Brucellosis and Tetanus -علاء خطار Flashcards
whats the brucellosis ?
its a systemic bacterial zoonotic disease
whats the other name of brucellosis ?
Malta fever , medierian , undulant , gastric fever
how many species of brucellosis ?
brucella is Gram-negative bacteria
and its have 4 species
1- in BASRA that founded in the cows (cattle) called abortus which cause the abortion to the caws
2- in the NORTH its found in the gout and sheep it called
melitensis
3- rare found in swine (pigs). suis
4- in the dogs and the cat is Canis
what the species that commonly seen in basra ?
abortus
what the species that commonly seen in the north ?
melitensis
what the rout of transmission of the brucellosis ?
1-by unpasturized milk
2- uncooked meat
3- raw diary product
3- infected animals as veterinarians
what the incubation period of the brucellosis ?
its few days about 3 months
which is start as acute illness then chronic
So what’re the clinical features of the acute illness in brucellosis ?
the most common and diagnostic feature is the fever and the back pain
1- fever is with peaks happen with sweating and rigor
2- back pain in the sacroiliac joint
3- poor appetite and weight loss
4- headache
5- weakness
on the physical examination
- check the LN and splenomegaly ( because the thrombocytopenia)
- tender sacroiliac joint
what’re the clinclical features of chronic infection ?
its happen in 30% in pt
on the CNS 1- pt is depression 2- meningitis , stroke and hemorrhage 3- cranial nerve palsy 4- myopathy
on the HEART
1- *endocarditis which could be very fatal
2- myocarditis
on the HEAMATOLOGIACL
1- decrease the WBCs pancytopnea
on the SKELETAL
- supportive arthritis
- spinal spondylitis and sacroilitis
- paravetabral abscess
- osteomylitis
OTHERS
1-pt will have chronic fatigue
2- spleen abscess or spleenomeglay
3-hilar lymph node
what the differential diagnosis of the brucellosis ?
1- lymphoma similar by the fever
2- TB by the hilarious LN
3-Infective endocarditis _because the chronic case cause endocarditis
4-Malaria __fever occurring every two days
5-HIV -_also have swelling in the LN
6-depression ___ brucellosis can cause depression
7-leishmania and relapsing fever
(Relapsing fever is a recurring febrile disease caused by several species of the spirochete Borrelia and transmitted by lice or ticks. Symptoms are recurrent febrile episodes with headache, myalgia, and vomiting lasting 3 to 5 days, separated by intervals of apparent recovery.)
(leishmaniasis or kala-azar (‘black fever’) is the most serious form, and is potentially fatal if untreated. Other consequences, which can occur a few months to years after infection, include fever, damage to the spleen and liver, and anemia.)
how to diagnosis the brucellosis ?
1- send blood staple for culture its benefit if pt with acute status (fever and back pain)
2- serology have big beneficial espacilly if the pt in chronic status or taking antibiotic test are ( RBT , tube angulation and Elisha ) but main problem there is false positive
3- PCR
4- X ray : us ton see the erosion the (ANT-SUP) border of the lumber vertebrae osteophytosis(The formation of bone spurs)
5- skin test indicates only the past infection
what mean if the IgM is higher than the IgG ?
- IgM mean recent infection
- IgG mean past infection or chronic
what the treatment of brucellosis in the mild cases ?
docoxycycline and rifampin for 6 week (more than 1month )
what the treatment of brucellosis in the sever cases ?
we use 3 drugs
- Gentamicin
- doxacycline
- rifampin
for 8 weeks
what the treatment of brucellosis in pregnancy and children ?
- CO trimaxazole
- rifamoicin
(8-12 week)
the death in the brucellosis as the result of the :
1- endocarditis
2- meningitis
How to prevent and control the brucellosis ?
1- pasturizing the milk
2-for occupation use protective gloves
3- post -exposure prophylaxis
what the tetanus ?
is acute bacterial infection caused by the clostridium tetani
which gram + bacilli
spore forming cells
what the clinical feature of the tetanus ?
A- start acutely by hypotonia
B- then painful muscle contraction for the jaw and the neck
like
1- lock jaw can’t open his mouth
2-Risus sardonicus ضحكه الشيطان which result from the frontalis and the angle of the mouth
3-opsthotonus –arch back
C-finaly will have generlize muscle spasm
what the incubation period of the tetanus ?
its only 1-7 days
in neonate happen 2 week after birth
what the neonatal tetanus ?
fetus will have feature will have this 2 weeks after birth symptoms ------------------ 1- inability to feed 2- seizure 3- muscle contaction
by doing the spatula test
when we use the spatula (tongue depressor )he will bit it with spasm of the master
what the complication of the tetanus ?
1- breathing problem because of the laryngospasm
2- if sever spasm cause the fractures and dislocation
3- hypertension na d arrthymeia
4- because pt only lay in the bed without movement he will be liable for the pulmonary emboli
5- malnutrient
6- coma , neuropathy and psychological effect
what’s the differential diagnosis of the tetanus?
1- meningitis _ caused spasm only the neck
2- low ca and K will similar to the tetanus
3- rabies – very similar but can differnate by the history
4- status epilepticus
5- multiple sclerosis
6- hysterical
whats the treatment of the tetanus ?
1- give antitoxin in the same day
2- if it too late give antibiotic as penicillin and metronidazole
3- if there is spasm should be controlled be
-valum (diazepam)
- Mg to minimise sedation and reduce the need for mechanical ventilation and also able to minimise sympathetic overactivity associated with tetanus.
- human tetanus immunoglobulin (antibody) intarthecially for sever cases
- mechanical ventilation
4- general feature
as hydration and nutrient
with treating the infection
how to prevent the tetanus ?
1- sterlization of the injuries
2- active and passive immunization
