Brucellosis in a dog, raw meat origin

My friend Scott Weese wrote this up in his Worms and Germs Blog so I don’t have to.

˙(I still miss Sadie, who we had to relo˙cate before we moved to Australia).

A recent report from the Netherlands in Emerging Infectious Diseases (van Dijk et al 2018) describes a new twist on raw feeding concerns, Brucella suis infection. For the full details, you can read the whole paper here, but the short version of the story is outlined below.

The dog had fever, ascites (fluid free in the abdomen) and inflammation of the testicles, and after failing to respond to antibiotics, it was taken to surgery. At surgery, culture samples were collected from the epididymis (tissue adjacent to the testicle). Brucella suis was identified, which presumably caused a bit stir in the lab and clinic since that bacterium is a rarely identified, poses risks to people and is notifiable (the government has to be contacted when it’s found). Ultimately, the dog was euthanized after failing to respond to further treatment.

Because this is a notifiable disease, there was an investigation. The dog’s raw, rabbit-based diet became the leading potential source and Brucella suis was identified in samples from a 30,000 kg batch of raw rabbit imported from Argentina, a country where B. suis is present.

It’s a single case report so we can’t get too worked up about it, but it’s noteworthy for a couple reasons.

One is the disease…brucellosis is a nasty disease. It can be hard to treat, is potentially zoonotic and sometimes results in public health-mandated euthanasia of the dog.

Another is the importation aspect. The dog wasn’t imported but the bacterium was, via food. We’re trying to get increasing awareness of the need to query travel and importation history, since that can impact disease risks. Querying diet origins is tougher, since, while most people would know where their dog has been in the past few weeks, they may not know much about where their dog’s diet has been. With commercial processed food, it’s not a big deal but with a higher risk food like raw meat, importing food can be similar to the dog visiting the country of origin, from a disease standpoint. With raw meat, knowing where the meat came from and the disease risks in those areas may be important, but that’s not often easy to find.

The incidence of disease in dogs and cats associated with raw meat feeding ins’t clear and is probably low. Nevertheless, I recommend avoiding raw meat feeding, especially in  high risk households (e.g. with elderly individuals, kids <5 yrs of age, pregnant women or immunocompromised individuals). However, if raw meat is to be fed, some basic practices can be taken to reduce the risk, as we outline in the info sheet in our Resources section.

Raw is risky: Brucellosis from unpasteurized milk in Texas

In July 2017, the Texas Department of State Health Services (DSHS) Region 2/3 office reported a human case of brucellosis associated with the consumption of raw (unpasteurized) cow’s milk purchased from a dairy in Paradise, Texas. CDC’s Bacterial Special Pathogens Branch (BSPB) confirmed the isolate as Brucella abortus vaccine strain RB51 (RB51).

Brucellosis is a zoonotic bacterial disease that affects humans and many animal species. In humans, the disease is characterized by fever and nonspecific influenza-like symptoms that frequently include myalgia, arthralgia, and night sweats. Without appropriate treatment, brucellosis can become chronic, and life-threatening complications can arise. Human brucellosis transmitted by cattle was once common in the United States. Control strategies have focused on elimination of brucellosis through vaccination and surveillance of cattle herds, in addition to milk pasteurization. Because of these measures, domestically acquired human cases are now rare (1).

RB51, a live-attenuated vaccine used to prevent B. abortus infection in cattle, has been documented to cause human disease, most commonly through occupational exposures such as needle sticks (2). Importantly, unlike wild strains of B. abortus, RB51 does not stimulate an antibody response detectable by routine serological assays, requiring culture for confirmation. Additionally, RB51 is resistant to rifampin, a common treatment choice for human brucellosis (2,3). This case represents the first documented instance of human brucellosis caused by RB51 through consumption of raw milk acquired in the United States.

Following isolation of RB51 from the patient’s blood, bulk milk tank samples from the farm tested positive for RB51 by polymerase chain reaction and bacterial culture. Culture of individual milk samples from all 43 cows in the herd identified two RB51 culture-positive cows. Subsequent whole genome sequencing indicated genetic relatedness between the cow and human isolate.

