OVERVIEW
Overview of Brucellosis
Brucellosis is an infectious-anaphylactic zoonotic disease caused by the invasion of bacteria of the genus Brucella. In China, sheep are the main source of infection, and contact with lambs by herders or veterinarians is the main means of transmission. The population is generally susceptible to Brucella. The clinical manifestations of the disease are variable and can be categorized into subclinical infections, acute, subacute and chronic infections, limited and recurrent infections.
Whether medical insurance
yes
Department
Infection
Synonyms: Brucellosis, Brucellosis, Brucellosis, Brucellosis
Brucellosis, brucellosis, brucellosis, brucellosis, undulant fever, Mediterranean flaccid fever, Malta fever, etc.
Clinical symptoms
Fever, typical fever pattern of wavy ups and downs, excessive sweating, joint and muscle pain, as well as malaise, depression, rash, enlarged liver and spleen lymph nodes, enlarged testes, enlarged joints, and subcutaneous nodules.
Hazards
Patients untreated with antimicrobial drugs can develop endocarditis, severe neurologic complications, and pancytopenia, which can lead to death. Chronic patients may be left with arthropathy, tendon contracture and other limb movement limitation.
Complications
Anemia, leukopenia, thrombocytopenia; uveitis, optic neuritis, optic disk edema and corneal damage; meningitis, meningoencephalitis, myelitis, polyneurogenic neuropathy; endocarditis.
Examination
Peripheral blood picture, bacterial culture, serum agglutination test, enzyme-linked immunosorbent assay, 2-mercaptoethanol test, complement binding test, anti-human globulin test, cerebrospinal fluid examination, etc.
Diagnosis
Diagnosis is made on the basis of epidemiologic history, clinical manifestations such as fever, excessive sweating, muscle and joint pain, and immunologic tests.
Treatment principle
Anti-infection treatment with sensitive antibiotics.
Curable
The morbidity and mortality rate of brucellosis patients without antimicrobial treatment is 2%~3%, while the prognosis of those treated with antimicrobial drugs is good.
Dietary advice
In the acute phase, pay attention to water, electrolyte and nutritional supplementation, and give adequate amounts of vitamins B and C, as well as easy-to-digest foods.
Questions you may be concerned about
What are the fever patterns that characterize human brucellosis?
Human brucellosis is most commonly characterized by flaccid fever, but is most typically characterized by undulant fever, and some may present with irregular low-grade fever and intermittent fever.
Brucellosis is also known as brucellosis and Mediterranean flaccid fever. Flaccid fever is the most common fever type, with temperature >39℃, and temperature fluctuation >2℃ within 24 hours, and the lowest temperature is also higher than normal.
And the most typical heat pattern of the disease is wave-shaped fever, accounting for 5%-20%, in which the body temperature gradually rises to ≥39℃, gradually returns to normal after 2-3 weeks, and then gradually rises again in the following days, and so on for many times, in the shape of waves.
Other irregular low-grade fever and intermittent fever may also be present. Before the fever is mostly accompanied by chills or chills, high fever patients are conscious, some can also get out of bed activities, the fever subsides after the symptoms worsen, often manifested as depression, weakness.
Brucellosis infected people to isolate?
It is best to isolate people who have contracted brucellosis.
In China, the main source of brucellosis is sheep, the main transmission pathway is herdsmen or veterinarians lambing, fur, milking, meat processing, etc. can be infected through the skin mucous membranes, dairy products and eating diseased animal meat can be transmitted through the digestive tract. Its clinical symptoms are prolonged fever, excessive sweating, hepatosplenomegaly, arthralgia, etc. It will not produce lasting immunity.
It is best to isolate a person who has contracted brucellosis, as transmission can easily occur through contact with other people or animals. Once diagnosed, it is important to treat the disease promptly. Brucellosis is more damaging to the organs and can be severe enough to render a person incapacitated.
It is also important to wash your hands regularly, sterilize the items you use, and avoid close contact with people.
Is brucellosis contagious?
Brucellosis can be transmitted from person to person.
Brucellosis is caused by Brucella abortus infection, which can lead to human infection through person-to-person transmission, contaminated environment transmission, occupational exposure, and foodborne transmission.
1. Human-to-human transmission: This is very rare, and only in a few cases, through blood donation and transfusion, organ transplantation, sexual behavior, and mother-to-child transmission may lead to transmission of the disease from a sick person to an uninfected person.
2. Contaminated environment: Borrelia burgdorferi may be found in feces, soil, dust, meat and dairy products in the environment. Long-term exposure to these dangerous environments may lead to the transmission of the disease to human beings.
