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Chapter 32

Brucellosis

The history of brucellosis is an excellent study of painstaking clinical investigation reinforced by the work of astute bacteriologists in many parts of the world. It was known in the early nineteenth century, and possibly earlier, that abortion was contagious in cattle. In 1895, Bang in Copenhagen isolated the organism Brucella abortus and proved that it caused abortions in cattle (hence the synonym "Bang's abortion disease"). Twenty-three years passed before the organism was incriminated as the etiological agent of "undulant" or "Malta" fever in man.

Such a disease, originally described as "Mediterranean or gastric fever;" had been recognized as a separate entity in 1859 by Marston and was fully described in a classic monograph in 1897 by Hughes. Both authors were British army surgeons and a third, David Bruce, had isolated the organism in 1887 from the spleen of a young soldier in Malta 10 minutes after his death. Specific agglutinins were demonstrated in 1897.

In 1905, the organism was found in the milk of goats. In 1906 the British Army and Navy in the garrison of Malta were forbidden "the consumption of unboiled goat's milk," and the disease fell to negligible proportions within the garrison. Regrettably, the civilians in Malta did not follow this instruction and continued to suffer and die. Thereafter, both diseases were recognized in domestic animals and in man, but it was not until 1918 that an American bacteriologist, Alice Evans, showed that "Malta fever" and "Bang's abortion" were caused by the same bacillus.

Today, the disease remains worldwide in its distribution in man, even though numerous international congresses have been held in an attempt to eradicate it. A joint Food and Agriculture Organization/ World Health Organization (FAO/WHO) brucellosis organization established centers for the training of personnel and the unification of field and laboratory procedures. Despite these efforts, many cases still occur (a 1990 estimate was over half a million) and brucellosis must be considered by the clinician in the differential diagnosis of any recurrent fever, and by the radiologist in bone infections, particularly those in the spine.

Synonyms

Brucellosis. Abortus fever. Malta fever. Undulant fever. Mediterranean fever. Rock, or Gibraltar, fever. Bang's abortion disease. Goat fever. Milk fever. Gastric remittent fever. Dust fever. Slow fever. Rio Grande fever. Cyprus fever. Neapolitan fever. Bruce's septicemia. Melitococcosis. Febris sudoralis. Morbus Bang. (In 1897 there was a total of 46 synonyms). Sp: Fiebre ondulante (enfermedad de Bang). Fiebre de Malta. Melitoccocia. Fr: Fièvre ondulante (maladie de Bang). Brucelle bovine. Brucellose. Brucelle de Malte. Fievre méditerranée. Melitococcie. Fièvre caprine. Ger: Febris undulans (bruzellose). Malta fieber. Mittelmeerfieber. Bangsche Krankheit. Febris melitensis (undulans).


Definition

Brucellosis is caused by four organisms: Brucella melitensis, Brucella abortus, Brucella suis, and Brucella canis. All are small gram-negative aerobic, nonmotile coccobacilli. All are pathogenic for man, although Br. abortus is the least infective and Br. canis is very uncommon and usually causes mild illnesses only.

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