DESCRIPTION ã…¡ The infection is transmitted from animals to humans. Brucella abortus (cattle), Brucella suis (hogs), and Brucella melitensis (goats) are the main agents. Transmission to humans occurs by contact with infected meat (slaughterhouse workers), placentas of infected animals (farmers, veterinarians) and ingestion of infected unpasteurized milk or cheese. The incubation period varies from a few days to several weeks. The disorder may become chronic.
ASSESSMENT AND DIAGNOSIS
SYMPTOMS AND SIGNS ã…¡ Insidious onset of weakness, weight loss, low-grade fevers, sweats and exhaustion with minimal activity and headache. Abdominal or back pains with anorexia and constipation. Arthralgia may occur. Epididymitis occurs in 10% of cases in men. 50% of cases have peripheral lymph node enlargement and splenomegaly; hepatomegaly is less common.
DIAGNOSIS ã…¡ Early in the course of infection, the organism can be recovered from the blood, cerebrospinal fluid, urine, and bone marrow. Most modern culture systems can detect growth of the organism in blood by 7 days; cultures are more likely to be negative in chronic cases. Diagnosis is often made by serologic testing (rising serologic titers or an absolute agglutination titer of > 1:100 supports the diagnosis).
TREATMENT
Combination regimens of two or three drugs are more effective. Either doxycycline plus rifampin or streptomycin (or both) or doxycycline plus gentamicin or trimethoprim-sulfamethoxazole plus rifampin or streptomycin (or both) is effective in doses as follows...- Doxycycline 100 mg twice daily orally for 6 weeks.
- Trimethoprim 320 mg/day, plus sulfamethoxazole, 1600 mg, three times weekly orally for 6 weeks.
- Rifampin 600–1200 mg once daily orally for 6 weeks.
- Streptomycin 500 mg twice daily intramuscularly for 2 weeks.
- Gentamicin 5 mg/kg/day in three divided doses intravenously for 5–7 days.
REFERENCES
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Vilchez, G., Espinoza, M., D’Onadio, G., Saona, P. and Gotuzzo, E. (2015). Brucellosis in pregnancy: clinical aspects and obstetric outcomes. International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases, [online] 38, pp.95–100. Available at: https://pubmed.ncbi.nlm.nih.gov/26159844
P. GÅ‚owacka, Biological Threats Identification and Countermeasure Center of the General. Polish Journal of Microbiology, [online] 67(2), pp.151–161. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7256693/pdf/pjm-67-2-151.pdf