Signs and Symptoms of Brucellosis
Brucellosis presents with a wide range of clinical manifestations, primarily characterized by fever, sweats, fatigue, headache, and musculoskeletal pain, with potential for multi-organ involvement and serious complications if left untreated. 1
Common Clinical Manifestations
Acute Phase Symptoms
- Fever (86.9% of patients) - often undulant or intermittent 2
- Hyperhidrosis/night sweats (88.1%) 2
- Fatigue/weakness (91%) 2
- Headache 1
- Joint pain/arthralgia (81%) 2
- Anorexia and weight loss 1
- Back pain - especially with spinal involvement 3
Physical Examination Findings
- Hepatomegaly (29.8% of patients) 2
- Splenomegaly (26.1%) 2
- Lymphadenopathy
- Joint tenderness and swelling - particularly in affected joints 3
Organ-Specific Manifestations
Osteoarticular Involvement (10-85% of cases) 3
- Sacroiliitis (up to 80% of osteoarticular cases) 3
- Spondylitis/spondylodiscitis (up to 54%) - most commonly affecting lumbar spine (L4-L5) 3
- Peripheral arthritis 3
- Osteomyelitis 3
- Bursitis and tenosynovitis 3
Genitourinary Involvement (2-20% of cases) 4
- Epididymo-orchitis - most common genitourinary manifestation 4
- Prostatitis - less common but can mimic prostate cancer with elevated PSA 4
- Urinary symptoms - urgency, difficulty, and pain during urination 4
Neurological Manifestations
- Neurobrucellosis - can present with meningitis, encephalitis, or myelitis 1
- Radiculopathy - especially sciatica with spinal involvement 3
- Progressive neurologic deficits - in cases with spinal cord compression 1
Other Systemic Manifestations
- Gastrointestinal symptoms - abdominal pain, nausea 5
- Cardiovascular involvement - endocarditis (rare but serious) 1
- Respiratory symptoms 1
- Cutaneous manifestations - rash, nodules 1
Disease Progression
Acute Phase (0-2 months)
- Characterized by prominent systemic symptoms (fever, sweats, fatigue)
- Affects 53.6% of patients at presentation 2
Subacute Phase (2-12 months)
- Less severe but persistent symptoms
- Localized infections may become more apparent
Chronic Phase (>12 months)
- Affects 21.5% of patients 2
- Characterized by persistent focal infections
- Increased risk of complications
- Relapse rate of approximately 6% 2
Diagnostic Considerations
- Serological testing - Standard agglutination test (SAT) titers ≥1:160 support diagnosis 1
- Blood cultures - Positive in approximately 34% of cases 2
- Imaging - MRI is essential for suspected spinal involvement 1
Clinical Pitfalls and Caveats
- Brucellosis can mimic many other conditions, leading to misdiagnosis
- In endemic areas, brucellosis should be considered in patients with:
- Fever of unknown origin
- Persistent joint pain, especially sacroiliac or spinal
- Unexplained hepatosplenomegaly
- Neurological symptoms without clear etiology
- Prostate involvement can mimic prostate cancer due to elevated PSA levels 4
- Neurobrucellosis can be confused with multiple sclerosis, tuberculous meningitis, or neurosarcoidosis 1
Early recognition of these signs and symptoms is crucial for prompt diagnosis and treatment to prevent complications and chronic disease.