127. Brucella

In which Callum and Jame discuss Brucellosis, named after a Scottish feminist, a disease hard to diagnose but easy to treat, as long as the treatment works which it may not. Listen on! 

Transcript

jame_1_05-12-2025_150152: 0:18

Now Callum, I hope you're not about to disrupt the introduction to this podcast by telling me about the home beer making apparatus you've got set up in your downstairs basement. None of the loyal listeners have come here to the show to hear about your brew cellar and what a coincidence that is, Callum.'cause what are we discussing today

callum---jame_1_05-12-2025_150151: 0:38

We are talking about a bruise cellar.

jame_1_05-12-2025_150152: 0:40

and what do you know about Bruce?

callum---jame_1_05-12-2025_150151: 0:42

Well, I do know a lot, but I don't want them to sue us, so I'm not gonna say,

jame_1_05-12-2025_150152: 0:49

Fine.

callum---jame_1_05-12-2025_150151: 0:51

gonna abort this, this show.

jame_1_05-12-2025_150152: 0:54

Okay. You gonna do the other two or are we just gonna move on?

callum---jame_1_05-12-2025_150151: 0:58

I think we should just, can it?

jame_1_05-12-2025_150152: 0:59

Oh God. Okay. Let's talk about the genus Bruce. Now this is a condition that's not native to the UK really. We've had our last case quite a long time ago, but worry about it with people returning from other parts of the world where Bruce is a lot more prominent. You know, notably like the Mediterranean, Southeast Asia, Africa, places like that. So it's still of relevance to the ID clinician and quite an interesting bug to research. Actually, Kalan, why don't you take us through the genus?

callum---jame_1_05-12-2025_150151: 1:28

So the genus, it's sella. It's within the family, Bruce cell, a CA, and I don't, is there anything else in that family?

jame_1_05-12-2025_150152: 1:35

nothing of relevance.

callum---jame_1_05-12-2025_150151: 1:37

No. So there's four species of briella that cause disease in humans, which is what we're interested in. The first is melitensis, and that affects humans and it's normal host is goat, sheep or camels. And you've got abortus, which usually affects cattle sue, which affects pig and canus, which affects dog.

jame_1_05-12-2025_150152: 2:03

Yeah, although though we're talking about them as if they're from separate species, I note from the WHO 2006 guidance on brucellosis, which a lot of this episode is based on quote on genetic grounds. The Briella group can be regarded as variants of a single species, which for historical reasons is identified as B melitensis. However, for practical purposes, this approach is considered unsatisfactory, and six main species are distinguished and Kalama. And alternating the list of the species to follow. Abor, melitensis.

callum---jame_1_05-12-2025_150151: 2:35

Neo

jame_1_05-12-2025_150152: 2:36

Ovis.

callum---jame_1_05-12-2025_150151: 2:38

can.

jame_1_05-12-2025_150152: 2:38

Yeah. so that's four of the six that we've just mentioned, plus two others. So this is uh, cha and e coli all over again. But for the remainder of the show, we are gonna treat them as if they are four separate species.

callum---jame_1_05-12-2025_150151: 2:52

So this organism's been around for a very long time. Ever since we've been drinking milk, most likely from animals. Humans have been affected by Bruces. And looking back through the history, there's several descriptions or what seems likely to be bru in a history starting with Hippocrates, the one of the most famous clinicians in four 50 bc and a patient called. And then throughout the 18th and 19th century, there was various subscriptions generally related to military endeavors. So I guess the, the whole field of tropical medicine in the UK was born out of, the British Empire and the you know, the forced colonization and military endeavors abroad.

jame_1_05-12-2025_150152: 3:38

Hmm.

callum---jame_1_05-12-2025_150151: 3:38

And a lot of tropical medicine funding was relating to the army in order because, you know, you don't want sexual soldiers.

jame_1_05-12-2025_150152: 3:45

Yeah. Apparently the option of keeping them all at home never occurred.

callum---jame_1_05-12-2025_150151: 3:49

Yes.

