Overview
Brucellosis is caused by infection with the bacterium called Brucella. This organism causes infection in domestic animals such as sheep, goats, pigs and cattle, and is transmitted to humans via contact with infected animals, or by drinking unpasteurised milk.
With the introduction of milk pasteurisation, this disease is now uncommon in the United Kingdom, but remains highly prevalent in many parts of the world. There are 4 species of Brucella causing human disease: Brucella melitensis (sheep and goats), Brucella abortus (cattle), Brucella suis (pigs) and Brucella canis (dogs). In animals, Brucella causes chronic infection, particularly involving the bladder and reproductive organs and leading to abortion and sterility.
Symptoms
The clinical presentation ranges from an acute flu-like illness with chills, muscle and joint aches and headache to a more chronic disease with an insidious onset in which the fever may be low grade or intermittent, and focal symptoms may eventually emerge. The disease may last for several days, months or years if not adequately treated. Any organ or system of the body can be affected; common presentations include meningitis, bone and joint infection, particularly involving the back and pelvis, and chronic infection of the testes or prostate in men. Very rarely brucellosis may lead to disease of the female reproductive system, although infection in males is much commoner because of the occupational nature of the infection. Mortality from brucellosis is low, of the order of 2%, and usually results from Brucella infection of the heart valves. Depression is a common accompaniment to chronic infection.
Mode of Transmission
Most cases in the United Kingdom occur in people who work closely with animals and animal tissues, such as farmers and abattoir workers, who pick up infection by direct contact with animal tissues, blood, urine, aborted foetuses and especially placentas. Airborne transmission can also occur in animal pens and abattoirs. Prior to pasteurisation, Brucellosis occurred regularly as a result of drinking unpasteurised milk, or eating cheese made from this. Wild animals, particularly deer, can also carry infection. Brucella canis is an infection found in dogs, and human disease is seen in dog handlers. Brucella is a potential agent of bioterrorism, although to date there have been no reports of its use for this purpose.
Regions Affected
Brucellosis occurs world-wide, but is particularly common in Mediterranean countries for example Malta; indeed another name for the infection is Malta fever. It is also found commonly in Africa, Middle East, India and central Asia, and south and central America. The infection is usually an occupational disease of people working with infected animals and their tissues, although sporadic cases and outbreaks occur as a result of eating and drinking contaminated milk products.
Prevention
Prevention of human disease relies on controlling the infection in animals. In the first instance it is important to educate people exposed by virtue of occupation about the importance of protective clothing, ventilation of work premises, disinfection of contaminated areas and care in disposing of aborted animals and placentas. Animals should be screened for infection by antibody tests, and infected herds slaughtered. There is a vaccine that can be used to vaccinate animals. Milk should always be pasteurised, or boiled if this is not possible. Patients with brucellosis need antibiotic treatment, and every case should be thoroughly investigated to pinpoint the source of infection.
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