Brucellosis and tuberculosis

What are these two diseases?

Brucellosis (Malta fever)

Brucellosis is an infection caused by a bacterium called Brucella. It passes to people from farm animals (sheep, cattle, goats, camels). The main routes in the sources are:

• drinking raw milk, or eating dairy (milk, cheese, ice cream) made from unpasteurised milk
• eating undercooked meat from an infected animal
• direct contact with an infected animal or its fluids (for example when an animal gives birth), or breathing in a contaminated environment
• working in a laboratory, or in jobs such as farming, slaughterhouse work and veterinary work

WHO says that most cases come from unpasteurised goat or sheep milk or cheese. The symptoms feel like a bad flu: fever, weakness, sweating, headache, muscle and joint pain, loss of appetite and weight loss. Sometimes the symptoms are mild and the illness is missed. Symptoms usually begin two to four weeks after exposure, but can start anywhere from one week to two months.

Tuberculosis (TB)

TB is a disease caused by a bacterium, and it mostly affects the lungs. It spreads through the air when a person with active TB coughs, sneezes or speaks. The sources separate two states:

• Infection without symptoms (latent TB). The bacteria are in the body, but the person feels well and cannot pass it on. If it is not treated, it may become active one day.
• Active disease. The bacteria multiply, the person is ill and can infect others.

Symptoms of active TB are a cough lasting three weeks or more, sometimes with blood in the phlegm, fever, night sweats, tiredness, loss of appetite and weight loss. The symptoms can stay mild for months.

Who should see a doctor?

For brucellosis, if you have fever, sweating, joint or back pain and weakness, and in recent weeks or months you:

• drank raw milk or ate unpasteurised cheese or ice cream
• had contact with farm animals, especially during birth or slaughter
• ate undercooked meat

The CDC says symptoms can sometimes start weeks or months after exposure, so be sure to mention any past contact.

For TB, if:

• your cough has lasted more than three weeks
• you cough up blood (the NHS says this needs urgent attention)
• you have fever, night sweats, loss of appetite and weight loss with no reason
• you have been in close contact with someone who has active TB

The sources say people with diabetes, a weak immune system (such as HIV), malnutrition, or who use tobacco or alcohol are more likely to develop active TB. Young children who become infected are also more likely to develop active disease.

How is it investigated?

Neither can be diagnosed from symptoms alone.

• Brucellosis: tests are needed. The CDC says early symptoms are not specific, and the diagnosis is made with blood tests (an antibody test and sometimes a culture). Sometimes a second sample is needed a few weeks later. Questions about animal contact and dairy help choose the right test.
• TB: after your history and examination, the doctor chooses the TB tests that suit your situation.

What does treatment generally look like?

Both diseases are treated with antibiotics chosen by the doctor, and in both, finishing the whole course is very important.

Brucellosis. Treatment with a combination of antibiotics lasts weeks. The CDC gives at least 6 to 8 weeks. Full recovery can take from a few weeks to a few months. If treatment is not done properly, the infection becomes chronic and can cause arthritis, heart infection, long-lasting tiredness and swelling of organs. The same sources say death from this illness is rare (under 2 percent of those infected).

TB. TB is preventable and curable (WHO). Treatment of drug-sensitive TB takes 4 to 9 months depending on the regimen, and the NHS says “at least 6 months”. If the course is left incomplete, surviving bacteria may cause disease again and may become resistant. Resistant TB can also be treated, but with different medicines, usually with more side effects and harder treatment. The CDC says that if the medicines are taken completely, almost all patients are cured.

When a person with TB is no longer a risk to those around them depends on the individual and should be asked of the doctor. The CDC says that completing treatment helps both the patient’s recovery and preventing others from getting infected.

What can you do yourself?

• Buy pasteurised dairy. The CDC says that if you are not sure dairy is pasteurised, do not eat or drink it. Ask the doctor about local or traditional dairy and about ways to make it safer.
• Cook meat thoroughly.
• If you work with animals, use gloves, goggles and a mask or other suitable protection, and do not touch animal fluids (especially during birth) without protection.
• Take your medicines on time and to the end. If you forget a dose, contact your doctor or pharmacist. Do not double up.
• If a medicine has side effects, tell the doctor quickly and do not stop it yourself.
• With TB, ventilate the place where you live (the CDC says closed, unventilated spaces raise the risk), and talk to the doctor about testing family members.
• With brucellosis, you do not need to fear passing it to your family, but if they ate the same dairy, they should watch for symptoms.

When to seek urgent care

Call 115 (Iran’s emergency number) or go to the emergency department if:

• fever comes with a severe headache and stiff neck, a seizure, confusion or sudden weakness of an arm or leg (the NHS says in TB this may be a sign that the brain is involved)
• you have confusion, very fast or difficult breathing, blue or mottled skin and severe shivering (signs of sepsis)

If you cough up blood, in any amount, let a doctor know the same day.

Every patient’s treatment plan is different. Ask your doctor about your own situation.