jame_1_05-12-2025_150152: 3:49

Priscilla actually

callum---jame_1_05-12-2025_150151: 3:50

So Briela gets his name from a clinician called David Bruce, who we're gonna claim as a Scottish microbiologist, although variably can be described as British or Australian as well,

jame_1_05-12-2025_150152: 4:00

mean, all

callum---jame_1_05-12-2025_150151: 4:00

and

jame_1_05-12-2025_150152: 4:00

people can be described as British people too. Callum,

callum---jame_1_05-12-2025_150151: 4:03

well, that's true, but if you look at, depending where you look.

jame_1_05-12-2025_150152: 4:05

on you here.

callum---jame_1_05-12-2025_150151: 4:06

People tried to claim him. So he's Scottish, right? Get off. But, so he did some research when he was stationed in Malta on a diagnosis called Malt Fever which has since been named osis. And the, issue was that British soldiers stationed in Malta were suffering outbreaks of what was called Malta fever. So you get this undulating fever and abortion and goats, and around this time was sort of early bacteriology. So people were starting to be able to identify microorganisms using a microscope and he identified something called micrococcus Melitensis. And that was from a splenic biopsy or aspirate from a dying patient.

jame_1_05-12-2025_150152: 4:45

Have a quote to you, Callum, if you, if you.

callum---jame_1_05-12-2025_150151: 4:47

Yeah, you go.

jame_1_05-12-2025_150152: 4:48

So specifically he recovered a bacteria in which he referred to as Micrococcus, which he described as followers. Quote, when a minute portion taken from one of these culture colonies is placed in a drop of sterilized water and examined under a high power microscope. Innumerable small micro co eye are seen. very active in dance about. As a rule, singly sometimes impairs, rarely in short chains. And this was later identified as the cause of agent of Malta fever, then called brucellosis and the genus was then named after him. He also did a lot of work with TSIs and Tso. Brucei Eye, is named for him as well. That's the same. David Bruce.

callum---jame_1_05-12-2025_150151: 5:27

Hmm.

jame_1_05-12-2025_150152: 5:27

he was actually the man who identified that ly as the vector for TSOs. He was also a very early feminist and collaborated with his wife, Mary Bruce, on more than 30 papers in the late 18 hundreds, which must have been fairly groundbreaking at the time.

callum---jame_1_05-12-2025_150151: 5:42

Power couple.

jame_1_05-12-2025_150152: 5:43

Yeah,

callum---jame_1_05-12-2025_150151: 5:44

Yeah.

jame_1_05-12-2025_150152: 5:44

us.

callum---jame_1_05-12-2025_150151: 5:46

Sometimes I think it would be very. Exciting to have been a bacteriologist in this period, in this late 19th century.'cause so many things were being discovered and we newly had ways of identifying organisms and proving sort of Cox postulates about linking diseases.

jame_1_05-12-2025_150152: 6:04

Yeah.

callum---jame_1_05-12-2025_150151: 6:04

But then you read about how many people died from the diseases they were studying. You're like math actually, probably rather live in the era of antibiotics than vaccines.

jame_1_05-12-2025_150152: 6:13

Yeah, absolutely. 100% and soap and potable water and all that

callum---jame_1_05-12-2025_150151: 6:18

So soap's been around for a long time. The in, in ancient France had soap and complained about the Romans not using it. So epidemiology. So in the UK this is a notifiable disease. So if you ever get somebody's notified public health because they obviously will trace and make sure that it's not setting up shop in UK again in our animal populations.

jame_1_05-12-2025_150152: 6:39

gone to some efforts to get rid of this in our local cattle population and would not be keen to repeat it.

callum---jame_1_05-12-2025_150151: 6:46

Yeah.

jame_1_05-12-2025_150152: 6:46

What's the incidence per species in the uk then

callum---jame_1_05-12-2025_150151: 6:49

So because it's notifiable, we've got good data on the cases that happening in the uk. 75% of them are melitensis and Abortus. 25% are seus, and less than 1% are Canis. And what's interesting to note from a diagnostics point of view is whilst the first three you mentioned there. They've got diagnostic tests, you can use serology, et cetera, and Canis is more difficult to diagnose because you won't pick it up in the same tests.

jame_1_05-12-2025_150152: 7:15

I've got some data on that,

callum---jame_1_05-12-2025_150151: 7:17

More on that later.

