Brucellose

Zusammenfassung

Die Brucellose ist eine vor allem mit Schafen, Ziegen und Rindern assoziierte Zoonose. Sie tritt in Deutschland selbst nicht endemisch auf, ist aber eine wichtige importierte Infektionserkrankung. Bei Patienten, die nach einem Aufenthalt in den hochendemischen Ländern des Mittelmeerraums oder der arabischen Welt eine unklare fieberhafte Erkrankung aufweisen, sollte die Brucellose daher diagnostisch ausgeschlossen werden. Vor den serologischen Verfahren ist der Erregerdirektnachweis das wichtigste Instrument zur Diagnosestellung. Aufgrund besonderer Anforderungen bei der Anzucht des Erregers muss das Labor vorab über die Verdachtsdiagnose informiert werden. Therapeutisch bedarf es einer mindestens 6-wöchigen antimikrobiellen Kombinationstherapie, deren Dauer und Zusammensetzung von der Schwere des Krankheitsbildes und eventuell auftretenden Komplikationen abhängt. Dafür ist meist eine besondere Therapieadhärenz des Patienten nötig.

Abstract

Although brucellosis, a zoonosis mostly associated with sheep, goats and cattle, is not endemic in Germany, it is a relevant imported infectious disease. If patients suffer from fever of unknown origin after a stay in highly endemic countries like the Mediterranean area or the Arab world, it is mandatory to formally exclude brucellosis. Cultural methods are the diagnostic gold standard, but due to special methodical and infrastructural requirements it is essential to inform the laboratory at suspicion of infection. The treatment of brucellosis is challenging and usually based on a long-term combination regime using doxycycline and rifampin for at least 6 weeks.

Schlüsselwörter

Zoonose - importierte Erkrankung - Verdachtsmitteilung ans Labor - Kombinationstherapie

Keywords

zoonosis - imported disease - combination therapy

• Literatur

• 1 Mableson HE, Okello A, Picozzi K et al. Neglected zoonotic diseases-the long and winding road to advocacy. PLoS Negl Trop Dis 2014; 8: e2800
• 2 Welburn SC, Beange I, Ducrotoy MJ et al. The neglected zoonoses-the case for integrated control and advocacy. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis 2015; 21: 433-443
• 3 Franco MP, Mulder M, Gilman RH et al. Human brucellosis. Lancet Infect Dis 2007; 7: 775-786
• 4 Pappas G, Papadimitriou P, Akritidis N et al. The new global map of human brucellosis. Lancet Infect Dis 2006; 6: 91-99
• 5 Dean AS, Crump L, Greter H et al. Global burden of human brucellosis: a systematic review of disease frequency. PLoS Negl Trop Dis 2012; 6: e1865
• 6 Robert Koch-Institut. Online: https://survstat.rki.de (Stand: 30.05.2016)
• 7 Versalovic J, Jorgensen JH, Funke G et al. Manual of clinical microbiology, 10th Edition. Washington DC: American Society for Microbiology; 2011
• 8 Moreno E. Retrospective and prospective perspectives on zoonotic brucellosis. Front Microbiol 2014; 5: 213
• 9 Federal Select Agent Program. Online: www.selectagents.gov/SelectAgentsandToxinsList.html (Stand: 01.10.2015)
• 10 De Figueiredo P, Ficht TA, Rice-Ficht A et al. Pathogenesis and immunobiology of brucellosis: review of brucella-host interactions. Am J Pathol 2015; 185: 1505-1517
• 11 Galińska EM, Zagórski J. Brucellosis in humans - etiology, diagnostics, clinical forms. Ann Agric Environ Med AAEM 2013; 20: 233-238
• 12 Meltzer E, Sidi Y, Smolen G et al. Sexually transmitted brucellosis in humans. Clin Infect Dis Off Publ Infect Dis Soc Am 2010; 51: e12-15
• 13 Colebunders RL. Control of communicable diseases manual, 19th Edition. Washington DC: American Public Health Association; 2009
• 14 Dean AS, Crump L, Greter H et al. Clinical manifestations of human brucellosis: a systematic review and meta-analysis. PLoS Negl Trop Dis 2012; 6: e1929
• 15 Köse Ş, Serin Senger S, Akkoçlu G et al. Clinical manifestations, complications, and treatment of brucellosis: evaluation of 72 cases. Turk J Med Sci 2014; 44: 220-223
• 16 Gul HC, Erdem H, Bek S. Overview of neurobrucellosis: a pooled analysis of 187 cases. Int J Infect Dis IJID Off Publ Int Soc Infect Dis 2009; 13: e339-343
• 17 Dasari S, Naha K, Prabhu M. Brucellosis and tuberculosis: clinical overlap and pitfalls. Asian Pac J Trop Med 2013; 6: 823-825
• 18 Baysallar M, Aydogan H, Kilic A et al. Evaluation of the BacT / ALERT and BACTEC 9240 automated blood culture systems for growth time of brucella species in a turkish tertiary hospital. Med Sci Monit Int Med J Exp Clin Res 2006; 12: BR235-238
• 19 Solís García, del Pozo J, Solera J. Systematic review and meta-analysis of randomized clinical trials in the treatment of human brucellosis. PloS One 2012; 7: e32090
• 20 Skalsky K, Yahav D, Bishara J et al. Treatment of human brucellosis: systematic review and meta-analysis of randomised controlled trials. BMJ 2008; 336: 701-704
• 21 Solera J. Update on brucellosis: therapeutic challenges. Int J Antimicrob Agents 2010; 36: S18-20
• 22 Bossi P, Tegnell A, Baka A et al. Bichat guidelines for the clinical management of brucellosis and bioterrorism-related brucellosis. Euro Surveill Bull Eur Sur Mal Transm Eur Commun Dis Bull 2004; 9: E15-16
• 23 Ariza J, Bosilkovski M, Cascio A et al. Perspectives for the treatment of brucellosis in the 21st century: the Ioannina recommendations. PLoS Med 2007; 4: S.e317
• 24 Alavi SM, Alavi L. Treatment of brucellosis: a systematic review of studies in recent twenty years. Casp J Intern Med 2013; 4: 636-64
• 25 Brucellosis in humans and animals. Online: http://www.who.int/csr/resources/publications/Brucellosis.pdf (Stand: 16. 12. 2015)