Brucellosis and Tetanus -علاء خطار

Question 1

whats the brucellosis ?

Answer 1

its a systemic bacterial zoonotic disease

Question 2

whats the other name of brucellosis ?

Answer 2

Malta fever , medierian , undulant , gastric fever

Question 3

how many species of brucellosis ?

Answer 3

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

Question 4

what the species that commonly seen in basra ?

Answer 4

abortus

Question 5

what the species that commonly seen in the north ?

Answer 5

melitensis

Question 6

what the rout of transmission of the brucellosis ?

Answer 6

1-by unpasturized milk
2- uncooked meat
3- raw diary product
3- infected animals as veterinarians

Question 7

what the incubation period of the brucellosis ?

Answer 7

its few days about 3 months

which is start as acute illness then chronic

Question 8

So what’re the clinical features of the acute illness in brucellosis ?

Answer 8

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

Question 9

what’re the clinclical features of chronic infection ?

Answer 9

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

Question 10

what the differential diagnosis of the brucellosis ?

Answer 10

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.)

Question 11

how to diagnosis the brucellosis ?

Answer 11

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

Question 12

what mean if the IgM is higher than the IgG ?

Answer 12

• IgM mean recent infection

- IgG mean past infection or chronic

Question 13

what the treatment of brucellosis in the mild cases ?

Answer 13

docoxycycline and rifampin for 6 week (more than 1month )

Question 14

what the treatment of brucellosis in the sever cases ?

Answer 14

we use 3 drugs

• Gentamicin
• doxacycline
• rifampin

for 8 weeks

Question 15

what the treatment of brucellosis in pregnancy and children ?

Answer 15

• CO trimaxazole
• rifamoicin

(8-12 week)

Question 16

the death in the brucellosis as the result of the :

Answer 16

1- endocarditis

2- meningitis

Question 17

How to prevent and control the brucellosis ?

Answer 17

1- pasturizing the milk
2-for occupation use protective gloves
3- post -exposure prophylaxis

Question 18

what the tetanus ?

Answer 18

is acute bacterial infection caused by the clostridium tetani
which gram + bacilli
spore forming cells

Question 19

what the clinical feature of the tetanus ?

Answer 19

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

Question 20

what the incubation period of the tetanus ?

Answer 20

its only 1-7 days

in neonate happen 2 week after birth

Question 21

what the neonatal tetanus ?

Answer 21

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

Question 22

what the complication of the tetanus ?

Answer 22

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

Question 23

what’s the differential diagnosis of the tetanus?

Answer 23

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

Question 24

whats the treatment of the tetanus ?

Answer 24

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

Question 25

how to prevent the tetanus ?

Answer 25

1- sterlization of the injuries

2- active and passive immunization