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بسم الله الرحمن الرحيمبسم الله الرحمن الرحيم Brucellosis

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A disease, primarily of animals, that can be transmitted to humans as a result of direct or indirect contact with the infected animal population

ZOONOSIS

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Brucella are Ideal Biological Warfare Agents

• They are highly infectious

• They can be easily aerosolized

• They are stable in production, storage, & delivery

• They are sensitive to sunlight

• They cause high morbidity, but low mortality

• There are no human vaccines against brucellosis

• There is high economic loss to animal agriculture

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Fastidious & aerobicFacultative intracellular

Gram negative non motile cocobacilli

- عامل يا عوامل - عامل يا عوامل 22اتيولوژيكاتيولوژيك

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Brucella spp. Source Virulence Infective Dose

B. melitensisGoats, sheep, Cattle, Swine

++++ 1 – 10

B. suis Swine, Cattle +++ 1,000 – 10,000

B. abortus Cattle ++ 100,000

B. canis Dogs + 1,000,000

Etiologic agents

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Resistance of brucellaHeating at 60ºC For 10 minutes

Phenol 1% For 15 minutes

Direct sunlight In a few hours

Milk For several days

Milk (till the milk turns sour)

Fresh cheese For 3 months

Tap-water For 57 days

Human urine For 1 week

Dust For 6 weeks

Damp soil For 10 weeks

Animal feces For 100 days

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Species BiotypesBr. Abortus 1,2,3,4,5,6,8,9

Br. Melitensis 12

Br. Suis 12

Br. Canis Not found

Isolated species in Iran

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Skin abrasion, conjunctivae, inhalation or ingestionEngulfed by neutrophils and monocytes (resistant to killing)Localize regional lymph nodesInfect phagocytic cells in the RE system and form granulomas

Pathogenesis

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ـ دوره نهفتگي ـ دوره نهفتگي11

• 5-60 days (1-2 month)5-60 days (1-2 month)

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• Occurs worldwideOccurs worldwide

• Endemic areas - Africa, AsiaEndemic areas - Africa, Asia

• True incidence not knownTrue incidence not known

ـ انتشار ـ انتشار 3 3جغرافيائيجغرافيائي

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Season Re. 42 Ref. 41 Ref. 36 Ref. 34 Min

Spring 49 41 28 52 42

Summer

33 22 35 34 34

Autumn

15 15 25 14 17

Winter 3 12 12 0 7

Seasonal distribution in Iran

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Effect of GenderEffect of Gender• Men aged 15-45 years are affected

twice as often as women of the same age

• Male predominance seem to be a factor in some cases

• The man is more likely than the woman to be exposed to the heaviest concentration of organisms

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Effect of GenderEffect of Gender• In Iran both sexes are nearly always

equally contacted with contaminated animals and dairy products

• There is not a significant predominance of male to female brucellosis in Iran

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Sex distribution in Iran

0

10

20

30

40

50

60

Male56%

Female44%

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Age distribution Age distribution • Children are affected very much less

than adults

• The odd low incidence in children is unexplained

• It may be that gastric acidity is less often deficient than in adult

• Occupational exposure is much more important

160-4 5-9 10-14 20-24 30-34 40-44 50-54 + 60

بيمار ايراني بيمار ايراني 5600056000توزيع سني توزيع سني 13701370در سال در سال

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Occupational hazardsOccupational hazards• Farmers

• Shepherds, goatherds

• Veterinarians

• Abattoir workers

• Laboratory workers

• Butchers

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33

1311

20

1 1 1 1 24

63 4

0

5

10

15

20

25

30

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دارنهخا

صلمح

رزشاوك

نچوبا

گرعتصن

يظام

ن

فليباقا

بصاق

مندكار رگركا

دكوك

كاربي

صشخما

ن

5600056000موقعيت اجتماعي و شغلي موقعيت اجتماعي و شغلي مورد بروسلوز گزارش شده در مورد بروسلوز گزارش شده در

13701370ايران در سال ايران در سال %

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ـ تاثير عوامل مساعد كننده ـ تاثير عوامل مساعد كننده66

عوامل فرهنگي و عقيدتيعوامل فرهنگي و عقيدتي•زمينه هائي نظير ضعف ايمني ، زمينه هائي نظير ضعف ايمني ، •

