MycoplasmaRegistryReports&News-Lady with the Lamp sheds light on ME (chronic brucellosis?)

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" ...chronic brucellosis should be classed as a form of chronic fatigue

syndrome (CFS)... " (Dr Robert Fekety, of Michigan University)

 

" ...Brucellosis-In the chronic form (>1 year from onset), symptoms may

include chronic fatigue syndrome, depression, and arthritis... (according

to the Centers for Disease Control, see CDC page below.)

 

 

Lady with the Lamp sheds light on ME

IAN JOHNSTON

The Scotsman, UK - May 11, 2004

http://news.scotsman.com/health.cfm?id=535962004

 

SHE was the founder of modern nursing who worked so long into the night

to help injured soldiers in the Crimean War that they came to know her as

" the Lady with the Lamp " . But she was also later derided as a malingerer

and a hypochondriac for taking to her bed on and off for more than 20

years.

 

Now sufferers of ME are claiming Florence Nightingale had the condition

and have been holding a series of awareness-raising flag days in Scottish

cities to mark her birthday on 12 May.

 

But the claim that Nightingale was a sufferer of a condition once

dismissed as " yuppie flu " has sparked controversy among leading

historians.

 

During her lifetime, Nightingale’s condition was treated seriously by

doctors, who saw it as a form of nervous exhaustion thought common among

women at the time.

 

Later scholars have viewed her retreat to her bedroom as a way to escape

public life as she struggled to cope with the horrors of the Crimea.

 

But for Kelly McLellan, 32, the convener of the Edinburgh ME Self-Help

group (MESH), the suggestion that Nightingale - who died in 1910 at the

age of 90 - may have been a fellow sufferer could help increase

understanding of the condition.

 

" It goes to show that ME, or at least a poorly understood illness which

causes serious chronic fatigue, is not a recent phenomenon and is an

illness which can strike anyone, " he said.

 

" But I think that we still have a long way to go. Recognition is not just

about getting treatment - it is also about respect. A lot of ME sufferers

are not treated well because people don’t recognise their illness. I hope

that Florence Nightingale’s life shows that ill people deserve respect

even if their illness isn’t understood. "

 

Mr McLellan, of Barnton, Edinburgh, was forced to give up a PhD in

biochemistry at Oxford University in 1996, two years after contracting

ME, and now works as a private tutor.

 

" Florence Nightingale’s story sounds a lot like many of the ME sufferers

that I know. We all try to work round the condition in some way, " he

said.

 

Nightingale’s illness has been the subject of much debate since an

academic paper in 1995 suggested she had chronic brucellosis, a bacterial

infection often found in the Mediterranean.

 

Her own doctors decided she had been suffering from what was then called

neurasthenia, an obsolete term now associated with a psychosomatic

illness.

 

They recorded her symptoms as including headache, nausea at the sight of

food, breathlessness, an irregular heartbeat, palpitations and a

generally neurotic disposition.

 

Last year, a conference in the United States which looked into her

illness decided she had " bipolar depression " , which combines periods of

depression with manic behaviour over a long period of time.

 

However, it is the claim by Dr Robert Fekety, of Michigan University,

that chronic brucellosis should be classed as a form of chronic fatigue

syndrome (CFS), or can lead to it, which has been seized on by ME

sufferers. Allen Hutchinson, a professor of public health at the

University of Sheffield and an expert on ME, said the condition was still

not fully understood - studies are ongoing in UK, Australia and the US -

and was used as an umbrella term for a range of ailments.

 

" There’s no doubt that a few people with CFS spend very long periods of

their lives in bed, but only very few of them. But if there is a truism

it is likely to be that CFS has more than one underlying cause, " he said.

 

 

Prof Hutchinson dismissed claims that ME was " yuppie flu " , or all in the

mind, as " simplistic and ridiculous " .

 

He said: " Clearly, these people need to be helped in some way or another.

 

 

" I think it is possible that someone like Florence Nightingale had CFS;

it’s almost certainly not a new illness. The notion of it being yuppie

flu is not very likely. "

 

Professor Lynn McDonald, of the University of Guelph in Ontario, a

leading expert on Nightingale, said: " There’s an enormous amount of

speculation as to what her ailment was, but obviously none of us is going

to know.

 

" I just don’t see the point of speculating - it’s something we cannot

possibly know.

