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Brucellosis 

Brucellosis

Chapter:
Brucellosis
Author(s):

M. Monir Madkour

DOI:
10.1093/med/9780199204854.003.070621

May 31, 2012: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

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date: 24 April 2017

There are four species of the Gram-negative, aerobic brucella bacillus, each comprising several biovars: Brucella melitensis (‘Malta fever’, most commonly associated with goats, sheep, and camels), B. abortus (cattle), B. suis (pigs), and B. canis (dogs). The disease that they cause—brucellosis—occurs worldwide, but is especially prevalent in the Mediterranean region, the Indian subcontinent, Mexico, and Central and South America. Transmission is commonly by ingestion of untreated dairy products or other contaminated foods, but can also be by inhalation or inoculation.

Clinical features—symptoms are highly variable, simulating other febrile illnesses, hence travel to endemic areas (with details of drinking and eating behaviour) and occupation are crucial elements in the history. Joint pains, back pain and headache are common (each found in >80% of cases). Signs include spinal tenderness (48%), arthritis (40%), lymphadenopathy (32%), splenomegaly (25%), hepatomegaly (20%), and epididymo-orchitis (21% of men).

Diagnosis and treatment—definite diagnosis requires the isolation of the organism from the blood, body fluids, or tissues. Treatment is with supportive care and antibiotics: regimens containing doxycycline in combination with streptomycin/gentamicin/netilmicin are most effective, incurring fewer therapeutic failures and relapses.

Prevention—human brucellosis can be prevented by eradicating the disease in animals by vaccination. Other preventive measures include avoiding keeping farm animals in close proximity to houses, drinking raw milk and its products, and consumption of raw liver, meat, and bone marrow. There is no effective vaccine for human use.

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