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THE BRUCELLAE
The brucellae are obligate parasites of animals and humans and are characteristically located intracellularly. They are relatively inactive metabolically. Brucella melitensis typically infects goats; Brucella suis , swine; Brucella abortus, cattle; and Brucella canis, dogs. Other species are found only in animals.. The disease in humans, brucellosis (undulant fever, Malta fever), is characterized by an acute bacteremic phase followed by a chronic stage that may extend over many years and may involve many tissues.
Antigenic Structure
Differentiation among brucella species or biovars is made possible by their characteristic sensitivity to dyes and their production of H2S. Few laboratories have maintained the procedures for these tests, and the brucellae are seldom placed into the traditional species. Because brucellae are hazardous in the
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laboratory, tests to classify them should be performed only in reference public health laboratories using biosafety precautions.
Clinical Findings
The incubation period is 16 weeks. The onset is insidious, with malaise, fever, weakness, aches, and sweats. The fever usually rises in the afternoon; its fall during the night is accompanied by drenching sweat. There may be gastrointestinal and nervous symptoms. Lymph nodes enlarge, and the spleen becomes palpable. Hepatitis may be accompanied by jaundice. Deep pain and disturbances of motion, particularly in vertebral bodies, suggest osteomyelitis. These symptoms of generalized brucella
infection generally subside in weeks or months, although localized lesions and symptoms may continue. Following the initial infection, a chronic stage may develop, characterized by weakness, aches and pains, low-grade fever, nervousness, and other nonspecific manifestations compatible with psychoneurotic symptoms. Brucellae cannot be isolated from the patient at this stage, but the agglutinin titer may be high. The diagnosis of chronic brucellosis is difficult to establis h with certainty unless local lesions are present.
of B melitensis can yield a positive test less than 5 minutes after inoculating the slant; other strains will take a few hours to 24 hours. Bacteria that meet these criteria should be quickly submitted to a reference public health laboratory for presumptive identification. If organisms resembling brucellae are isolated, they are typed by H2S production, dye inhibition, and agglutination by absorbed sera. C. SEROLOGY IgM antibody levels rise during the first week of acute illness, peak at 3 months, and may persist during chronic disease. Even with appropriate antibiotic therapy, high IgM levels may persist for up to 2 years in a small percentage of patients. IgG antibody levels rise about 3 weeks after onset of acute disease, peak at 68 weeks, and remain high during chronic disease. IgA levels parallel the IgG levels. The usual serologic tests may fail to detect infection with B canis . 1. Agglutination test To be reliable, serum agglutination tests must be performed with standardized heat-killed, phenolized, smooth brucella antigens. IgG agglutinin titers above 1:80 indicate active infection. If the serum agglutination test is negative in patients with strong clinical evidence of brucella infection, tests must be made for the presence of blocking antibodies. These can be detected by adding antihuman globulin to the antigen-serum mixture. 2. Blocking antibodies these are IgA antibodies that interfere with agglutination by IgG and IgM and cause a serologic test to be negative in low serum dilutions (prozone) although positive in higher dilutions. These antibodies appear during the subacute stage of infection, tend to persist for many years independently of activity of infection, and are detected by the Coombs antiglobulin methods.
3. ELISA assays- IgG and IgM antibodies may be detected using ELISA assays, which use
cytoplasmic proteins as antigens. These assays tend to be more sensitive and specific than the agglutination assays.
Immunity
An antibody response occurs with infection, and it is probable that some resistance to subsequent attacks is produced. Immunogenic fractions from brucella cell walls have a high phospholipid content; lysine predominates among eight amino acids; and there is no heptose (thus distinguishing the fractions from endotoxin).
Treatment
Brucellae may be susceptible to tetracyclines or ampicillin. Symptomatic relief may occur within a few days after treatment with these drugs is begun. However, because of their intracellular location, the
organisms are not readily eradicated completely from the host. For best results, treatment must be prolonged. Combined treatment with streptomycin and a tetracycline is recommemded.
Dr. Shama M.J Saadaldin Al-Shadidi 3rd grade / College of Medicine Mustansiryah University 1/4/2012 Updated 2012