بروسلوز (Brucellosis)

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Brucellosis 

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ZOONOSIS ۱ ‏مر‎ VE A EN be trocscnited to hucvoas us a result oP SS aR tN a Ba تم لصا 

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Brucella are Ideal Biological Warfare Agents ا الل ان لتنا ‎They can be easily aerosolized‏ * * They are stable in production, storage, & delivery ¢ They are sensitive to sunlight ‏خالل ا ا ا ا ا اانا‎ ¢ There are no human vaccines against brucellosis ¢ There is high economic loss to animal ‏تدای ور‎ 

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۲- عامل با عوامل اتیو لوژیک ee aN oS rr od 

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Etiologic agents ۷11 Virulen | Infective ۳۹۵ 51010۰ ‏ع‎ Dose — melitensi 61 ‏دب‎ + 1-10 3 8 Swine ۲ 56, 1,000 - ‏ال ا‎ st ۹ ‏ا‎ 0 B. 2018 Cattle ++ 100,000 B. canis |Dogs 3 1260 

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Resistance of brucella For 10 minutes For 15 minutes In a few hours For several days (till the milk turns sour) For 3 months For 57 days For 1 week For 6 weeks For 10 weeks For 100 davs Heating at 60°C Phenol 1% Direct sunlight ۱/۱ Milk ةا ‎g‏ ااا 11 11111112113 ‎Dust‏ Damp soil Animal feces 

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Isolated species in Iran Biotypes 1,2,3,4,5,6,8 A!) 12 12 Not found Species Br. Abortus 33am Melitensis 11. ‏15ناك‎ ‎Br. Canis 

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Pathogenesis §& Skin abrasion, conjunctivae, inhalation or ingestion ل ا ا ل ال لكا ‎monocytes (resistant to‏ ‎killing)‏ Localize regional lymph nodes Infect phagocytic cells in the RE system and form granulomas 

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1 دوره نهفنگي °5-60 days (1-2 month) 

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اه . هد و۶ ‎ce‏ جتیلشلنی 1 * Occurs worldwide ° Endemic areas - Africa, Asia ¢ True incidence not known 0 

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Seasonal distribution in Iran Min 42 34 17 ۹9 34 52 34 14 Ref. 36 28 35 25 12 Ref. 41 41 22 15 12 10. ۷ 49 Seas on ‏الك‎ ‎9 ‎(۲ ‎۱۱۹0 ‎Autu ‎1۳010 ‎Wint Pe 

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Effect of Gender °Men aged 15-45 years are affected twice as often as women of the same 29.۰ °*Male predominance seem to be a factor in some cases ‎atte‏ ال ا ا ان ‎woman to be exposed to the‏ ‎heaviest concentration of organisms‏ 

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۱ 01 ۳01 °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 

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Pas UO fw ‏ليس.‎ 8a) C0) less than adults The odd low incidence in children is unexplained ٠ 11 ‏عتتاعهن أقطا عط توهمد‎ 22101177 15 less often deficient than in adult ° Occupational exposure is much more important 

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توزیم ستي 56000 بیمار ابراني در سال 1370 ییماران ۶ Ss hg . 7 a ۳ ‏و‎ ۳ ‏يکي ی کر‎ و ‎iF‏ يکي سن سال 

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Occupational hazards ¢Farmers *Shepherds, goatherds ‏نك‎ ‎¢ Abattoir workers *Laboratory workers *Butchers 

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۲ ۳۳ ۲ 

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6- لیر عوامل مساعد کننده * عوامل ف رهنكى و عقيدتى * زمينه هائى نظي ضعف ايمنى » ابتلاء به بيماريهاى سر كويك ايمنى ؛ مصرف داروهاى مضعف سيستم ايمنى * استرس هاى مختلف * فق وبى خانمانى 

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‎Pa ER Spree) Ce esr] ere geen‏ بيماري ‏ایس ۱۳ ‏5 ار ‎۱:1 RS PS Rep ee See ‏در انسان ؟‎ - ‏- در حيوانات ؟ 

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Brucellosis in animals Transmitted by contact with infected tissue or milk (oral, aerosol or abrasion) ل اكت اك ا ا ل ۱ ‎organs (breast, uterus,‏ ‎epididymis, ect.)‏ & Abortions, mastitis and sterility 

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Transmission of brucellosis ¢Farmers / Ranchers °Veterinarians (food animal practice) * Brucellosis eradication personnel ‏ا ل ا ب كا الك‎ ل ان *Laboratory personnel 

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ار و ۳ ۷ ‎ellosis. | ne‏ 25 که ‎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 2 

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Reservoirs Natural Human Species Host Pathogen ¢ Brucella abortus Cattle * ¢ Brucella suis Swine * ¢ Brucella melitensis Goats/Sheep ¢ Brucella ovis Sheep ¢ Brucella canis Dogs * ۰ 1711007] 60 Desert wood ۹۹ 