ابتالء به بيماريهاي سركوبگر ابتالء به بيماريهاي سركوبگر ايمني ، مصرف داروهاي مضعف ايمني ، مصرف داروهاي مضعف

سيستم ايمنيسيستم ايمنياسترس هاي مختلفاسترس هاي مختلف•فقر و بي خانمانيفقر و بي خانماني•

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ـ حساسيت و مقاومت در مقابل ـ حساسيت و مقاومت در مقابل 77بيماريبيماري

مقاومت طبيعيمقاومت طبيعي•مصونيت اكتسابي بعد از ابتالءمصونيت اكتسابي بعد از ابتالء•مصونيت اكتسابي بعد از مصونيت اكتسابي بعد از •

واكسيناسيونواكسيناسيون

- در انسان ؟- در انسان ؟

- در حيوانات ؟- در حيوانات ؟

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Brucellosis in animals

Transmitted by contact with infected tissue or milk (oral, aerosol or abrasion) Predilection for erythritol rich organs (breast, uterus, epididymis, ect.)Abortions, mastitis and sterility

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Transmission of brucellosisTransmission of brucellosis

• Farmers / Ranchers

• Veterinarians (food animal practice)

• Brucellosis eradication personnel

• Meat inspection personnel

• Abattoir workers

• Laboratory personnel

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Transmission of brucellosisTransmission of brucellosis

Brucellosis as a Food Borne Disease

• Is not occupation related

• Often no history of animal contact

• May occur outside brucellosis enzootic areas

• Often occurs in outbreaks

• May involve women & children

• May involve travelers to brucellosis enzootic areas

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ReservoirsReservoirsNatural Human

Species HostPathogen

• Brucella abortus Cattle *• Brucella suis Swine *• Brucella melitensis Goats/Sheep *• Brucella ovis Sheep• Brucella canis Dogs *• Brucella neotomae Desert wood rat7

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Occurrence in Wildlife

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ReservoirReservoir• Mammalian parasite

• Host specificity is not exclusive

• Horse is occasionally infected

• Serum from camels have proved positive

• Have been isolated from foxes, buffaloes, elk, moose, deer, polecats

• Rabbits have been infected

• Infection of hares have proved

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ReservoirReservoir• Flies, mosquitoes, ticks and other insects

can be infected with all species

• Ticks have transmitted to guinea pigs by biting

• Dogs and cats are fairly resistant

• Has not been found in monkeys

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• In many parts of the world, cattle are heavily infected

• Br. Abortus is most commonly involved

• They may readily infect with Br. Melitensis and Br. suis

Infection of CattleInfection of Cattle

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• Br. Melitensis do not cause serious symptoms in cattle

• Br. Abortus may lead to death of the fetus and abortion

• The aborted fetus, the placenta and the discharge from vagina are all heavily contaminated

Infection of CattleInfection of Cattle

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Infection of CattleInfection of Cattle• Brucella tend to lodge in mammary gland

and supramammary lymph nodes

• They may shed in the milk for years

• The organisms tend to settle in the testicles, epididymis and seminal vesicles

• Organisms may be present in the semen and may transmit sexually

• Transmission by artificial insemination

• In cattle is a serious economic and public health problem

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Infection of GoatsInfection of Goats

• Is always due to Br. Melitensis

• Abortion is not a prominent symptoms

• Reduced fertility in the herd

• Br. Melitensis is passed in enormous numbers in the milk

for 6-7 month

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Infection of SheepInfection of Sheep

• Is always due to Br. Melitensis

• Is occasionally due to Br. Abortus or Br. Suis

• Affecting fertility and meat and wool production

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Infection of SwineInfection of Swine

• Br. Suis is the most common brucella in swine

• Swine may infect with brucella abortus and melitensis

• The semen may be teeming with brucella and the boar may disseminate infection throughout the herd

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Transmission between animalsTransmission between animals

• Milk

• Meat

• Trans placentally

• Sexually (& artificial insemination)

• Respiratory

• Urine

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Mode of transmissionMode of transmission• IngestionIngestion

• InhalationInhalation

• Abrasion skinAbrasion skin

• Mucous membranesMucous membranes

• ConjunctiveConjunctive

• Sexual Sexual

• Blood transfusionBlood transfusion

• Organ transplantOrgan transplant

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Mode of transmissionMode of transmission

ا ـشير ـخام در دوران ـشيرخوارگي و بـعد 11 ه ـب ا ـشير ـخام در دوران ـشيرخوارگي و بـعد ( تغذـي ه ـب ( تغذـياز آن.از آن.

