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{{short description|Human and animal disease}}
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{{Infobox medical condition (new)
| name = Brucellosis
| synonyms = undulant fever, undulating fever, Mediterranean fever, Malta fever, Cyprus fever, rock fever (''Micrococcus melitensis'')<ref>{{cite journal|journal=Journal of Maltese History |volume=4 |issue=1 |page=41 |publisher=Department of History, [[University of Malta]] |location=[[Malta]] |url=http://www.um.edu.mt/__data/assets/pdf_file/0005/238838/JMH_-_2014_Wyatt.pdf |title=How did Sir David Bruce forget Zammit and his goats ? |last=Wyatt |first=H. Vivian
| field = [[Infectious disease (medical specialty)|Infectious disease]]
|
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| prevention = avoid unpasteurized dairy foods, cook meat thoroughly, wear gloves, take safety precautions in high-risk workplaces, vaccinate domestic animals.<ref name=Brucellosis />
| treatment =[[antibiotics]]
| medication = [[tetracyclines]], [[rifampicin]], [[aminoglycosides]]
| prognosis =
| frequency =
| deaths =
}}
'''Brucellosis'''<ref>{{cite news |url=http://education.yahoo.com/reference/dictionary/entry/brucellosis |title=Brucellosis |work=American Heritage Dictionary |url-status=dead |archive-url=https://web.archive.org/web/20110606062045/http://education.yahoo.com/reference/dictionary/entry/brucellosis |archive-date=2011-06-06
The bacteria causing this disease, ''[[Brucella]]'', are small, [[Gram-negative]], nonmotile, nonspore-forming, rod-shaped ([[Coccobacillus|coccobacilli]]) bacteria. They function as [[Facultative parasite|facultative]] [[intracellular parasite]]s, causing [[Chronic (medicine)|chronic disease]], which usually persists for life. Four species infect humans: ''B. abortus'', ''B. canis'', ''B. melitensis'', and ''B. suis''. ''B. abortus'' is less virulent than ''B. melitensis'' and is primarily a disease of cattle. ''B. canis'' affects dogs. ''B. melitensis'' is the most virulent and invasive species; it usually infects goats and occasionally sheep. ''B. suis'' is of intermediate virulence and chiefly infects pigs. Symptoms include [[Diaphoresis|profuse sweating]] and [[Arthralgia|joint]] and [[Myalgia|muscle pain]]. Brucellosis has been recognized in animals and humans since the early 20th century.<ref>Park. K., Park’s textbook of preventive and social medicine, 23 editions. Page 290-91</ref><ref>{{Citation |last=Roy |first=Rabindra |title=Chapter-23 Biostatistics |date=2013 |url=http://dx.doi.org/10.5005/jp/books/12262_23 |work=Mahajan and Gupta Textbook of Preventive and Social Medicine |pages=434–449 |publisher=Jaypee Brothers Medical Publishers (P) Ltd |doi=10.5005/jp/books/12262_23 |isbn=978-93-5090-187-8 |access-date=2022-11-13}}</ref>
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==Signs and symptoms==
{{
[[File:BrucellosisGraph.png|right|thumb|200px|A graph of the cases of brucellosis in humans in the United States from the years 1993–2010 surveyed by the Centers for Disease Control and Prevention through the National Notifiable Diseases Surveillance System<ref>{{cite web |
The symptoms are like those associated with many other [[fever|febrile]] diseases, but with emphasis on muscular pain and night sweats. The duration of the disease can vary from a few weeks to many months or even years.
In the first stage of the disease, [[bacteremia]] occurs and leads to the classic triad of undulant fevers, sweating (often with a characteristic foul, moldy smell sometimes likened to wet hay), and migratory [[arthralgia]] and [[myalgia]] (joint and muscle pain).<ref>{{
This complex is, at least in Portugal, Palestine, Israel, Syria, Iran, and Jordan, known as Malta fever. During episodes of Malta fever, melitococcemia (presence of brucellae in the blood) can usually be demonstrated by means of blood culture in tryptose medium or Albini medium. If untreated, the disease can give origin to focalizations{{clarify|date=June 2020}} or become chronic. The focalizations of brucellosis occur usually in bones and joints, and [[osteomyelitis]] or [[spondylodiscitis]] of the lumbar spine accompanied by [[sacroiliitis]] is very characteristic of this disease. [[Orchitis]] is also common in men.