jame_1_05-12-2025_150152: 7:18

And worldwide, the incidence is about 500,000 cases a year. So, so not to be sniffed at, are a few areas of the world considered to be Bruce free, that's Western Europe, including the uk if you believe that UK is in Europe. This is a very political show that we are recording today Australia and New Zealand, Canada and Japan. And

callum---jame_1_05-12-2025_150151: 7:38

Is in Europe, be.

jame_1_05-12-2025_150152: 7:39

oh, well just, just putting your colors to the mass Now. Are you Callum? Okay, fine. You're one of those guys. Are you?

callum---jame_1_05-12-2025_150151: 7:45

A fact.

jame_1_05-12-2025_150152: 7:46

And then there are areas where it's much more common, and that would be the Middle East, the Mediterranean, Sub-Saharan, Africa, China, India, and Peru and Mexico. I don't know about the rest of South America, but certainly those two areas were listed of, of high prevalence. Let's talk about the, disease itself. So, so how do you get it, Cal?

callum---jame_1_05-12-2025_150151: 8:06

So, by and large this is something that is transmitted by consuming an infected animal product.

jame_1_05-12-2025_150152: 8:13

Okay,

callum---jame_1_05-12-2025_150151: 8:14

generally speaking, that's gonna be milk.'cause we don't tend to drink animal saliva. That's the other possibility. I don't think that'd be very appealing. But infected milk. And specifically unpasteurized milk. Yeah. So Louis Pasture came with this technique of heating milk and it kills microorganisms in it. Ella amongst them and lots of other things like e coli, other sort of venture ies,

jame_1_05-12-2025_150152: 8:34

Hmm.

callum---jame_1_05-12-2025_150151: 8:35

and there's, I guess, worry that there might be a resurgence in Briella and other pathogens that are zoonotic and transmitted through milk with the resurgence in people wanting raw milk or natural milk, whatever you want to call it. But pasteurization is, is a really great technique for killing all these nasty microorganisms that might make us sick. And as they were able to show Malta the. Pasteurization of the milk really just cut off the, the Malta fever as they called it, although the local Maltese at the time were incensed because obviously it does affect flavor and so on.

jame_1_05-12-2025_150152: 9:08

Oh, does it? I didn't realize that.

callum---jame_1_05-12-2025_150151: 9:11

Yeah, I think that's why people are keen on the wild milk, but we're not, we're not pro that. We're against that. So.

jame_1_05-12-2025_150152: 9:18

You don't know what I'm for or against Callum God, uh, other transmission, Products.

callum---jame_1_05-12-2025_150151: 9:23

Yeah, so the other thing, so we, one of the organisms called Ella bti, and that's be, well it's named such because it causes in animals. One of the common presentations is abortion. And so it tends to just like it reproduces in the sort of mammary glands and gets into the milk, it reproduces the microorganism in the placenta. And so, again, that can lead to stillbirth in animals and, and when those

jame_1_05-12-2025_150152: 9:50

have to handle that to get

callum---jame_1_05-12-2025_150151: 9:52

Yes, exactly. And if it's very hot and dry, the sort of carcass can dry out and be aerosolized and you can breathe in. Actually,

jame_1_05-12-2025_150152: 10:00

And then there's the RB 51 vaccine as well., So there, there, there is a vaccine. It's not used in humans, it's used in cattle. So they use it in places like America. And there have been reports of, transmission via needle stick injury to vets. Yeah. And, and so then in terms of the, the risk groups, we, we talk about like abattoir workers, farmers, vets, like people that have close contact with the kind of animals that we're, are we discussed above that are the sort of endemic hosts of, of briella I suppose. There's there's one other, there's a couple of other sort of very small risk factors and, and one is imported dogs. So, as you're probably aware, cam, there's a trend to, adopt dogs sometimes from, from overseas.

callum---jame_1_05-12-2025_150151: 10:48

Hmm.

jame_1_05-12-2025_150152: 10:48

and they, it's not very common obviously, but our potential vectors from for B Canis, if they're coming from sort of Southern Europe and the Mediterranean side. And then lastly, there's the potential for BSC to be used as a bioterrorism agent as it can be aerosolized. Although I couldn't actually find any information on this. I think this is a theoretical risk only, and frankly, if I was going to use. as a bioterrorism agent, it wouldn't be like number one on my list. Frankly,

callum---jame_1_05-12-2025_150151: 11:18

Yeah, I don't think we're gonna do an episode on what the ideal microorganism for bio-terrorism is, but

jame_1_05-12-2025_150152: 11:23

that would be an absolutely amazing episode, but maybe we'll leave that one for for later.