In Texas, farm sales of raw milk products to the public are legal with a “Grade ‘A’ Raw for Retail” license, regulated by the DSHS Milk and Dairy Group. By the end of August, through correspondence with the dairy, DSHS had identified approximately 800 persons who might have visited the farm during June 1–August 7. On September 1, Texas DSHS and BSPB began notification calls to these households, recommending that all exposed persons (i.e., those who consumed raw milk products from the farm during June 1–August 7) seek medical attention and begin 3 weeks of postexposure prophylaxis, even if asymptomatic (4).

Contact information was available for 582 households. The notification was issued successfully to 397 (68.2%) households. Among these notified households, 324 (81.6%) identified at least one exposed household member. Contacted persons referred 34 additional potentially exposed households, including households from seven other states.* A nationwide press release and Health Alert Network Health Advisory were issued in September to facilitate further identification of exposed persons (5).

To date, there are no other confirmed cases associated with this investigation. CDC and Texas DSHS continue measures to increase awareness among health care providers and the public regarding unique challenges associated with treatment and diagnosis of RB51 in humans and the risks of consuming raw milk.

Notes from the Field: Brucella abortus vaccine strain RB51 infection and exposures associated with raw milk consumption

09.mar.18

CDC

Caitlin Cossaboom

https://www.cdc.gov/mmwr/volumes/67/wr/mm6709a4.htm?s_cid=mm6709a4_w

Brucella Free Villages: India says raw (milk) is risky

Neetu Chandra Sharma of DNA India reports the government has geared up following new outbreaks down South India. In a bid to curb cases of Brucellosis, a bacterial disease affecting cattle like cow and buffalo and causing undulant fever in humans, Department of Biotechnology, Ministry of Science & Technology has come up with a pilot project called “Brucella Free Villages”.

brucellosis-cattle-indiaBrucellosis is an infectious disease caused by bacteria belonging to the genus Brucella. Brucellosis is also an important zoonotic disease of worldwide importance; people acquire the infection by consuming unpasteurized milk and other dairy products, and by coming in contact with the contaminated animal secretions and tissues.

According to the World Health Organization (WHO), brucellosis is transmitted to humans from animals through direct contact with infected materials like afterbirth or indirectly by ingestion of animal products and by inhalation of airborne agents. Consumption of raw milk and cheese made from raw milk is the major source of infection in humans.

In humans, brucellosis can cause range of symptoms that are similar to the flu and may include fever, sweats, headache, back pain and physical weakness. Severe infections of the central nervous system or lining of the heart may also occur.

Doctors say that often brucellosis is diagnosed after ruling out all other fevers such as those caused by malaria, typhoid, dengue etc. Therefore, the disease is under reported and many medical professionals are not even aware of the problem. It is estimated that the disease causes economic losses of about Rs 28,000 crores.

“There is an urgent need for addressing this important issue of not only livestock health and production, but also public health. India is the world’s largest milk producer and hosts around 20 per cent of the world’s livestock population,” said Sudarshan Bhagat, Minister of State, Agriculture and Farmers Welfare.

Unpasteurized cheese making record number sick in Texas

Claire Z. Cardona of The Dallas Morning News reports a record number of people in Dallas County have been sickened from an infection caused by consuming unpasteurized cheese, health officials said. 

brucellosisThere have been 13 brucellosis infections in residents so far this year, affecting patients between 6 and 80 years old, according to a health advisory released Thursday

All of the patients reported eating the cheese brought into the U.S. from Mexico by friends or relatives, consuming the cheese while traveling in Mexico or eating unidentified cheese products from local street vendors, officials said. 

The county typically sees two to six cases a year, though 11 were recorded in 2004. 

Health officials confirmed all the Dallas County cases by blood culture. In two instances, hospital lab personnel were exposed while handling the samples. 

The Brucella bacteria can infect livestock and is most commonly transmitted to humans who consume the unpasteurized dairy products. Some areas, such as Mexico and Central and South America, are considered high-risk, according to the Centers for Disease Control and Prevention. 

