Brucellosis (Brucella melitensis, abortus, suis, and canis)

 

Purpose

 

To recommend procedures for handling potential biological threats of Brucellosis exposure.

 

Description of Agent/Syndrome

 

Brucellosis is an infectious disease caused by the bacteria of the genus Brucella. These bacteria are primarily passed among animals, and cause disease in many different vertebrates.

 

Transmission

 

1.    Naturally acquired

 

a)         Most common way: by eating or drinking non-pasteurized milk or milk products.

 

b)         Contamination of skin wounds may be a problem for persons working in slaughterhouses, meatpacking plants or for veterinarians. Hunters may be infected through skin wounds by accidentally ingesting the bacteria after cleaning deer, elk, moose, or wild pigs they have killed.

 

c)         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 forms of transmission, if the infant or person at risk is treated their risk of becoming infected will probably be eliminated within 3 days

 

2.         Inhalation Dissemination

                

a)         Inhalation of Brucella organisms is not a common route of infection. It is a significant hazard for people in certain occupations, such as those working in laboratories where the organism is cultured.

 

 

3.         Intentional (possible terrorist action) – slurry of bomblets.

 

 

Incubation

 

6—60     days

 

Signs and Symptoms

 

  1. Clinical presentations include 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.

 

  1. Acute Form:                     <8 weeks from onset, “flu-like” symptoms including fever,
                                                          sweats, malaise, anorexia, headache, myalgia, and back
                                                          pain.

 

  1. Undulant Form:              <1 year from onset, undulant fevers, arthritis, and
                                                          orchiepididymitis in young males.

 

  1. Chronic Form:                >1 year from onset, symptoms may mimic chronic fatigue syndrome,

                                                                       with episodes of depression.

 

Diagnosis

 

1.             A serum tube agglutination test is the usual diagnostic method. Cultures must be kept for at least 6 weeks with periodic blind subculturing onto enriched agar plates.

 

2.             Brucellosis is diagnosed in a laboratory by culturing Brucella organisms in samples of blood or bone marrow.

 

Treatment

 

Patients should be treated with combinations of antibiotics, as treatment with single agents leads to poor response of relapse. A combination of 200 mg/d of doxycycline orally and 600 to 900 mg/d of rifampin orally for 6 weeks is usually the treatment of choice. Trimethoprim­sulfamethoxazole may be substituted for rifampin.

 

Prophylaxis

 

Chemoprophylaxis is not recommended. No human vaccine available.

 

Control Measures and Decontamination

 

Standard Precautions 

Contact Precautions

Isolation

 

Notification

 

Internal:       At hospital notify ________.

 

External:    All suspected cases of suspected brucellosis exposure are Class A3 Reportable and should be reported immediately to the Local Health Department who will then contact the State Health Department and/or CDC.

 

Lab

 

Due to potential risks associated with handling infectious materials, laboratory testing should be the minimum necessary for diagnostic evaluation and patient care. Laboratory specimens should be placed in plastic bags that are sealed, and then transported in clearly labeled, durable, leak-proof sterile containers directly to the specimen handling area of the laboratory. Care should be taken not to contaminate the external surfaces of the container. Lab personnel should be notified of what they are handling. Bio-Safety Level 2 should be used for handling specimens. Because of the highly infection nature of some Brucella spp. (BLS 3), laboratory consultation with the state public health laboratory is recommended if Brucella spp. is suspected.

 

BRUCELLOSI S (brucella species, incl B abortus, B ovus; B suis)

2 Red-top or Gold-Top Tubes (for serology)

B2 Blood culture same as others

Body fluid, bone marrow, spleen, liver or abscess if applicable

ID Consult

Note on requisition

Possible Brucellosis exposure in an asymptomatic patient

No

No

No

No

Not applicable

Brucellosis, symptomatic

Yes

Yes

If appropriate

Yes

R/OP Brucella

 

 

         

 

References

 

Brucellosis: an Overview

http://www.cdc.gov/ncidod/diseases/submenus/sub_brucellosis.htm

 

JAMA, August 6,1997-Vol 278, No.5 — Exposure to Biological Warfare Agents-Franz at al

 

 

Note:    These are guidelines that have been developed with data available as of 5/9/02.

 

 

Initially Prepared by

The Akron Regional Hospital Association

Emergency Preparedness Subcommittee

August 20, 2002