- Apr 2017
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emedicine.medscape.com emedicine.medscape.com
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Brucella can gain entry into the human body through breaks in the skin, mucous membranes, conjunctivae, and respiratory and gastrointestinal (GI) tracts.
Modes of entry
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international tourism and migration
-have you traveled recently? specifically ask about CA, TX, and Mexico
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consumption of illegally imported unpasteurized dairy products from Mexico. Approximately 60% of human brucellosis cases in the United States now occur in California and Texas.
SO INTERESTING. Geographical importance highlighted here
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use of milk and meat products
-do you consumer milk or meat (i.e are you lactose intolerant or vegetarian)?
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North American
-where do you live?
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aerobic
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localize in the reproductive organs of host animals, causing abortions and sterility
Information useful for this: -are you a vet/farmer/etc. ? -do you have pets? -are your pets sterile, do you know?
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by ingestion through infected food products, direct contact with an infected animal, or inhalation of aerosols
modes of transmission
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zoonotic infection
-specifically asking if you have pigs or have been exposed to anything pig-related in the near past?
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placental fluid
If yes to pet, did she give birth recently?
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has the highest age/sex-related incidence in males in their mid-20s.
Are you a male in the mid-20s or from 13-40 years of age?
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www.who.int www.who.int
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The infection is transmitted to humans by animals through direct contact with infected materials like afterbirth or indirectly by ingestion of animal products and by inhalation of airborne agents. Consumption of raw milk and cheese made from raw milk (fresh cheese) is the major source of infection in man. Most of the fresh cheeses are sheep and goat cheese.
Have you come into contact with these? Do you work with livestock?
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www.mayoclinic.org www.mayoclinic.org
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Chronic brucellosis may cause complications in just one organ or throughout your body.
long term effects (sequelae)
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can affect almost any part of your body, including your reproductive system, liver, heart and central nervous system
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very rare in the United States
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bacteria may be spread from animals to people
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Long-term signs and symptoms
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Signs and symptoms are similar to those of the flu
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5 days to 5 months after initial exposure to Brucella species
Ask about traveling history/dairy consumption for at least 6 months, possibly a year?
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initial symptoms(https://www.cdc.gov/brucellosis/symptoms/index.html) are non-specific
Means narrowing down before concluding Bru, need context especially risk of exposure
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www.aphis.usda.gov www.aphis.usda.gov
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This modeof transmissionoccurs whena herd owner buys replacementcattle or domestic bisonthat are infected or have been exposed to infected animals, animal tissues or animal dischargespriortopurchase
Have you come into contact with any infected animals/animal tissues/animal discharges? (or with anyone who may have come into contact with these)
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www.cdc.gov www.cdc.gov
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People who hunt animals may also be at risk
Have you been hunting recently?
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Infected mothers who are breast-feeding may transmit the infection to their infants
-is the friend a woman/has she given given birth recently? important to know for baby's safety and well-being
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meat-packing employees
-are you a meat-packer?
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Bacteria can also enter wounds in the skin/mucous membranes through contact with infected animals.
Do you work in a slaughterhouse, meat-packing facility, or a veterinarian and could have been exposed to an infected animal?
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www.cdc.gov www.cdc.gov
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malaise
"a general feeling of discomfort, illness, or uneasiness whose exact cause is difficult to identify" (Google)
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Initial symptoms can include:
What are the symptoms and how many from this list does the patient have?
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Some signs and symptoms may persist for longer periods of time
Duration of symptoms? Severity of symptoms? Can help determine when it's onset
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www.cdc.gov www.cdc.gov
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wild hogs (feral swine) elk bison caribou moose
Have they been in areas where this would be common (if they haven't participated themselves)?
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www.webmd.com www.webmd.com
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General symptoms of brucellosis are often vague and similar to the flu. They may include: Fever (the most common symptom, with high "spikes" that usually occur in the afternoon) Back pain Body-wide aches and pains Poor appetite and weight loss Headache Night sweats Weakness Abdominal pain Cough
Do you have any flu-like symptoms and how bad have those symptoms been? Have you had vomiting or diarrhea?
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www.cdc.gov www.cdc.gov
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Laboratory tests and a short course of antibiotics
Bacterial! Harmful to unborn children, therefore need to provide prophylaxis if this is possible/likely
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www.cdc.gov www.cdc.gov
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infected include sheep, cattle, goats, pigs, and dogs, among others.
Have you had any contact with any of these animals?
Tags
Annotators
URL
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y unknowingly consume unpasteurized dairy products.
Be skeptical if they have traveled to these areas but report not consuming dairy products - may not realize they have consumed products
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Unpasteurized cheeses (sometimes called "village cheeses
Have you consumed dairy products outside/from outside of the US recently? (how long ago?)
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www.cdc.gov www.cdc.gov
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slaughterhouse workers meat-packing employees veterinarians laboratory workers
Do you work with/around animals or animal remains?
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www.cdc.gov www.cdc.gov
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lthough brucellosis can be found worldwide, it is more common in countries that do not have effective public health and domestic animal health programs.
Have you traveled to any of these countries recently? (In the past year, 6 months, etc.?)
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