 

" I think Nightingale is very interesting and her strategy for coping with

her condition is interesting. But what she was coping with ... I think

this is far-fetched, speculating about somebody who died in 1910. "

 

Alex Attewell, the director of the Florence Nightingale Museum in London,

said:

 

" I can see why it’s been suggested that Florence Nightingale may have had

ME, because having a famous person who suffered from it helps to promote

understanding of it. "

 

©2004 Scotsman.com

 

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Brucellosis (Brucella melitensis, abortus, suis, and canis)

Centers for Disease Control and Prevention

National Center for Infectious Diseases

Division of Bacterial and Mycotic Diseases

http://www.cdc.gov/ncidod/dbmd/diseaseinfo/brucellosis_t.htm

For comprehensive CDC information about bioterrorism and related issues,

please visit http://www.bt.cdc.gov.

 

Clinical Features

 

In the acute form

(<8 weeks from illness onset), nonspecific and " flu-like " symptoms

including fever, sweats, malaise, anorexia, headache, myalgia, and back

pain.

 

In the undulant form

(<1 year from illness onset), symptoms include undulant fevers,

arthritis, and epididymo-orchitis in males. Neurologic symptoms may occur

acutely in up to 5% of cases.

 

In the chronic form

(>1 year from onset), symptoms may include chronic fatigue syndrome,

depression, and arthritis.

 

Etiologic Agent

Brucella species, usually B. abortus (cattle), B. melitensis, B.ovis

(sheep, and goats), B. suis (pigs), and rarely B. canis (dogs).

 

Incidence

In the United States, < 0.5 cases per 100,000 population, primarily B.

melitensis. . Most cases are reported from California, Florida, Texas,

and Virginia.

 

Sequelae

Variable, including granulomatous hepatitis, peripheral arthritis,

spondylitis, anemia, leukopenia, thrombocytopenia, meningitis, uveitis,

optic neuritis, papilledema, and endocarditis.

 

Transmission Zoonotic.

Commonly transmitted through abrasions of the skin from handling infected

mammals. In the United States, occurs more frequently by ingesting

unpasteurized milk or dairy products. Highly infectious in the laboratory

via aerosolization; handling cultures warrants biosafety level-3

precautions.

 

Risk Groups

Abattoir workers, meat inspectors, animal handlers, veterinarians, and

laboratorians.

Surveillance Brucellosis is a nationally notifiable disease and

reportable to the local health authority.

Trends For previous 10 years, approximately 100 cases per year have been

reported.

 

Challenges

Elimination of domestic and feral animal reservoirs. In 2001, the

National Brucellosis Eradication Program reported only 3 newly affected

cattle herds, compared to 14 herds identified in 2000. Establish and

validate methods for isolation and detection of Brucella spp. in foods.

 

Opportunities

Validation of rapid diagnostic technologies developed for identification

of Brucella spp. in natural or bioterrorism-associated outbreaks.

 

December 2003

This page last reviewed February 4, 2004

Centers for Disease Control and Prevention

National Center for Infectious Diseases

Division of Bacterial and Mycotic Diseases

 

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Brucellosis (Brucella melitensis, abortus, suis, and canis)

Frequently Asked Questions

http://www.cdc.gov/ncidod/dbmd/diseaseinfo/brucellosis_g.htm

For comprehensive CDC information about bioterrorism and related issues,

please visit http://www.bt.cdc.gov.

 

1. What is brucellosis?

Brucellosis is an infectious disease caused by the bacteria of the genus

Brucella. These bacteria are primarily passed among animals, and they

cause disease in many different vertebrates. Various Brucella species

affect sheep, goats, cattle, deer, elk, pigs, dogs, and several other

animals. Humans become infected by coming in contact with animals or

animal products that are contaminated with these bacteria. In humans

brucellosis can cause a range of symptoms that are similar to the flu and

may include fever, sweats, headaches, back pains, and physical weakness.

Sever infections of the central nervous systems or lining of the heart

may occur. Brucellosis cab also cause long-lasting or chronic symptoms

that include recurrent fevers, joint pain, and fatigue.

 

2. How common is brucellosis?

Brucellosis is not very common in the United States, where100 to 200

cases occur each year. But brucellosis can be very common in countries

where animal disease control programs have not reduced the amount of

disease among animals.