The consequences of ''Brucella'' infection are highly variable and may include [[arthritis]], [[spondylitis]], [[thrombocytopenia]], [[meningitis]], [[uveitis]], [[optic neuritis]], [[endocarditis]], and various neurological disorders collectively known as neurobrucellosis.
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==Cause==
[[Image:Brucella granuloma.jpg|thumb|[[Granuloma]] and [[necrosis]] in the liver of a guinea pig infected with ''Brucella suis'']]
Brucellosis in humans is usually associated with consumption of unpasteurized milk and soft cheeses made from the milk of infected
Overall findings support that brucellosis poses an [[
==Diagnosis==
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# Histologic evidence of granulomatous hepatitis on hepatic biopsy
# Radiologic alterations in infected vertebrae: the Pedro Pons sign (preferential erosion of the anterosuperior corner of lumbar vertebrae) and marked osteophytosis are suspicious of brucellic spondylitis.
Definite diagnosis of brucellosis requires the isolation of the organism from the blood, body fluids, or tissues, but serological methods may be the only tests available in many settings. Positive blood culture yield ranges between 40 and 70% and is less commonly positive for ''B. abortus'' than ''[[Brucella melitensis|B. melitensis]]'' or ''B. suis''. Identification of specific [[antibodies]] against bacterial [[lipopolysaccharide]] and other [[antigens]] can be detected by the standard agglutination test ([[Agglutination (biology)|SAT]]), rose Bengal, 2-mercaptoethanol (2-ME), antihuman [[globulin]] (Coombs') and indirect enzyme-linked immunosorbent assay ([[ELISA]]). SAT is the most commonly used [[serology]] in endemic areas.<ref>{{cite journal | vauthors = Franco MP, Mulder M, Gilman RH, Smits HL | title = Human brucellosis | journal = The Lancet. Infectious Diseases | volume = 7 | issue = 12 | pages = 775–86 | date = December 2007 | pmid = 18045560 | doi = 10.1016/S1473-3099(07)70286-4 }}</ref><ref>{{cite journal | vauthors = Al Dahouk S, Nöckler K | title = Implications of laboratory diagnosis on brucellosis therapy | journal = Expert Review of Anti-Infective Therapy | volume = 9 | issue = 7 | pages = 833–45 | date = July 2011 | pmid = 21810055 | doi = 10.1586/eri.11.55 | s2cid = 5068325 | doi-access = free }}</ref> An agglutination titre greater than 1:160 is considered significant in nonendemic areas and greater than 1:320 in endemic areas.{{citation needed|date=May 2021}}
Due to the similarity of the O [[polysaccharide]] of ''Brucella'' to that of various other [[Gram-negative bacteria]] (e.g. ''[[Francisella tularensis]]'', ''[[Escherichia coli]]'', ''[[Salmonella urbana]]'', ''[[Yersinia enterocolitica]]'', ''[[Vibrio cholerae]]'', and ''[[Stenotrophomonas maltophilia]]''), the appearance of cross-reactions of class M [[immunoglobulin]]s may occur. The inability to diagnose ''B. canis'' by SAT due to lack of cross-reaction is another drawback. False-negative SAT may be caused by the presence of blocking antibodies (the [[prozone phenomenon]]) in the α2-globulin (IgA) and in the α-globulin (IgG) fractions.{{citation needed|date=June 2021}}
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The main way of preventing brucellosis is by using fastidious hygiene in producing raw milk products, or by [[pasteurization|pasteurizing]] all milk that is to be ingested by human beings, either in its unaltered form or as a derivative, such as [[cheese]].{{citation needed|date=May 2021}}
