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- Brucellosis

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
- Nonlocalised disease- doxycycline+gentamicin/rifampicin
- Bone disease- doxycycline+gentamicin+rifampicin
- Neurobrucellosis- Doxycycline+rifampicin+ceftriaxone
- Endocarditis- doxycycline+rifampicin+cotrimoxazole +surgery
- Pregnancy- rifampicin+ cotrimoxazole
Differential diagnosis
- Tuberculosis
- Malaria
- Visceral leishmaniasis
- HIV infection
- Endocarditis
- Sarcoidosis
- Malignancy