Brucella Infections: Assessment And Management

Year 2016, , 25 - 30, 30.09.2016

Selim Öncel

https://doi.org/10.30934/kusbed.358664

Cited By: 6

Abstract

The causative agent of brucellosis was discovered in 1887 by David Bruce, who was a physician in British military corps in Malta. Vehicles for animal to human transmission are unpasteurized milk, milk products, and raw meat; whereas human to human transmission occurs by means of blood, exudate, genital secretions (during sexual intercourse or birth), and human milk. Brucella escapes the lysosomal enzyme killing of macrophages by altering the intracellular environment. Brucella causes protean clinical manifestations ranging from fever to behavioral changes. Any organ may be involved. Diagnosis is made in a patient with clinical findings consistent with brucellosis and a definitive test, such as bacterial culture or serum agglutination test. Therapy is a combination of tetracyclines, co-trimoxasole, aminoglycosides, and rifampin. For laboratory workers who have inadvertently been exposed to Brucella, chemoprophylaxis is recommended. As of today, no human vaccine, that is sufficiently effective and safe, exists for Brucella - a potential bioweapon.

Keywords

Brusella vaccine, Brucella canis, Brucella melitensis, Brucella suis, brucellosis

Brusella Enfeksiyonları: Değerlendirme Ve Yönetim

Abstract

Brusella enfeksiyonunun etkeni, 1887'de Malta'daki Britanya askeri birliklerinde bir hekim olarak çalışan David Bruce tarafından saptanmıştır. Bruselloz, dünyadaki en yaygın zoonoz olup her yıl 500 000 vaka bildirilmektedir. Türkiye'deki insidansı 12-50/100 000'dir. Brusella bütünlüğü bozulmuş ciltten, mukozadan, plasentadan geçerek ve solunum yoluyla bulaşabilir. Bulaşma araçları hayvanlardan insana, pastörize edilmemiş çiğ süt ve ürünleri ile az pişmiş et; insandan insana ise kan, eksuda, genital salgılar (cinsel ilişki, doğum kanalından geçiş sırasında) ve anne sütüdür. Brusella, makrofajların lizozomal enzimlerinden hücre içi ortamını değiştirerek korunur ve yüksek ateşten davranış değişikliklerine uzanan geniş bir yelpazede klinik bulgulara neden olur. Bütün organlar tutulabilir. Brusellozun tanısı, brusellozla uyumlu bulguları olan bir hastada bakteri kültürü veya serum aglütinasyon testi gibi doğrulayıcı testlerle konur. Tedavide tetrasiklinler, kotrimoksazol, aminoglikozitler ve rifampinin çeşitli kombinasyonları kullanılmaktadır. Laboratuar çalışanlarının brusellaya yanlışlıkla maruz kalmaları durumunda kemoprofilaksi önerilmektedir. Potansiyel bir biyosilah olan brusellanın şu an için yeterince etkili ve güvenli bir aşısı yoktur.

