Symptoms and treatment of brucellosis in a person likeinfection occurs, complications, prognosis

Update: October 2018

Brucellosis is an infection caused by several types of bacteria.
kind of brucella. The disease is transmitted from animals to humans, more often –
with unpasteurized milk, cheese and other dairy
products.

Although in the developed countries of Europe and the United States the disease is not
widespread, it affects hundreds of thousands of people around the world.
For example, if the United States registers no more than 200 cases annually,
то во всем мире заболеваемость составляет 500 000 случаев
annually.

As a separate disease, brucellosis in humans has
minimum occurrence in EU member states. Annually in
only a few confirmed
incidents mainly among tourists arriving from endemic regions
or immigrants. The maximum incidence among European
States is registered in Spain.

Eastern European countries are not at risk of infection
brucellosis. In Poland, rare cases of morbidity are noted.
only veterinarians and visitors from the Mediterranean countries. AT
Russia, the increased incidence of brucellosis is present
only in the Caucasus. For example, in Dagestan, 100 cases are recorded.
per 1 million population.

The region with the highest incidence is the Middle East. AT
five out of ten countries with the highest frequency
заболеваемости brucellosis. The country with the highest performance
worldwide incidence is Syria (more than 15 thousand cases
annually). Potentially dangerous countries should also be considered
Iran, Saudi Arabia, Mongolia, Kyrgyzstan, Armenia, Georgia,
Uzbekistan and Turkmenistan.

How can you get sick?

Brucellosis in humans develops after contact with an animal (cows,
pigs, sheep, goats, less often horses, camels, etc.) or product
животноводства, зараженным бактерией Brucella. Highly
rarely can bacteria also be transmitted from person to person, in
including sexually.

In a sick animal, the release of the pathogen occurs:

  • with milk
  • with amniotic fluid
  • with feces (urine, feces)

Попадание возбудителя в организм человека  происходит:

  • By the fecal-oral route, that is, through food and fluid,
    seeded with bacteria (especially unpasteurized milk, koumiss,
    cheese, cheese or raw meat)
  • By production of products from skin and wool of animals (at
    processing of animal raw materials)
  • Cuts and scratches on the skin, that is, through microtrauma on
    mucous and skin care for animals
  • Respiratory tract (bacteria inhalation with air)
  • With their excrements, animals pollute water, land, food –
    подвергая человека риску  заражения бруцеллезом непищевым
    by.

People have a high susceptibility to brucellosis, after
infection transmission for 6-9 months remains immune.
Re-infection with brucella is observed in 2-7% of cases.
Usually, one of the 4 main types causes the disease.
pathogens:

  • Brucella Melitensis. Most cases of brucellosis in humans.
    The source is sheep and goats. Distributed in Spain, Greece, Latin
    Америке, на Ближнем ATостоке и в Индии.
  • Brucella Suis. The most common pathogen
    brucellosis in the United States. The source is wild pigs.
  • Brucella Canis. The source of infection is usually dogs.
    Distributed in North, Central and South America, Japan and
    central part of Europe.
  • Brucella abortus. The source of infection is cattle.
    Common everywhere. This species, as the primary pathogen
    diseases, was completely destroyed in several European
    Japan, Israel, Canada, Australia and New
    Zealand.

Can I get infected from my dog?

Dogs may become a carrier of B. Canis. There are several
confirmed cases when brucellosis characteristic of the disease
symptoms developed in owners of infected dogs, but the course
the disease in these cases was mild and patients quickly
cured without serious consequences.

Infected with brucellosis from a dog is very difficult, since the main
the path of infection is food. The only exceptions are
veterinarians constantly in contact with bodily fluids
animals (blood, saliva).

Risk factors

AT США бруцеллез более часто встречается у мужчин. Usually this
people working or once working in the field of animal husbandry. Have
children disease is rare.

Risk factors for brucellosis include:

  • Haveпотребление в пищу непастеризованных молочных продуктов, в том
    the number of cheeses, called “country”, especially brought from
    endemic regions (Mediterranean)
  • Travel or business trips to areas with high
    morbidity
  • Work at a slaughterhouse or slaughterhouse
  • Work in agriculture, rural life
    terrain

Also at high risk are veterinarians,
working with brucellosis vaccines, and hunters.

