HEALTH ALERT

Brucellosis Contracted from Consumption of Raw Milk
August 14, 2017

Background

Raw milk is milk from cows or other animals that has not been pasteurized to kill harmful bacteria. This raw, unpasteurized milk can carry dangerous bacteria such as Brucella, Listeria, Salmonella, E. coli, and Campylobacter, which are responsible for causing numerous foodborne illnesses and outbreaks.

The Texas Department of State Health Services (DSHS) recommends that people drink and eat only pasteurized dairy products (including soft cheese, ice cream, and yogurt).

• Pasteurization is the process of heating milk to a high enough temperature for a long enough time to kill dangerous bacteria.
• This is especially important for people at higher risk for foodborne illness: children younger than 5, pregnant women, adults 65 and older, and people with weakened immune systems.
• However, healthy people of any age can get very sick or even die if they drink raw milk contaminated with harmful germs.

Brucellosis

Brucellosis is an infectious disease caused by bacteria. It is a reportable condition in Texas. People can get the disease when they are in contact with infected animals or animal products, including raw milk, contaminated with the bacteria. Animals that are most commonly infected include sheep, cattle, goats, and pigs, among others.

Initial symptoms can include fever, sweats, malaise, anorexia, headache, pain in muscles, joint, and/or back, and fatigue. Some signs and symptoms may persist for longer periods of time. Others may never go away or reoccur. These can include recurrent fevers, arthritis, swelling of the testicle and scrotum area, inflammation of the heart (endocarditis), neurologic symptoms (in up to 5% of all cases), chronic fatigue, depression, and swelling of the liver and spleen. Brucellosis in pregnancy is associated with risk of adverse pregnancy outcomes such as premature delivery, miscarriage, and intrauterine infection with fetal death. Neonatal infection may occur through transplacental transmission during a maternal bacteremic phase, from exposure to blood, urine, or vaginal secretions during delivery, or through breastfeeding.

Laboratory diagnosis of Brucellosis involves testing to look for bacteria in samples of blood, bone marrow, or other body fluids.

Treatment consists of combination antibiotic therapy. Depending on the timing of treatment and severity of illness, recovery may take a few weeks to several months. Death from brucellosis is rare, occurring in no more than 2% of all cases.
 

Brucellosis Case Investigation

In the course of diagnosing the cause of fever, muscle and joint pain, and fatigue in a Texas resident, blood culture results revealed that the patient was infected with Brucella. Through investigation by DSHS, the most probable source of the infection was determined to be raw cow’s milk which the person had been consuming. The source of the milk was K-Bar Dairy, a licensed raw milk dairy in Paradise, Texas.

DSHS is concerned that other people who consumed raw milk from K-Bar Dairy may also have been exposed to Brucella and became infected. Brucellosis may cause short-term and long-term disease. Without specific testing, this disease may elude correct diagnosis, and without appropriate antibiotic therapy, illness may persist.
 

Recommended Action

Health care providers should consider Brucellosis among differential diagnoses when a patient presents with a clinically-compatible constellation of signs and symptoms. The patient should be asked about risk factors for Brucellosis. A key question affecting the level of suspicion of Brucellosis in this scenario is the patient’s consumption of raw milk or raw milk products from K-Bar Dairy in Paradise Texas in Wise County since June 1, 2017. These individuals are considered to be at high risk of contracting brucellosis. Consumers are advised not to consume any raw milk or raw milk products from K-Bar Dairy that are still in their possession and to discard it.

At this time, it is uncertain how long Brucella may have been present in the raw milk from this dairy. Testing is ongoing in an attempt to answer that question. If a patient seeks consultation because they consumed raw milk or raw milk products from this dairy between January and June, 2017 they should be advised to be watchful for signs of chronic Brucellosis and clinically evaluated as appropriate.

As a healthcare professional, we ask you to familiarize yourself with Brucellosis, since it is an uncommon infection and can present with a wide variety of non-specific symptoms and signs that can wax and wane over weeks or even months. For these reasons, Brucellosis presents a diagnostic challenge that requires the clinician to become familiar with the risk factors (e.g., potential exposure), signs, symptoms, natural history, available diagnostic tests and treatment options.

CDC has indicated that laboratory testing for this strain of Brucella relies upon polymerase chain reaction (PCR) to establish timely presumptive results and recovery via blood culture for Brucella species confirmation. The strain of Brucella recovered from the index patient in this case is resistant to rifampin and penicillin.

The Centers for Disease Control and Prevention is one reliable source for current information on Brucella: https://www.cdc.gov/brucellosis/.

DSHS may issue additional alerts to aid the public and healthcare professionals as circumstances warrant.
 

For More Information

DSHS Health Service Region 2/3 in Arlington 817-264-4920
http://www.dshs.texas.gov/region2-3/default.shtm