Medknow Publications on behalf of Indian Association of Medical Microbiology
Abstract
Infection with Brucella spp. continues to pose a human health risk
globally despite strides in eradicating the disease from domestic
animals. Brucellosis has been an emerging disease since the discovery
of Brucella melitensis by Sir David Bruce in 1887. Although many
countries have eradicated B. abortus from cattle, in some areas B.
melitensis and B. suis have emerged as causes of this infection in
cattle, leading to human infections. Currently B. melitensis remains
the principal cause of human brucellosis worldwide including India. The
recent isolation of distinct strains of Brucella from marine mammals
as well as humans is an indicator of an emerging zoonotic disease.
Brucellosis in endemic and non-endemic regions remains a diagnostic
puzzle due to misleading non-specific manifestations and increasing
unusual presentations. Fewer than 10% of human cases of brucellosis may
be clinically recognized and treated or reported. Routine serological
surveillance is not practiced even in Brucella - endemic countries and
we suggest that this should be a part of laboratory testing coupled
with a high index of clinical suspicion to improve the level of case
detection. The screening of family members of index cases of acute
brucellosis in an endemic area should be undertaken to pick up
additional unrecognised cases. Rapid and reliable, sensitive and
specific, easy to perform and automated detection systems for Brucella
spp. are urgently needed to allow early diagnosis and adequate
antibiotic therapy in time to decrease morbidity / mortality. The
history of travel to endemic countries along with exposure to animals
and exotic foods are usually critical to making the clinical diagnosis.
Laboratory testing is indispensable for diagnosis. Therefore alertness
of clinician and close collaboration with microbiologist are essential
even in endemic areas to correctly diagnose and treat this protean
human infection. Existing treatment options, largely based on
experience gained > 30 years ago, are adequate but not optimal. In
our experience, an initial combination therapy with a three
drug-regimen followed by a two-drug regimen for at least six weeks and
a combination of two drugs with a minimum of six weeks seems warranted
to improve outcome in children and adult patients respectively with
laboratory monitoring. A safe and effective vaccine in humans is not
yet available. Prevention is dependent upon the control of the disease
in animal hosts, effective heat treatment of dairy produce and hygienic
precautions to prevent occupational exposure. This review compiles the
experiences and diagnostic and treatment paradigms currently employed
in fighting this disease