10 sick: Unpasteurized, this time ‘green for life’ camel milk in Israel

Ten additional people have come down with brucellosis after consuming camel milk, it was revealed today (Thursday, 8 Sep 2016) when the Ministry of Health extended the administrative closure of a business dealing with this product. A month ago, it was reported that 2 children were hospitalized in mild to moderate condition at the Ichilov Hospital [Tel-Aviv] with brucellosis resulting of drinking the said milk.

camel-milkConcurrently, the Be’er Sheva Magistrate indicted E.L., the manager of an enterprise engaged with the storage and marketing of milk and milk products “Green for Life” or “Genesis Milk” in Moshav Sitria, Shefela district. Prof. Shmuel Rishpon, Acting District Medical Officer [DMO] – Center District, signed today the extension of the closure order of the business, issued by the DMO/Center, Dr. Ofra Havkin, on 11 Aug 2016, for 30 additional days.

The Acting DMO’s decision stated that the closure order was extended because during an inspection/control visit to the enterprise, performed about 2 weeks ago, it was found that — in breach with the previous order — camel milk was encountered in the premises. Even worse, since the decree was issued last month, information on 10 additional brucellosis patients, infected by the consumption of the milk, has been obtained. “This situation is indicative of continued immediate danger to public health from the consumption of the camel milk,” Prof Rishpon stated in the issued order.

Brucellosis linked to unpasteurized camel milk in Israel

Two patients have been hospitalized at Meir Medical and another patient at Schneider Hospital in Petach Tikvah, suffering from brucellosis linked to the consumption of unpasteurized camel milk produced by the dairy company “Genesis.”

camel.milkLast week, two children were hospitalized for mild to moderate condition at Ichilov Hospital, following a drinking camel’s milk marketed by the company. Following the admission office ordered destroyed four tons of camel milk.

Amir Shreibman (64) and his wife, Kfar Sava have suffered in recent weeks from a high fever. “Four months ago we started to drink camel’s milk of Genesis, after we were convinced that it had medicinal properties,” he said. “They told us that many people drink this milk, and everything was fine. We did not think anything would happen to us, even if unpasteurized milk.”

Brucellosis linked to raw milk cheese, coupled with Lyme disease, leaves woman bedridden

Reve Fisher of Opposing Views writes a vacation in Greece may have been the factor that left an English woman in debilitating pain.

brucellosis.cheeseWhile in Kos, Greece, with her family in 2013, Sam Philpott ate a “significant amount” of unpasteurized goat cheese in sandwiches, on pizzas, and as part of salads.

A few weeks later, she experienced a number of troubling symptoms, such as constant vomiting and nausea, migraines, intense weakness, fevers, exhaustion, and horrific pain. Three years later, she is barely able to walk.

“Who knew that [unpasteurized] cheese; that is delicious and has brought me much momentary happiness, could cause the mind numbing and wanting to end my life type of pain that I have been suffering with,” she said, as reported by The Mirror. “With each mouthful, to my unfortunate complete lack of knowledge and utter surprise, I was ingesting the bacteria that has led to my being bedridden.”

Sam is receiving intravenous therapy treatment at Sponaugle Wellness Institute in Oldsmar, Florida, a facility with an “incredible” success rate for treating patients with Lyme disease, as said on the family’s Go Fund Me page.

However, it is recommended that patients with Lyme disease be diagnosed within six months for the clinic’s regular treatment to be effective. The 22-year-old has been struggling with health ailments for six years.

In 2010, she was bitten by a tick while in Weimar, California, and developed intense joint pain, nausea, anxiety, depression, and poor concentration afterwards. By 2012, she needed a walking frame. Her 51-year-old mother became her full-time caregiver.

“At the clinic, they have said she is one of the worst patients they have seen, in terms of how far her illness has progressed,” said Joe Philpott, Sam’s 24-year-old brother. “It’s a kick in the teeth, but she has faith they’ll be able to help. She just wants to go back to studying and get her life back.”

Sam is receiving medication for both Brucellosis and Lyme disease, as her symptoms match both conditions.

“Doctors believe that she more than likely contracted brucellosis the summer she was in Kos – so they think it is linked to eating cheese,” Joe explained.

13 sick: Illegal cheese factory in Portugal leads to brucellosis outbreak

An unauthorized cheese factory in the northern Portuguese town of Baiao, 370 km north of Lisbon, is the source of an outbreak of brucellosis in the area, which has so far led to 13 confirmed infections, according to local press reports on Tuesday.

imagesBrucellosis, which is also known as Malta Fever, Rock Fever or Mediterranean Fever, is most often contracted from unpasteurized milk or milk products such as cheese. The disease leads to parasites in the host’s bloodstream and episodes may last weeks, months or even years. It causes potentially recurrent episodes of high fever, sweating and related anemia.

