Brucella: Difference between revisions
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* 1.'''Uncomplicated brucellosis in adults and children eight years of age and older '''<ref>{{cite book | last = Corbel | first = Michael | title = Brucellosis in humans and animals | publisher = World Health Organization | location = Geneva | year = 2006 | isbn = 9241547138 }}</ref> | * 1.'''Uncomplicated brucellosis in adults and children eight years of age and older '''<ref>{{cite book | last = Corbel | first = Michael | title = Brucellosis in humans and animals | publisher = World Health Organization | location = Geneva | year = 2006 | isbn = 9241547138 }}</ref> , <ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref> | ||
:* Preferred regimen: [[Doxycycline]] 100 mg PO bid for 6 weeks {{and}} [[Streptomycin]] 1 g/day IM for 2-3 weeks | :* Preferred regimen: [[Doxycycline]] 100 mg PO bid for 6 weeks {{and}} [[Streptomycin]] 1 g/day IM for 2-3 weeks | ||
:* Alternative regimen (1): [[Doxycycline]] 100 mg/day PO for six weeks {{and}}[[Gentamicin]] 5mg/kg IM for 7-days | :* Alternative regimen (1): [[Doxycycline]] 100 mg/day PO for six weeks {{and}}[[Gentamicin]] 5mg/kg IM for 7-days | ||
Revision as of 13:10, 2 July 2015
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Overview
Brucella is a genus of Gram-negative bacteria.[1] They are small (0.5 to 0.7 by 0.6 to 1.5 µm), non-motile, encapsulated coccobacilli.
Brucella is the cause of brucellosis, a true zoonotic disease (i.e. human-to-human transmission has not been identified).[1] It is transmitted by ingesting infected food, direct contact with an infected animal, or inhalation of aerosols. Minimum infectious exposure is between 10 - 100 organisms. Brucellosis primarily occurs through occupational exposure (e.g. exposure to cattle, sheep, pigs), but also by consumption of unpasteurised milk products.
There are a few different species of Brucella, each with a slightly different presentation, such as B. melitensis, B. abortus, B. suis and B. citicosis.
Laboratory isolation
Brucella are slow-growing, but may be isolated from normal blood cultures using standard media. In traditional blood culture media, prolonged incubation (up to 6 weeks) may be required, but on modern automated machines the cultures often come positive within seven days. On Gram stain they appear as dense clumps of Gram-negative coccobacilli and are exceedingly difficult to see.
Laboratory acquired brucellosis is common.[2] This most often happens when the disease is not thought of until cultures become positive, by which time the specimens have already been handled by a number of laboratory staff. The idea of preventative treatment is to stop people who have been exposed to Brucella from becoming unwell with the disease.
There are no clinical trials to be relied on as a guide for optimal treatment, but a three week course of rifampicin and doxycycline twice daily is the combination most often used, and appears to be efficacious;[2][3] the advantage of this regimen is that it can be taken by mouth and there are no injections, however, a high rate of side effects (nausea, vomiting, loss of appetite) has also been reported.[3]
Blue light study
In a study published in Science magazine in August of 2007, it was revealed that Brucella reacts strongly to the presence of the blue spectrum in natural light, reproducing at a great rate and becoming infectious. Conversely, depriving Brucella of the blue wavelengths dropped its reproductive rate by 90%, a result one of the co-authors called "spectacular."[4][5]
Treatment
- Preferred regimen: Doxycycline 100 mg PO bid for 6 weeks AND Streptomycin 1 g/day IM for 2-3 weeks
- Alternative regimen (1): Doxycycline 100 mg/day PO for six weeks ANDGentamicin 5mg/kg IM for 7-days
- Alternative regimen (2): Gentamicin 5mg/kg/dayIV/ IM for 7-10 days AND Rifampicin 600–900 mg/day PO for six weeks
- 2.Complications of brucellosis
- 2.1Spondylitis
- Preferred regimen:Doxycycline for 3 months AND Streptomycin for 2 to 3 weeks.
- 2.2 Neurobrucellosis
- Preferred regimen: Ceftriaxone 2 mg IV bid for 1 month AND Doxycycline 100 mg PO bid for 4-5 month AND Rifampicin 600–900 mg/day PO for 4-5 month
- 2.3 Brucella endocarditis
- Preferred regimen: Doxycycline AND an Aminoglycoside for at least 8 weeks, and therapy should be continued for several weeks after surgery when valve replacement is necessary
- NOTE: Rifampicin OR Trimethoprim/sulfamethoxazole are used for their ability to penetrate cell membranes
- 3. Pregnancy
- Preferred regimen:Rifampin 900 mg PO qd for 6 weeks
- NOTE: Adding Trimethoprim-sulfamethoxazole can be considered, but this option should probably be avoided preceding the 13th week and after the 36th week of gestation because of concern about teratogenicity and kernicterus Co-trimoxazole has been used in individual cases with reported success.
- 4.For children < eight years of age
- Preferred regimen: TMP/SMZ 8/40 mg/ kg/day bid PO for 6 weeks AND Streptomycin 30 mg/kg/day IM qd for 3 weeks OR Gentamicin 5 mg/kg/day IM/ IV qd for 7-10 days
- Alternative regimen (1): TMP/SMZ AND Rifampicin 15 mg/kg/day PO for 6 weeks
- Alternative regimen (2): Rifampicin AND an Aminoglycoside
References
- ↑ 1.0 1.1 Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed. ed.). McGraw Hill. ISBN 0-8385-8529-9.
- ↑ 2.0 2.1 Robichaud S, Libman M, Behr M, Rubin E (2004). "Prevention of laboratory-acquired brucellosis". Clin. Infect. Dis. 38 (12): e119–22. doi:10.1086/421024. PMID 15227634.
- ↑ 3.0 3.1 Maley MW, Kociuba K, Chan RC (2006). "Prevention of laboratory-acquired brucellosis: significant side effects of prophylaxis". Clin. Infect. Dis. 42 (3): 433–4. doi:10.1086/499112. PMID 16392095.
- ↑ "Deadly in the Daylight" August 23, 2007 in ScienceNOW Daily News. Accessed September 8, 2007.
- ↑ [http://www.sciencemag.org/cgi/content/abstract/317/5841/1090 "Blue-Light-Activated Histidine Kinases: Two-Component Sensors in Bacteria "], August 24 2007, Science Vol. 317:5841, pp. 1090 - 1093 Accessed September 8, 2007.
- ↑ Corbel, Michael (2006). Brucellosis in humans and animals. Geneva: World Health Organization. ISBN 9241547138.
- ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
External links