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Public Health Solutions
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Crete, NE 68333-2562
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Brucellosis
What is brucellosis?
Brucellosis is an infectious disease caused by the bacteria of the genus Brucella. These bacteria are primarily passed among animals, and they cause disease in many different vertebrates. Various Brucella species affect sheep, goats, cattle, deer, elk, pigs, dogs, and several other animals. Humans become infected by coming in contact with animals or animal products that are contaminated with these bacteria. In humans brucellosis can cause a range of symptoms that are similar to the flu and may include fever, sweats, headaches, back pains, and physical weakness. Severe infections of the central nervous systems or lining of the heart may occur. Brucellosis can also cause long-lasting or chronic symptoms that include recurrent fevers, joint pain, and fatigue.
How common is brucellosis?
Brucellosis is not very common in the United States, where 100 to 200 cases occur each year. But brucellosis can be very common in countries where animal disease control programs have not reduced the amount of disease among animals.
Where is brucellosis usually found?
Although brucellosis can be found worldwide, it is more common in countries that do not have good standardized and effective public health and domestic animal health programs. Areas currently listed as high risk are the Mediterranean Basin (Portugal, Spain, Southern France, Italy, Greece, Turkey, North Africa), South and Central America, Eastern Europe, Asia, Africa, the Caribbean, and the Middle East. Unpasteurized cheeses, sometimes called "village cheeses," from these areas may represent a particular risk for tourists.
How is brucellosis transmitted to humans, and who is likely to become infected?
Humans are generally infected in one of three ways: eating or drinking something that is contaminated with Brucella, breathing in the organism (inhalation), or having the bacteria enter the body through skin wounds. The most common way to be infected is by eating or drinking contaminated milk products. When sheep, goats, cows, or camels are infected, their milk is contaminated with the bacteria. If the milk is not pasteurized, these bacteria can be transmitted to persons who drink the milk or eat cheeses made it. Inhalation of Brucella organisms is not a common route of infection, but it can be a significant hazard for people in certain occupations, such as those working in laboratories where the organism is cultured. Inhalation is often responsible for a significant percentage of cases in abattoir employees. Contamination of skin wounds may be a problem for persons working in slaughterhouses or meat packing plants or for veterinarians. Hunters may be infected through skin wounds or by accidentally ingesting the bacteria after cleaning deer, elk, moose, or wild pigs that they have killed.
Can brucellosis be spread from person to person?
Direct person-to-person spread of brucellosis is extremely rare. Mothers who are breast-feeding may transmit the infection to their infants. Sexual transmission has also been reported. For both sexual and breast-feeding transmission, if the infant or person at risk is treated for brucellosis, their risk of becoming infected will probably be eliminated within 3 days. Although uncommon, transmission may also occur via contaminated tissue transplantation.
Is there a way to prevent infection?
Yes. Do not consume unpasteurized milk, cheese, or ice cream while traveling. If you are not sure that the dairy product is pasteurized, don't eat it. Hunters and animal herdsman should use rubber gloves when handling viscera of animals. There is no vaccine available for humans.
My dog has been diagnosed with brucellosis. Is that a risk for me?
B. canis is the species of Brucella species that can infect dogs. This species has occasionally been transmitted to humans, but the vast majority of dog infections do not result in human illness. Although veterinarians exposed to blood of infected animals are at risk, pet owners are not considered to be at risk for infection. This is partly because it is unlikely that they will come in contact with blood, semen, or placenta of the dog. The bacteria may be cleared from the animal within a few days of treatment; however re-infection is common and some animal body fluids may be infectious for weeks. Immunocompromised persons (cancer patients, HIV-infected individuals, or transplantation patients) should not handle dogs known to be infected with B. canis.
How is brucellosis diagnosed?
Brucellosis is diagnosed in a laboratory by finding Brucella organisms in samples of blood or bone marrow. Also, blood tests can be done to detect antibodies against the bacteria. If this method is used, two blood samples should be collected 2 weeks apart.
Is there a treatment for brucellosis?
Yes, but treatment can be difficult. Doctors can prescribe effective antibiotics. Usually, doxycycline and rifampin are used in combination for 6 weeks to prevent reoccuring infection. Depending on the timing of treatment and severity of illness, recovery may take a few weeks to several months. Mortality is low (<2%), and is usually associated with endocarditis.
What are the recommendations for post-exposure prophylaxis (PEP) to prevent brucellosis?
Interim PEP recommendations are:
Doxycycline 100 mg orally twice a day plus rifampin 600 mg orally once a day for 21 days.
Note: PEP recommendations for B. abortus RB51 (attenuated vaccine strain) differ from those for fully pathogenic Brucella spp. As RB51 was derived by selection in rifampin-enriched media and is resistant to rifampin in vitro, the use of rifampin for PEP or treatment will not be effective for RB51. Post-exposure prophylaxis for those at high risk of exposure should include doxycycline 100 mg orally twice daily for at least 21 days. For those with contraindication to doxycycline, trimethoprim-sulfamethoxazole may be used.
After a potential laboratory exposure, all individuals classified as high-risk should begin PEP. PEP should be discussed with, and offered to, laboratory workers with low-risk exposures. For women who are pregnant, PEP should be considered in consultation with their obstetricians.
Serial serum specimens should be monitored for all exposed workers. Obtain baseline serum as soon as possible after the exposure has been recognized, and obtain available pre-exposure stored specimens. Arrange for serologic testing (Brucella microagglutination testing) at 2, 4, 6, and 24 weeks. These tests will monitor for the development of infection and can be performed at your state public health laboratory or CDC.
Note: RB51 does not induce a measurable antibody response. Monitoring serum specimens in individuals exposed to RB51 will not provide a useful indicator of infection.
How long should exposed workers be observed for the development of illness?
All exposed individuals, regardless of risk status, should be monitored for the development of symptoms. From the last exposure, temperature should be actively monitored for fever for four weeks. Broader symptoms of brucellosis should be passively monitored for six months from the last exposure. These symptoms include:
Acutely: fever, chills, headache, low back pain, joint pain, malaise, occasionally diarrhea
Sub-acutely: malaise, muscle pain, headache, neck pain, fever, sweats
Chronically: anorexia, weight loss, abdominal pain, joint pain, headache, backache, weakness, irritability, insomnia, depression, constipation.
Source: www.cdc.gov
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