Brucelosis
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Transcript of Brucelosis
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Dr. Juan Carlos López AcevedoR2MI
IMSS: CMN 25
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BrucelosisFiebre ondulante
Fiebre de malta
Fiebre de Gibraltran
Fiebre del mediterran
eo. Brucella spp.
N Engl J Med 352:2325, June 2, 2005 Review Article — Medical Progress
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EpidemiologiaoB. abortus de mayor
distribución mundial.
oB. melitensis: Peor cuadro clínico al hombre
http://ssj.app.jalisco.gob.mx/pdf/servicios/brucelosis.pdf
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MicrobiologíaCocobacilo gramnegativo aerobio
NO: cápsula, flagelo,
endosporas, endo o
exotocinas o
plásmidos.
Inhibe apoptosi
s.
abortus, suis,
melitensis y canis
Doble membrana
Antigenos peri plasmáticos
Inmunodominancia por
lipopolisacarido (base para las
pruebas serologicas)
** cruzada con Echerichias, salmonela,
stenotrophomona
multophila, vibrae
cholerae y Yersinia
enterocolitica
N Engl J Med 352:2325, June 2, 2005 Review Article — Medical Progress
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Tiempo de supervivencia de brucela en medio ambiente
Norma Oficial Mexicana NOM-022-SSA2-1994
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Vías de infección:
N Engl J Med 352:2325, June 2, 2005 Review Article — Medical Progress
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PatogénesisInhibe apoptos
is
N Engl J Med 352:2325, June 2, 2005 Review Article — Medical Progress
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ClínicaClínica Porcentaje de
casos
Signos y síntomas.
Fiebre 91
Síntomas generales
26
Hepatomegalia 17
Esplenomegalia 16
Linfadenopatia
7Hallazgos laboratorio
Hematológico 49 (linfocitosis relativa 40,
trombocitopenia 5, leucopenia 2, pancitopenia
2)
Transaminasemia
24
Cultivos positivos
16
Complicaciones
Artritis periférica
22 (cadera 8, rodillas 7, muñeca 4)
Sacroileitis 3
Spondilitis 19 (lumbar 15, dorsal 3,
cervical 1)
SNC 3
Emesis y diarrea
3
Respiratorias 6
Rash 3
Cardiovascular 0
Clinical manifestations, diagnosis, and treatment of brucellosisUptodate 2010
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LocalizadaOsteoarticular:
Sacroileitis 20-30%
Genitorurinario: epididimoorquitis 2-40%
Neurobrucelosis: meningitis 1-2%
Endocarditis: 1%
Absceso hepatico 1%
Clinical manifestations, diagnosis, and treatment of brucellosisUptodate 2010
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Fiebre +
hepatitis granulomatosa
Microabscesos hepáticos
Granulomatosis o hemofagocitosis en medula
ósea
Meningitis Aséptica: deaminasa adenosina.
Clinical manifestations, diagnosis, and treatment of brucellosisUptodate 2010
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Brucelosis crónica
+ 6 meses
Malestar general
Asteniadepresión
JOURNAL OF CLINICAL MICROBIOLOGY, July 2009, p. 2084–2089
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Diagnostico
Fiebre + síntomas
inespecíficos
BH: Normal o
pancitopenia.
Elevación escasa de enzimas
hepáticas.
Clinical manifestations, diagnosis, and treatment of brucellosisUptodate 2010
80%
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Cultivos: oGold Estándar. 80% sensibilidad.
oBACTEC 9240 o 9050. 5-7 días
oAlertar siempre al laboratorio de la sospecha de brucelosisoLisis pos centrifugación****
oRuiz Castañeda S: 60% E:100%
Biopsia Medula ósea o hepática si sospecha es alta. 80-90% sensibilidad 100% especificidad
N Engl J Med 352:2325, June 2, 2005 Review Article — Medical Progress
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Aglutinación tubo:
1:160 diagnostico
Endémicos: 1:320
> 95%
Rosa de bengala:
Sensibilidad y especificidad
alta
Coombs: Brucelosis
crónica. IgG
ELISA: Sensibilidad y especificidad
alta (99%)
Mejor para neurobrucelosis
o crónica.
PCR: positivo 10 días
posterior a inoculación.
N Engl J Med 352:2325, June 2, 2005 Review Article — Medical Progress
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Tratamiento
oRégimen A:
oDoxiciclina 100 mgrs cada 12hrs 6 semanas
oEstreptomicina: 1gr IM 14-21 días.
oÍndice de recaídas: 7.4
Clinical manifestations, diagnosis, and treatment of brucellosisUptodate 2010
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oRégimen B:
oDoxiciclina 100mgrs cada 12hrs
oRifampicina 600-900mgrs día
o6 semanas
oMisma eficacia y recaída que régimen B.
Clinical manifestations, diagnosis, and treatment of brucellosisUptodate 2010
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oAlternativas:
oFluoroquinolonas:
oOfloxacino 400mgrs diario + Doxiciclina 100mgrs cada 12hrs 45 días.
oMismo resultados que régimen A y B
Clinical manifestations, diagnosis, and treatment of brucellosisUptodate 2010
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Embarazo
oRifampicina 900mgrs diario 6 semanas
oTMP mas SMX 4 semanas ?????
Clinical manifestations, diagnosis, and treatment of brucellosisUptodate 2010
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Brucelosis osteoarticular
oTriple esquema:
oDoxiciclina-estreptomicina- rifampicina
oCirprofloxacino-rifampicina.
o5 meses.
Clinical manifestations, diagnosis, and treatment of brucellosisUptodate 2010
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Neurobrucelosis
oDicloxacilina + rifampicina + trimetroprim con sulfametoxazol
oHasta 19 meses
oCosticoesteroides ???
Clinical manifestations, diagnosis, and treatment of brucellosisUptodate 2010
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Recomendaciones postexposición profilaxis
Alto o bajo riesgoAlto riesgo (6 meses)
o- Doxiciclina 100mgs cada 12 horas o TMP y SMX 160/800mgrs
o- Rifampicina 600mgrs día
o3 semanasBajo Riesgo:
o- serología 2-4-6- y 24 semanas. Pruebas de aglutinación-
oVigilancia hasta 6 meses.
Clinical manifestations, diagnosis, and treatment of brucellosisUptodate 2010
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Endocarditis.
oTriple esquema
oManejo quirúrgico
Clinical manifestations, diagnosis, and treatment of brucellosisUptodate 2010