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brucellosis

Etiology: - systemic infection with: - Brucella abortus - Brucella suis - Brucella melitensis one of the infectious causes of fever of unknown origin. Epidemiology: 1) rare in US: - vaccination of livestock (cattle) has reduced incidence in U.S. [5] - most common in California, Texas, Virginia & Florida - case from dairy in Pennsylvania 2) associated with: a) exposure to livestock b) drinking unpasteurized milk [7,8] 3) highest in Mediterranean countries 4) also common in Middle East, South America, Central America Pathology: - caseating granulomas - endocarditis may develop Clinical manifestations: 1) variable incubation period, generally weeks 2) lassitude, malaise, fatigue 3) headache 4) weight loss 5) recurrent fevers, night sweats 6) arthralgias, myalgia 7) tender bones or joints 8) hepatosplenomegaly 9) lymphadenopathy 10) endocarditis (uncommon) 11) neuropsychiatric features in some patients - depression [5] Laboratory: - complete blood count - anemia, leukocytosis or mild leukopenia - urinalysis - may be associated with sterile pyuria - Brucella serology - positive complement fixation test - Brucella antigen in specimen - Brucella DNA - Brucella identified by culture - Brucella identified by blood cultures - bone marrow biopsy - may reveal granulomas - Brucella identified by bone marrow culture - see ARUP consult [4] Radiology: - splenic calcifications Management: 1) doxycycline + rifampin or gentamicin [5] 2) cotrimoxazole is sometimes helpful 3) duration of therapy: 42 days 4) neurobrucellosis requires several months of combined ceftriaxone, doxycycline & rifampin [4] 5) antimicrobial prophylaxis not recommended [5] 6) prophylaxis with doxycycline & trimethoprim/sulfamethoxazole for 21 days for Brucella RB51 [8]

Related

Brucella

General

bacterial infection granulomatous disease

References

  1. DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 871
  2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 500
  3. The Sanford Guide to Antimicrobial Therapy, 29th ed., Gilbert, DN et al (editors), Antimicrobial Therapy, Inc., Hyde Park VT, 1999
  4. ARUP Consult: Brucella Species - Brucellosis The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/brucella-species
  5. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2021.
  6. Ariza J, Bosilkovski M, Cascio A et al Perspectives for the treatment of brucellosis in the 21st century: the Ioannina recommendations. PLoS Med. 2007 Dec;4(12):e317. PMID: 18162038
  7. Centers for Disease Control & Prevention (CDC) CDC and Texas Health Officials Warn About Illness Linked to Raw Milk from Texas Dairy. CDC Newsroom. Sept 15, 2017 https://www.cdc.gov/media/releases/2017/p0915-raw-milk-brucella.html
  8. Centers for Disease Control & Prevention (CDC) Third Case of Rifampin/Penicillin-Resistant Strain of RB51 Brucella from Consuming Raw Milk. CDC Health Alert Network. January 23, 2019 https://emergency.cdc.gov/han/han00417.asp