Brucellosis

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Presentation :

• Highest prevalence is found in the Mediterranean countries, Balkans, Persian Gulf, Middle East, and Central and South America
• Symptoms include fever, myalgia, arthralgia, fatigue, headache, and night sweats.
• Focal infection may involve the central nervous system and osteoarticular, cardiovascular, and genitourinary systems.
• Disease relapse and chronic infection may occur.

Pathophysiology :

• Caused by infection with Brucella genus, which are small, Gram-negative, nonmotile, nonspore-forming, coccobacilli.
  • Four species infect humans: B. abortus, B. canis, B. melitensis, and B. suis
• Infection occurs via ingestion of unpasteurized dairy products or undercooked meat, by direct contact with fluids from infected animals, or by inhalation of contaminated aerosols

Diagnostic Testing:

• Diagnosis relies on cultures of blood, bone marrow, other body fluids, or tissue. An initial elevated titer of 1:160 or greater on the serum agglutination test or demonstration of a fourfold increase from acute to convalescent titers is diagnostic.

Treatment :

• For uncomplicated brucellosis, treat with extended course of doxycycline plus either rifampin or gentamicin.
• Neurobrucellosis requires several months of combined ceftriaxone, doxycycline, and rifampin.

Prognosis:

References:

• MKSAP