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Brucellosis

- An unsual
- Imp cause of subacute or chronic granulomatous infection in bones & jts
- 3 species of orgs seen in humans:
a) Brucella melitensis
b) B. abortus (from cattle)
c) B. suis (from pigs)
- Infection: usually from drinking unpasteurized milk or from coming into contact with infected
meat (among farmers & meat packers)
- Common in countries around Mediterranean & certain parts of Africa & India
- 50% pt with brucellosis develop arthritis
- Pathology:
a) Org enters body with infected milk products or
b) Occasionally: directly thru skin or mucosal surfaces
c) Taken up by lymphatics & carried by blood to distant sites
d) Foci of infection: in bones (usually vertebral bodies) or in synovium of larger jts
e) Characteristic lesion: chronic inflammatory granuloma with round-cell infiltration & giant
cells
f) Central necrosis & caseation leading to abscess formation & surr t/s invasion
- c/fs:
a) fever, headache, generalized weakness
b) followed by jt pain & backache
c) initial illness: acute & alarming; more often insidious onset; progressive until sympts
localizing in a single large jt (hip/knee) or spine
d) jt: painful, swollen. Tender
e) movements: restricted in all directions
f) spine affected: usually local tenderness; restricted back movements
g) fluctuating course systemic illness with alternating periods of fever & apparent
improvement (older term undulating fever)
h) diagnosis: long delayed; not resolved until advanced destructive changes
- X-rays
a) Subacute arthritis picture
b) Loss of articular space
c) Slowly progressive bone erosion
d) Peri-articular OP
e) Spine: destruction; collapse of adjacent VB; with disc obliteration
- Inv:
a) +ve agglutination test (titre >1/80): diagnostic
b) Jt aspiration or biopsy: culture & identify org
- Diagnosis: usually delayed to R/O other subacute arthritis
a) TB: similar clinical & radiological features as brucellosis; difficult to distinguish; await results
of agglutination tests, synovial biopsy & bacteriological investigations
b) Reiters d/s & other forms of reactive arthritis following an initial systemic illness (not so
marked fever; usually late & mild jt erosion)
- T/t:
a) Antibiotics: combined onslaught with tetracycline & streptomycin for 3-4 weeks; alternative
drugs: equally effective combination therapy: rifampicin + newer cephalosporins
b) Operation: drainage of an abscess; meticulous excision of necrotic bone & cartilage;
arthrodesis/arthroplasty (if jt destroyed) once infection is completely controlled

Leprosy

- Mildly infectious chronic inflammatory d/s


- Cause: acid-fast mycobacterium leprae
- Characterized by granulomatous lesions in peripheral nerves, skin, URT mucosa
- Once common throughout the world
- Rare outside south Asia, Africa, Latin America & some of the pacific islands
- Easily cured d/s with drugs
- Persistent crippling effect in a cumulative no of people
- infection acquired by respiratory transmission; (unbroken skin conta