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Occurrence in Wildlife 

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Reservoir ‎Tac hy IK)‏ ل لان ‎* 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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Reservoir ¢ Flies, mosquitoes, ticks and other insects can be infected with all species ¢ Ticks have transmitted to guinea PCCM ey my annie) * Dogs and cats are fairly resistant ل لل ةن 

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Infection of Cattle ¢ 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 

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Infection of Cattle ° Br. Melitensis do not cause serious symptoms in cattle 01 قمعل 860 20ع]1 تتممط كتتاعسمطك .تد8 ‎٠‏ ‏12 2ه كتناع؟ عطةا ¢ The aborted fetus, the placenta and the discharge from vagina ‏لالت كفت‎ 

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Infection of Cattle ¢ Brucella tend to lodge in mammary gland and supramammary lymph nodes ¢ They may shed in the milk for years BWM ger vevcst mK Mem nA ‏ل الا‎ testicles, epididymis and seminal vesicles * Organisms may be present in the semen ‏كله‎ Mae TCM EIN ¢ Transmission by artificial insemination ¢ In cattle is a serious economic and public health problem 

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Infection 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 Sheep *Is always due to Br. AV CVE a Rey ety iy *Is occasionally due to Br. Abortus or Br. Suis عيضا تتا لاقت ادك ‎meat and wool production‏ 

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Infection of Swine *Br. Suis is the most common ‏طا و11اععتخاط‎ 11 le یر ‎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 animals ٠ 21111 ٠١ ‏أجع1/‎ ‎¢Trans placentally * Sexually (& artificial insemination) * Respiratory * Urine 

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1001© 1 eo s 911 1 ۱۱۱۱ ‏نت‎ yey ۱۱۱۱۲۰۱ ۱۱ *Mucous membranes * Conjunctive * 5 ‏لمنتترء‎ ‎٠ 21000 2 ° Organ transplant 

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مايه بنير ‎nde 3 1‏ 2 جد كردن چربی | ‎sty ule‏ سطح ظروف حاوى ‏شیر خام + شکر گلاب و .. ‏گاو گوسفند وبز ‎ ‏بدون حرارت ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ 

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لاه ۹86 ۶ ظ 1۴ بعر 18-۱ ۱ ‎ren eas‏ نظيس بنير و خامه روستايى. ‏ها ‎۱ bors. bye here ree el Or ‏۵ ) تماس مستقیم با نسوج حیوانی آلوده نظیس مثانه حیوانات ذیح شده. ‎۱ ‎1 ee ‏۸ )از طبریق پاها و دست‌های ترک خورده کودکان روستایی. ‏لامعا اال دخیل دانسته اند. 

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۱ ا الاك ‎hazards to health”‏ ¢ Primary Prevention: © Prevention of disease in “well” individuals *Secondary Prevention: © Identification and intervention in early stages of disease = Tertiary Prevention: = Prevention of further deterioration, reduction in complications 

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کنترل بروسلوز 1 س مبارزه با منابع و مخازن 2 س قطع زنحیره انتقال 3 س حفظ افراد سالم 

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۱ Ded eee ‏؟؟‎ DCP eee Be) ie ‏منابع محيطى ؟؟‎ * 

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۱ ,۳۳۹ زن ه انتقا " تماس‌های مستقیم و غیر مستقیم *آب غذاو ۰۰۰ * يوستء. مخاط هواء جفت ‎٠ ٠ ٠‏ 

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۱ ۲ ۱۲۱۶ * مصونسازى اكتيو ؟ * مصونسازى ياسيو ؟ * کموپروفیلاکسی ؟ 

