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flyonthewallmedstudent · 7 months

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Brucellosis

Case Report

a 45M goat herder in Malaysia develops 3 weeks of fevers, lethargy, night sweats and headache

history revealed he drank unpasteurised milk from said goats, which he also sold to consumers

blood cultures were negative and he tested negative for more common tropical diseases such as malaria, dengue, typhus and lepto

eventually he tested positive for brucella serology, unfortunately about 80 people also developed brucellosis from drinking milk from his farm, and a few lab staff also picked it up from handling their blood samples

consider this differential in PUO

Microbiology

causative organism: Brucella melitensis

gram negative coccobacillus, facultative intracellular

hardy bacteria that can survive prolonged periods in meat/dairy products unless pasteurised/cooked as well as dust & surfaces

picked up in the intestinal submucosa on ingestion and transported by macropahges to lymphoid tissue

it then has the possibility of spreading haematogenously in the liver, spleen, joints etc. causing systemic or localized infection

Transmission

zoonoses (animal associated)

in particular: feral pigs, so hunters are often at increased risk (due to handling the carcasses), but also cattle, sheep, goat and dogs

outbreaks often associated with consumption of unpasteurized milk from infected animals

Epidemiology

global and notifiable disease in most countries

endemic to Mediterraena, South America and the indian subcontinent

in Australia - largely QLD and NT, but now NSW

Increased risk groups (i.e. what to ask on history and what clues on history to consider for brucellosis)

regular contact with animals (herders, abbatoir workers, vets - there are case reports of lab workers who pick up brucellosis etc)

people who ingest unpasteurized dairy/milk, or the undercooked meat of infected animals

History

first described by another European white man, Dr. George Cleghorn, British Army Surgeon in minorca in 1751 on the island of Malta following the Crimean war

it was named for another British white man, Sir David Bruce who led a commission into a fever outbreak among the army in Malta before they found the organism causing the disease (Sir Themistocles Zammit identified that goats transmit it in milk)

Sir bruce also discovered that trypanosoma brucei (also named for him) was the microbe responsible for animal trypanosomiasis/sleeping sickness. incidentally, he was born in Melbourne Australia

trivia with the Crimean war - was ironically a war fought between Russia and the UK + it's Western Allies and the empire that preceded Turkey (Ottoman)

Today the Crimean war is more well known for producing Florence Nightingale, founder of modern nursing and yay, finally a woman in random medical history that hardly is related to brucellosis.

Clinical features

PUO - cyclical fevers, fatigue, headache, insomnia, myalgias/arthralgias, weight loss, anorexia (fairly non specific, but also systemic)

incubation times can be long, which can be deceptive, reportedly up to 50 yrs from first exposure

otherwise, most cases it ranges from 3 days to several week, on average, expect 2-4

sometimes: hepatosplenomegaly

critical on history to clarify travel/living situation or contacts and consumption of unpasteurised dairy or undercooked meat

localized disease also possible, depending on organs involved

up to 40% will report peripheral arthritis, sacroillitis and spondylititis (kinda sounds like ank spa), at worst can cause osteomyelitis and septic arthritis

endocraditis is a rare but serious complication, with a 5% mortality rate, outside of this it's rarely fatal

if the lungs are affected, cough and SOB can occur but hte CXR will be lcear

GBS has been reported to occur following infection

hepatic abscess and granulmoa in a few

also possible: epididymoorchitis and skin manifestations like erythema nodosum

ocular changes like uveitis, cataracts etc.

it really feels rheum flavoured.

Investigations

hints on basic bloods - neutropaenia and anaemia, thromobcytopaenia in the case of hepatosplenomegaly or ITP

raised ESR and CRP, ALP and LDH

elevated LFTs in hepatomegaly

but diagnosis: blood cultures --> can take weeks as slow growing (due to aerosol transmission, must be handled in a biohazard hood as with the case report)

key really: serology is the most commonly used tool

PCR can also be used, including 16S

tissue also an option depending on organ affected

Management:

atypical cover: azith and doxy

several weeks of treatment usually - i.e. if uncomplicated, doxy for 6 weeks (however relapses are common on monotherapy, up to 40%), often rifampicin 600 mg daily for 6/52 is also added or gentamicin

where doxy can't be used, bactrim is the alternative

Sources

CDC guideilnes

WHO guidelines

ETG - behind a paywall, if your institution covers it, uptodate is gold standard, that said, plenty of free resources that provide a great start

Wikipaedia

Statpearls

Case report (There's actually a lot of background pathophysio, investigations and treatment listed in case reports and many are free)

#brucella #brucellosis #crimean war #medblr #infectious diseases #infectious disease #bacteriology #microbiology

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lybrate00-blog · 6 years

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10 Vitamins & Minerals That You Must Eat Everyday!

Discuss sustenance and carbs, proteins and fats ring a bell promptly. Nonetheless, these are the macronutrients and are by all account not the only gathering of supplements. More imperative are the micronutrients, containing a gathering of vital substances known as minerals and vitamins. Read on to know the most critical vitamins and minerals that your body needs and the part they play.

Vitamin An: Essential for sound eyes, general development and advancement and sparkling skin. These are found in carrots, sweet potatoes and oranges.

Vitamin B: These are fundamental for press ingestion, enhanced insusceptibility and generation of vitality. Entire grains and natural nourishments and vegetables like lentils, potatoes, bananas, yeast and molasses are great wellsprings of these vitamins.

Vitamin C: Required for press ingestion, blood thickening, versatile skin and cancer prevention agent work. Found in great sums in citrus natural products, guava, kiwi, grapefruits, strawberries, and so forth.

Vitamin D: Extremely vital for bone improvement, these are found in eggs, mushrooms and fish.

Vitamin E: It enhances the blood flow and decreases free radicals, which is fundamental for growth insurance. Almonds, nuts, tomatoes and sunflower seeds are great wellsprings of vitamin E.

Vitamin K: It is exceptionally fundamental for the procedure of blood coagulation, these are found in spinach, broccoli, kale and other green vegetables.

Press: Very basic element for blood development and muscle building, shellfishes, clams, soybeans, lentils and spinach are incredible wellsprings of iron.

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Zinc: A key fixing basic for by and large development, insusceptibility and richness, spinach, beans, clams and dull chocolate convey a decent measure of Zinc.

Folic corrosive: Essential for press retention, cell recovery, and in pregnancy for solid improvement of the infant. Green verdant vegetables, asparagus, peas, seeds, nuts, lentils, beets, corn, and so forth are great sources.

Follow minerals like iodine, manganese, copper, fluoride, selenium, and chromium are likewise basic however in little sums. While these are by all account not the only basic vitamins and minerals, these are the most critical ones. The amounts of these substances required consistently are little, yet basic for the capacities recorded previously. What's more, some of them additionally help in discharging free radicals, which gives assurance against tumor and interminable aggravation. This forestalls incessant wellbeing conditions like coronary illness, diabetes, and stroke.

An essential point to consider is while there are different supplements accessible in the market today to ensure you get these supplements, endeavor to eat a healthy feast and get these through common sources to the greatest degree conceivable. The characteristic sustenances are the best source, and supplements ought to be utilized just when these can't be acquired normally

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