Keywords

Brusella aşısı, Brucella canis, Brucella melitensis, Brucella suis, bruselloz

References

• Centers for Disease Control and Prevention. Brucellosis - Humans and Brucella Species [Internet]. Brucellosis Homepage. 2012 [Kaynağa 27 Şubat 2015 tarihinde http://www.cdc.gov/brucellosis/clinicians/brucella-species.html adresinden erişildi.].
• Madkour MM. Madkour Bruselloz. Springer-Verlag. Berlin 2001. Çev. Zeki Yumuk, Nobel Tıp Kitabevleri, İstanbul, 2008.
• DynaMed Editorial Team. Brucellosis. DynaMed [Internet]. 2014 Mar 18. Ipswich (MA): EBSCO Information Services; 2014 [Kaynağa 24 Şubat 2015 tarihinde http://www.ebscohost.com/dynamed adresinden erişildi.].
• Corbel MJ, World Health Organization. Brucellosis in Humans and Animals (1. Baskı). World Health Organization, Cenevre, 2007.
• Franco MP, Mulder M, Gilman RH ve diğ. Human brucellosis. Lancet Infect Dis. 2007;7(12):775–786.
• Yagupsky P. Pediatric brucellosis: an (almost) forgotten disease. Adv Exp Med Biol. 2011;719:123–132.
• Mantur BG, Amarnath SK, Shinde RS. Review of clinical and laboratory features of human brucellosis. Indian J Med Microbiol. 2007;25(3):188–202.
• Centers for Disease Control and Prevention (CDC). Summary of notifiable diseases--United States, 2010. MMWR Morb Mortal Wkly Rep. 2012;59(53):1–111.
• Dean AS, Crump L, Greter H ve diğ. Global burden of human brucellosis: a systematic review of disease frequency. PLoS Negl Trop Dis. 2012;6(10):e1865. doi:10.1371/journal.pntd.0001865.
• Foster G, Osterman BS, Godfroid J ve diğ. Brucella ceti sp. nov. and Brucella pinnipedialis sp. nov. for Brucella strains with cetaceans and seals as their preferred hosts. Int J Syst Evol Microbiol. 2007;57(Pt 11):2688–2693.
• Memish ZA, Balkhy HH. Brucellosis and international travel. J Travel Med. 2004;11(1):49–55.
• Doganay GD, Doganay M. Brucella as a potential agent of bioterrorism. Recent Patents Anti-Infect Drug Disc. 2013;8(1):27–33.
• American Academy of Pediatrics. Brucellosis. Red Book: 2012 Report of the Committee on Infectious Diseases, 29. Baskı, LK Pickering, CJ Baker, A Kimberlin, W David, SS Long (Ed), Elk Grove Village. American Academy of Pediatrics, 2012; s. 256–258.
• Zamani A, Kooraki S, Mohazab RA ve diğ. Epidemiological and clinical features of Brucella arthritis in 24 children. Ann Saudi Med. 2011;31(3):270–273.
• Tassinari E, Di Motta D, Giardina F ve diğ. Brucella infection in total knee arthroplasty. Case report and revision of the literature. Chir Organi Mov. 2008;92(1):55–59.
• Kasim RA, Araj GF, Afeiche NE, Tabbarah ZA. Brucella infection in total hip replacement: case report and review of the literature. Scand J Infect Dis. 2004;36(1):65–67.
• Weil Y, Mattan Y, Liebergall M ve diğ. Brucella prosthetic joint infection: a report of 3 cases and a review of the literature. Clin Infect Dis Off Publ Infect Dis Soc Am. 2003;36(7):e81–86. doi:10.1086/368084.
• Tena D, Romanillos O, Rodríguez-Zapata M ve diğ. Prosthetic hip infection due to Brucella melitensis: case report and literature review. Diagn Microbiol Infect Dis. 2007;58(4):481–485.
• Guven T, Ugurlu K, Ergonul O ve diğ. Neurobrucellosis: clinical and diagnostic features. Clin Infect Dis Off Publ Infect Dis Soc Am. 2013;56(10):1407–1412.
• Dean AS, Crump L, Greter H ve diğ. Clinical manifestations of human brucellosis: a systematic review and meta-analysis. PLoS Negl Trop Dis. 2012;6(12):e1929. doi:10.1371/journal.pntd.0001929.
• Amirghofran AA, Karimi A, Emaminia A ve diğ. Brucellosis relapse causing prosthetic valve endocarditis and aortic root infective pseudoaneurysm. Ann Thorac Surg. 2011;92(4):e77–79. Doi:10.1016/j.athoracsur.2011.03.144.
• Botta L, Bechan R, Yilmaz A ve diğ. Prosthetic valve endocarditis due to Brucella: successful outcome with a combined strategy. J Cardiovasc Med Hagerstown Md. 2009;10(3):257–258.
• Sungur GK, Hazirolan D, Gurbuz Y ve diğ. Ocular involvement in brucellosis. Can J Ophthalmol J Can Ophtalmol. 2009;44(5):598–601.
• Al-Tawfiq JA. Therapeutic options for human brucellosis. Expert Rev Anti Infect Ther. 2008;6(1):109–120.
• Mantur BG, Mulimani MS, Bidari LH ve diğ. Bacteremia is as unpredictable as clinical manifestations in human brucellosis. Int J Infect Dis IJID Off Publ Int Soc Infect Dis. 2008;12(3):303–307.
• Ulu-Kilic A, Metan G, Alp E. Clinical presentations and diagnosis of brucellosis. Recent Patents Anti-Infect Drug Disc. 2013;8(1):34–41.
• Sisirak M, Hukić M. Evaluation and importance of selected microbiological methods in the diagnosis of human brucellosis. Bosn J Basic Med Sci Udruženje Basičnih Med Znan Assoc Basic Med Sci. 2009;9(3):198–203.
• Ruiz-Mesa JD, Sánchez-Gonzalez J, Reguera JM ve diğ. Rose Bengal test: diagnostic yield and use for the rapid diagnosis of human brucellosis in emergency departments in endemic areas. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis. 2005;11(3):221–225.
