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CBRNE - Brucellosis: Follow-up
Updated: Apr 29, 2009
Follow-up
Further Inpatient Care
- Starting the appropriate antibiotic therapy is the mainstay of care.
- Depending on what other systems are involved, more specialized care may be needed.
- Use appropriate precautions (eg, mask, gloves, eye protection) for respiratory procedures or handling body fluids.
- Handle specimens from the patient in the lab under biosafety level III conditions.
- Tests and other procedures are discussed in Lab Studies.
Further Outpatient Care
- Outpatient care consists of completing the course of antibiotics, treating any exposed patients, and avoiding contact with the initial source of infection.
- Arrange outpatient follow-up care with the infectious disease specialist and any other necessary specialist.
- Strongly emphasize the need to complete the full 6-week course of antibiotics, as failure to do so increases the risk of relapse.
Inpatient & Outpatient Medications
- Administer antibiotic and corticosteroid therapy as outlined in the Medication section. Also administer any additional drugs needed for symptomatic treatment (eg, antipyretics, analgesics). Additional medication is based on the patient's presenting symptoms.
Transfer
- Transfer to another facility depends on the needs of the patient. As most patients do not require highly specialized interventions, the need to transfer should not be frequent.
- Personnel involved in the transfer should maintain respiratory and contact precautions, and the vehicle should be decontaminated after transport as needed.
Deterrence/Prevention
- Avoiding the source of infection prevents reinfection. Better handling of infected animals or animal products is paramount.
- As no human vaccine is available, immunization is not an option for humans, but immunization of animals reduces the pool of vectors and thereby reduces human infection.
- As the brucellosis vaccine is attenuated for animals but not humans, accidental percutaneous exposure to the vaccine may cause disease. Labs should handle all specimens under biosafety level III conditions.
- Military personnel should take appropriate precautions if use of biological weapons by an unfriendly source is anticipated.
Complications
- Complications are rare in the patient who is treated appropriately.
- The primary complication is the need for valve replacement in the patient with endocarditis.
- Residual musculoskeletal complaints may be present in the patient with long-term infection and sacroiliitis.
- Relapse of infection may occur in 10% of patients.
Prognosis
- Most patients with brucellosis recover completely without lasting sequelae, provided they receive appropriate antibiotic treatment. The relapse rate is approximately 10%, even with treatment. Prognosis generally is excellent.
Patient Education
- Center patient education on the need for strict compliance with the antibiotic regimen and the need to avoid potential sources of infection. This primarily involves avoidance of infected animals or stricter precautions (eg, gloves, mask) when dealing with a potentially infected animal.
- Advise farmers and ranchers to immunize their cattle against the disease as needed.
- Laboratory workers should maintain the appropriate level of containment.
- Travelers to regions where the disease is endemic need to take precautions against infection (eg, avoid potentially contaminated dairy products).
- For excellent patient education resources, visit eMedicine's Bioterrorism and Warfare Center. Also, see eMedicine's patient education articles Biological Warfare and Personal Protective Equipment.
Miscellaneous
Medicolegal Pitfalls
- As brucellosis manifests in such a nonspecific manner, the diagnosis can be difficult. The primary pitfall is failure to consider possible Brucella infection in a patient with history that suggests a possible source of infection (eg, farmer, traveler to an endemic region, veterinarian).
- In a patient with endocarditis or meningitis and history suggestive of possible exposure, failure to treat for brucellosis is a potential downfall.
- Brucella species have not yet been implicated in any major bioterrorism incident; however, were they used in such a way, patients may not present until several weeks later. Detailed history and knowledge of such potential exposures in the recent past is essential. Given the rare occurrences of brucellosis in the United States, especially in more urban areas, any clustering of brucellosis cases should be thoroughly investigated and reported to public health officials because a biological warfare attack could be the cause.
Special Concerns
- Pregnancy: B abortus is associated strongly with miscarriage in cattle. Whether this increases the risk of spontaneous abortion in humans more than other severe bacterial infection is unknown. Therefore, consider any pregnant female with brucellosis to carry an increased risk of spontaneous abortion. Brucella species may be transmitted across the placenta.
- Pediatric: Pediatric brucellosis is more common than originally suspected; however, given the relative infrequency of infection in the US, it is still rare. The presentation is similar in neonates, children, and adults.
- Zoonosis: As brucellosis is a zoonotic infection, immunization of at-risk animals reduces the number of infected animals and therefore the reservoir of infection. Results of an assessment and simulation study on the planned brucellosis control program in Egypt showed that removal of infected animals under the actual implementation of the program would likely permit brucellosis to remain endemic in the goat and sheep population.3
More on CBRNE - Brucellosis |
| Overview: CBRNE - Brucellosis |
| Differential Diagnoses & Workup: CBRNE - Brucellosis |
| Treatment & Medication: CBRNE - Brucellosis |
 Follow-up: CBRNE - Brucellosis |
| References |
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References
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Further Reading
Keywords
Malta fever, Crimean fever, undulant fever, Brucella, zoonotic infection, brucellosis infection, brucellae, Brucella suis, Brucella melitensis, Brucella abortus, Brucella canis, Brucella species
