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Life threatening disease in Uganda today (Brucella)

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What is Brucellosis?

Brucellosis is an infectious disease caused by bacteria from the genus Brucella. It is an infection that affects mainly animals, including goats, sheep, camels, pigs, elk, deer, cattle, and dogs. Humans develop brucellosis when they come in contact with contaminated animals or animal products. The symptoms of brucellosis often resemble a flu-like illness.



Causes
Brucellosis affects many wild and domestic animals. Cattle, goats, sheep, pigs, dogs, camels, wild boar and reindeer are especially prone to the disease. A form of brucellosis also affects harbor seals, porpoises and certain whales. The bacteria may be spread from animals to people in three main ways:

Raw dairy products. Brucella bacteria in the milk of infected animals can spread to humans in unpasteurized milk, ice cream, butter and cheeses. The bacteria can also be transmitted in raw or undercooked meat from infected animals.
Inhalation. Brucella bacteria spread easily in the air. Farmers, laboratory technicians and slaughterhouse workers can inhale the bacteria.
Direct contact. Bacteria in the blood, semen or placenta of an infected animal can enter your bloodstream through a cut or other wound. Because normal contact with animals — touching, brushing or playing — doesn't cause infection, people rarely get brucellosis from their pets. Even so, people with weakened immune systems should avoid handling dogs known to have the disease.
This poses a problem for workers who have close contact with animals or animal excretions (newborn animals, fetuses, and excretions that may result from birth). Such workers may include:
    • slaughterhouse workers
    • meat-packing plant employees
    • veterinarians
People who hunt animals may also be at risk. When they are in contact with infected animals, exposure to the bacteria may occur through:


  • skin wounds
  • accidentally ingesting undercooked meat
  • inhaling the bacteria while dressing their game. Commonly infected animals include: bison, elk, caribou, moose and wild hogs (feral swine).


Brucellosis normally doesn't spread from person to person, but in a few cases, women have passed the disease to their infants during birth or through their breast milk. Rarely, brucellosis may spread through sexual activity or bone marrow transfusions or tissue transplantation or blood transfusions.

Risk factors
Brucellosis is very rare in the United States. Other parts of the world have much higher rates of brucellosis infection, especially:


  • Around the Mediterranean Sea
  • Eastern Europe
  • Latin America
  • Asia
  • Africa
  • The Caribbean
  • The Middle East

People who live or travel in these areas are more likely to consume unpasteurized goat cheese, sometimes called village cheese. Unpasteurized goat cheese imported from Mexico has been linked to many cases of brucellosis in the United States.

Occupations at higher risk
People who work with animals or come into contact with infected blood are at higher risk of brucellosis. Examples include:


  • Veterinarians
  • Dairy farmers
  • Ranchers
  • Slaughterhouse workers
  • Hunters
  • Microbiologists

Signs and Symptoms
Brucellosis can cause of range of signs and symptoms, some of which may present for prolonged periods of time.

Initial symptoms can include:

  • fever
  • sweats
  • malaise
  • anorexia
  • headache
  • pain in muscles, joint, and/or back
  • fatigue

Some signs and symptoms may persist for longer periods of time. Others may never go away or reoccur.

These can include:

  • recurrent fevers
  • arthritis
  • swelling of the testicle and scrotum area
  • swelling of the heart (endocarditis)
  • neurologic symptoms (in up to 5% of all cases)
  • chronic fatigue
  • depression
  • swelling of the liver and/or spleen

Complications
Brucellosis can affect almost any part of your body, including your reproductive system, liver, heart and central nervous system. Chronic brucellosis may cause complications in just one organ or throughout your body. Possible complications include:

Infection of the heart's inner lining (endocarditis). This is one of the most serious complications of brucellosis. Untreated endocarditis can damage or destroy the heart valves and is the leading cause of brucellosis-related deaths.
Arthritis. Joint infection is marked by pain, stiffness and swelling in your joints, especially the knees, hips, ankles, wrists and spine. Spondylitis — inflammation of the joints between the bones (vertebrae) of your spine or between your spine and pelvis — can be particularly hard to treat and may cause lasting damage.
Inflammation and infection of the testicles (epididymo-orchitis). The bacteria that cause brucellosis can infect the epididymis, the coiled tube that connects the vas deferens and the testicle. From there, the infection may spread to the testicle itself, causing swelling and pain, which may be severe.
Inflammation and infection of the spleen and liver. Brucellosis can also affect the spleen and liver, causing them to enlarge beyond their normal size.
Central nervous system infections. These include potentially life-threatening illnesses such as meningitis, an inflammation of the membranes surrounding the brain and spinal cord, and encephalitis, inflammation of the brain itself.



Prevention

To reduce the risk of getting brucellosis, take these precautions:

Avoid unpasteurized dairy foods
In recent years in the United States, few cases of brucellosis have been linked to raw dairy products from domestic herds. Still, it's probably best to avoid unpasteurized milk, cheese and ice cream, no matter what their origin. If you're traveling to other countries, avoid all raw dairy foods.
Cook meat thoroughly.
 Cook all meat until it reaches an internal temperature of 145 to 165 F (63 to 74 C). When eating out, order beef and pork at least medium-well. It's unlikely that domestic meat in the United States contains brucella bacteria, but proper cooking destroys other harmful bacteria such as salmonella and Escherichia coli. When traveling abroad, avoid buying meat from street vendors, and order all meat well-done.
Wear gloves.
 If you're a veterinarian, farmer, hunter or slaughterhouse worker, wear rubber gloves when handling sick or dead animals or animal tissue or when assisting an animal giving birth.
Take safety precautions in high-risk workplaces
If you're a laboratory worker, handle all specimens under appropriate biosafety conditions. Treat all workers who have been exposed promptly. Slaughterhouses should also follow protective measures, such as separation of the killing floor from other processing areas and use of protective clothing.
Vaccinate domestic animals
In the United States, an aggressive vaccination program has nearly eliminated brucellosis in livestock herds. Because the brucellosis vaccine is live, it can cause disease in people. Anyone who has an accidental needle stick while vaccinating an animal should be treated.




Treatment

Before treatment begins, a diagnosis of brucellosis infection must be made by a doctor.

Tests will be performed to look for bacteria in samples of blood, bone marrow, or other body fluids. In addition, a blood test can be performed to detect antibodies against the bacteria.

Once a diagnosis is made, a doctor can prescribe antibiotics.

Depending on the timing of treatment and severity of illness, recovery may take a few weeks to several months. Death from brucellosis is rare, occurring in no more than 2% of all cases.

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