Another important aspect of Brucellosis prevention is public awareness. People in endemic areas demonstrated a high lack of knowledge and understanding of the disease and its causes.<ref>{{cite journal |last1=Zhang |first1=Ning |last2=Zhou |first2=Hao |last3=Huang |first3=De-Sheng |last4=Guan |first4=Peng |date=May 2, 2023 |title=Brucellosis awareness and knowledge in communities worldwide: A systematic review and meta-analysis of 79 observational studies |journal=PLOS Neglected Tropical Diseases |volume=13 |issue=5 |pages=e0007366 |doi=10.1371/journal.pntd.0007366 |pmid=31048848 |pmc=6497230 |doi-access=free }}</ref> To combat this, the One Health concept has been proposed. One Health is a method for combining disciplines such as public health, veterinary services, and microbiology to bring awareness to the disease. However, the implementation of this method faces many challenges including economic, political, and social barriers.<ref>{{cite journal |last1=Moriyón |first1=Ignacio |last2=Blasco |first2=José María |last3=Letesson |first3=Jean Jacques |last4=De Massis |first4=Fabrizio |last5=Moreno |first5=Edgardo |date=August 2023 |title=Brucellosis and One Health: Inherited and Future Challenges |journal=Microorganisms |language=en |volume=11 |issue=8 |pages=2070 |doi=10.3390/microorganisms11082070 |pmid=37630630 |pmc=10459711 |issn=2076-2607 |doi-access=free }}</ref>
==Treatment==
[[Antibiotic]]s such as [[tetracycline]]s, [[rifampicin]], and the [[aminoglycoside]]s [[streptomycin]] and [[gentamicin]] are effective against ''Brucella'' bacteria. However, the use of more than one antibiotic is needed for several weeks, because the bacteria incubate within [[cell (biology)|cells]].{{citation needed|date=June 2021}}
The gold standard treatment for adults is daily [[intramuscular injection]]s of streptomycin 1 g for 14 days and oral [[doxycycline]] 100 mg twice daily for 45 days (concurrently). Gentamicin 5 mg/kg by intramuscular injection once daily for 7 days is an acceptable substitute when streptomycin is not available or contraindicated.<ref name="pmid16575723">{{cite journal | vauthors = Hasanjani Roushan MR, Mohraz M, Hajiahmadi M, Ramzani A, Valayati AA | title = Efficacy of gentamicin plus doxycycline versus streptomycin plus doxycycline in the treatment of brucellosis in humans | journal = Clinical Infectious Diseases | volume = 42 | issue = 8 | pages = 1075–80 | date = April 2006 | pmid = 16575723 | doi = 10.1086/501359 | doi-access = free }}</ref> Another widely used regimen is doxycycline plus rifampicin twice daily for at least 6 weeks. This regimen has the advantage of oral administration. A triple therapy of doxycycline, with rifampicin and [[co-trimoxazole]], has been used successfully to treat neurobrucellosis.<ref name="pmid1420670">{{cite journal | vauthors = McLean DR, Russell N, Khan MY | title = Neurobrucellosis: clinical and therapeutic features | journal = Clinical Infectious Diseases | volume = 15 | issue = 4 | pages = 582–90 | date = October 1992 | pmid = 1420670 | doi = 10.1093/clind/15.4.582 }}</ref> Doxycycline plus streptomycin regimen (for 2 to 3 weeks) is more effective than doxycycline plus rifampicin regimen (for 6 weeks).<ref>{{cite journal | vauthors = Yousefi-Nooraie R, Mortaz-Hejri S, Mehrani M, Sadeghipour P | title = Antibiotics for treating human brucellosis | journal = The Cochrane Database of Systematic Reviews | volume = 10 | pages = CD007179 | date = October 2012 | issue = 10 | pmid = 23076931 | pmc = 6532606 | doi = 10.1002/14651858.cd007179.pub2 }}</ref>
Doxycycline is able to cross the [[blood–brain barrier]], but requires the addition of two other drugs to prevent relapse. [[Ciprofloxacin]] and co-trimoxazole therapy is associated with an unacceptably high rate of relapse. In brucellic [[endocarditis]], surgery is required for an optimal outcome. Even with optimal antibrucellic therapy, relapses still occur in 5 to 10% of patients with Malta fever.{{citation needed|date=June 2021}}
==Prognosis==