3. Occupational exposure: including staff working with sheep, cattle, pigs and other livestock, such as farm workers, herders, animal breeders, farmers, veterinarians, quarantine personnel, etc., are susceptible to infection with Borrelia burgdorferi and thus to disease.
4. Foodborne transmission: the most common cause of brucellosis in urban populations, i.e., consumption of infected dairy products, meat, etc., may be infected with Brucella and thus become ill.
Brucella can be transmitted through the digestive tract, respiratory tract, skin and mucous membranes, etc. Therefore, people with relevant risk factors should pay attention to the protection; after infected with this disease, they need to consult the doctor in time and receive regular treatment.
Causes
Epidemiology
Occupation: veterinarians, animal husbandry workers, slaughter workers; age: young adults; gender: male; season: late spring and early summer.
Etiology
Bacteria of the genus Brucella are a group of tiny spherical rod-shaped gram-negative bacteria. Brucella genus is divided into 6 species and 19 biotypes: sheep species bacteria (3 types), cattle species bacteria (8 types), swine species bacteria (5 types), canine species bacteria, sheep epizootic species bacteria and sarin rodent species bacteria each a type. Sheep-type brucellosis is the most common in China.
Transmission pathway
Herders contact with lambs as the main means of infection, veterinarians for the sick animal delivery is also very susceptible to infection. Skin, meat processing, milking, etc. can be infected through the skin mucous membrane, eating sick animal meat, milk and milk products can be infected through the digestive tract.
Questions you may be concerned about
Can bovine brucellosis cause miscarriage?
It is possible for a pregnant woman to contract bovine brucellosis, which can lead to miscarriage.
Brucellosis is also known as brucellosis, brucellosis, etc. Almost all organs in the body of the patient may be violated, and the patient will have recurrent high fever, profuse sweating, etc., accompanied by wandering arthralgia, testicular pain, enlarged lymph nodes in the liver and spleen, headache rash, anorexia and weight loss, etc. The patient may be infected with brucellosis during pregnancy, which may lead to miscarriage.
If the human body is infected during pregnancy and not treated in time, it may lead to miscarriage, preterm labor, stillbirth, etc. It is a more serious type of infectious diseases during pregnancy.
If a pregnant woman is infected, she can be treated with rifampicin plus sulfamethoxazole under a doctor’s supervision. If she is infected during the twelve weeks of pregnancy, it is recommended to use third-generation cephalosporins in combination with sulfamethoxazole, such as ceftazidime and cefoperazone in combination with sulfamethoxazole.
Brucellosis long-term lesions can not only lead to miscarriage or even lead to infertility, it is recommended that patients go to regular hospitals for treatment in a timely manner.
Symptoms and Diagnosis
Typical symptoms
1. Subacute and acute infection
About 10% to 30% of the patients have an acute onset of the disease. A few patients have up to a few days of prodromal symptoms, such as weakness, insomnia, low fever, loss of appetite, upper respiratory tract inflammation. The main clinical manifestations in the acute phase are fever, excessive sweating, malaise, arthritis, and orchitis.
(1) Fever type is most common in flaccid type, wave-like type only accounts for 5% to 20%, but the most characteristic, manifested as fever for 2 to 3 weeks, followed by 3 to 5 days to 2 weeks without fever, and then fever, so the cycle of ups and downs and wave-like type; most of the patients have only 2 to 3 waves, and occasionally up to 10 or more. Other types of fever include irregular type, persistent low fever and so on.
(2) Excessive sweating is a prominent symptom of this disease, more than other febrile diseases. Often in the late night and early morning, there is a sudden drop in heat and sweating, and most patients feel weak and feeble.
(3) Joint pain often makes the patients moan and groan and the pain is unbearable, which may involve one or several joints, mainly sacroiliac, hip, knee, shoulder, wrist, elbow and other large joints, and in acute stage, it may be wandering. The pain is in the form of a cone, and general analgesics are ineffective. Some patients have redness and suppuration in the joints, and localized swelling such as bursitis, tenosynovitis and periarthritis are also more common. Muscle pain is mostly seen in both thighs and buttocks, and the latter can be spasmodic.
(4) Testiculitis is also one of the characteristic symptoms of the disease, due to the involvement of testis and epididymis, mostly unilateral, can be as large as a goose egg, accompanied by obvious pressure pain.
(5) Secondary symptoms include headache, neuralgia, hepatosplenomegaly, enlarged lymph nodes, etc. Rash is rare.