callum---jame_1_05-12-2025_150151: 11:27

Yes,

jame_1_05-12-2025_150152: 11:28

say,

callum---jame_1_05-12-2025_150151: 11:28

I.

jame_1_05-12-2025_150152: 11:28

Okay. In terms of pathogenic mechanisms, I, I found a couple of things, but not very much to be honest with you. the, it, it prefers to infect phagocytes, and so the organ systems in humans, and so the organ systems that are involved tend to be, things that have large amount of macrophages and, and monocytes in them. So the spleen, lymph nodes, the liver and the bone marrow. And it's got a bunch of mechanisms for evading, phagocytosis and phagocytic killing. The I looked up a couple of papers and then it, it kept on saying through an unknown mechanism and three, three papers in. I think I abandoned my my quiz to find out exactly what the pathogenic mechanisms are. Take us through acute osis, then ka.

callum---jame_1_05-12-2025_150151: 12:19

Yeah, so in humans generally speaking, we're gonna see acute brucellosis. So that's about 50% of patients will present with that. They've been infected. I. And that includes things like cyclical fever. So initial reports, they saw this sort of inundating fever. A fever goes up and down, so 90% of people will be expected to have that. Other symptoms might include headache fatigue. Myalgia oral in about 65% of patients. Depression, weight loss, weak knot weakness hepatitis and then another sign that's reported is foul smelling perspiration. I don't know what the mechanism of

jame_1_05-12-2025_150152: 12:57

No, I mean

callum---jame_1_05-12-2025_150151: 12:57

that is. As well as lymphadenopathy. And there is a symptom frequency list that Jane has put in the show notes from the WHO 2006 guidance, which is a bit old. The other thing to note is that the presentation might vary slightly between the species. So Ella Melitensis is the goat and camel one, and sheep tends to be more aggressive and acute. Bruce Abortus tends to be more chronic. Priscilla Sue tends more towards causing abscesses, and as we said, Priscilla Canus is rare. What about chronic though?

jame_1_05-12-2025_150152: 13:32

Well, chronic, I mean, this is gonna be a very familiar symptom list to anybody who's working in a chronic fatigue clinic. But continuing malaise, debil, myalgia, arthralgia fever lasting over. Six months. This is commonly what people are presenting with in the chronic fatigue clinic. So Bruce has to be on your differential list for that. And even the acute to brucellosis, apart from the cyclical fever, if you think about headache, fatigue, myalgia, arthralgia, depression, weight loss, like a lot of that is again, a chronic fatigue kind of presentation. This can lead to some complications as well. So 20 to 60% of cases if untreated could lead to septic arthritis or osteomyelitis. About a fifth are associated with epididymitis in males. And then very uncommonly they can be caused of meningitis and endocarditis. And actually before the institution of antibiotic therapy, a lot of the deaths were associated with endocarditis. That was the, that was the end stage

callum---jame_1_05-12-2025_150151: 14:33

So one of the issues with. Brucellosis, is that it? As Jane mentioned, the areas that it's affecting are, are generally sort of low middle income countries and may not have access to diagnostics. So one of the main clinical issues is trying to differentiate chronic brucellosis from tuberculosis.'cause both have a predilection for the spine.

jame_1_05-12-2025_150152: 15:01

Mm.

callum---jame_1_05-12-2025_150151: 15:01

So you, I guess clinical scenario would be someone presenting with. Chronic back pain, fever, be delays,

jame_1_05-12-2025_150152: 15:11

Yeah.

callum---jame_1_05-12-2025_150151: 15:11

maybe other symptoms and maybe you get some imaging. You might have access to a CT or maybe just an x-ray and you get a person with spinal disease. And differentiating that is meant to be very challenging because they are. Both quite hard to diagnose there's a couple of features that might help you differentiate. So, Bruce, when it causes spinal disease, tends to be less destructive.

jame_1_05-12-2025_150152: 15:37

Okay.

