Brucellosis in humans and animals Food and Agriculture Organization of the United Nations Brucellosis in humans and animals Brucellosis in humans and animals Brucellosis in humans and animals 92 4 154713 8 Brucellosis in humans and animals Brucellosis in humans and animals World Organisation for Animal Health i WHO/CDS/EPR/2006.7 Brucellosis in humans and animals Food and Agriculture Organization of the United Nations World Organisation for Animal Health Brucellosis in humans and animals ii WHO Library Cataloguing-in-Publication Data Brucellosis in humans and animals. Produced by the World Health Organization in collaboration with the Food and Agriculture Organization of the United Nations and World Organisation for Animal Health Principal author: M.J. Corbel. 1.Brucellosis - prevention and control. 2.Brucellosis - epidemiology. 3.Brucellosis - complications. 4.Guidelines. I.Corbel, M.J. II.World Health Organization. III.Food and Agriculture Organization of the United Nations. IV.World Organisation for Animal Health. ISBN 92 4 154713 8 (NLM classification: WC 310) ISBN 978 92 4 154713 0 © World Health Organization 2006 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The named authors alone are responsible for the views expressed in this publication. iii Contents Principal author, list of contributors .......................................................................................................... vii Preface ............................................................................................................................................................................... viii Acknowledgments ............................................................................................................................................................................... viii Abbreviations .................................................................................................................................................................................. ix 1. INTRODUCTION ................................................................................................................................................................................... 1 2. CLINICAL MANIFESTATION .................................................................................................................... 3 2.1 The disease in humans ...................................................................................................... 4 2.1.1 Osteoarticular complications .................................................................................. 6 2.1.2 Gastrointestinal complications ............................................................................... 6 2.1.3 Hepatobiliary complications .................................................................................... 7 2.1.4 Respiratory tract complications .............................................................................. 7 2.1.5 Genitourinary complications .................................................................................... 7 2.1.6 Pregnancy and breastfeeding .................................................................................. 7 2.1.7 Cardiovascular complications ................................................................................. 8 2.1.8 Neurological complications ..................................................................................... 8 2.1.9 Cutaneous complications ........................................................................................ 8 2.1.10 Opthalmic complications......................................................................................... 9 2.1.11 Chronic brucellosis .................................................................................................. 9 2.1.12 Childhood brucellosis ............................................................................................ 10 Î Key points on the disease in humans ...................................................................... 10 2.2 The disease in animals..................................................................................................... 10 Î Key points on the disease in animals ...................................................................... 12 3. EPIDEMIOLOGY ............................................................................................................................... 13 3.1 Epidemiology of brucellosis in humans.......................................................................... 13 3.1.1 Reservoirs of infection .......................................................................................... 13 3.1.2 Transmission of brucellosis to humans ................................................................ 14 3.1.3 Seasonal factors ................................................................................................... 17 3.1.4 Age and sex distribution ........................................................................................ 17 3.1.5 Travel-acquired brucellosis ................................................................................... 17 3.1.6 Bio-terrorism ......................................................................................................... 18 Î Key points on the epidemiology of brucellosis in humans ..................................... 19 3.2 Epidemiology of brucellosis in animals .......................................................................... 19 Î Key points on the epidemiology of brucellosis in animals ..................................... 21 Brucellosis in humans and animals iv 4. DIAGNOSIS ............................................................................................................................... 22 4.1 Diagnosis in humans........................................................................................................ 22 4.1.1 Bacteriological diagnosis ...................................................................................... 22 4.1.2 Serological diagnosis ............................................................................................ 24 4.1.3 Diagnostics of Brucella meningitis and meningoencephalitis .............................. 27 4.1.4 Intradermal tests ................................................................................................... 27 4.1.5 Conclusion ............................................................................................................. 27 Î Key points on the diagnosis in humans ................................................................... 28 4.2 Diagnosis in animals ........................................................................................................ 28 4.2.1 Bacteriological methods........................................................................................ 29 4.2.2 Serological methods.............................................................................................. 30 4.2.3 Supplementary tests ............................................................................................. 32 4.3 Remarks on the diagnosis of brucellosis in other species than cattle ........................ 33 4.3.1 Sheep and goats .................................................................................................... 33 4.3.2 Pigs ........................................................................................................................ 34 4.3.3 Camels, buffalo, reindeer, yaks ............................................................................. 34 4.3.4 Dogs ....................................................................................................................... 35 Î Key points on the diagnosis in animals ................................................................... 35 5. TREATMENT OF BRUCELLOSIS IN HUMANS .....................................................................................