2. Chronic infection
Characterized by: (1) many complaints, especially night sweats, headache, myalgia and arthralgia, but also fatigue, prolonged low-grade fever, chills or chills. There may be insomnia, depression, and agitation, which are easily diagnosed as neurosis. (2) Symptoms left over from the acute phase, such as back pain, arthralgia, sciatica, obvious fatigue, night sweats, etc., which have been prolonged for many days.
Diagnostic basis
1. History of living in endemic areas, contact with sick animals and their excreta, or consumption of unpasteurized milk.
2. Clinical manifestations such as fever, excessive sweating, muscle and joint pains, malaise, or suspicious symptoms and signs such as enlarged liver, spleen, lymph nodes and testicles for several days or even weeks.
3. Laboratory examination of brucellosis slide or tiger red plate agglutination reaction is positive or suspicious, or skin allergy test after 24, 48 hours of skin erythema infiltration range once in 2.0cm × 2.0cm and above.
4. Isolation of Brucella from the patient’s blood, bone marrow, other body fluids and excreta.
5. serological examination standard tube agglutination test (SAT) titer is 1:100 and above; for half a year with Brucella vaccine contact history, SAT titer although 1:100 and above, after 2 ~ 4 weeks should be re-examined, the titer rises 4 times and above, or with the complement binding test (CFT) test, CFT titer 1:10 and above; anti-human immunoglobulin test (Coomb’S) titer 1:400 and above; anti-personal immunoglobulin test (Coomb’S) titer 1:400 and above; anti-personal immunoglobulin test (Coomb’S) titer 1:10 and above. (Coomb’S) titer 1:400 or higher.
Diagnosis of suspected cases: those with 1, 2 and 3.
Diagnosis of confirmed cases: suspected cases plus any of 4 or 5.
Treatment
Treatment guidelines
Acute infections are usually treated with antimicrobial combination therapy; desensitization therapy can be used in chronic cases with strong allergic symptoms; hormone therapy, immunomodulators and surgical treatment can be given if necessary.
Drug therapy
1. Antibacterial therapy
It is suitable for the treatment of patients in acute or chronic active stage. Commonly used antibiotics include tetracycline, streptomycin, doxycycline, rifampicin and so on.
2. Specific desensitization therapy
It is suitable for those with strong allergic symptoms in the chronic stage, and often adopts Brucella vaccine, bacterin and other types of Brucella antigenic preparations. The reaction of this therapy is large, and should be carried out with caution.
3.Chinese medicine therapy
It is applicable to patients in all stages of the disease, and it is especially common for patients in the chronic stage.
4. Antipyretic and analgesic agents can be applied to patients with high fever.
5. Adrenocorticotropic hormone can help to improve the symptoms, but it must be used in combination with antibiotics for 3-4 days.
Surgery
Surgical incision and drainage can be performed for purulent lesions. Osteomyelitis of Borrelia burgdorferi should be thoroughly debrided and supplemented with long-term antimicrobial therapy.
Prognosis
The prognosis is favorable, with most patients recovering within 3 to 6 months, and only 10% to 15% of cases lasting longer than 6 months.
Questions you may be concerned about
What are the medications for brucellosis
Brucellosis treatment drugs include symptomatic drugs such as ibuprofen, dexamethasone, mannitol and antibacterial drugs such as doxycycline, rifampicin, cotrimoxazole.
1. Symptomatic treatment of drugs: patients with high body temperature over 38.5 ℃, the use of towels and cold compresses and other physical cooling measures are not effective, you can apply ibuprofen, indomethacin and other drugs to lower the temperature; combined with testicular inflammation, you can take a small dose of dexamethasone; combined with meningitis, intravenous injection of 20% mannitol dehydration.
2. For the cause of the treatment of drugs: adults and children over 8 years of age preferred doxycycline combined with rifampicin treatment, but also doxycycline combined with streptomycin treatment; children under 8 years of age can be rifampicin combined with cotrimoxazole or rifampicin combined with gentamicin treatment; pregnant women can be used in the weighing of the pros and cons of the combination of cotrimoxazole and rifampicin treatment.
Note that the medication should be used under the supervision of a physician.
Nursing care
Daily care
1. Improve the awareness of self-protection, and do personal protection when in close contact with livestock or livestock products.
2. Adhere to regular, complete and combined treatment, take medication on time after discharge, and review regularly.
Dietary management
1. Eat high-calorie, high-protein, vitamin-rich, easy-to-digest diet, avoid greasy, cold, sour and spicy stimulating food. Eat more high-fiber foods to keep the bowel movement smooth.
2. Do not consume milk and meat products that have not been quarantined or sterilized.
3. Avoid eating meat and dairy products of sick animals.
Other precautions
High-risk groups can be vaccinated with Brucella vaccine.