callum---jame_1_05-12-2025_150151: 15:38

So I think there was a paper from 2014 said that 73% in a case series of 293 patients were uncomplicated. 27% were complicated in that they had extension beyond the disc or vertebrae, and most of them affected only a single vertebra. So 80% of cases and finally, it was mostly the lumbar vertebrae. So 72% of these Turkish patients that were studied had lumbar disease, whereas tuberculosis tends more likely to affect the thoracic spine, although it can affect any level of spine and also tends to be more destructive.

jame_1_05-12-2025_150152: 16:13

Yeah.

callum---jame_1_05-12-2025_150151: 16:14

So whilst it's not completely definitive it, those sort of things can be helpful.

jame_1_05-12-2025_150152: 16:19

How do you diagnose this then, Cal?

callum---jame_1_05-12-2025_150151: 16:20

So this organism, you can grow it in the lab. But the most important thing to say here from a lab safety is, and as we alluded to earlier on, this is a potential lab hazard. So, early in the days of brucellosis discovery and trying to culture laboratory, it was a well-recognized pathogen that laboratory staff would acquire. So it needs to be handled there's a, a CDP hazard category, free organism. So needs to be handled in appropriate conditions level lab conditions.

jame_1_05-12-2025_150152: 16:48

called the CAT three Lab. So a

callum---jame_1_05-12-2025_150151: 16:50

yeah,

jame_1_05-12-2025_150152: 16:51

of the bigger labs will have the capacity to do this.

callum---jame_1_05-12-2025_150151: 16:53

yeah,

jame_1_05-12-2025_150152: 16:54

will presumably send the sample on.

callum---jame_1_05-12-2025_150151: 16:56

yeah. Well, I don't, I don't think you would try and culture it locally, generally speaking.

jame_1_05-12-2025_150152: 17:01

did, I suppose, yeah, fair enough.

callum---jame_1_05-12-2025_150151: 17:03

Yeah.

jame_1_05-12-2025_150152: 17:03

does it look like when you, when you do grow it, now that you do very much?

callum---jame_1_05-12-2025_150151: 17:07

So when you grow it so culture is considered the gold standard and laboratory diagnostics, so that's rarely done. An oblig Abe and improves growth in five to 10% CO2. So it'll grow in blood agar after about one to three days. There's a very small round smooth or translucent colony, and there won't be any hemolysis. It may turn into rough colonies later on. It won't grow in McConkey. In terms of the gram stain, this is a gram negative coco bacillus. It's very small. And generally speaking it's slow growing non motile and non spore forming. So it's pretty nondescript, isn't it?

jame_1_05-12-2025_150152: 17:46

Yeah.

callum---jame_1_05-12-2025_150151: 17:46

So it's small al Bacillus, but you can grow it. And because it's still growing, if you're looking for it to culture it, if you're suspecting someone has it, you might say be doing your blood cultures, you would ask for extended incubation. Most of the time it'll grow within seven days of incubation

jame_1_05-12-2025_150152: 18:03

Hmm.

callum---jame_1_05-12-2025_150151: 18:03

with newer blood culture modalities. But I think traditionally people would've held it for longer. And obviously you would warn your laboratory, you're worried about Priscilla, and tell'em about the travel history so that they didn't risk contempt exposing the laboratory staff.

jame_1_05-12-2025_150152: 18:17

I see a

callum---jame_1_05-12-2025_150151: 18:19

And as

jame_1_05-12-2025_150152: 18:19

to

callum---jame_1_05-12-2025_150151: 18:20

and as Bruce describes it earlier on, when you see them done the Gram thing, they're generally single or they might be in short chains.

jame_1_05-12-2025_150152: 18:28

Are there any reference units that may assist us with our diagnostic journey call?

callum---jame_1_05-12-2025_150151: 18:33

Well you could send them in the UK to the Sela reference unit. So the sella reference units that's based in Liverpool in the uk and they do a couple things. So they they offer zero diagnosis, so they'll do antibody testing, so total and specific IgM and IgG. They also can do PCR confirmation if you've got someone with a possible active infection. And they'll also speciate. And finally they'll give clinical advice on diagnosis and treatment.

