Signs and Symptoms of Brucellosis
Brucellosis presents with a wide range of clinical manifestations including fever, sweats, headaches, back pains, physical weakness, fatigue, and potentially severe infections of the brain, bone, heart, liver, or spleen. 1, 2
Common Clinical Manifestations
General Symptoms
- Acute or insidious onset of fever
- Night sweats
- Undue fatigue
- Anorexia and weight loss
- Headache
- Arthralgia (joint pain) 1, 2
- Myalgia (muscle pain) 3
- Malaise 3
Systemic Involvement
Osteoarticular Manifestations (10-85% of cases) 4
- Sacroiliac joint involvement (up to 80%)
- Spinal involvement (up to 54%)
- Spondylitis and spondylodiscitis
- Peripheral arthritis
- Osteomyelitis
- Bursitis and tenosynovitis
Hepatobiliary Manifestations
Gastrointestinal Manifestations
- Abdominal pain
- Nausea and vomiting
- Digestive disturbances 3
Neurological Manifestations (0.5-25% of cases) 3
- Meningitis
- Encephalitis
- Peripheral neuropathy 5
Genitourinary Manifestations (2-20% of cases)
- Epididymal-orchitis
- Orchitis 3
Cardiovascular Manifestations
- Endocarditis (less than 2% but accounts for 80% of deaths) 3
Respiratory Manifestations
- Pneumonia
- Pleurisy
- Pleural effusion
- Pulmonary nodules 3
Hematologic Manifestations
Clinical Presentation Patterns
Acute Brucellosis
- Abrupt onset of high fever
- Profuse sweating
- Chills
- Severe headache
- Arthralgia 2
Subacute Brucellosis
- Undulant fever
- Generalized aches
- Fatigue
- Depression 2
Chronic Brucellosis
- Persistent or recurrent fevers
- Chronic fatigue
- Depression
- Arthritis 2
Special Considerations
Atypical Presentations
- Fever of unknown origin
- Isolated joint pain
- Lower backache
- Burning feet
- Ischemic heart attacks 7
High-Risk Groups
- Individuals who consume unpasteurized dairy products
- Occupational exposure (veterinarians, farmers, laboratory workers)
- Residents of endemic areas (Mediterranean, Middle East, Latin America, Western Asia, parts of Africa) 2
Diagnostic Pitfalls
Misdiagnosis: Brucellosis can mimic many other diseases, leading to delayed diagnosis and treatment.
Variable Presentation: Symptoms may be mild to severe, making clinical diagnosis challenging 6.
Non-specific Symptoms: Many patients present with non-specific complaints that overlap with other conditions.
Regional Considerations: In endemic areas, brucellosis should be considered in patients with persistent fever and musculoskeletal symptoms, even with atypical presentations 2.
Laboratory Confirmation: Diagnosis often requires serological testing or blood cultures, as clinical presentation alone is insufficient 2.
Brucellosis should always be considered in the differential diagnosis for patients with persistent fever, joint pain, and constitutional symptoms, particularly those with a history of consuming unpasteurized dairy products or occupational exposure to animals in endemic regions.