1. Brucellosis, Tetanus
&
Plague
By
Dr. Riaz Ahmed

2. Brucellosis
 Also known as undulant fever / malta fever /
mediterranean fever.
 Bacterial zoonosis which is transmitted to man
by direct / indirect contact with animals.
 Caused by different species of brucella- group
of organisms and characterized by:
• Intermittent / irregular febrile attacks
• Arthritis / enlarged spleen etc.

3. Epidemiology
 Agent factors:
• Brucella abortus – in bovine – abortus fever
• B.Suis – Pigs – Swine – F or Porcine
• B.Canis – Canines – Canine fever
• B.Melitensis – Goats – Caprine fever
 Host factors: predominantly disease of males.
• Farmers
• Shepherds
• Butchers
• Slaughter house men
• Veterinarians
• Lab-workers – are at special risk because of
occupational exposure.

4.  Environmental factors:
Most prevalent under conditions of advanced
domestication in the absence of corresponding
advanced S.O. Hygiene (+) where there is
• Overcrowding of herds
• Increased rain fall
• Lack of exposure to sunlight
• Unhygienic practice of milking/ heat
production

5.  M.O.T:
• Ingestion – milk / milk products
- meat even of camel
• Contact – absorption from skin
• Inhalation
• Inoculation 02mm – throat or oral cavity
 Source / Reservoir:
S – milk, lochial secretions, placenta, urine,
feces & meat.
R – farm animals e.g., cattle, goats, swine etc.
 I.P: highly variable usually 1-3 weeks.

6.  Lab diagnosis:
• Bacteriological
• Serological / allergic test
 Control:
 in animals:
• Test / slaughter
• Vacc – B.Abortus strain – 19
• Hygienic measures
 In humans:
• At individual level
• At community level

7. Tetanus
 An acute disease caused by exotoxins of
clostridium tetani clinically characterized by :
• Muscular rigidity
• Painful paraoxysmal spasms of voluntary
muscles esp.
 Masseters ( trismus / lock-jaw )
 Facial (risus sardonicus)
 Back / neck (opisthotonus)
And those of lower limbs and abdomen
o Mortality : 40-80%

8.  Agent factors:
• Clostridium tetani
• Reservoir of infection
• Source – soil / dust
• Exotoxin
• P.O.C – None
 Host factors:
• Age / sex
• Occupation
• Rural / urban differences
• Immunity
 Environmental factors:
• Tetanus is a positive environmental hazard.
 M.O.T: contamination of wounds with tetanus spores.

9.  I.P: 6 – 10 days
 Types:
• Traumatic
• Puerperal
• Otogenic
• Idopathic
• Tetanus Neonatorum (8th day syndrome)
 Prevention:
• Active immunization – DPT
• Passive – ATS
• Both
• Antibiotics
• Observe tetanus schedule for pregnant women

10. Plague (Black Death)
 Basically & primarily a zoonotic disease caused by
Yersinia pestis involving rodents & fleas.
 It exists in natural foci & is transmitted by
infected flea bites to humans living or intruding
into the same ecological environment.
 Occurrence: many forms e.g.,
• Epizootic
• Enzootic
• Sporadic
And in epidemics of all forms including
anthroporotic primarily pnemonic.

11. History
 Epidemics of plague are mentioned in Bible
 Association of plague with rats is known to be
ancient.
 1st out-break – 1320 B.C.
 1st Pandemic – 542 A.D. called Justinian plague,
which lasted for 50 years & estimated mortality was
100 deaths.
 2nd Pandemic – 1346 B.C. lasted for 30 years &
claimed one forth world mortality.
 In 1840 B.C. – Pandemic of pneumonic type
 In 1930 – 6 million deaths in India.
 In 1994 - out-break in India, then subsided gradually.

12. Plague
 Def: Highly fatal disease characterized by high fever,
progressive heart failure & nervous symptoms.
o Conjunctiva is injected with reddish appearance.
o Skin – hemorrhage & pustular eruptions.
 Clinical forms:
• Bubonic
• Pnemonic
• Septicemic
• sylvatic

13. Bubonic plague
 Onset sudden, most common type
 High temperature, prostration
 Painful buboos
 Vesicular / pustular skin lesions
 Complications:
secondary terminal pneumonia

14. Pneumonic plague
 Primary P. Plague is rare. Generally follows as
a complication of bubonic - septicemic plague.
 Incidence decreased 1%
 Highly infectious
 Symptoms – acute bacterial infection
 Sputum – hemorrhagic
 Most deadly form of plague

15.  Septicemic :
• Rare
• Buboes absent
• Fever – low
• Hemorrhages into skin
 Sylvatic :
• Endemic in rodents in jungles
• Man is affected accidentally while doing
activities like hunting etc.

16.  Source of infection:
 In bubonic plague : by bite of inf. Rat – fleas
Xenophsylla cheopis
Xenophsylla actia
Xenophsylla braziliensis
 In pneumonic plague:
exhaled droplets of saliva
sputum of patients
 Reservoir : rats & wild rodents, out of 1700
species 200 associated with plague.

17.  I.P:
• Bubonic : 2-7 days
• Septicemic : 2-7 days
• Pneumonic : 1-3 days
 P.O.C: pneumonic is very communicable
from person to person, bubonic if terminal inf.
is there.
 M.O.T:
• Bubonic plague – bite of infected rat flea
• Pneumonic plague – droplets

18. Epidemiology
 Agent factors: yersinia pestis, occur in blood,
buboes, spleen, liver, other viscera of infected
persons.
 Host factors:
• Age / sex – all ages & both sexes
• Activities of man e.g., hunting, cultivation, grazing,
harvesting, construction etc.
• Movements – ship, land, cargo
• Immunity – no natural immunity
 Environmental factors:
• Season : september – May
• Temp : 20-25 C
• Humidity less than 60%, Rain fall
• Rural / urban, Human dwellings

19.  Population at risk:
• Geologists, Biologists
• Anthropologists
• Hunters, agriculturists etc.
 Vector of plague: Pulex irritants (human fleas)
 Blocked / Partially blocked flea
 Flea Indices:
o Total flea index
o Specific index – if >1
o Sp.% of fleas
o Burrow index

20. Prevention & Control
 Control of cases:
• Early diagnosis
• Notification
• Isolation
• Treatment
• Disinfection
 Control of fleas/ rodents:
Application of insecticides, rodenticides and other
preventive measures to be adopted.
 Vaccination: 0.5-1ml SC after 7-10 days.

21.  Chemoprophylaxis:
 Surveillance
 Health education