- US Incidence <100 cases per year (0.34/100,000)
- Brucella abortus (cows)
- Brucella suis (pigs)
- Brucella melitensis (goats, camels)
- Brucella canis (dogs)
- Veterinarians
- Farm workers
- Meat processing plants
- Travel or residence in endemic region
- Mediterranean
- India
- North Africa, East Africa
- Central Asia, South Asia
-
Intermittent Fevers
- Undulating fever
- Temperature peaks in evening to 101-104
- Arthralgia especially sacroileitis (20-30%, up to 90% in some studies)
- Weakness
- Lassitude
- Weight loss
- Headache
- Sweating
- Chills
- Hepatosplenomegaly (20-30%)
- Cervical or Inguinal Lymphadenopathy (12-20%)
- Orchitis or Epididymitis (2-40%)
- Purpura (5%)
- Meningitis
- Endocarditis
- Culture (Slow growing, fastidious organism)
- Blood Culture (70% sensitive in acute illness)
- Discharge Culture
- Bone Marrow Aspirate (90% sensitive in acute illness)
-
Complete Blood Count
- Thrombocytopenia
- Granulopenia
- Leukopenia with relative Lymphocytosis
- Anemia
- Brucella Serology
- Brucella PCR
- Liver Function Tests (elevated in 30-60%)
- Bone Marrow Biopsy show Granuloma
- Non-localized
- Precautions
- Risk of relapse in 10% of cases
- See other references for neurobrucellosis and endocarditis
- Age <8 years old or pregnancy
- Age >8 years old and adults
- Doxycycline 100 mg orally twice daily for 6 weeks AND
- Gentamicin 5 mg/kg IV daily for 7 days AND
- Consider Rifampin 15-20 mg/kg up to 600-900 mg orally daily for 6 weeks
- May be used in place of Gentamicin
- For Spondyloarthropathy or Arthritis, use all 3 agents, with Rifampin with Doxycycline for 3 months
- When combined with Doxycyline and Gentamicin improves clearance rates without relapse
- See other references for Post-exposure Prophylaxis
- Weeks to months
- Case Fatality <5% treated
- (2016) Sanford Guide to Antibiotics, IOS app accessed 4/14/2016
- (1998) Medical Management of Biological Casualties
- U.S. Army Medical Research Institute of ID