Brucellosis

Infectious diseases

Clinicals - History

Fact Explanation
Asymptomatic Patients with subclinical disease can be asymptomatic. Asymptomatic
Patients with subclinical disease can be asymptomatic.
Presence of risk factors These include recent visit to endemic areas. Consumption of unpasteurized dairy products, and raw or poorly cooked meat. Exposure to animal hosts (goats, sheep, cows, camels, pigs, reindeer, rabbits, or hares) is a risk factor. Certain occupations are at high risk of exposing to above animals. (eg: hunters, farmers, dairy workers, veterinarians) Presence of risk factors
These include recent visit to endemic areas. Consumption of unpasteurized dairy products, and raw or poorly cooked meat. Exposure to animal hosts (goats, sheep, cows, camels, pigs, reindeer, rabbits, or hares) is a risk factor. Certain occupations are at high risk of exposing to above animals. (eg: hunters, farmers, dairy workers, veterinarians)
Fever Most patients present with fever or prolonged fever. Fever
Most patients present with fever or prolonged fever.
Brest fed babies of infected mothers Brucellosis is transmitted via breast milk. Brest fed babies of infected mothers
Brucellosis is transmitted via breast milk.
Constitutional symptoms These include anorexia, fatigue, weight loss, arthralgia, low back pain and joint pain. Constitutional symptoms
These include anorexia, fatigue, weight loss, arthralgia, low back pain and joint pain.
Neuropsychiatric symptoms Patients present with headache and depression. Some have unsteady gait. Neuropsychiatric symptoms
Patients present with headache and depression. Some have unsteady gait.
Symptoms of gastrointestinal tract involvement Dyspepsia, constipation, diarrhea and abdominal pain are common complains. Abdominal pain is due to hepatic abscess. Symptoms of gastrointestinal tract involvement
Dyspepsia, constipation, diarrhea and abdominal pain are common complains. Abdominal pain is due to hepatic abscess.
Symptoms of urinary tract infection Increased frequency of micturition, dysuria and nocturia are symptoms suggestive of a urinary tract infection. Symptoms of urinary tract infection
Increased frequency of micturition, dysuria and nocturia are symptoms suggestive of a urinary tract infection.
Symptoms of orchitis Patients complain of swelling and pain in the testicles. Symptoms of orchitis
Patients complain of swelling and pain in the testicles.
Cough and dyspnea Bronchitis, bronchopneumonia and pleural effusions can cause dyspnea and cough. Cough and dyspnea
Bronchitis, bronchopneumonia and pleural effusions can cause dyspnea and cough.
Pleuritic chest pain This is due to the irritation of the parietal pleura by the empyema. Pleuritic chest pain
This is due to the irritation of the parietal pleura by the empyema.
Muscular skeletal complications Arthiritis and joint swelling can present. Muscular skeletal complications
Arthiritis and joint swelling can present.

Clinicals - Examination

Fact Explanation
Febrile This is a common examination finding. Febrile
This is a common examination finding.
Palpable lymph nodes Lymphadenopathy is present in about 10% of patients. Palpable lymph nodes
Lymphadenopathy is present in about 10% of patients.
Examination of the joints Involved joints can be tender and swollen. Examination of the joints
Involved joints can be tender and swollen.
Signs of orchitis Testicular swelling and tenderness are present. Testicle is erythematous due to inflammation. Signs of orchitis
Testicular swelling and tenderness are present. Testicle is erythematous due to inflammation.
Abdominal examination Tender hepatomegaly and or splenomegaly can be present. Right upper quadrant pain and jaundice are indicative of hepatic abscess. If peritonitis develops diffuse abdominal tenderness, rebound tenderness, and sluggish or absent bowel sounds are present. Abdominal examination
Tender hepatomegaly and or splenomegaly can be present. Right upper quadrant pain and jaundice are indicative of hepatic abscess. If peritonitis develops diffuse abdominal tenderness, rebound tenderness, and sluggish or absent bowel sounds are present.
Signs of infective endocarditis Patients rarely can have Roth spots, splinter hemorrhages, Osler nodes, Janeway lesions, hepatosplenomegaly and changing murmurs. This is a rare complication of the disease. Infective endocarditis can be complicated with blindness due to embolic phenomenon. Signs of infective endocarditis
Patients rarely can have Roth spots, splinter hemorrhages, Osler nodes, Janeway lesions, hepatosplenomegaly and changing murmurs. This is a rare complication of the disease. Infective endocarditis can be complicated with blindness due to embolic phenomenon.
Examination of the respiratory system Rales and wheezes are heard on auscultation. Pleural friction rubs results due to pleural involvement. Pleural effusion can present in some patients. Examination of the respiratory system
Rales and wheezes are heard on auscultation. Pleural friction rubs results due to pleural involvement. Pleural effusion can present in some patients.
Examination of the nervous system Meningismus, papilledema, altered mental status can be found in some patients. Examination of the nervous system
Meningismus, papilledema, altered mental status can be found in some patients.
Skin involvement Erythema nodosum, skin abscesses, dermal cysts and papulonodular eruptions are the commonest. Some skin lesions are similar to impetigo, psoriasis, eczema, purpura, Stevens-Johnson syndrome and pityriasis rosea. Vasculitic lesions are seen in some. Skin involvement
Erythema nodosum, skin abscesses, dermal cysts and papulonodular eruptions are the commonest. Some skin lesions are similar to impetigo, psoriasis, eczema, purpura, Stevens-Johnson syndrome and pityriasis rosea. Vasculitic lesions are seen in some.
Ophthalmic manifestations These include uveitis, conjunctivitis, nummular keratitis and cataracts. Ophthalmic manifestations
These include uveitis, conjunctivitis, nummular keratitis and cataracts.