ــه 22 ــير و خامـ ــير پنـ ــام، نظـ ــه ( مصـــرف لبنيـــات خـ ــير و خامـ ــير پنـ ــام، نظـ ( مصـــرف لبنيـــات خـروستايي.روستايي.

( خـوردن دنبالن آلـوده اي كـه خـوب پختـه نشـده ( خـوردن دنبالن آلـوده اي كـه خـوب پختـه نشـده 33باشد.باشد.

( تمــاس مســتقيم بــا نــوزادان تــازه متولــد شــده ( تمــاس مســتقيم بــا نــوزادان تــازه متولــد شــده 44 00حيوانات )گوساله، بزغاله، بره( حيوانات )گوساله، بزغاله، بره(

وده، نظـير 55 واني آـل ا نسـوج حـي اس مسـتقيم ـب وده، نظـير ( تـم واني آـل ا نسـوج حـي اس مسـتقيم ـب ( تـممثانه حيوانات ذبح شده.مثانه حيوانات ذبح شده.

( از طريــق افشــانه هاي )آئروســل( موجــود در ( از طريــق افشــانه هاي )آئروســل( موجــود در 66هواي آغل و اصطبل .هواي آغل و اصطبل .

ق 77 اورزي، از طرـي ايل كـش ا وـس ازي ـب ام ـب ه هنـگ ق ( ـب اورزي، از طرـي ايل كـش ا وـس ازي ـب ام ـب ه هنـگ ( ـبپوست آسيب ديده.پوست آسيب ديده.

ان 88 ورده كودـك رك ـخ ا و دـست هاي ـت ق پاـه ان ( از طرـي ورده كودـك رك ـخ ا و دـست هاي ـت ق پاـه ( از طرـيروستايي.روستايي.

ادر و انتـقال داـخل رحمي 99 وده ـم ا ـشير آـل ه ـب ادر و انتـقال داـخل رحمي ( تغذـي وده ـم ا ـشير آـل ه ـب ( تغذـيادرزادي ) لوز ـم يز در بروـس ادرزادي )را ـن لوز ـم يز در بروـس ل CongenitalCongenitalرا ـن ل (، دخـي (، دخـي

دانسته اند.دانسته اند.

روستائي كودكان و شيرخواران در

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ج ـ پيشگيري و كنترل ج ـ پيشگيري و كنترل بروسلوزبروسلوز

• Primordial Prevention:Primordial Prevention: “…minimize “…minimize hazards to health”hazards to health”• Primary Prevention:Primary Prevention:

Prevention of disease in “well” Prevention of disease in “well” individualsindividuals

• Secondary Prevention:Secondary Prevention: Identification and intervention in Identification and intervention in

early stages of diseaseearly stages of disease

Tertiary Prevention:Tertiary Prevention: Prevention of further deterioration, Prevention of further deterioration,

reduction in complicationsreduction in complications

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كنترل بروسلوزكنترل بروسلوز

ـ مـبارزه ـبا مـنابع و 1مخازن

ــيره 2 ــ ــع زنج ــ ـ قطانتقال

ـ حفظ افراد سالم3

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كنترل بروسلوزكنترل بروسلوز

ـ مبارزه با مخازن1شناسائي حيوانات بيمار•ايزوله كردن بيماران ؟؟•منابع محيطي ؟؟•

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كنترل بروسلوزكنترل بروسلوز

ـ قطع زنجيره انتقال2ــتقيم و • ــاي مسـ تماس هـ

غيرمستقيمآب، غذا و . . . •ــوا، • ــاط، هـ ــت، مخـ پوسـ

جفت . . .

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كنترل بروسلوزكنترل بروسلوز

ـ حفظ افراد سالم3؟ مصونسازي اكتيو•مصونسازي پاسيو ؟•كموپروفيالكسي ؟•