The mortality of the disease in 1909, as recorded in the British Army and Navy stationed in Malta, was 2%. The most frequent cause of death was [[endocarditis]]. Recent advances in [[antibiotics]] and surgery have been successful in preventing death due to endocarditis. Prevention of human brucellosis can be achieved by eradication of the disease in animals by vaccination and other veterinary control methods such as testing herds/flocks and slaughtering animals when infection is present. Currently, no effective vaccine is available for humans. Boiling milk before consumption, or before using it to produce other dairy products, is protective against transmission via ingestion. Changing traditional food habits of eating raw meat, liver, or bone marrow is necessary, but difficult to implement.{{citation needed|date=September 2017}} Patients who have had brucellosis should probably be excluded indefinitely from donating blood or organs. {{citation needed|date=June 2024}} Exposure of diagnostic laboratory personnel to ''Brucella'' organisms remains a problem in both endemic settings and when brucellosis is unknowingly imported by a patient.<ref>{{cite journal | vauthors = Yagupsky P, Baron EJ | title = Laboratory exposures to brucellae and implications for bioterrorism | journal = Emerging Infectious Diseases | volume = 11 | issue = 8 | pages = 1180–5 | date = August 2005 | pmid = 16102304 | pmc = 3320509 | doi = 10.3201/eid1108.041197 }}</ref> After appropriate risk assessment, staff with significant exposure should be offered postexposure prophylaxis and followed up serologically for 6 months.<ref>{{cite journal | title = Laboratory-acquired brucellosis--Indiana and Minnesota, 2006 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 57 | issue = 2 | pages = 39–42 | date = January 2008 | pmid = 18199967 | author1 = Centers for Disease Control Prevention (CDC) }}</ref>
==Epidemiology==
=== Argentina ===
According to a study published in 2002, an estimated 10–13% of farm animals
===Australia===
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===Canada===
On 19 September 1985, the [[Canadian government]] declared its cattle population brucellosis-free. Brucellosis ring testing of milk and cream, and testing of cattle to be slaughtered ended on 1 April 1999. Monitoring continues through testing at auction markets, through standard disease-reporting procedures, and through testing of cattle being qualified for export to countries other than the United States.<ref>{{cite web |url= http://www.inspection.gc.ca/english/anima/heasan/man/avmmva/avmmva_mod8e.shtml |title= Reportable Diseases |access-date= 2007-03-18 |work= Accredited Veterinarian's Manual |publisher= Canadian Food Inspection Agency |archive-date= 2007-02-08 |archive-url= https://web.archive.org/web/20070208153207/http://www.inspection.gc.ca/english/anima/heasan/man/avmmva/avmmva_mod8e.shtml |url-status= dead }}</ref>
===China===
An outbreak infecting humans took place in [[Lanzhou]] in
According to Georgios Pappas, an infectious-disease specialist and author of a report published in the journal ''[[Clinical Infectious Diseases]]'',<ref name=Pappas>{{cite journal|last=Pappas|first=Georgios|date=15 November 2022|title=The Lanzhou Brucella Leak: The Largest Laboratory Accident in the History of Infectious Diseases?|url=https://academic.oup.com/cid/article-abstract/75/10/1845/6604450 |journal=Clinical Infectious Diseases|volume=75|issue=10|pages=1845–1847|doi=10.1093/cid/ciac463 |pmid=35675697 }}</ref> the result was “possibly the largest laboratory accident in the history of infectious diseases.” According to Pappas, out of nearly 70,000 people tested, more than 10,000 were seropositive, citing figures compiled by the provincial health authorities in Lanzhou’s Gansu province. Pappas also states that Chinese documents show that more than 3,000 people living near the plant applied for compensation, an indication of at least a mild illness.<ref name=Warwick&Willman>{{cite news|last1=Warwick|first1=Joby|last2=Willman|first2=David|date=April 12, 2023|title=China's struggles with lab safety carry danger of another pandemic|url=https://www.washingtonpost.com/investigations/interactive/2023/china-lab-safety-risk-pandemic/? |newspaper=[[The Washington Post]]|location=Washington D.C.}}</ref>
