Brucellosis, also known as undulant fever, Malta fever, and Bang's disease, is a systemic infection characterized by an undulant (intermittent) fever pattern. While the distribution is worldwide, higher incidence is found in the Mediterranean Basin, South and Central America, Eastern Europe, Asia, Africa, the Caribbean, and the Middle East. Brucellosis is more common in countries without effective
animal disease control programs. Typically a zoonotic infection of farm animals, the disease is produced in humans by infection with the gram-negative coccobacilli of the genus Brucella. Natural infection in humans occurs by skin contact with or ingestion of infected animal tissues or fluids, or through the respiratory tract by inhalation of animal fluid aerosols. The species of Brucella that cause infection in humans are Brucella melitensis (sheep, goats, and camels), Brucella suis (pigs), Brucella ovis (sheep and goats), Brucella abortus (cattle), and rarely Brucella canis (dogs). melitensis are the most common cause of brucellosis in humans. Brucellosis is found globally and is a reportable disease in most countries
The disease causes flu-like symptoms, including fever, weakness, malaise and weight loss
Person-to-person transmission is rare
Brucellosis is a bacterial disease caused by various Brucella species, which mainly infect cattle, swine, goats, sheep and dogs
Brucellosis is a bacterial disease caused by various Brucella species, which mainly infect cattle, swine, goats, sheep and dogs. Humans generally acquire the disease through direct contact with infected animals, by eating or drinking contaminated animal products or by inhaling airborne agents. Most cases are caused by ingesting unpasteurized milk or cheese from infected goats or sheep. Brucellosis is one of the most widespread zoonoses transmitted by animals and in endemic areas, human brucellosis has serious public health consequences. Expansion of animal industries and urbanization, and the lack of hygienic measures in animal husbandry and in food handling, partly account for brucellosis remaining a public health hazard. Who is at risk? Brucellosis is found globally and is a reportable disease in most countries. It affects people of all ages and both sexes. In the general population, most cases are caused by the consumption of raw milk or its derivatives such as fresh cheese. Most of these cases are from sheep and goat products. The disease is also considered an occupational hazard for people who work in the livestock sector. People who work with animals and are in contact with blood, placenta, foetuses and uterine secretions have an increased risk of contracting the disease. This method of transmission primarily affects farmers, butchers, hunters, veterinarians and laboratory personnel. Worldwide, Brucella melitensis is the most prevalent species causing human brucellosis, owing in part to difficulties in immunizing free-ranging goats and sheep. Human-to-human transmission is very rare. Prevention and control
Prevention of brucellosis is based on surveillance and the prevention of risk factors. The most effective prevention strategy is the elimination of infection in animals. Vaccination of cattle, goats and sheep is recommended in enzootic areas with high prevalence rates. Serological or other testing and culling can also be effective in areas with low prevalence. In countries where eradication in animals through vaccination or elimination of infected animals is not feasible, prevention of human infection is primarily based on raising awareness, food-safety measures, occupational hygiene and laboratory safety. Pasteurization of milk for direct consumption and for creating derivatives such as cheese is an important step to preventing transmission from animals to humans. Education campaigns about avoiding unpasteurized milk products can be effective, as well as policies on its sale. In agricultural work and meat-processing, protective barriers and correct handling and disposal of afterbirths, animal carcasses and internal organs is an important prevention strategy. Human brucellosis during pregnancy is characterized by significantly less pronounced adverse obstetric outcomes than in animals, but with remarkably more adverse obstetric outcomes when compared to healthy pregnant women. Seroprevalence of brucellosis in pregnancy and cumulative incidence of brucellosis cases per 1000 delivered obstetrical discharges in endemic regions were reported to be 1.5–12.2% and 0.42–3.3, respectively. Depending on the region, the frequency of pregnant women in the cohorts of patients with brucellosis was from 1.5% to 16.9%. The most common and the most dramatic unfavorable outcomes during brucellosis in pregnancy are the obstetric ones, manifested as abortions (2.5–54.5%), intrauterine fetal death (0–20.6%), or preterm deliveries (1.2–28.6%), depending on the stage of pregnancy. Other unfavorable outcomes due to brucellosis are addressed to infant (congenital/neonatal brucellosis, low birth weight, development delay, or even death), the clinical course of disease in mother, and delivery team exposure. When diagnosed in pregnant women, brucellosis should be treated as soon as possible. Early administration of adequate therapy significantly reduces the frequency of adverse outcomes. Rifampicin in combination with trimethoprim-sulfamethoxazole for 6 weeks is the most commonly used and recommended regimen, although monotherapies with each of these two drugs are also widely used while waiting for the results from prospective randomized therapeutic trials. As no effective human vaccine exists, screening of pregnant women and education of all women of childbearing age about brucellosis should be compulsory preventive measures in endemic regions.
