How do they get infected?
Brucella enters the body through the digestive tract, through damaged skin and mucous membranes, and sometimes through inhaled dust. The infection is practically not transmitted from person to person, so there is no need to isolate the sick person - but you need to check everyone who ate the same product or worked with the same animal.
- Raw, unboiled milk from cow, sheep, goat or camel
- Fresh feta cheese and homemade cheese made from unpasteurized milk are the most common sources, since the pathogen in soft cheese persists for weeks
- Homemade cottage cheese, kaymak, suzma, ayran and other raw milk products
- Assistance with calving and lambing, work with placenta and amniotic fluid - here the risk is especially high
- Milking, caring for livestock, shearing sheep, slaughtering and cutting up carcasses
- Professional contact: shepherds, milkmaids, veterinarians, slaughterhouse and meat processing workers, laboratory employees
- Rare: inhalation of dust in a pen or slaughterhouse
The incubation period usually takes from one to four weeks, but can last several months. This is an essential detail: by the time symptoms appear, a person no longer associates his condition with the feta cheese he bought a month and a half ago, and when asked about raw milk, he answers negatively quite sincerely. Therefore, you need to ask not about yesterday, but about the previous several months.
Symptoms: why they are mistaken for anything
The classic description is undulating fever: the temperature rises for several days or weeks, then subsides, the person feels relief, and after a while everything repeats. Hence the historical name "undulant fever". However, this in itself does not prove anything, because other diseases give rise to similar cycles. More indicative is the combination of symptoms, each of which individually is nonspecific.
- Prolonged fever, often with chills, often with rises in the evening
- Heavy sweat, especially at night - shirt and bedding have to be changed, sweat has a peculiar smell
- Severe weakness and fatigue, disproportionate to temperature
- Pain in large joints and muscles, pain in the lower back and back
- Headache, irritability, sleep disturbance, depression
- Enlarged liver, spleen and lymph nodes
- Loss of appetite and weight loss
- Sometimes rash, abdominal pain, cough
An essential feature: with brucellosis, the gap between the severity of well-being and the external picture is large. A person with a temperature of 39 may look relatively well, and this is one of the reasons why his condition is underestimated. Another typical situation is dealing not with fever, but with pain in the back or joints, when the fever has passed and they simply forgot to mention it.
Damage to the spine and joints
The musculoskeletal system suffers most often with brucellosis, and it is these manifestations that determine the severity of the disease and the duration of treatment. The most serious of them is brucellous spondylitis, inflammation of the vertebrae and intervertebral discs, most often in the lumbar region. It develops gradually, gives persistent back pain, which intensifies at night, and is easily mistaken for a disc herniation or exacerbation of osteochondrosis.
- Spondylitis - persistent pain in the lower back or thoracic region, night pain, pain when tapping on the spinous processes
- Sacroiliitis - inflammation of the sacroiliac joints with pain in the buttock and lower back
- Arthritis of large joints: hip, knee, shoulder, usually on one side
- Bursitis and tendinitis, pain in the tendon insertions
- Formation of abscesses near affected vertebrae—requires imaging and sometimes surgery
- Compression of nerve structures due to significant destruction of the vertebra
A practical guideline for the patient: back pain that lasts for weeks, gets worse at night and is or has been accompanied by fever, sweating and weight loss is not osteochondrosis. This combination does not require massage and warming, but examination, including tests for infections and MRI of the spine. Warming up and manual therapy in this situation are not only useless, they can accelerate the spread of the process.
How is the diagnosis confirmed?
The diagnosis is based on three bases: epidemiological data, clinical picture and laboratory confirmation. The first link is the most underestimated: without asking about milk, feta cheese and contact with livestock, the doctor often simply does not think about this infection.
- Подробный расспрос об употреблении непастеризованных молочных продуктов и контакте с животными за последние несколько месяцев, включая поездки в сельскую местность.
- Серологические реакции — Райта, Хеддльсона, а также определение антител методом ИФА. Это main способ подтверждения.
- Повторное исследование через 10–14 дней: нарастание титра антител в динамике информативнее однократного результата.
- Посев крови на специальные среды — метод точный, но требует длительной инкубации, и врачу лаборатории обязательно сообщают о подозрении на бруцеллёз.
- Общий анализ крови: чаще нормальное или сниженное число лейкоцитов при относительном увеличении лимфоцитов — картина, не похожая на обычную бактериальную инфекцию.
- МРТ позвоночника, УЗИ или ЭхоКГ — при подозрении на поражение позвонков, органов брюшной полости или сердца.
Serology results have features that are worth being aware of. At the earliest stage, antibodies may not yet be detected, so one negative result with an obvious clinical picture does not close the question - the study is repeated. On the other hand, after an illness, antibodies persist for a long time, and their detection in a person without symptoms does not mean an active infection and does not require treatment. An infectious disease specialist should interpret the result, comparing it with the clinical picture and dynamics.
Treatment: why does it take so long?
The main feature of the treatment of brucellosis is that the pathogen is located inside the cells, where antibiotics penetrate less easily. Hence, there are two principles: combinations of two and sometimes three drugs are used, and the course lasts at least six weeks, and in case of damage to the spine, heart or nervous system - much longer, several months. There is no such thing as “we took an antibiotic for a week and felt better”: relief really comes quickly, but if the course is interrupted, the disease returns.
- A combination of two antibiotics - monotherapy for brucellosis is not used due to the high frequency of relapses
- The minimum duration of the course is six weeks; in complicated forms it is significantly extended
- For spondylitis, endocarditis and damage to the nervous system, a third drug is added to the regimen and treated in a hospital
- Separate regimens for children and pregnant women - some standard drugs are contraindicated for them
- Monitoring general blood count and liver function during treatment
- Observation after completion of the course: relapse most often occurs during the first months
Relapses occur in a significant proportion of patients, and their main causes are an interrupted course, an incorrectly chosen regimen, and a late start of treatment. That is why the improvement in well-being in the second week of use is not a reason to stop: the temperature drops, strength returns, but the pathogen remains inside the cells. The second common mistake of the opposite nature is taking antibiotics before testing: this blurs the culture results and makes it difficult to confirm the diagnosis.
Prevention: what really works
There is no widespread vaccine for humans, so all prevention comes down to product safety and protection when working with animals. The measures are simple, but require consistency, because homemade milk and fresh cheese are perceived as obviously healthy and natural products, and that is why the risk is underestimated.
- Молоко of частного хозяйства кипятить обязательно, независимо от того, насколько надёжным кажется продавец.
- Не покупать свежую брынзу, домашний творог и каймак неизвестного происхождения; отдавать предпочтение продукции промышленной пастеризации.
- При работе со скотом использовать перчатки, а при отёле, окоте и работе с последом — перчатки и защиту лица.
- Никогда не работать с животными и сырым мясом при наличии порезов и ссадин на руках без защиты.
- Больных и абортировавших животных изолировать и обращаться к ветеринарной службе — именно ветеринарный контроль стада решает проблему в корне.
- Если в семье кто-то заболел бруцеллёзом, обследовать всех, кто ел тот же продукт, — заражение обычно групповое.
Separately, it is worth mentioning trips to the village and the gifts brought from there. Fresh homemade cheese, kaymak and fresh milk are a typical gift from relatives, and this is how the infection enters the city. Boiling the milk and avoiding fresh, unpasteurized cheese removes virtually all the risk, requiring no expense or special knowledge. Freezing, salting and adding vinegar, contrary to popular belief, do not provide reliable protection.