brucellosis
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Etiology
- systemic infection with:
one of the infectious causes of fever of unknown origin.
Epidemiology
- 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
- associated with:
- highest in Mediterranean countries
- also common in Middle East, South America, Central America
Pathology
- caseating granulomas
- endocarditis may develop
Clinical manifestations
- variable incubation period, generally weeks
- lassitude, malaise, fatigue
- headache
- weight loss
- recurrent fevers, night sweats
- arthralgias, myalgia
- tender bones or joints
- hepatosplenomegaly
- lymphadenopathy
- endocarditis (uncommon)
- neuropsychiatric features in some patients
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
- see ARUP consult[4]
Radiology
- splenic calcifications
Management
- doxycycline + rifampin or gentamicin[5]
- cotrimoxazole is sometimes helpful
- duration of therapy: 42 days
- neurobrucellosis requires several months of combined ceftriaxone, doxycycline & rifampin[4]
- antimicrobial prophylaxis not recommended[5]
- prophylaxis with doxycycline & trimethoprim/sulfamethoxazole for 21 days for Brucella RB51[8]
More general terms
Additional terms
References
- ↑ DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 871
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 500
- ↑ The Sanford Guide to Antimicrobial Therapy, 29th ed., Gilbert, DN et al (editors), Antimicrobial Therapy, Inc., Hyde Park VT, 1999
- ↑ 4.0 4.1 4.2 ARUP Consult: Brucella Species - Brucellosis The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/brucella-species
- ↑ 5.0 5.1 5.2 5.3 5.4 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2021.
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/18162038
- ↑ 7.0 7.1 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
- ↑ 8.0 8.1 8.2 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