jame_1_05-12-2025_150152: 19:01

And what about when, when you say total and specific IGA and IgG? Callum, like, what are you talking about there?

callum---jame_1_05-12-2025_150151: 19:07

So total antibodies would be all the antibodies per cell, and then you look for specific IgM and IgG, and I think that's to do with telling if it's acute or chronic. Yeah, so the total antibody titer is where you're just looking at sort of serial dilution and one, one of the issues of that is to do with the pro zone effect. So if you have a very strong level of antibody, then you can get false negative'cause the antibody binds to itself.

jame_1_05-12-2025_150152: 19:30

to each other. Yeah.

callum---jame_1_05-12-2025_150151: 19:31

Yeah, so you have to make sure you do all the tions all the way down so you, you don't get you know, you might do a couple dilution to get a false negative. And then if you're looking for zero conversion in chronic cases. So you'll see a rising or persistent IgG level, which is just suggest of a chronic infection.

jame_1_05-12-2025_150152: 19:49

And then a couple of other notes on the serology, which are available on the Bruce reference unit pages on, on the U-K-H-S-A. So the titers aren't worth rechecking for assessing treatment response because they fall really slowly, as does the PCR results. The, the patient will remain positive even if you've treated them adequately. And then they, they mentioned that you have to interpret this. Total and specific I, GM and IgG in context. So early disease will cause a false negative prior exposure, even if treated will cause a PO false positive in a lot of cases. And they finish by mentioning that Bruce Canis in particular you need to request specific serology if you're concerned about this because this thing doesn't flag on standard bro cell serology'cause it doesn't have surface LPS and that's what the antibodies are against to the

callum---jame_1_05-12-2025_150151: 20:37

Hmm.

jame_1_05-12-2025_150152: 20:40

And if you do need to, they don't culture them. I in the Bruce l reference unit, but a PHA sury, which is the agricultural lab do culture from blood pus and joint fluid and sometimes urine. But they don't recommend doing this actually because it's very low yield and you're more likely to get positive blood and serum. So a PHA sorry would do the culturing if that was felt to be indicated, which almost never is. All right, so how are we going to treat brucellosis? So, so down here I've got some break points B atten. So we've got some UCA break points for, ceftriaxone, Cipro, gentamycin, streptomycin, doxycycline, tetracycline, rifampicin, and cotrimoxazole. I won't read about the, the listener can have a look in the prep notes if they are interested, but I will say two things about them. One is that every break point is in brackets with the exception of the tetracycline and cotrimoxazole break points. And the Cipro Levo breakpoint. The SPR point is 0.001, so it's always suggested to use it at the higher dosage that kind of thing. So really the only one that you can use upfront, without any modification is doxycycline and cotrimoxazole. And wouldn't, you know, doxycycline forms the backbone of the recommended treatments for uncomplicated brucellosis. So it's six weeks of therapy and it's doxycycline plus either streptomycin. Which I think you would have difficulty finding, let alone using in the uk Cotrimoxazole or Rifampin. For complicated brucellosis, which would be endocarditis or meningitis, there's no uniform agreement, but general recommendations are to use three anti Bruce cell drugs for three months. And even used correctly, there will be a treatment failure rate of between five and 17%. So call it one and 10 something like that. So even if you're using the right stuff, and although I've mentioned that the break points here Cal, when I was looking up the reference lab uk Bruce reference unit guidance, they mentioned that they don't do. Testing against antibiotics because no appreciable resistance has developed. So ucast has break points. You can in theory do it, but the reference lab in practicality does not. so you just use these antibiotics blind, assuming that no resistance has evolved, but bearing in mind that one in 10 fail rate, even with appropriate use.

callum---jame_1_05-12-2025_150151: 23:14

Yeah, I think there was a quite old. Systematic review and meta-analysis in 2008 where they looked at the different treatments. And overall that seemed to favor tetracycline streptomycin versus tetracycline rifampicin, although you know, I think there was some, there might be some issues with that'cause it was all quite small studies and meta-analysis wasn't RCTs, but,

jame_1_05-12-2025_150152: 23:40

and the evidence would come from fairly back in the day if they were using streptomycin as there I. Oxide of choice, although apparently in Eastern Europe it is used, because of availability a little bit more than it is over here. The only other thing to add here is that there is some guidance from the CDC available on pep. I've linked to it in the in the notes. In somewhat interestingly, it does advise doing serial titers in high risk exposures to check for serial conversion, but I, I suppose that's a different use case to what the UK. unit we're advising. So once you've got established infection, that monitoring the tits isn't worth it. here, they're, they're checking that the tits aren't developing

callum---jame_1_05-12-2025_150151: 24:22

Mm.

