Brucellosis is a zoonotic infection caused by gram-negative bacilli

  • B.melitensis– goats, sheep, and camels. Causes most severe disease
  • B.abortus– cattle
  • B.suis– pigs. Causes abscesses.
  • B.canis– dogs

Infection to humans- ingestion of contaminated dairy products, uncooked meat, or offal. Also, direct contact with irritated skin or aerosols to the respiratory tract. Incubation 2- 4 weeks.

Clinical features

  • The disease is chronic and tends to relapse- survive for long in the reticuloendothelial system.
  • Insidious onset of high swinging fevers, malaise, night sweats, arthralgias, scrotal pain, weight loss, headache, and abdominal pain
  • Examination- lymphadenopathy, hepatomegaly, splenomegaly

Complications – due to focal disease

  • Osteoarticular disease
  • Orchitis, epididymitis
  • Spontaneous abortion, fetal demise, premature delivery
  • Meningitis, encephalitis, endocarditis
  • Abdominal abscess, uveitis

Diagnosis

  • Definitive- a culture of blood, CSF, and bone marrow
  • Serology- high titer of antibodies or four-fold rise- shows acute infection
  • Liver function tests- raised transaminases
  • Complete blood count- anemia, lymphocytosis, thrombocytopenia

Management

  • Depends on the area with localized disease
  • Aminoglycosides+ tetracyclines- synergistic
  1. Nonlocalised disease- doxycycline+gentamicin/rifampicin
  2. Bone disease- doxycycline+gentamicin+rifampicin
  3. Neurobrucellosis- Doxycycline+rifampicin+ceftriaxone
  4. Endocarditis- doxycycline+rifampicin+cotrimoxazole +surgery
  5. Pregnancy- rifampicin+ cotrimoxazole

Differential diagnosis

  • Tuberculosis
  • Malaria
  • Visceral leishmaniasis
  • HIV infection
  • Endocarditis
  • Sarcoidosis
  • Malignancy

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