A month after Texas public health officials urged raw milk drinkers and their doctors to be on the lookout for symptoms of Brucella infection, the federal government weighed in with its own advice.

Anyone who drank unpasteurized, “raw” milk from the K-Bar Dairy in Paradise, TX, from June 1 through Aug. 7 is “at an increased risk for brucellosis and should receive appropriate post-exposure prophylaxis (PEP),” the Centers for Disease Control and Prevention recommended Wednesday.

The CDC echoed advice and warnings that the Texas Department of State Health Services (DSHS) posted Aug. 14.

“A person who drank raw milk from K-Bar Dairy in Paradise, Texas, has been hospitalized with brucellosis. Milk samples from the dairy have tested positive for a Brucella strain called RB51,” according to the CDC health advisory.

“Brucella strain RB51 is resistant to rifampin and penicillin. A combination of doxycycline and trimethoprim/sulfamethoxazole for 21 days is the recommended first-line PEP regimen for RB51 exposure.”

Complicating the situation is the fact that symptoms of Brucella infection can take five days to six months to develop. Consequently, anyone who consumed raw dairy products from the K-Bar Dairy from June 1 through Aug. 7 should monitor themselves for symptoms for the coming months.

Even if symptoms have not developed, the CDC recommends the post-exposure course of antibiotics for 21 days. There isn’t a serological test to detect RB51 infection. Blood culture is the diagnostic test recommended by the CDC for exposed symptomatic individuals.

Symptoms of brucellosis can include fever, sweats, malaise, anorexia, headache, fatigue, muscle and joint pain, and potentially more serious complications such as swelling of heart, liver, or spleen, and neurologic symptoms.

Sometimes symptoms continue for long periods of time. They can also be chronic or recurring. The confirmed patient in Texas had fever, muscle and joint pain, and fatigue before the diagnosis of brucellosis.

Diagnosis is often difficult because symptoms can come and go. Also, brucellosis is relatively uncommon, so some health care providers may not be familiar with its symptoms, according to the Texas health department’s Aug. 14 advisory.

“The 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,” according to the Texas advisory.

“… 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.”

The RB51 strain of Brucella is dangerous for medical staff and lab personnel in addition to patients, particularly because of its resistance to some antibiotics. Therefore, the CDC’s health advisory includes an extra warning for health care providers.

“When ordering blood cultures to diagnose brucellosis, please advise the laboratory that the blood culture may grow Brucella and that appropriate laboratory precautions should be observed,” the CDC recommended.

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