Bichat guidelines for the clinical management of brucellosis and bioterrorism-related brucellosis

Abstract

Interest in Brucella species as a biological weapon stems from the fact that airborne transmission of the agent is possible. It is highly contagious and enters through mucous membranes such as the conjunctiva, oropharynx, respiratory tract and skin abrasions. It has been estimated that 10-100 organisms only are sufficient to constitute an infectious aerosol dose for humans. Signs and symptoms are similar in patients whatever the route of transmission and are mostly non-specific. Symptoms of patients infected by aerosol are indistinguishable from those of patients infected by other routes. Regimens containing doxycycline plus streptomycin or doxycycline plus rifampin are effective for most forms of brucellosis. Isolation of patients is not necessary. Trimethoprim-sulfamethoxazole and fluoroquinolones also have good results against Brucella, but are associated with high relapse rates when used as monotherapy. The combination of ofloxacin plus rifampicin is associated with good results. Even if there is little evidence to support its utility for post-exposure prophylaxis, doxycycline plus rifampicin is recommended for 3 to 6 weeks.

Identification of Immune Effectors Essential to the Control of Primary and Secondary Intranasal Infection with Brucella melitensis in Mice

“…infection, and they teach us little about mucosal immune defenses constituting the first barrier protecting the host against brucellosis under natural conditions. Human brucellosis is frequently acquired via aerosol exposure (18), and 10-100 bacteria seem sufficient to infect humans in this manner (19). Aerosol or intranasal (i.n.)…”

A case of brucellosis displaying Parkinsonian-like tremor

“…Therefore, in our opinion, doctors should follow the principles of chemotherapy of tuberculosis "early, regular, entire journey, sufficient quantum and combination", in other words, early treatment to rapidly kill the bacteria, regular medication to avoid drug resistance, entire journey of treatment to reduce recurrence, sufficient quantum to prevent resistance and reduce the drug toxicity, and combination therapy to enhance efficacy. Given the resistance associated with use of oxytetracycline and the side effects after long-term use of streptomycin and rifampin, we recommend the combination therapy of levofloxacin and TMP-SMZ; this is also in agreement with the guideline issued by the Public Health Directorate, European Commission, Luxembourg [29] The above two kinds of drugs could penetrate effectively into cells, maintain an effective therapeutic plasma drug concentration for a long time, but with a low relapse rate [12,16,25,[29][30][31][32].…”

Renal Cyst Infection Caused byBrucella abortus

“…The recommended first-line therapy for brucellosis includes streptomycin or doxycycline in combination with rifampicin. 12 Although there are some cases seriesly reporting successful outcomes with quinolone including regimen, it is not supported by randomized clinical studies. 13,14 Even so, the long duration of unresponsiveness to doxycycline plus rifampicin pushed us also to add ciprofloxacin to the treatment according to the available antibiotic properties and reported case series.…”