PRESUMPTIVE CASE OF BRUCELLOSIS IN DELAWARE, JUNE 8, 2010
On June 9, 2010, the Delaware Public Health (DPH) Laboratory confirmed brucellosis by culture in a 58 year old, female, New Castle County
resident. The patient had no history of recent travel, or contact with pets, farm animals or wildlife, and has been unemployed since
2008. The patient experienced similar symptoms following consumption of unpasteurized milk and cheese products one year ago and was
treated at that time with a short course of antibiotics.
While person-to-person transmission is rare, humans can be infected by eating or drinking raw milk and cheese made with unpasteurized
dairy products. They can also be exposed to bacteria through skin wounds when hunting or working in slaughterhouses, meat packing plants,
and poultry plants.
- Brucellosis is a bacterial disease transmitted from animals to humans. Approximately 100 to 200 human cases are reported annually in
the United States. If aerosolized, brucellosis has the potential for use as an agent of bioterrorism.
- Transmission occurs through direct contact with infected mammals (ccommonly through abrasions of the skin). In the United States,
transmission occurs more frequently by ingesting unpasteurized milk or dairy products. Transmission may occur through inhalation of
aerosols, and while handling cultures in laboratory settings. There is no evidence of person-to-person transmission. Brucellosis is most
often seen in farmers, ranchers, veterinarians, and others who work directly with animals. Employees in certain types of laboratories,
slaughterhouses and meat inspectors may also be infected. Sporadic cases and outbreaks occur among consumers of unpasteurized milk and
milk products, especially soft cheeses.
- The incubation period is variable, ranging from 5-60 days but may be several months.
- Symptoms may last for several days, months, or even a year or more if not adequately treated. The onset of the disease can be acute
or insidious and include fever, night sweats, headache, weakness, sweating, arthralgia, myalgias, weight loss and anorexia. Physical
findings include lymphadenopathy, splenomegaly, hepatomegaly, and occasionally arthritis. Complications of brucellosis include
meningitis, endocarditis, and osteomyelitis.
- Laboratory criteria for diagnosis: Isolation of Brucella species from a clinical specimen; or fourfold or greater rise in Brucella
agglutination titer between acute and convalescent phase serum specimens obtained >2 weeks apart and studied at the same laboratory;
or demonstration by immunofluorescence of Brucella species in a clinical specimen.
- Prolonged antibiotic treatment for at least 6 weeks is necessary to achieve a cure. Combination therapy (2 antibiotics) is
recommended. Monotherapy is associated with a high rate of relapse. Doxycycline and rifampicin are the treatments of choice.
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