 

3. Where is brucellosis usually found?

Although brucellosis can be found worldwide, it is more common in

countries that do not have good standardized and effective public health

and domestic animal health programs. Areas currently listed as high risk

are the Mediterranean Basin (Portugal, Spain, Southern France, Italy,

Greece, Turkey, North Africa), South and Central America, Eastern Europe,

Asia, Africa, the Caribbean, and the Middle East. Unpasteurized cheeses,

sometimes called " village cheeses, " from these areas may represent a

particular risk for tourists.

 

4. How is brucellosis transmitted to humans, and who is likely to become

infected?

Humans are generally infected in one of three ways: eating or drinking

something that is contaminated with Brucella, breathing in the organism

(inhalation), or having the bacteria enter the body through skin wounds.

The most common way to be infected is by eating or drinking contaminated

milk products. When sheep, goats, cows, or camels are infected, their

milk is contaminated with the bacteria. If the milk is not pasteurized,

these bacteria can be transmitted to persons who drink the milk or eat

cheeses made it. Inhalation of Brucella organisms is not a common route

of infection, but it can be a significant hazard for people in certain

occupations, such as those working in laboratories where the organism is

cultured. Inhalation is often responsible for a significant percentage of

cases in abattoir employees. Contamination of skin wounds may be a

problem for persons working in slaughterhouses or meat packing plants or

for veterinarians. Hunters may be infected through skin wounds or by

accidentally ingesting the bacteria after cleaning deer, elk, moose, or

wild pigs that they have killed.

 

5. Can brucellosis be spread from person to person?

Direct person-to-person spread of brucellosis is extremely rare. Mothers

who are breast-feeding may transmit the infection to their infants.

Sexual transmission has also been reported. For both sexual and

breast-feeding transmission, if the infant or person at risk is treated

for brucellosis, their risk of becoming infected will probably be

eliminated within 3 days. Although uncommon, transmission may also occur

via contaminated tissue transplantation.

 

6. Is there a way to prevent infection?

Yes. Do not consume unpasteurized milk, cheese, or ice cream while

traveling. If you are not sure that the dairy product is pasteurized,

don't eat it. Hunters and animal herdsman should use rubber gloves when

handling viscera of animals. There is no vaccine available for humans.

 

7. My dog has been diagnosed with brucellosis. Is that a risk for me?

B. canis is the species of Brucella species that can infect dogs. This

species has occasionally been transmitted to humans, but the vast

majority of dog infections do not result in human illness. Although

veterinarians exposed to blood of infected animals are at risk, pet

owners are not considered to be at risk for infection. This is partly

because it is unlikely that they will come in contact with blood, semen,

or placenta of the dog. The bacteria may be cleared from the animal

within a few days of treatment; however re-infection is common and some

animal body fluids may be infectious for weeks. Immunocompromised persons

(cancer patients, HIV-infected individuals, or transplantation patients)

should not handle dogs known to be infected with B. canis.

 

8 How is brucellosis diagnosed?

Brucellosis is diagnosed in a laboratory by finding Brucella organisms in

samples of blood or bone marrow. Also, blood tests can be done to detect

antibodies against the bacteria. If this method is used, two blood

samples should be collected 2 weeks apart.

 

9. Is there a treatment for brucellosis?

Yes, but treatment can be difficult. Doctors can prescribe effective

antibiotics. Usually, doxycycline and rifampin are used in combination

for 6 weeks to prevent reoccuring infection. Depending on the timing of

treatment and severity of illness, recovery may take a few weeks to

several months. Mortality is low (<2%), and is usually associated with

endocarditis.

 

10 I am a veterinarian, and I recently accidentally jabbed myself with

the animal vaccine (RB-51 or B-19, or REV-1) while I was vaccinating cows

(or sheep, goats). What do I need to do?

These are live vaccines, and B-19 is known to cause disease in humans.

Although we know less about the other vaccines, the recommendations are

the same. You should see a health care provider. A baseline blood sample

should be collected for testing for antibodies. We recommend that you

take antibiotics (doxycycline and rifampin for B-19 and REV-1, or

doxycycline alone for RB-51) for 3 weeks. At the end of that time you

should be rechecked and a second blood sample should be collected. (The

sample can also be collected at 2 weeks.) The same recommendations hold

true for spraying vaccine in the eyes (6 weeks of treatment in this case)

or spraying onto open wounds on the skin.

 

This page last reviewed February 17, 2004

 

Centers for Disease Control and Prevention

National Center for Infectious Diseases

Division of Bacterial and Mycotic Diseases

 

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