Local infections: brucellosis, tuberculosis and leishmaniasis

Why are these three together?

We put these three together because each can go on for weeks or months with vague symptoms such as fever and tiredness. That is why the doctor asks about your job, contact with animals, dairy and travel. The Yellow Book lists brucellosis and tuberculosis under fever lasting more than two weeks after travel, and tuberculosis under fever starting more than six weeks after travel.

Brucellosis

What it is. A bacterial illness. The CDC says people catch it from contact with infected animals or infected animal products. WHO says most cases in the general population come from drinking unpasteurized milk or eating cheese from infected goats and sheep. Farmers, butchers, vets and laboratory workers are more exposed. Both sources describe human-to-human spread as very rare.

Signs. Fever, tiredness, sweating, headache, body aches, poor appetite and weight loss. WHO gives the incubation period as one week to two months, usually two to four weeks. The CDC says that without treatment the symptoms can persist or come and go and can reach the joints, heart, testicles, liver and spleen. So “fever, chills and joint pain” without a clear cause, with a history of raw dairy or livestock, should be mentioned to a doctor.

Investigation and treatment. Diagnosis uses tests your doctor chooses. Treatment is with antibiotics. WHO says treatment plans use several antibiotics together. The CDC gives the treatment length as at least 6 to 8 weeks and says incorrect treatment can make the infection chronic. The doctor sets the medicine and length. WHO notes that the right treatment for pregnant women, newborns and children under 8 is still not settled. If you are pregnant or worried about a child, tell your doctor early.

Prevention. The CDC names not consuming unpasteurized milk and dairy as the best way, and says if you are not sure it is pasteurized, do not eat it. When handling animal tissue, gloves, eye protection and a mask are needed.

Tuberculosis

What it is. WHO describes TB as a bacterial disease that mostly affects the lungs, spreads through the air when a patient coughs, sneezes or spits, and is preventable and curable. Not everyone who catches the germ becomes ill. WHO estimates that 5 to 10 percent of those infected become ill. The NHS also describes latent TB as not contagious and active TB as contagious.

Signs. A long-lasting cough (NHS: more than three weeks), sometimes blood in the sputum, fever or night sweats, tiredness, poor appetite and weight loss. If TB leaves the lungs, the NHS says it can affect glands, bones, skin or the brain, and WHO also names the kidney and spine.

Investigation. The NHS lists imaging, sputum tests and sometimes a biopsy. WHO says rapid tests can give an initial result within 48 hours of the sample. For people who have no symptoms but are at risk, there are skin and blood tests. To prepare a sputum sample, see the samples and cultures guide.

Treatment. Several antibiotics that must be taken regularly every day. WHO gives the usual length as 4 to 6 months and the NHS as at least 6 months. Your doctor will set the exact length for you. WHO says stopping early or without advice is dangerous and that drug resistance arises from misuse and incomplete use of medicine. The NHS also says to complete the course even when you feel better.

In Iran. According to the research paper by Bay and colleagues (2017), Iran’s TB control programme has used directly observed treatment (DOTS) since 1997. Ask your doctor or health centre about the visiting schedule and where to collect the medicine.

Leishmaniasis

What it is. A parasitic illness spread by the bite of the female sandfly. WHO recognizes three forms: the skin form, with sores on parts of the body that leave scars; the visceral form (kala-azar), which is the most serious; and the mucosal form, which damages tissue in the nose and mouth. WHO writes that without treatment the visceral form is fatal in more than 95 percent of cases, but leishmaniasis can be treated, and a patient with the visceral form needs prompt and complete treatment.

Signs of the visceral form. Recurring fever, weight loss, an enlarged liver and spleen, and anaemia. WHO says every patient with this form needs prompt and complete treatment.

In our region. The paper by Moradi-Asl and colleagues (2017) says Ardabil province is the most important focus of kala-azar in Iran. Its background section says there are at least four main foci, of which East Azerbaijan is one, and the paper itself studied only Ardabil. The same paper says most patients are young children and that dogs and canids are the main reservoir. The paper does not describe a treatment method. So we cannot say how great the risk is for an adult in Tabriz. If you or your child has a long fever with a swollen belly or anaemia and has been in a rural area, tell your doctor.

Investigation and treatment. WHO says diagnosis of the visceral form combines clinical signs with parasitological or serological tests. The type of medicine depends on the form of the disease, the parasite species, the site and other conditions. In a patient with weakened immunity, relapse is more likely.

What can you do yourself?

• Do not eat unpasteurized dairy, and wear gloves and protection when working with livestock and during animal births.
• Do not put a long fever or cough down to “tiredness”. The sooner the cause is known, the easier treatment is.
• Tell your doctor about your job, contact with livestock, local dairy, trips to villages, and any contact with someone who has TB.
• Do not stop medicine until your doctor says so. Do not touch leftover antibiotics or other people’s medicine.
• If your illness is active TB, covering your mouth and nose when you cough and disposing of sputum and tissues properly are among WHO’s advice. Your doctor will give you the details. Household members of someone with active TB should also be checked. Ask your doctor or health centre.

When to act urgently

Call 115 (Iran’s emergency number) right now (NHS, for TB): a stiff neck with a severe headache, extreme sensitivity to light, a seizure, sudden confusion or change in behaviour, or weakness or loss of movement in part of the body. The TB may have reached the brain.

The same day: coughing up blood (the NHS says to get an urgent doctor’s appointment). If there is a lot of blood or you are short of breath, call 115. A child or adult with recurring fever, pallor and a swelling belly. A fever and chills after raw dairy or contact with livestock that do not improve. The full list, including sudden fever after a tick bite or slaughtering livestock (Crimean-Congo haemorrhagic fever), is in the urgent signs.

This page is for information only and does not replace an examination.