A strange fever transmitted by animals? Let's talk about Brucellosis!

Do you sometimes feel weak for no reason? Either your joints ache, you feel feverish, you sweat, but it goes away after a few days and then comes back? If these symptoms persist, it could be a disease that we don't talk about much, but it's worth knowing about. One such disease is Brucellosis.

What is Brucellosis?

Simply put, brucellosis is a disease caused by a type of bacteria called Brucella . Symptoms include fever, joint pain, and sweating. However, these symptoms do not come and go all at once, and sometimes they come and go over time.

Brucellosis is a zoonotic disease, meaning it originates from animals . It is also known by other names, such as 'undulant fever', 'Malta fever', and 'Mediterranean fever'.

Who is more likely to develop brucellosis?

This disease called brucellosis is found in many countries around the world. You are at higher risk of contracting this `Brucella` bacteria if you:

• Someone who works with animals , like a veterinarian.
• If you work on a dairy farm or ranch.
• If you work in a butcher shop, a slaughterhouse, or someone who handles raw meat.
• If you are a hunter or prepare the meat of hunted animals.
• If you work in a lab that tests for the `Brucella` bacteria.
• If you eat undercooked meat or use unpasteurized dairy products (e.g. milk, cheese, yogurt).

How common is this?

If you look around the world, about 500,000 cases of brucellosis are reported every year. However, in countries like America, this is a little less, only about 100-200 cases are reported every year. Although there are no exact statistics on how it is in our country, this risk may exist among those who deal with animals.

What does brucellosis do to people?

Think about it, this bacterium called `Brucella` is very cunning. It enters your body through your mouth, nose, eyes, or even a small wound in your skin . Then, it goes to your lymph nodes or other tissues and slowly begins to multiply. From there, this bacterium can spread to almost any part of your body. It can even go to places like your heart, liver, brain, and bones , where they can swell and start to get damaged.

What are the symptoms of this?

It can take two to four weeks, or even longer, for symptoms to appear after you have been exposed to the Brucella bacteria.These symptoms can come and go for months, even years. Here's what they are:

• Fever.
• Sweating (sometimes it can smell like mold).
• Joint pain, especially in your hips, knees, or lower back.
• Unexplained weight loss.
• Headache .
• Abdominal pain.
• Feeling like you have a loss of appetite or an upset stomach.
• Mental conditions like depression.
• Lymph nodes become enlarged and painful.
• A general feeling of discomfort and unwellness.

What is the reason for this?

Brucellosis is caused by several types of `Brucella` bacteria. The main ones are `B. abortus`, `B. canis`, `B. melitensis` (the type that most affects humans) and `B. suis`. Animals carry this `Brucella` bacteria. That means these animals are the carriers of this bacteria. Let's see who those animals are:

• Cattle
• Goats
• Pigs
• Deer
• Moose, Elk - Although these animals are not in Sri Lanka, they are found in other parts of the world.
• Sheep
• Dogs - Yes, dogs can also transmit this disease, especially the strain `B. canis`.
• Camels

How is brucellosis transmitted?

Brucellosis is spread through contact with infected animals or through unpasteurized dairy products . There are several ways you can get the disease:

• By drinking unpasteurized (raw) milk or eating unpasteurized dairy products such as cheese and ice cream. Milk from infected animals can contain this bacteria. However, the bacteria are destroyed by a process called pasteurization. Therefore, even if the animal has brucellosis, it is safe to drink pasteurized goat, cow, sheep, or camel milk.
• By touching the tissue or body fluids of an infected animal. The Brucella bacteria can enter your body through a small scratch or cut on your skin, or through your eyes, nose, or mouth.
• By breathing in the Brucella bacteria. You can breathe in Brucella particles that have been released into the air from exposed tissues or blood of an infected animal. This risk is higher if you work with Brucella in a lab, prepare wild game meat, work on a farm, in a slaughterhouse, or in a meatpacking plant.
• By eating undercooked meat.

Human-to-human transmission of brucellosis is extremely rare, but there have been several reported cases:

• From a pregnant mother to the child in the womb.
• By breastfeeding.
• From sexual intercourse (but this is very rare).

Is this a sexually transmitted disease (STI)?

No, brucellosis is not considered a sexually transmitted infection (STI). There have been very few reported cases of brucellosis spreading through sexual contact.

How do doctors diagnose this?

A doctor diagnoses brucellosis by asking about your symptoms and then testing your blood, tissue, or other samples for signs of the Brucella bacteria. Because the symptoms of brucellosis are similar to those of other diseases, your doctor may also do tests to rule out other diseases.

The best way to confirm a Brucella infection is to culture the bacteria from a body fluid or tissue. However, Brucella is a slow-growing bacterium, so it may take several weeks to confirm your diagnosis. You may need to have more than one blood test over several weeks to check for signs of Brucella.

What kind of tests are done?