• Pappas G, Akritidis N, Bosilkovski M ve diğ. Brucellosis. N Engl J Med. 2005;352(22):2325–2336.
• Memish ZA, Almuneef M, Mah MW ve diğ. Comparison of the Brucella Standard Agglutination Test with the ELISA IgG and IgM in patients with Brucella bacteremia. Diagn Microbiol Infect Dis. 2002;44(2):129–132.
• Mantur BG, Amarnath SK, Parande AM ve diğ. Comparison of a novel immunocapture assay with standard serological methods in the diagnosis of brucellosis. Clin Lab. 2011;57(5-6):333–341.
• Navarro E, Segura JC, Castaño MJ ve diğ. Use of real-time quantitative polymerase chain reaction to monitor the evolution of Brucella melitensis DNA load during therapy and post-therapy follow-up in patients with brucellosis. Clin Infect Dis Off Publ Infect Dis Soc Am. 2006;42(9):1266–1273.
• Queipo-Ortuño MI, Colmenero JD, Baeza G ve diğ. Comparison between LightCycler Real-Time Polymerase Chain Reaction (PCR) assay with serum and PCR-enzyme-linked immunosorbent assay with whole blood samples for the diagnosis of human brucellosis. Clin Infect Dis Off Publ Infect Dis Soc Am. 2005;40(2):260–264.
• Al-Sous MW, Bohlega S, Al-Kawi MZ ve diğ. Neurobrucellosis: clinical and neuroimaging correlation. AJNR Am J Neuroradiol. 2004;25(3):395–401.
• Press J, Peled N, Buskila D ve diğ. Leukocyte count in the synovial fluid of children with culture-proven brucellar arthritis. Clin Rheumatol. 2002;21(3):191–193.
• Andonopoulos AP, Asimakopoulos G, Anastasiou E ve diğ. Brucella arthritis. Scand J Rheumatol. 1986;15(4):377–380.
• Solera J. Update on brucellosis: therapeutic challenges. Int J Antimicrob Agents. 2010;36(Suppl)1:S18–20.
• Yousefi-Nooraie R, Mortaz-Hejri S, Mehrani M ve diğ. Antibiotics for treating human brucellosis. Cochrane Database Syst Rev. 2012;10:CD007179.
• Solera J, Geijo P, Largo J ve diğ. A randomized, double-blind study to assess the optimal duration of doxycycline treatment for human brucellosis. Clin Infect Dis Off Publ Infect Dis Soc Am. 2004;39(12):1776–1782.
• Skalsky K, Yahav D, Bishara J ve diğ. Treatment of human brucellosis: systematic review and meta-analysis of randomised controlled trials. BMJ. 2008;336(7646):701–704.
• Khan MY, Mah MW, Memish ZA. Brucellosis in pregnant women. Clin Infect Dis Off Publ Infect Dis Soc Am. 2001;32(8):1172–1177.
• Buzgan T, Karahocagil MK, Irmak H ve diğ. Clinical manifestations and complications in 1028 cases of brucellosis: a retrospective evaluation and review of the literature. Int J Infect Dis IJID Off Publ Int Soc Infect Dis. 2010;14(6):e469–478. doi: 10.1016/j.ijid.2009.06.031.
• Solera J, Martínez-Alfaro E, Espinosa A ve diğ. Multivariate model for predicting relapse in human brucellosis. J Infect. 1998;36(1):85–92.
• Ariza J, Corredoira J, Pallares R ve diğ. Characteristics of and risk factors for relapse of brucellosis in humans. Clin Infect Dis Off Publ Infect Dis Soc Am. 1995;20(5):1241–1249.
• Centers for Disease Control and Prevention. Brucellosis - Treatment [Internet]. Brucellosis Homepage. 2012 [Kaynağa 26 Şubat 2015 tarihinde http://www.cdc.gov/brucellosis/treatment/index.html adresinden erişildi.].
• Koruk ST, Erdem H, Koruk I ve diğ. Management of Brucella endocarditis: results of the Gulhane study. Int J Antimicrob Agents. 2012;40(2):145–150.
• Centers for Disease Control and Prevention. Brucellosis - Prevention [Internet]. Brucellosis Homepage. 2012 [Kaynak 26 Şubat 2015 tarihinde http://www.cdc.gov/brucellosis/prevention/index.html adresinden erişildi.].
• Centers for Disease Control and Prevention. Brucellosis - Assessing Laboratory Risk Level and PEP [Internet]. Brucellosis Homepage. 2012 [Kaynağa 27 Şubat 2015 tarihinde www.cdc.gov/brucellosis/laboratories/risk-level.html adresinden erişildi.].
• United States of America Department of Energy. Final Revised Environmental Assessment for The Proposed Construction and Operation of a Biosafety Level 3 Facility at Lawrence Livermore National Laboratory, Livermore, California [Internet]. Department of Energy, National Nuclear Security Administration, Livermore Site Office; 2008 [Kaynağa 27 Şubat 2015 tarihinde https://wwwenvirinfo.llnl.gov/content/enviroRecent/livermoreSite/BSL-3_EA_Final_Revised_25Jan08.pdf adresinden erişildi.].
• Centers for Disease Control and Prevention. Recommendations for Safe Laboratory Practices [Internet]. Brucellosis Homepage. 2012 [Kaynağa 27 Şubat 2015 tarihinde http://www.cdc.gov/brucellosis/laboratories/safety.html adresinden erişildi.].
• Almuneef MA, Memish ZA, Balkhy HH ve diğ. Importance of screening household members of acute brucellosis cases in endemic areas. Epidemiol Infect. 2004;132(3):533–540.
• Siadat SD, Salmani AS, Aghasadeghi MR. Brucellosis Vaccines: An Overview. Zoonosis Dr. Jacob Lorenzo-Morales (Ed), Rijeka. InTech, 2012; s. 143-167.