Symptoms of the disease

Early brucellosis in a person whose symptoms are very
similar to flu or other viral infections, very difficult
diagnose. To initial manifestations of brucellosis include:

  • Temperature increase with high “candles” in day and
    evening time (the most common sign of brucellosis)
  • Back pain, pain or burning in the limbs
  • Poor appetite and weight loss.
  • Headache, night sweats, weakness

After penetration into the body of the pathogen causing
brucellosis, symptoms in humans occur in 5 to 30 days (in
on average, 2-3 weeks), with latent carriage can be lengthened
до 3 months. The severity of the flow depends on the type of pathogen:

  • B. abortus causes mild manifestations. condition
    the patient is regarded as mild or moderate severity, but
    the disease often becomes chronic.
  • Symptoms of the disease, вызванного B. canis могут иметь
    transient character. The course is similar to infection caused by B.
    abortus, but more often vomiting and diarrhea.
  • B. suis may cause the formation of abscesses in various
    organs.
  • B. melitensis causes severe course with a sudden onset.
    Such a disease can lead to disability of the patient.

Protracted (chronic) course of brucellosis
constant, increasing weakness, apathy, pain in the joints. Such
character has a less favorable prognosis and may lead to
underestimation of the condition and late treatment for medical care.
According to statistics, chronic course several times.
often ends in disability patients.

Acute brucellosis

Have молодых людей и лиц среднего возраста развивается
rapidly, in older people usually gradually:

  • general malaise, feeling of weakness, loss of appetite
  • insomnia (see how to fall asleep quickly), emotional
    lability
  • muscle and joint pain
  • and so for several days, then the temperature is sharp
    rises up for no apparent reason
  • chill alternating with heavy perspiration
  • hectic and intoxicating period lasts up to 3-4
    weeks
  • at the peak of fever – general blanching of the skin, but at the same time
    redness and swelling of the face
  • all patients had an increase in the liver, spleen,
    regional lymph nodes (mainly axillary and cervical,
    which are moderately painful when palpating).

Subacute form

  • The febrile state alternates with periods of normal or
    low-grade body temperature, at high temperatures possible
    the occurrence of bradycardia (mismatch of heart rate)
    body temperature), weakness, goosebumps in different parts
    тела, muscle and joint pain. At normal temperature sick
    experiencing thirst, constipation, dry mouth, increased heart rate.
  • There are dense formations, the size of a pea or chicken
    the egg along the muscles and tendons, the so-called fibrositis and
    cellulite
  • Signs of allergic reactions appear – vascular
    disturbances, dermatitis, rash.
  • Also suffer the joints of the patient – bursitis, polyarthritis,
    tendovaginitis.
  • Have мужчин бруцеллез может поражать яички и их придатки, у женщин
    – endometritis and menstrual disorders occur, with
    pregnancy can cause premature birth or miscarriage.
  • With severe infection there is a risk of developing
    infectious toxic shock, which is complicated by pericarditis –
    inflammation of the lining of the heart.

Chronic brucellosis

  • The duration of the disease increases with re-infection
    and reach 2-3 years
  • In this form, the temperature is rarely above subfebrile,
    relapse occurs after 1-2 months, when another
    infection or virus (flu, cold, etc.)
    getting worse.
  • Symptoms depend on which functional system
    the body is more affected. If the joints, they are often exposed
    deformations and destruction, if the spine develops
    spondylitis, limiting the movement of the patient and causing severe pain.
    Fibrosis and cellulite develop in the elbow joints and in the area
    sacrum and loins.
  • Notредко развиваются невриты, такие как неврит лицевого нерва,
    auditory or optic nerve, sciatica, paresthesia, inflammation
    nerve plexus and even reactive neurosis.
  • ATстречаются расстройства фертильности — импотенция у мужчин
    (see drugs to increase potency), infertility in women,
    allergic inflammation of the genital glands.
  • A prolonged course of the disease leads to irreversible changes.
    in joints and ligaments – muscle atrophy, spondylosis, ankylosis, that
    requires surgical intervention.

Residual brucellosis is the so-called delayed
consequences of infection when pathological
reactivity. An immunological rearrangement occurs, which
accompanied by pathology of the joints, low-grade fever,
psychological changes.

Treatment

The main goal of treatment for brucellosis is to control symptoms and
preventing their further deterioration. The main principle of therapy is
multicomponent antibacterial treatment, as in most cases
cases, there was a lack of effect from the use of any
single antibiotic.

