'Continue fight against COVID-19, but be alert about Brucellosis too'

Health workers collect swab samples at Kapad Bazar area in Mahim West. File pic

While the nation continues to fight the COVID-19 pandemic and the socio-economic problems that have come along with it, health experts and scientists are now worried about a new zoonotic bacterial disease Brucellosis, that surfaced in China in December last year and has already infected more than 3,000 people. While some feel that as the disease is already present in India, it won't be as severe as COVID-19, others are of the opinion that it might snowball into a pandemic and become more severe than the current one.

Authorities of Lanzhou city in Gansu province have confirmed that 3,245 people have tested positive for Brucellosis - a zoonotic disease - which is usually spread through contact with infected farm animals such as cows, goats and pigs. The outbreak started with a leak at the Lanzhou Veterinary Research Institute in central China, which infected 96 laboratory staff on December 7, 2019.

Speaking to mid-day, Dr Seyed E Hasnain, professor of Molecular Medicine, vice chancellor of Jamia Hamdarad and Hon. professor at IIT-Delhi, said, "This disease is caused by Brucella bacterium. Recent evidence suggests that Brucellosis is now getting more associated with returning travellers and is a serious concern in countries with low and middle income. It is transmitted to humans from animal reservoirs such as cattle, sheep, goats and pigs either through direct contact with the animals or using unpasteurised animal products. Therefore we have to be careful as there could overlap between Covid 19 similarities and Burcuellosis, and therefore health experts need to be extra alert."

No association

Dr Hasnain added, "So far there has been no association of Brucellosis with COVID-19 but similarities include: a) Spread due to inhalation of air containing the bacteria, as happened recently in China; b) initial infection due to movement of travellers; c) disease symptoms such as fever, chills, headache, body ache, general weakness, fatigue, etc; d) infection can affect most parts of the body including liver, inflammation of the testicles leading to infertility in men, inflammation of the meninges and CVDs; and e) about 2 percent of infected persons die, but so far no deaths have been reported from China. Brucellosis can be treated by administration of antibiotics, namely rifampin doxycycline and streptomycin."

Swab samples being collected at an antigen testing camp at Chunabhatti, Dahisar. Pic/Satej Shinde

Professor Dr Sarman Singh, director of All India Institute of Medical Sciences (AIIMS), Bhopal, and an expert in clinical microbiology and molecular medicine said, "The outbreak of Brucellosis in China, is a matter of concern, and both CDC and WHO are closely monitoring the situation. An advisory on Brucellosis, amidst covid pandemic is welcome, but we must understand that Brucellosis is still treatable but not Covid 19."

Dr Singh added, "We must understand that the consequences or sequels of so called cured Covid 19 cases go for a long time, which we seeing is having wider areas of concerns as it adversely impacts multiple organs - brain to heart to intensive or even general condition, post recovery covid 19 so called recovered patients, do complain of weight loss, fatigue, neurological and psychological issues etc, which is not the case with Brucellosis."

"Moreover we must understand that there is significant difference between the two - viruses like SARS-CoV2 can cause pandemics, whereas bacteria's do not usually cause pandemic. And even if it does, we can easily make molecular modifications to treat such a bacterial attack. At this moment, while the entire health machinery is focusing on Covid 19 pandemic, globally and in India, we should continue our fight against the same, though keeping our eyes and ears open for other future likely possible outbreaks for ‘Brucellosis," said Dr Singh.

'Already present in India'

Dr Wiqar Shaikh, senior allergy and asthma specialist said, "Is the World looking at the beginning of a new pandemic? The recent episodes, of Brucellosis, cases multiplying in North West China, cannot be taken sitting low, because like Covid 19, this may result in a spread to the neighbouring countries and then result in a pandemic, if not controlled in time."

Dr Shaikh further said, "Unlike Covid 19, which was a new disease, the incidences, of Brucello's in India, is approximately 1 lakh cases per year, with a mortality of approximately of 2 percent. Unfortunately, in a disease, which already exist in our country, a pandemic situation, will be faster, and more severe, than Covid 19. It is therefore extremely important, for medical practitioners, doctors in government, and civic hospitals to have a high index of suspicion for Brucelloo's in the near future, in patients presenting, with fever. In such cases, it would be mandatory, to not only test the patient with a swab for Covid 19, but also to do the blood culture and IgM antibodies, against Brucella. This would be imperative, to formulate a strategy for adequate and effective treatment against both the ailments. Currently no effective vaccine is available for Brucella, as is also the case with Covid 19."

Dr Shaikh is concerned, that, a given patient may have a dual infection, with both Brucella bacterium and Covid 19 virus, which would spell disaster.

Echoing similar concerns, Dr Subhash Hira, professor of Global Health at the University of Washington-Seattle, USA, said, "While brucellosis watch is yet to start globally, it sends out a strong message to all countries to scale-up vigilance at their apex Centres for Disease Control. Scientists have been talking about 21st century as the "Century of pandemics" and while the world is still struggling to deal with health and socio-economic effects of COVID-19, a new zoonotic bacterial disease called ‘Brucellosis' outbreak has been reported in northwest China this week."

Dr Hira added, "Brucellosis in humans occurs when a person comes into contact with an animal or animal product infected with the Brucella bacteria. It then spreads from person to person only under exceptional conditions. Breastfeeding moms with brucellosis may pass the bacteria on to their baby. Brucella may also be spread through sexual contact. It can enter the human body through a cut or scratch in the skin, breathing contaminated air through aerosol, or eating or drinking something contaminated with the bacteria, such as unpasteurized milk or undercooked meat. Four types of Brucella bacteria cause the majority of brucellosis infections in humans, namely B. melitensis from goat and cow, B. suis from pig, B. canis from dog, B. abortus from cattle."

