What is the relationship between oral ulcers and brucellosis (Brucella infection)?

From the Guidelines

Oral ulcers are a potential manifestation of brucellosis, and prompt antibiotic treatment is essential to resolve the infection and alleviate symptoms. Brucellosis is a bacterial zoonotic infection caused by Brucella species that requires prompt antibiotic treatment. The recommended treatment regimen for brucellosis is doxycycline combined with rifampicin for six weeks, as suggested by the Ioannina recommendations 1.

Key Considerations

• The optimal treatment of uncomplicated brucellosis should be based on a six-week regimen of doxycycline combined with rifampicin for six weeks 1.
• Gentamicin may be considered an acceptable alternative to streptomycin for complicated cases 1.
• Oral ulcers associated with brucellosis typically resolve with appropriate antibiotic therapy targeting the underlying infection.
• Symptomatic relief for oral ulcers can be achieved using topical agents like benzydamine hydrochloride rinses or lidocaine gel.
• Maintaining good oral hygiene and avoiding spicy or acidic foods can help reduce discomfort.

Clinical Implications

• The connection between brucellosis and oral ulcers stems from the systemic inflammatory response triggered by the infection, which can affect mucosal surfaces throughout the body, including the oral cavity.
• Patients should complete the full course of antibiotics even if symptoms improve early to prevent relapse.
• It is crucial to prioritize the treatment of the underlying brucellosis infection to effectively manage oral ulcers and prevent potential complications.

From the Research

Relationship Between Oral Ulcers and Brucellosis

There is no direct evidence in the provided studies to establish a relationship between oral ulcers and brucellosis.

Brucellosis Treatment

• The treatment of brucellosis typically involves a combination of antibiotics, such as doxycycline and streptomycin 2, 3, 4, or doxycycline and rifampicin 2, 3, 5.
• The choice of antibiotic regimen and duration of treatment may depend on the severity of the disease, the presence of complications, and the patient's underlying health conditions 4.
• Some studies have compared the efficacy of different antibiotic regimens for the treatment of brucellosis, including doxycycline plus streptomycin versus doxycycline plus rifampicin 2, 3, and doxycycline plus gentamicin versus streptomycin plus doxycycline 6.
• The results of these studies suggest that triple antibiotic therapy may be more effective than standard dual therapy with rifampicin and doxycycline 5, but the latter may still be suitable for uncomplicated disease.

Clinical Manifestations of Brucellosis

• Brucellosis can present with a broad spectrum of clinical manifestations, including fever, sweating, and other systemic symptoms 6.
• However, oral ulcers are not specifically mentioned as a common symptom of brucellosis in the provided studies.

Antibiotic Regimens for Brucellosis

• Doxycycline plus streptomycin is considered a first-line regimen for the treatment of brucellosis 3, 4.
• Doxycycline plus rifampicin is considered a second-line regimen 3, 5.
• Gentamicin plus doxycycline may be an alternative regimen, with efficacy similar to that of streptomycin plus doxycycline 6.