بسم الله الرحمن الرحيم ‏Brucellosis 1 ZOONOSIS A disease, primarily of animals, that can be transmitted to humans as a result of direct or indirect contact with the infected animal population 2 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 3  عامل يا عوامل اتيولوژيك-2 Fastidious & aerobic Facultative intracellular Gram negative non motile cocobacilli 4 Etiologic agents Brucella spp. Source Goats, B. sheep, melitensi Cattle, s Swine Swine, B. suis Cattle B. Cattle abortus B. canis Dogs Virulen ce Infective Dose ++++ 1 – 10 +++ 1,000 – 10,000 ++ 100,000 + 5 1,000,000 Resistance of brucella Heating at 60ºC Phenol 1% Direct sunlight Milk Milk Fresh cheese Tap-water Human urine Dust Damp soil Animal feces For 10 minutes For 15 minutes In a few hours For several days (till the milk turns sour) For 3 months For 57 days For 1 week For 6 weeks For 10 weeks For 100 days 6 Isolated species in Iran Species Biotypes Br. Abortus 1,2,3,4,5,6,8 ,9 Br. 12 Melitensis Br. Suis 12 Br. Canis Not found 7 Pathogenesis Skin abrasion, conjunctivae, inhalation or ingestion Engulfed by neutrophils and monocytes (resistant to killing) Localize regional lymph nodes Infect phagocytic cells in the RE system and form granulomas 8  1ـ دوره نهفتگي )• 5-60 days (1-2 month 9 3ـي ـيائ ـف ـرا ـغ ـتشار ج ـن ـا • Occurs worldwide • Endemic areas - Africa, Asia • True incidence not known 10 Seasonal distribution in Iran Seas on Sprin g Sum mer Autu mn Wint Re. 42 49 Ref. 41 41 Ref. 36 28 Ref. 34 52 Min 33 22 35 34 34 15 15 25 14 17 3 12 12 0 7 42 11 Effect 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 12 Effect 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 13 Sex distribution in Iran 60 50 40 30 20 10 0 Male 56% Female 44% 14 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 15 توزيع سني 56000بيمار ايراني در سال 1370 16 40-44 30-34 20-24 10-14 5-9 0-4 Occupational hazards •Farmers •Shepherds, goatherds •Veterinarians •Abattoir workers •Laboratory workers •Butchers 17 ـت اجتماعي و شغلي 56000مورد موقعي بروسلوز گزارش شده در ايران در سال 1370 33 % 35 30 25 20 11 2 1 1 1 1 كارمند قصب ا ق اليباف ن ظامي 4 13 15 10 صعتگر ن 4 3 6 20 5 0 خ ن ا مش بيكار ك ودك كارگر چوبان شور ز كا محصل خانهدار 18 ـر عوامل مساعد كننده 6ـ تاثي • عوامل فرهنگي و عقيدتي • زمينه هائي نظير ضعف ايمني ،ابتالء به بيماريهاي سركوبگر ايمني ،مصرف داروهاي مضعف سيستم ايمني • استرس هاي مختلف • فقر و بي خانماني 19  7ـ حساسيت و مقاومت در مقابل بيماري • مقاومت طبيعي • مصونيت اكتسابي بعد از ابتالء • مصونيت اكتسابي بعد از واكسيناسيون در انسان ؟ -در حيوانات ؟ 20 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 21 Transmission of brucellosis • Farmers / Ranchers • Veterinarians (food animal practice) • Brucellosis eradication personnel • Meat inspection personnel • Abattoir workers • Laboratory personnel 22 Transmission 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 23 brucellosis enzootic areas Reservoirs Natural Human Species Host Pathogen • Brucella abortus Cattle * • Brucella suis Swine * • Brucella melitensis Goats/Sheep • Brucella ovis Sheep • Brucella canis Dogs * • Brucella neotomae Desert wood rat7 * 24 Occurrence in Wildlife 25 Reservoir • 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 26 Reservoir • 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 27 Infection of Cattle • 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 28 Infection of Cattle • 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 29 Infection 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 30 Infection 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 31 Infection of Sheep • Is always due to Br. Melitensis • Is occasionally due to Br. Abortus or Br. Suis • Affecting fertility and meat and wool production 32 Infection 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 33 Transmission between animals • Milk • Meat • Trans placentally • Sexually (& artificial insemination) • Respiratory • Urine 34 Mode of transmission • Ingestion • Inhalation • Abrasion skin • Mucous membranes • Conjunctive • Sexual • Blood transfusion • Organ transplant 35 36 Mode of ‏transmission در شيرخواران و كودكان روستائي ) 1تغذيه با شير خام در دوران شيرخوارگي و بعد از آن. ) 2مصرف لبنيات خام ،نظير پنير و خامه روستايي. ) 3خوردن دنبالن آلوده اي كه خوب پخته نشده باشد. ) 4تماس مستقيم با نوزادان تازه متولد شده حيوانات (گوساله ،بزغاله ،بره) 0 ) 5تماس مستقيم با نسوج حيواني آلوده ،نظير مثانه حيوانات ذبح شده. ) 6از طريق افشانه‌هاي (آئروسل) موجود در هواي آغل و اصطبل . ) 7به هنگام بازي با وسايل كشاورزي ،از طريق پوست آسيب ديده. ) 8از طريق پاها و دست‌هاي ترك خورده كودكان روستايي. ) 9تغذي`ه ب`ا شي`ر آلوده مادر و انتقال داخ`ل رحم`ي را ني`ز در بروس`لوز مادرزادي (،)Congenital دخيل دانسته اند. 37 ج ـ پيشگيري و كنترل بروسلوز • Primordial Prevention: hazards to health” “…minimize • Primary Prevention:  Prevention of disease in “well” individuals • Secondary Prevention:    Identification and intervention in early stages of disease Tertiary Prevention: Prevention of further deterioration, reduction in complications 38 كنترل بروسلوز 1ـ مبارزه با منابع و مخازن 2ـ قطع زنجيره انتقال 3ـ حفظ افراد سالم 39 كنترل بروسلوز 1ـ مبارزه با مخازن • شناسائي حيوانات بيمار • ايزوله كردن بيماران ؟؟ • منابع محيطي ؟؟ 40 كنترل بروسلوز 2ـ قطع زنجيره انتقال •تماس‌هاي مستقيم و غيرمستقيم •آب ،غذا و . . . •پوست ،مخاط ،هوا ،جفت . . . 41 كنترل بروسلوز 3ـ حفظ افراد سالم ـ؟ •مصونسازي اكتيو •مصونسازي پاسيو ؟ •كموپروفيالكسي ؟ 42