Dr Shaikh added, "Although, Brucellosis is a bacterial infection, caused by the bacteria called as ‘Brucella' unlike the covid 19 disease, which is caused by SARS-CoV2 virus, unfortunately, the presenting symptoms of both ailments are fairly similar. Fever, vomiting, diarrhoea, loss of appetite, body aches and headaches are symptoms which are common to both, Brucella and Covid 19, besides, liver damage, damage to the heart, are also common, for both Brucella and Covid 19."

Dr Shaikh further said, "Although there are differences between the two such as arthritis (joint swelling) spondylitis (swelling of back bone) and swelling of the testicles which are commonly seen in Brucello's. The other common feature between Covid 19 and Burcellosis is that both could be transmitted through close contact between animals and human beings, and human to human transmission, because of infected secretion (coughing, sneezing, etc), either through animals or affected human beings."

The difference between ailments, however, that Brucella could be caused by ingestion of unpasteurised milk or under cook meat from infected animals, whereas covid 19, has not been proved yet to be transmitted through food. The other major difference is that although no current, treatment is specifically available for covid 19, there are multiple antibiotics available for treating Brucello's. Also the diagnosis, of Brucellosis is through either blood culture or identification of antibodies against Brucella, whereas immunology - the science of defence system of the body clearly knows, that antibodies, have a poor role in a viral infection such as Covid 19, in which memory T- lymphosites have exclusive role in defence against the virus, explained Dr Shaikh.

Dr Ketan Vagholkar, professor of surgery, DY Patil medical college said, "The Covid 19 pandemic, should serve as an eyeopener, for health authorities all over the world. Research laboratories, from countries in the far East, are involved in biological engineering of Zoonotic organisms. Covid 19, is a concrete example of such engineered virus. Most of these laboratories are involved in researching organism, in animals, especially like Bat. There attempt is to modify the organism, which do not cause disease in bat, and similar animal and ensure, that they can be transmitted to human being, and further spread by infected human beings. The focus therefore should be on identifying, all possible organisms, both viruses and bacteria's, which otherwise are seen in animals of various species and can be transmitted to human beings."

Dr Vagholkar added, "A rough strategy to identify, and treat such potential organisms, should be developed, well in advance or knowing breakouts, of otherwise uncommon diseases, such as brucellosis. All health care workers, should be trained, in order to create, awareness, about such potential modified organisms, which can lead to not only epidemics, but a serious pandemic, which the world is struggling to treat."

Different view

Dr T Jacob John, known globally for his extensive work in the fields of virology and paediatrics, who headed the ICMR Centre of Advanced Research in Virology and the National HIV/AIDS Reference Centre at the Christian Medical College, Vellore, where he set up the country's first diagnostic virology laboratory, has a different view. He says, "Brucellosis is a most unlikely candidate for a pandemic as it is already prevalent in many countries and in India too. Its original names were Malta fever and Mediterranean fever. In this case human-to-human transmission is extremely rare and not a problem. It can be easily diagnosed and treated with antibiotics. Also, the mortality rate is very low.

When asked if our health experts need to be alert, Dr Jacob stated, "We often miss brucellosis when it comes to diagnosis and antibiotics are given without a specific/proper/lab-based diagnosis, but patients recover."

'COVID-19 has long-term effects as it affects multiple organs. Recovered patients do complain of weight loss, fatigue, neurological and psychological issues etc, which is not the case with Brucellosis. Moreover, there is a significant difference between the two - viruses like SARS-CoV2 can cause pandemics, whereas bacteria do not usually lead to the same'
- Dr Sarman Singh, director of AIIMS Bhopal

'Unlike COVID-19, which was a new disease for this country, the incidence of Brucellosis in India is approximately 1 lakh cases per year, with a mortality of approximately of 2 per cent. Unfortunately, a disease that already exists in the country, can turn into a pandemic faster and become more severe. So doctors should test patients with high fever both for COVID-19 and Brucellosis'
- Dr Wiqar Shaikh, senior allergy and asthma specialist

'Recent evidence suggests that Brucellosis is getting associated with returning travellers and is a serious concern in countries with low- and middle-income group people. It is transmitted to humans from farm animals either through direct contact or by using unpasteurised animal products. We have to be careful as symptoms of COVID-19 and Brucellosis might overlap'
- Dr Seyed E Hasnain, professor of Molecular Medicine

3,245
No. of people who have been infected in China's Lanzhou city

Expert Virologist differ's in his view

Dr T Jacob John, known globally for his extensive work in the fields of virology and paediatrics, who headed the ICMR Centre of Advanced Research in Virology and the National HIV/AIDS Reference Centre, at the Christian Medical College, Vellore, where he set up the country's first diagnostic virology laboratory, tells has a different view - Brucellosis is a most unlikely candidate for a pandemic as it is already prevalent in many countries and in India in almost all States. Its original names were Malta fever and Mediterranean fever.

Cattle, sheep, goats and pigs are the natural hosts. Man is accidental victim but human-to-human transmission is extremely rare and not a problem. It is easily diagnosed (by laboratory) once it is suspected, and easily treated with antibiotics.

Laboratory staff getting infected is sad and bad; that indicates sloppy lab discipline.

All over India farm animals have infection and a lot of people get infected, many without major symptoms, some with fever and fatigue. Death rate is very low.

When asked if our health experts need to be alert, so that they do not miss out on signs of Brucellosis, while they are in the midst of treating Covid 19 pandemic, Dr Jacob stated, "Yes. Brucellosis if often a missed diagnosis and missed when antibiotics are given without a specific/proper/lab-based diagnosis -- patients recover. Typhoid, malaria, dengue, chikungunya and leptospirosis are remembered by doctors in Fever Cases, but brucellosis often forgotten.

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