Thread by @IUIDfellowship

#idboardreview 20 M farmer consumes unpasteurized milk presents w/ several months of headache, fever & now ill with projectile vomiting, F 106F, myalgia, back pain, areflexia. Csf 100wbc 70%pmn, protein150, gluc20. Dx? #medEd #idmedEd #idtwitter

#brucellosis ddx chronic meningitis
Pic ref phil.cdc.gov/Details.aspx?p…

#Neurobrucellosis is the most serious form of the disease and affects between 5 and 7% of all brucellosis

ingestion of unpasteurized/raw dairy products. (milk of infected 🐑 🐐 🐄 🐪)
-occupation risk:veterinarians, slaughterhouse workers, meat packers & lab workers
Inhalation risk: labs & slaughter- house
Hunters: butchering
TransPlacental, breastfeed& sexual risk extremely rare

#neurobrucellosis can present as meningioencephalitis, cranial or peripheral nerves can be involved, myelitis, radiculopathh etc.
Dx: high clinical suspicion & serology

#neurobrucellosis Tx doxy or tetracycline + rifampin x6wks.
Can use tmp-smx if tetracycline can’t be used.
AG can be used for 1st 2 wks.
Ceftriaxone can be used as third agent
Duration of tx maybe 4-6 mo for meningoencephalitis

Ddx for #chronic #meningitis
Ref P&P Mandell #IDTwitter

#brucellosis in humans as a clinical entity “Mediterranean Gastric Remittent Fever” JA Marston in 1860. -David Bruce (1865–1931) described a “micrococcus” in 1887 w/ Maltese microbiologist Carruana Scicluna
1905, Zammit a Maltese doctor showed that goats transmitted the disease

#brucellosis Davis Bruce moved to Africa and identified ‘Trypanosoma Brucei” as a cause of Sleeping sickness

#brucellosis Bang was Danish veterinarian who identified an intracellular bacillus as cause of miscarriage in cattle (Bang’s bacillus). For many years no relation was thought to exist between Bruce’s micrococcus and Bang’s bacillus

#brucellosis
Mary Elizabeth Steel (daughter of Scottish doctor & wife of David Bruce) trained microbiologist was instrumental in early work
Alice Evans (1881–1975) American microbiologist prove micrococcus melitensis & Bang’s bacillus were different species of same genus

#brucellosis Alice Evans worked for many years to establish that milk was source of infection & her work led to pasteurization of cow’s milk
-The assistant of David Bruce, Surgeon Captain M Louis Hughes, 1st report on isolation of M. melitensis from the brain in Malta

#brucellosis Ref jns-journal.com/article/S0022-…