At least four of the victims of the outbreak have been hospitalized in the neighboring city of Porto, a spokesperson from the Northern Regional Health Administration told the Expresso newspaper.

Re-emergence of brucellosis in cattle in France and risk for human health via raw milk cheese

In January 2012, a human case of brucellosis was diagnosed by blood culture in a district of the French Alps. The isolated strain was identified as Brucella melitensis biovar 3. Excerpts from the paper by Mailles et al. in the current issue of Eurosurveillance appear below.

In April 2012, brucellosis was confirmed in a dairy cow in a herd of the same district of the French Alps. The seropositive cow had aborted in late January, and a strain of Brucella melitensis biovar 3 was isolated from the milk sampled from the animal. The animal belonged to a herd 21 dairy cows, and no other animal in the herd presented with symptoms suggesting brucellosis or showed any serological reaction. Approximately 20 kg of Reblochon cheese (soft raw milk cheese) are usually produced daily on the affected farm.

France has been officially free of brucellosis in cattle since 2005, and the last outbreak of brucellosis in sheep and goats was reported in 2003. In order to detect and prevent any re-emergence of the disease, annual screening using Rose Bengale test or complement fixation test is carried out in all cattle, sheep and goat farms producing raw milk as well as in all cattle herds, and every one to three years in small ruminant, according to EU regulations. Moreover, abortion in ruminants is mandatorily notifiable and the investigation of abortion includes examination for brucellosis.

Reblochon cheese is a raw milk soft cheese, requiring a maturation period of three weeks to one month. The cheese from the affected farm had been commercialised after the abortion in seven districts. Cheese was sold directly at the farm, and as whole pieces or in parts in supermarkets. Cheese produced by the affected farm had not been exported to other countries but might have been bought by foreign tourists during their winter holidays in several ski resorts in the area. For this reason, the European rapid alert system for food and feed (RASFF) was informed.

After the identification of the first bovine case, the human case was interviewed again to investigate any direct or indirect epidemiological link with the infected herd. During the second interview, it became clear that the patient and their family had visited the infected farm in autumn 2011, although it was not possible to determine the exact date. During this visit, the family had bought Tome Blanche cheese, a fresh cheese obtained during the first step of Reblochon production. The four family members had shared the Tome Blanche on the same day, but the index case was the only one who later presented with symptoms.

All cheese pieces produced by the affected farm and still within the shelf life were withdrawn from retailers. In addition, a recall of already sold products was carried out via a national press release by the cheese producer and by posters in the sale points. Medical doctors in the concerned districts were informed by the regional health authorities. Consumers of these products were advised to seek medical attention should they present symptoms consistent with brucellosis.
The release of cheese from the affected farm was immediately stopped. The movements of animals from other herds that had epidemiological links with the infected herd (those that were geographically close to the infected herd, or had been bought from the infected herd) have been restricted until the end of the investigation. Furthermore, raw cheese products from farms with epidemiological links to the infected farm were put on sale only after negative bacteriological tests results had been obtained.

Public health types have better things to do; E. coli O157, brucellosis in raw milk

 On-going outbreaks and recalls in Washington State, the same E. coli O157:H7 scattered throughout a California dairy that sickened five children, and now a man who drank raw milk produced at a Western Massachusetts dairy farm is suspected of being infected with brucellosis, raising concerns about the emergence of a germ that has not been seen in New England livestock in at least two decades.

Brucellosis is an infectious disease passed primarily between animals, but it can be acquired by humans through the consumption of raw milk.

Officials from the state Department of Public Health said they are investigating Twin Rivers Farm in Ashley Falls as the possible source of the infection, because the infected man purchased raw milk there. The dairy sells raw milk only at the facility, not in retail stores, and officials urged anyone who bought raw milk there to discard it.

The owners of Twin Rivers Farm could not be reached for comment.

Dr. Alfred DeMaria, the state’s top disease tracker, said the man has believed to have consumed the milk in late December. But because the illness often starts with flu-like symptoms, it was difficult to pinpoint at first, adding, “It’s an astute physician that worked it out.”

A table of raw-milk related outbreaks is available at http://bites.ksu.edu/rawmilk.