Brucellosis

Brucellosis is an acute febrile illness that is transmitted to humans from animals. It's also called undulant fever, Malta fever, Gibraltar fever, Cyprus fever, and Mediterranean fever.

Brucellosis occurs throughout the world, but such measures as pasteurization of dairy products and immunization of cattle have reduced the incidence of brucellosis in the United States.

Sources of infection occur through travel abroad, consuming imported cheese, and occupation-related exposure. Brucellosis most frequently occurs among farmers, stock handlers, butchers, and veterinarians.

The incubation period usually ranges from 5 to 35 days but sometimes lasts for months. The prognosis is good. With treatment, brucellosis seldom is fatal, although complications can cause permanent disability.

Causes

Brucellosis is caused by the bacterium Brucella. This bacterium infects domesticated animals. It can be spread to humans through:

• Drinking unpasteurized milk
• Eating dairy foods from infected cows, sheep, or goats
• Having direct contact with the secretions, excretions, or carcasses of infected animals
• Inhaling the bacteria
• Breast feeding
• Sexual transmission

Symptoms and Signs

Symptoms such as includes:

• Fever
• Chills
• Excessive sweating
• Weakness
• Weight loss
• Fatigue
• Headache
• Abdominal pain
• Enlarged liver
• Back pain

Diagnostic tests

Multiple agglutination tests help to confirm the diagnosis. About 90% of patients with brucellosis have agglutinin titers of 1 : 160 or more within 3 weeks of developing this disease. However, elevated agglutination titers also follow a relapse, skin tests, and vaccination against tularemia, Yersinia infection, or cholera. Agglutination tests also allow monitoring of treatment effectiveness.

Multiple (three to six) cultures of blood and bone marrow and biopsies of infected tissue (such as the spleen) provide a definitive diagnosis. Culturing is best done during the acute phase.

Blood studies indicate an increased erythrocyte sedimentation rate and a normal or reduced white blood cell count.

Treatment

The most effective therapy is a combination of doxycycline and aminoglycoside, such as streptomycin, gentamicin, or netilmicin for 4 weeks, followed by a combination of doxycycline and rifampin for 4 to 8 weeks. In pregnancy, trimethoprim-sulfamethoxazole can be given in combination with rifampin for 8 to 12 weeks. Alternative treatments include chloramphenicol, with or without streptomycin, and cotrimoxazole.

Cardiac surgery may be necessary in some cases.

Prevention

• Avoid eating or drinking unpasteurized milk and dairy foods. If you are unsure if a dairy product is pasteurized, don’t eat it.
• Wear rubber gloves and goggles, and securely cover open wounds when handling domesticated animals including their secretions, excretions, or carcasses.
• Wear a protective mask when dealing with brucellosis cultures in the laboratory.

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