===Europe===
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====Malta====
Until the early 20th century, the disease was [[Endemic (epidemiology)|endemic]] in Malta to the point of it being referred to as "Maltese fever". Since 2005, due to a strict regimen of certification of milk animals and widespread use of pasteurization, the illness has been eradicated from Malta.<ref>{{cite book|title=Brucellosis, The Malta Experience|last= Naudi|first= John Rizzo
====Republic of Ireland====
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The first state–federal cooperative efforts towards eradication of brucellosis caused by ''B. abortus'' in the U.S. began in 1934.{{citation needed|date=June 2021}}
Brucellosis was originally imported to North America with non-native domestic cattle (''Bos taurus''), which transmitted the disease to wild [[bison]] (''Bison bison'') and [[elk]] (''Cervus canadensis''). No records exist of brucellosis in ungulates native to America until the early 19th century.<ref>{{cite journal |title=On the Origin of Brucellosis in Bison of Yellowstone National Park: A Review | first1 = Mary | last1 = Meagher | first2 = Margaret E. | last2 = Meyer
==History==
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[[File:Sir Temi Zammit laboratory.jpeg|thumb|300px|The lab in which Sir [[Themistocles Zammit]] and the Mediterranean Fever Commission carried out research about brucellosis from 1904 to 1906 is located within the [[Castellania (Valletta)|Castellania]] in [[Valletta]], [[Malta]].]]
Brucellosis first came to the attention of [[United Kingdom|British]] medical officers in the 1850s in Malta during the [[Crimean War]], and was referred to as Malta Fever. [[Jeffery Allen Marston]] (1831–1911) described his own case of the disease in 1861. The causal relationship between organism and disease was first established in 1887 by [[David Bruce (microbiologist)|David Bruce]].<ref>{{cite book | last = Wilkinson | first = Lise | chapter= Brucellosis |editor-last = Kiple | editor-first = Kenneth F.
In 1897, [[Denmark|Danish]] [[veterinarian]] [[Bernhard Lauritz Frederik Bang|Bernhard Bang]] isolated a [[bacillus (shape)|bacillus]] as the agent of heightened spontaneous abortion in cows, and the name "Bang's disease" was assigned to this condition. Bang considered the organism rod-shaped and classified it as a [[bacillus]].
In the late 1910s, American bacteriologist [[Alice Catherine Evans|Alice C. Evans]] was studying the Bang bacillus and gradually realized that it was virtually indistinguishable from the Bruce coccus.<ref name="de_Kruif_1932">{{cite book | last = de Kruif | first = Paul
In the decades after Evans's work, this genus, which received the name ''[[Brucella]]'' in honor of Bruce, was found to contain several species with varying virulence. The name "brucellosis" gradually replaced the 19th-century names Mediterranean fever and Malta fever.<ref name = "Wyatt_2004">{{cite journal|journal=British Medical Journal|last=Wyatt|first=Harold Vivian
Neurobrucellosis, a neurological involvement in brucellosis, was first described in 1879. In the late 19th century, its symptoms were described in more detail by M. Louis Hughes, a Surgeon-Captain of the [[Royal Army Medical Corps]] stationed in Malta who isolated ''brucella'' organisms from a patient with meningo-encephalitis.<ref>{{cite book|title=Brucellosis|last=Madkour|first=M. Monir|year=2014|publisher=Elsevier Science|isbn=
These obsolete names have previously been applied to brucellosis:<ref name = "Wyatt_2004" /><ref>{{
