Answer 6

Undulating fever, myalgia, constitutional symptoms (malodorous perspiration)

OR

focal - osteoarticular, epididymo-orchitis

Question 7

Child below 12 years old with brucellosis. How to treat?

Answer 7

cotrimoxazole 6 weeks + rifampicin 6 weeks

Question 8

Pregnant laboratory worker worked with open brucella blood culture in cat 2 cabinet (instead of cat3). What is level of risk? How to manage?

Answer 8

High risk (worked with in non-cat 3 environment/sniffed/<5 feet away/aerosol generating procedure eg breakage/mouth-pipetted)

Send serology at 0, 6 weeks and 6 months.

If pregnant, prophylaxis with rifampicin 3 weeks OR cipro 3 weeks OR observe

Question 9

Gram negative coccobacilli.

Differentials are:

Answer 9

• Haemophilus influenza
• Haemophilus ducreyi
• Chlamydia trachomatis
• Brucella (oxidase +, catalase +)
• Gardnerella
• Bordetella pertussis
• Yersinia pestis

Hema Brutally Guarded Chinese Yen Borders

Question 10

Incubation period of brucella?

Answer 10

2-8 weeks, hide in lymph nodes then cause granulomas

Question 11

How to diagnose brucella?

Answer 11

1. bone marrow/blood culture (cat 3)
2. serology
3. histology (granuloma)
4. radiology - pedro pons sign (preferential erosion f antero-superior corner of lumbar vertebrae)
5. pcr

Question 12

12 years and above child with brucellosis.

How to treat?

Answer 12

As per adult.

Give doxy 6 weeks + rifampicin 6 weeks