– A zoonosis man. Pets are most affected and are the reservoir from which humans become infected.
– Contamination occurs through ingestion of infected raw milk unpasteurized and by direct contact with infected animals or objects contaminated with the favor of a skin abrasion. Direct human transmission is rare.
– The germs are Gram-negative bacilli of Brucella kind: B. melitensis (sheep, goats), B. abortus (cattle), B. am (pigs) and more rarely B. canis and B. ovis.
– The disease is found worldwide and mainly in rural areas. Insufficiently known in the tropics, its incidence is probably underestimated.
Clinical signs and symptoms are fluctuating and non specific.
The diagnosis is made difficult by the extreme variability of clinical presentations.
Acute form:
– Common form: signs gradually settled in a 2 weeks: undulant fever up to 39-40 ° C and then resolve spontaneously over a period of 10 to 15 days, night sweats, chills, fatigue, muscle and joint pain .
Sacroileitis, arthritis (knee), orchitis can be observed.
In the tropics, high fever that persists despite adequate treatment for malaria should be suspected acute brucellosis.
– Other clinical forms:
• Form typhoid sudden onset sepsis syndrome with high fever in plateau, delirium, tuphos, abdominal signs.
• subclinical form: nonspecific clinical signs, some marked, not encouraging the patient to view. positive serology.
Secondary brucellosis:
Prolonged asthenia. Events focused:
– Attacks bone and joint: hip arthritis, sacroiliitis, spondylitis with sciatica (pseudo Pott’s disease).
– Neurobrucellosis: aseptic meningitis (pseudo-tubercular), meningoencephalitis, peripheral neurologic involvement with motor disorders and / or sensory complicating vertebral home.
Chronic brucellosis:
– General signs: physical and psychic asthenia, sweating, polyalgia.
– Focal signs: little bone evolutionary homes, neuromeningeal or visceral.
laboratory:
– Blood culture where feasible allows highlighting the germ acute.
– The agglutination test Rose Bengal (or card test) is used to highlight specific antibodies. It is simple, inexpensive, specific and sensitive in acute and focused brucellosis.
– Other serological tests (Wright ELISA, IFA, Coombs test) are rarely achievable.
Treatment :
The treatment is based on the combination of two antibiotics. Streptomycin and rifampicin are also used in the treatment of TB, it is imperative to eliminate previously active tuberculosis (examination, clinical examination and chest X-ray if possible). The use of rifampicin should be restricted to the information below.
Acute form:
– Children over 8 years and adults (except pregnant or lactating women): doxycycline PO
Child: 100 to 200 mg / day or 2 divided doses for 6 weeks
Adult: 200 mg / day or 2 divided doses for 6 weeks + streptomycin IM
Children: 15 mg / kg / once daily for 2 weeks
Adult: 1 g / once daily for 2 weeks
– Children under 8 years:
cotrimoxazole PO: 40 mg SMX + 8 mg TMP / kg / day in 2 divided doses for 6 weeks + gentamicin IM: 7.5 mg / kg / day or 2 injections for 2 weeks or rifampicin PO: 15 mg / kg / once daily for 6 weeks
– Pregnant or breastfeeding women:
cotrimoxazole PO: 1600 mg SMX + TMP 320 mg / day in 2 divided doses for 6 weeks + rifampicin PO: 600 mg / once daily for 6 weeks
Note :
In pregnant women, the cotrimoxazole + rifampin may be administered whatever the age of the pregnancy if treatment is essential.
It is advisable to combine vitamin K to prevent hemorrhagic stroke:
phytomenadione (bulb to 10 mg / ml, 1 ml):
Maternal: 10 mg / day PO for 15 days before the expected date of delivery
In children: 2 mg PO at birth, repeated after 4 to 7 days
Focused brucellosis:
– Same regimen for acute but for a period of 6 weeks to 3 months depending on the importance of the home. Surgical drainage of a liver abscess or splenic may be indicated.
– Neurobrucellosis or endocarditis: doxycycline + rifampicin + gentamicin.
Antibiotics are of no benefit in the unfocused chronic brucellosis.
Prevention:
– Hand hygiene and clothing livestock contact.
– Boil the milk, avoid the cheese and consumption of undercooked meat.