{{Columns-list|colwidth=22em|
* Crimean fever
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===Biological warfare===
''Brucella'' species
The experimental American bacteriological warfare program focused on three agents of the ''Brucella'' group:{{citation needed|date=June 2021}}
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Agent US was in advanced development by the end of [[World War II]]. When the [[United States Air Force]] (USAF) wanted a biological warfare capability, the Chemical Corps offered Agent US in the [[M114 bomblet]], based on the four-pound bursting bomblet developed for spreading [[anthrax]] during World War II. Though the capability was developed, operational testing indicated the weapon was less than desirable, and the USAF designed it as an interim capability until it could eventually be replaced by a more effective biological weapon.{{citation needed|date=May 2021}}
The main drawback of using the M114 with Agent US was that it acted mainly as an incapacitating agent, whereas the USAF administration wanted weapons that were deadly. The stability of M114 in storage was too low to allow for storing it at forward air bases, and the logistical requirements to neutralize a target were far higher than
Agents US and AA had a median infective dose of 500 organisms/person, and for Agent AM it was 300 organisms/person. The incubation time was believed to be about 2 weeks, with a duration of infection of several months. The lethality estimate was, based on epidemiological information, 1 to 2
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''[[Brucella abortus|B. abortus]]'' is the principal cause of brucellosis in cattle. The bacteria are shed from an infected animal at or around the time of calving or [[Spontaneous abortion|abortion]]. Once exposed, the likelihood of an animal becoming infected is variable, depending on age, pregnancy status, and other intrinsic factors of the animal, as well as the number of bacteria to which the animal was exposed.<ref>Radostits, O.M., C.C. Gay, D.C. Blood, and K.W. Hinchcliff. (2000). ''Veterinary Medicine, A textbook of the Diseases of Cattle, Sheep, Pigs, Goats and Horses''. Harcourt Publishers Limited, London, pp. 867–882. {{ISBN|0702027774}}.</ref> The most common clinical signs of cattle infected with ''B. abortus'' are high incidences of abortions, arthritic joints, and retained [[placenta]].{{citation needed|date=June 2021}}
The two main causes for spontaneous abortion in animals are [[erythritol]], which can promote infections in the fetus and placenta,{{clarify|date=July 2022}} and the lack of anti-''Brucella'' activity in the amniotic fluid. Males can also harbor the bacteria in their reproductive tracts, namely [[seminal vesicle]]s, [[ampulla of ductus deferens|ampullae]], [[testicle]]s, and [[
===Dogs===
The causative agent of brucellosis in [[dog]]s, ''[[Brucella canis|B. canis]]'', is transmitted to other dogs through breeding and contact with aborted fetuses. Brucellosis can occur in humans who come in contact with infected aborted tissue or semen. The bacteria in dogs normally infect the genitals and [[lymphatic system]], but can also spread to the eyes, [[kidney]]s, and [[intervertebral disc]]s. Brucellosis in the intervertebral disc is one possible cause of [[discospondylitis]]. Symptoms of brucellosis in dogs include abortion in female dogs and [[scrotum|scrotal]] inflammation and [[orchitis]] in males. Fever is uncommon. Infection of the eye can cause [[uveitis]], and infection of the intervertebral disc can cause pain or weakness. Blood testing of the dogs prior to breeding can prevent the spread of this disease. It is treated with antibiotics, as with humans, but it is difficult to cure.<ref name="Ettinger_1995">{{cite book| last1 = Ettinger | first1 = Stephen J | last2 = Feldman | first2 = Edward C.
