Brucellosis

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(Undulant fever, malta fever, abortus fever) 

A zoonotic bacterial infection of acute onset. Common as an occupational disease among people working with infected livestock or associated fresh animal products, for example butchers, farmers, abattoir workers, and vendors of contaminated roasted meat (muchomo). Incubation is 2-4 weeks on average, but it can be from 1 to 8 weeks.

Causes

  • Brucella abortus (cattle)
  • Brucella canis (dog)
  • Brucella melitensis (goats and sheep)
  • Brucella suis (pigs)

Clinical features

  • Intermittent (fluctuating) fever
  • Aches and pains
  • Orchitis (inflammation of the testes)
  • Vertebrae osteomyelitis (uncommon but characteristic)
Differential diagnosis
  • Typhoid fever, malaria, tuberculosis
  • Trypanosomiasis (sleeping sickness)
  • Other causes of prolonged fever

Investigations

  • Blood: complement fixation test or agglutination test (where possible)

Interpretation of serological tests can be difficult, particularly in endemic areas where a high proportion of the population has antibodies against brucellosis. Positive serological test results can persist long after recovery in treated individuals so results have to be interpreted on the basis of the clinical picture.

  • Isolation of the infectious agent from blood, bone marrow, or other tissues by culture

Management

Treatment LOC

Adult and child > 8 years:

  • Doxycycline 100 mg every 12 hours for 6 weeks
    • Child > 8 years: 2 mg/kg per dose 
  • Plus gentamicin 5-7 mg/kg IV daily for 2 weeks
    • Child > 8 years: 7.5 mg/kg daily in 1-3 divided doses
  • Or ciprofloxacin 500 mg twice daily for 2 weeks
    • Child < 12 years: do not use
 HC4

Children below 8 years

  • Cotrimoxazole 24 mg/kg every 12 hours for 6 weeks
  • Plus gentamicin 5-7 mg/kg IV in single or divided doses for 2 weeks

Caution

  • Treatment duration must be adhered to at all times
  • Ciprofloxacin is contraindicated in children <12 years
  • Doxycyline, gentamicin: Contraindicated in pregnancy

 

Prevention

  • Provide public health education on
    • Drinking only pasteurised or boiled milk
    • Careful handling of pigs, goats, dogs, and cattle if a person has wounds or cuts
    • Provide veterinary services for domestic animals