Investigations - Diagnosis

Fact Explanation
Full blood count Leucocytosis, leucopenia or thrombocytopenia are seen. Full blood count
Leucocytosis, leucopenia or thrombocytopenia are seen.
Blood culture This is the gold standard in diagnosis but becomes positive only about 40% to 50% of patients. Blood culture
This is the gold standard in diagnosis but becomes positive only about 40% to 50% of patients.
Bone marrow cultures This is fast and more sensitive when compared to blood culture. Bone marrow cultures
This is fast and more sensitive when compared to blood culture.
This is fast and more sensitive when compared to blood culture. Culture of pus, tissue samples, and cerebrospinal, pleural, joint, or ascitic fluid will demonstrate the Brucella. This is fast and more sensitive when compared to blood culture.
Culture of pus, tissue samples, and cerebrospinal, pleural, joint, or ascitic fluid will demonstrate the Brucella.
Agglutination tests Rose Bengal test is used for screening and once positive serum agglutination test is done to confirm the disease. Brucella microagglutination test (BMAT) detects detect antibodies to Brucella species. Fourfold or greater rise in antibody levels would bean an individual is positive for brucellosis. Agglutination tests
Rose Bengal test is used for screening and once positive serum agglutination test is done to confirm the disease. Brucella microagglutination test (BMAT) detects detect antibodies to Brucella species. Fourfold or greater rise in antibody levels would bean an individual is positive for brucellosis.
ELISA (Enzyme-Linked ImmunoSorbent Assay) Detects Ig G and IgM antibodies. Fluorescent polarisation immunoassay (FPA) for brucellosis and immunochromatographic brucella lateral flow assay allows quick diagnosis of Brucella. ELISA (Enzyme-Linked ImmunoSorbent Assay)
Detects Ig G and IgM antibodies. Fluorescent polarisation immunoassay (FPA) for brucellosis and immunochromatographic brucella lateral flow assay allows quick diagnosis of Brucella.
Polymerase Chain Reaction (PCR) Detects diagnosis of genetic material hence it has higher sensitivity than culture. Polymerase Chain Reaction (PCR)
Detects diagnosis of genetic material hence it has higher sensitivity than culture.
Computed tomography or magnetic resonance imaging Visualizes the cerebral lesions. Computed tomography or magnetic resonance imaging
Visualizes the cerebral lesions.
Digital subtraction angiography Detect vascular lesions. Digital subtraction angiography
Detect vascular lesions.

Investigations - Management

Fact Explanation
Polymerase Chain Reaction (PCR) Reducing levels of Brucella DNA indicates successful treatment. Persistent high levels of DNA despite antibiotic therapy indicates treatment failure. Polymerase Chain Reaction (PCR)
Reducing levels of Brucella DNA indicates successful treatment. Persistent high levels of DNA despite antibiotic therapy indicates treatment failure.
Trans oesophageal echocardiography Aids in diagnosis of infective endocarditis. Trans oesophageal echocardiography
Aids in diagnosis of infective endocarditis.

Management - Supportive

Fact Explanation
Health education People should be advised not to consume raw meat or unpasteurized dairy products. Personal protective equipment (gloves, goggles, aprons) should be worn by people who are involved in high risk occupations. Health education
People should be advised not to consume raw meat or unpasteurized dairy products. Personal protective equipment (gloves, goggles, aprons) should be worn by people who are involved in high risk occupations.
Orchiectomy If necrotizing orchitis, or abscesses develops patients may need orchiectomy. Orchiectomy
If necrotizing orchitis, or abscesses develops patients may need orchiectomy.

Management - Specific

Fact Explanation
Oral antibiotics Doxycycline (200mg) and rifampicin (600—900 mg) daily for 6 weeks is the treatment of choice. Oral antibiotics
Doxycycline (200mg) and rifampicin (600—900 mg) daily for 6 weeks is the treatment of choice.
Intravenous antibiotics Rifampicin (15 mg/kg) and streptomycin daily for 2—3 weeks. Intravenous antibiotics
Rifampicin (15 mg/kg) and streptomycin daily for 2—3 weeks.

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