===Aquatic wildlife===
Brucellosis in cetaceans is caused by the bacterium ''[[Brucella ceti|B. ceti]]''. First discovered in the aborted fetus of a [[bottlenose dolphin]], the structure of ''B. ceti'' is similar to ''Brucella'' in land animals. ''B. ceti'' is commonly detected in two suborders of cetaceans, the [[Mysticeti]] and [[Odontoceti]]. The Mysticeti include four families of [[baleen whales]], filter-feeders, and the Odontoceti include two families of toothed cetaceans ranging from dolphins to sperm whales. ''B. ceti'' is believed to transfer from animal to animal through sexual intercourse, maternal feeding, aborted fetuses, placental issues, from mother to fetus, or through fish reservoirs. Brucellosis is a reproductive disease, so has an extreme negative impact on the population dynamics of a species. This becomes a greater issue when the already low population numbers of cetaceans are taken into consideration. ''B. ceti'' has been identified in four of the 14 cetacean families, but the antibodies have been detected in seven of the families. This indicates that ''B. ceti'' is common amongst cetacean families and populations. Only a small percentage of exposed individuals become ill or die. However, particular species apparently are more likely to become infected by ''B. ceti''. The harbor porpoise, striped dolphin, white-sided dolphin, bottlenose dolphin, and common dolphin have the highest frequency of infection amongst
=== Terrestrial wildlife ===
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Wild bison and elk in the greater [[Yellowstone]] area are the last remaining reservoir of ''B. abortus'' in the US. The recent transmission of brucellosis from elk back to cattle in Idaho and Wyoming illustrates how the area, as the last remaining reservoir in the United States, may adversely affect the livestock industry. Eliminating brucellosis from this area is a challenge, as many viewpoints exist on how to manage diseased wildlife. However, the [[Wyoming Game and Fish Department]] has recently begun to protect scavengers (particularly [[coyote]]s and [[red fox]]) on elk feedgrounds, because they act as sustainable, no-cost, biological control agents by removing infected elk fetuses quickly.<ref>{{cite journal | vauthors = Cross PC, Maichak EJ, Brennan A, Scurlock BM, Henningsen J, Luikart G | title = An ecological perspective on Brucella abortus in the western United States | journal = Revue Scientifique et Technique | volume = 32 | issue = 1 | pages = 79–87 | date = April 2013 | pmid = 23837367 | doi = 10.20506/rst.32.1.2184 | url = https://www.nps.gov/yell/learn/nature/upload/09cross7987.pdf }}</ref>
The National Elk Refuge in Jackson, Wyoming asserts that the intensity of the winter feeding program affects the spread of brucellosis more than the population size of elk and bison.<ref name="Brucellosis at Threecolumn">{{
=== Effects on hunters ===
Hunters may be at additional risk for exposure to brucellosis due to increased contact with susceptible wildlife, including predators that may have fed on infected prey. Hunting dogs can also be at risk of infection.<ref>[https://www.cdc.gov/brucellosis/exposure/hunters.html CDC - Hunters Risks - Animals That Can Put Hunters at Risk]</ref> Exposure can occur through contact with open wounds or by directly inhaling the bacteria while cleaning game.<ref name="Brucellosis at the CDC">{{
== See also ==
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== Further reading ==
* [https://www.who.int/news-room/fact-sheets/detail/brucellosis WHO fact sheet on brucellosis]
* [https://web.archive.org/web/20100714202209/http://patricbrc.org/portal/portal/patric/Taxon?cType=taxon&cId=234 Brucella] genomes and related information at [http://patricbrc.org/ PATRIC], a Bioinformatics Resource Center funded by [https://www.niaid.nih.gov/ NIAID]
* [https://web.archive.org/web/20040212170120/http://www.cdc.gov/ncidod/dbmd/diseaseinfo/brucellosis_g.htm Prevention about Brucellosis] from [[Centers for Disease Control]]
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* [http://ecdc.europa.eu/en/healthtopics/brucellosis/Pages/index.aspx Brucellosis], factsheet from [[European Centre for Disease Prevention and Control]]
{{Medical resources
| ICD11 = {{ICD11|1B95}}
| ICD10 = {{ICD10|A|23||a|20}}
| ICD9 = {{ICD9|023}}
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| Orphanet = 1304
}}
{{U.S. biological weapons}}
{{Bacterial diseases}}
{{Bacterial cutaneous infections}}
{{Authority control}}
[[Category:
[[Category:Bacterium-related cutaneous conditions]]
[[Category:
[[Category:Bovine diseases]]▼
[[Category:Occupational diseases]]
[[Category:Sheep and goat diseases]]
[[Category:Zoonoses]]
[[Category:
▲[[Category:Bovine diseases]]
▲[[Category:Sheep and goat diseases]]
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