jame_1_05-12-2025_150152: 24:22

their recommendation is mostly three weeks of doxy r with the exception of that vaccine strain related infection. So that's RB 51. That is a Bruce Abor vaccine that's used in cattle. It's live attenuated so you can, can get active infection, but it's rifampicin r.

callum---jame_1_05-12-2025_150151: 24:39

Yeah.

jame_1_05-12-2025_150152: 24:40

you would swap out the Reamp for Oxone.

callum---jame_1_05-12-2025_150151: 24:42

So I guess the reason that why we don't have this as a big issue in UK is because a lot of hard work has gone into ensuring the prevention of this disease in animals. And so it's monitored, I guess, on a national level. There have been cases more recently in, in Ireland compared to the uk, although it got a lot of work on trying to reduce that as well. So. Cattle will need to be vaccinated and certificates of that. And obviously that's a, a large part of the reduction in cases.

jame_1_05-12-2025_150152: 25:14

Hmm.

callum---jame_1_05-12-2025_150151: 25:14

The other part is pasteurization of milk and cheese products. And I guess that's a, a big issue. And then in terms of, I. Within the healthcare environment. So ensuring safety, using aerosol precautions and f fp, free mask, eye protection gown and gloves for when working with animals. So pregnancy delivery or handling placenta and in surgical safety. So using aerosol precautions when working in a area, whether it's briella or briella, is the differential for pregnancy delivery or handling a placenta and also surgery or on the abscess or septic joint. Because just like in animals and humans, Priscilla can replicate in the placenta or, or be treated, you know, rarely in human. Breast milk has been one potential root transmission, although very rare.

jame_1_05-12-2025_150152: 26:01

Yeah. Yeah.

callum---jame_1_05-12-2025_150151: 26:02

And then as you mentioned, the lab safety. So, essentially if you get an organism that sounds a bit like brist, so a small cocal, bacillary or pleomorphic might be another determining it. So different bodied gram negative then you would put that into the containment, level three laboratory until you'd identified it, particularly if there's a travel history.

jame_1_05-12-2025_150152: 26:19

Yeah.

callum---jame_1_05-12-2025_150151: 26:20

Yeah. And that's from the uk SMI.

jame_1_05-12-2025_150152: 26:23

Yeah, we've got some screenshots of some other recommended lab practices that we won't go over here. What about if you have a patient with brucellosis and they're, having their blood taken for a, used knees or full blood count, what recommendations do you need to do there?

callum---jame_1_05-12-2025_150151: 26:38

Well, as with most microorganisms in blood, because. You're not trying to culture it, it's not gonna be enhanced, and most of these systems are automated. It's, we don't really use any additional precautions. We're, we're gonna talk about viral hemorrhagic fevers at some point, and even there, most laboratory tests are fine to do. If there's a viral hemorrhage fever, so say in a patient of Ebola, it would normally be fine. You meant to tell the lab so that they know to be cautious with it, but you know, you can run those tests, say a full blood count or use knees and stuff.

jame_1_05-12-2025_150152: 27:10

Yeah.

callum---jame_1_05-12-2025_150151: 27:11

Laboratory tests now are much less exposure to humans and historically.

jame_1_05-12-2025_150152: 27:15

Very heavily automated. And then the last precaution that we'll say is that if you are a blood donor, any prior Bruce illness is equal to permanent exclusion from future donation in the uk.

callum---jame_1_05-12-2025_150151: 27:29

you ever seen anybody of Priscilla?

jame_1_05-12-2025_150152: 27:31

Not sure I have ever seen anyone with Bruce. If we could, if anybody an expert out there does want to give five or 10 minutes of the time, that would be great. And if there's anything that we have missed, again, please write in question, comments, suggestions. It is podcasting@gmail.com, but now I'm getting in the way of the outro. without any further ado, here's the outro.