Brucellosis: Identification, Prevention, and Treatment in Austere Circumstances

Brucellosis is another one of those diseases that few people have heard of.  It’s primarily a concern in underdeveloped countries that lack good public health and domestic animal health programs.  However, in the US, livestock are frequently screened for the disease and vaccinated against it.  The disease is common to game animals, so hunters need to take note of it as well.  Brucellosis is also considered a class B bioweapon.  While there are currently only 100-200 cases of brucellosis in the US each year, that number will increase as more people begin hunting, processing their own game, and taking risks with unpasteurized dairy products.[1]  Here’s what you need to know:

The following information comes verbatim from The Ship’s Medicine Chest and Medical Aid at Sea, a government publication.

Undulant Fever (Malta Fever, Brucellosis)

Incubation Period:  Variable; usually 5 to 21 days, at times several months.

Isolation Period:  Until convalescence begins.

Undulant fever is an infectious disease that strikes both humans and animals, but symptoms differ for both groups.  It is caused by several bacterial strains of the genus Brucella.  The disease is contracted mainly from milk and milk products obtained from dairy cattle with Bang’s disease (infectious abortion). 

At first fever may be the only symptom, but the patient will not appear acutely ill.  Then there is a gradual onset with irritability, a general feeling of discomfort, weakness, headache, pains in joints, with sweating and chills.  In early stages, it may be confused with rheumatic fever, tuberculosis, typhoid fever, or malaria.  The temperature may rise to 104°F (40°C) and remain elevated for one to four weeks followed by a fall to normal for a few days, and then a relapse.  The intermittent periods of fever, separated by days when symptoms are absent or reduced, may last for months, even years.  It is these repeated waves (undulations) of fever with intervening remissions that give the disease its name. 

As the disease becomes chronic, enlargement of the spleen and lymph nodes occurs.  Other symptoms in the later stages include weight loss; constipation; loss of appetite; aches in head, back joints, abdomen; insomnia; and mental depression. 

Exact diagnosis will be dependent upon laboratory procedures, so a suspected case should be transferred to a doctor’s care as soon as possible.  The patient should be asked if he drank goat’s milk, and any found aboard should be discarded.  Cow’s milk obtained in foreign ports should be boiled before use. 

Treatment

Medical advice by radio should be obtained, especially on the medication.  The patient should be isolated and the symptoms treated as they arise.  All utensils used by the patient should be disinfected.  Headache and pains in the joints and limbs may be relieved by aspirin 600 mg or codeine sulfate 30 mg, administered orally every four to six hours.  Tetracycline hydrochloride 500 mg may be given orally every six hours for 10 days to treat the infection. For relapses this treatment may be repeated.  Fluids should be forced.

 

Additional information from other sources:

The brucellosis fevers may vary in severity.  Generally, chills begin in the afternoon and conclude with sweating in the early morning.  With chronic brucellosis, the fevers may come and go.  Without antibiotic treatment, brucellosis may last for years.  Lymph nodes in the neck, armpits, and groin may swell.[2]  Additional signs and symptoms that may reoccur or never go away include:

• Arthritis
• Swelling of the testicles and scrotum
• Chronic fatigue
• Depression
• Swelling of the heart, liver, and/or spleen
• Neurologic symptoms (in up to 5% of cases)[3]

Risk factors

While drinking unpasteurized milk from infected cows or goats is the most common cause of brucellosis infections, the bacteria may also enter the body through compromised skin or by inhaling aerosolized droplets from infected animals. 

Individuals who come into contact with animal secretions, such as meat-packers, veterinarians, lab workers, and hunters are at elevated risk.

Also at risk are hunters and others who eat undercooked meat or inhale bacteria while dressing game.  Commonly infected animals include deer, moose, elk, caribou, bison, hunting dogs, and wild hogs.[4] 

The CDC recommends the following precautions for hunters:

• Use clean, sharp knives for field dressing and butchering.
• Wear eye protection and rubber or latex gloves (disposable or reusable) when handling carcasses.
• Avoid direct (bare skin) contact with fluid or organs from the animal.
• Avoid direct (bare skin) contact with hunting dogs that may have come into contact with hunted animals.
• After butchering, burn or bury disposable gloves and parts of the carcass that will not be eaten.
• Don’t feed dogs with raw meat or other parts of the carcass.
• Wash hands as soon as possible with soap and warm water for 20 seconds or more. Dry hands with a clean cloth.
• Clean all tools and reusable gloves with a disinfectant, like dilute bleach. (Follow the safety instructions on the product label).
• Thoroughly cook meat from any animal that is known to be a possible carrier of brucellosis (see the list above).
• Be aware that freezing, smoking, drying and pickling do not kill the bacteria that cause brucellosis.[5]

Pregnant women who may have been exposed to brucellosis should consult with their obstetrician about prophylactic treatment.[6]

Treatment:  Doxycycline 100 mg, 2 times per day, plus rifampicin 600 mg, once per day, for 60 days.  Treatment for post exposure prophylaxis is 21 days.[7]

Alcohol extracts of juniper have been shown effective in treating brucellosis.[8]

Links to related posts:

Doxycycline 

The Medicinal Uses of Juniper 

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[1] Centers for Disease Control, “Brucellosis,” https://www.cdc.gov/brucellosis/transmission/index.html (accessed 30 December 2020).

[2] David Werner, Where There Is No Doctor, 188.

[3] Centers for Disease Control, “Brucellosis,” https://www.cdc.gov/brucellosis/transmission/index.html (accessed 30 December 2020).

[4] Centers for Disease Control, “Brucellosis,” https://www.cdc.gov/brucellosis/transmission/index.html (accessed 30 December 2020).

[5] Centers for Disease Control, “Brucellosis:  Hunters Risks,” https://www.cdc.gov/brucellosis/exposure/hunters.html (accessed 30 December 2020).

[6] Centers for Disease Control, “Brucellosis: Risks for Expectant Mothers,” https://www.cdc.gov/brucellosis/exposure/expecting-mothers.html (accessed 30 December 2020).

[7] Cynthia Koelker, Armageddon Medicine, 489.

[8] Stephen Buhner, Herbal Antibiotics, 180.

 2.3.21