Antibiotics

Although under laboratory conditions, many antibiotics demonstrate
high activity against brucella, only a few drugs
really effective when used in medical practice:

  • Doxycycline
  • Gentamicin
  • Streptomycin
  • Rifampicin
  • Trimethoprim-sulfamethoxazole

Treatment of brucellosis in mild disease can begin with
use of one antibiotic – doxycycline tablets of 100 mg two
once a day for 6 weeks. However, in this case often
there is no effect (40% of cases), therefore in treatment add
rifampicin at a dosage of 600 – 900 mg / day. In regions with increased
frequency of pathogens resistance to rifampicin is preferable
use other combinations described below.

WHO recommendations for the treatment of severe brucellosis in adults and
Children over 8 years old include the following treatment regimens:

  • Doxycycline 100 мг 2 раа в день + Rifampicin 600-900 мг/сутки.
    Both drugs are taken for 6 weeks;
  • Doxycycline 100 мг 2 раза в день в течение 6 weeks +
    Streptomycin 1 г/сутки внутримышечно в течение 2-3 weeks. This
    the circuit is considered more efficient, especially to prevent
    development of pathogen resistance. As a replacement for streptomycin
    Gentamicin can be used.

The treatment of choice for the treatment of brucellosis in children under 8 years of age
is a combination of rifampicin and trimethoprim. Development frequency
stability in such cases is no more than 5%. Have pregnant
It is recommended to use rifampicin, both separately and in
combination with trimethoprim. It should be borne in mind that
the use of trimethoprim in the third trimester of pregnancy is associated with
high incidence of nuclear jaundice in a child.

Patients with endocarditis should be aggressive.
antibiotic therapy. To do this, use the combination
doxycycline + rifampicin + trimethoprim for 4 weeks,
enhanced by the additional appointment of aminoglycosides in the subsequent
8 – 12 weeks.

Chronic brucellosis is treated with a combination of three antibiotics:
rifampicin, doxycycline and streptomycin.

Corticosteroids

The use of corticosteroids is justified with brucellosis
meningitis Although their purpose is recommended by most
professionals, statistics indicate that
often corticosteroids in such cases are not prescribed at all. Not
there is consensus on dosing regimens, indications for
purpose and duration of treatment with these drugs.

Depending on the severity of other symptoms in patients
prescribe analgesics, anti-inflammatory and other
drugs.

The recovery period takes several weeks or even
months. The treatment prognosis is positive if applied
antibiotics have been started within a month of the appearance
first symptoms.

Surgical treatment of brucellosis is carried out only with the development of
complications (endocarditis – restoration of the heart valves,
opening and drainage of abscesses in the joints and spine).
Usually, treatment of endocarditis involves replacement of the affected valve with
artificial.

Complications

Brucellosis can cause damage to almost any part of the body.
patient, including organs of the reproductive system, liver, heart and
central nervous system. Among the possible complications
celebrate:

  • Endocarditis. This is one of the most serious conditions that
    can lead to disruption of the heart valves. Endocarditis
    – the main cause of death for patients with brucellosis;
  • Arthritis. Infectious inflammation of the joints is characterized by pain,
    stiffness of the movements and swelling in the affected area (usually – in
    knees, ankles, hip, wrists and
    spine);
  • Infectious inflammation of the testicles (epididymo-orchitis). Brucella can
    penetrate the epididymis, the tube connecting the vas deferens and
    testicles. From there, the infection can spread further to the testicles,
    causing swelling and pain;
  • Infectious inflammation of the liver and spleen. With the development
    This complication in a patient has an increase in these organs in
    size and pain appear in the epigastric region;
  • Infections of the central nervous system: meningitis (inflammation
    of the membranes surrounding the brain) and encephalitis (proper
    brain inflammation).

Brucellosis in pregnant women can cause miscarriage,
fetal abnormalities.

Death from brucellosis is rarely recorded. Most of them
are the result of impaired heart function after development
endocarditis.

Prevention

A specific effective brucellosis vaccine for humans is not
exists. The main recommendations for preventing
infections are:

  • Avoid unpasteurized dairy
    products;
  • Hygiene and workers wearing gloves
    Agriculture;
  • Vaccination of domestic animals. Thanks to total vaccination
    cattle brucellosis problem in the US was almost entirely
    eliminated.

Since vaccination is done by live, attenuated bacteria,
then the vaccine in the human body can cause
disease.

After contact with an animal contaminated with bacteria
Brucella, even in the absence of symptoms, requires careful
наблюдение за состоянием пациента в течение 6 months.

Автор: Коробов Никита Александрович врач-анестезиолог

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