Your doctor may do the following tests to find out if you have brucellosis:

• Blood tests: The doctor will take a sample of blood from a vein in your arm using a needle. The lab will check for signs of Brucella bacteria (antibodies, antigens, or DNA) in this blood sample, or it may be grown over time (culture).
• Testing other body fluids: Samples of fluid from your spinal fluid, joint fluid, or other parts of your body may be taken to look for and grow Brucella.
• Tissue biopsy: A sample of your bone marrow or other tissue may be taken to look for signs of Brucella and grow it.
• Imaging: Depending on the parts of your body that are affected, your doctor may order tests like X-rays, CT scans, MRIs, bone scans, ultrasounds, or echocardiograms. These take pictures of the inside of your body to see if there are any changes to your bones or organs.

How is this treated?

Your doctor will treat brucellosis with a combination of at least two types of antibiotics . You will need to take these medications for at least 6 to 8 weeks. Depending on your condition, other treatments (for example, to drain pus from infected areas or to manage complications) may also be needed.

What medications are used for brucellosis?

The antibiotics that doctors prescribe to treat brucellosis are:

• `(Streptomycin)` or `(Gentamicin)`
• `(Rifampin)`
• `( Doxycycline ( Doxycycline) ) `
• `(Trimethoprim/sulfamethoxazole - TMP/SMX)`
• `(Ciprofloxacin)`

The most important thing is to take these medications exactly as prescribed by your doctor, in the correct dosage, for the full duration of treatment. Otherwise, the disease may recur.

How to manage symptoms?

While you take the prescribed antibiotics to kill the bacteria, you can also manage some of the symptoms of brucellosis, such as joint pain and fever, at home. Ask your doctor if there are any over-the-counter (OTC) medications or other treatments that you can use for your symptoms and whether they are safe for you.

How can this be prevented?

You can reduce your risk of developing brucellosis by following food safety practices and wearing protective clothing when working with animals. For example:

• Do not drink unpasteurized milk, and do not eat foods made with unpasteurized milk.
• Wear appropriate safety gear when working with animals and animal tissue. This may include gloves, an apron, or safety goggles. People who work in butcher shops, veterinarians, hunters, farmers, abattoir workers, and medical lab workers should be especially careful.
• Cook meat to safe temperatures. Also, always wash your hands, utensils, and cutting boards thoroughly after preparing food. Game meat can contain the Brucella bacteria.

Remember, even in our country, some people in rural areas drink milk that they have just poured at home without heating it. That is not a good thing at all. It is safest to use only milk that has been properly heated or pasteurized.

What happens if you get brucellosis? (Prognosis)

Most people with brucellosis recover completely with antibiotic treatment. But it can take a while. You may need to take antibiotics for weeks, or even months, to make sure all the bacteria in your body are gone.

Sometimes, brucellosis can come back after treatment has finished. This is especially true if you don't take the antibiotics exactly as prescribed. Some symptoms, such as arthritis, may persist after treatment has finished. If brucellosis causes complications, you may need additional medication or treatment.

What are the possible complications of this?

Brucellosis is more likely to develop complications if left untreated for a long time. These complications include:

• Ongoing arthritis .
• Enlarged liver (Hepatomegaly) or enlarged spleen (Splenomegaly).
• A condition called `(Chronic Hepatosplenic Suppurative Brucellosis - CHSB) . This is when abscesses (pockets of pus) develop in your spleen and liver. This can happen years after a `Brucella` infection.
• Infections and swelling of your heart `(Endocarditis)` , infections of the brain or the coverings of the brain `(Encephalitis or Meningitis)` , infections of the spine `(Spondylitis)` , infections of the bones `(Osteomyelitis)` or infections of the lower back `(Sacroiliitis)` .
• Epididymo-orchitis is an inflammation of the testicles and vas deferens in men.
• Miscarriage.

Can Brucella in humans be cured?

Yes, Brucella infections in humans can be cured with antibiotics. However, some complications can cause long-term damage.

Can brucellosis cause death?

It is very rare for someone to die from brucellosis. The fatality rate for brucellosis is only between 1% and 2% of all cases.

How do I take care of myself as someone with brucellosis?

If your doctor tells you that you have brucellosis, even if you feel well, take all the medicine as prescribed and for the full duration. If you stop taking antibiotics too soon, the brucellosis can come back. If you develop new symptoms or if your symptoms get worse, tell your doctor right away.

When should I see a doctor?

If you have symptoms of brucellosis, especially if your job or hobbies put you at risk of contracting this infection, be sure to see a doctor.

When should you go to the Emergency Treatment Unit (ETU) ?

If you have these serious symptoms, go to an emergency room immediately:

• Very high fever (over 103 Fahrenheit / 39.4 Celsius).
• Severe stomach pain.
• Confusion or other mental changes.

What questions should you ask the doctor?

When you go to see the doctor, it's a good idea to ask these questions:

• How long does treatment take?
• How should I take the medicine?
• How can I manage my symptoms at home?
• When should I follow up with you next?
• What symptoms should I go to the ER for?

Final Take-Home Message

Brucellosis is a bacterial infection that can start very slowly, last a long time, and is not very common. Its symptoms are similar to many other diseases, so it is important to see a doctor for an accurate diagnosis and treatment. Brucellosis is usually not very serious. But it can affect your bones and internal organs, so it is important to pay close attention to your symptoms. If you develop new symptoms or if you are concerned about something you already have, don't hesitate to contact your doctor.

` Brucellosis, animal diseases, bacterial infections, fever, joint pain, unpasteurized milk