Brucellosis Symptoms and Treatment
Brucellosis causes fever, sweating, headaches, back pains, physical weakness, and potentially severe infections of the brain, bone, heart, liver, or spleen, requiring a six-week regimen of doxycycline combined with either streptomycin or rifampicin for effective treatment. 1, 2
Clinical Manifestations
- Fever with temperature swings is a hallmark symptom, often accompanied by profuse sweating, especially at night 1
- Musculoskeletal pains affect most patients, including back pain, arthralgia, and myalgia 1, 3
- General malaise and physical weakness are common manifestations 4
- Headaches are frequently reported and can be severe 1
Complications
Osteoarticular Involvement (10-85% of cases)
- Sacroiliac joint involvement (up to 80% of osteoarticular cases) 3
- Spinal involvement (up to 54% of osteoarticular cases) with spondylitis and spondylodiscitis being the most common complications 3
- Peripheral arthritis, osteomyelitis, discitis, bursitis, and tenosynovitis occur less frequently 3
- MRI should be performed when spinal involvement is suspected 5, 3
Other Organ System Involvement
- Neurobrucellosis - can cause meningitis and other neurological complications 1, 6
- Endocarditis - a rare but potentially fatal complication with high mortality 1, 4
- Hepatic dysfunction - can present with hyperbilirubinemia and liver function abnormalities 6
Diagnosis
- Blood cultures or tissue aspirate to isolate Brucella species, though the organism may be difficult to isolate 4
- Serological testing is highly sensitive and specific 4
- Imaging techniques including radiography, CT, MRI, and bone scintigraphy are useful for diagnosing osteoarticular involvement 3
- MRI helps differentiate between pyogenic spondylitis and brucellar spondylitis 3
Treatment
First-Line Treatment Options
Doxycycline-Streptomycin combination (preferred regimen with lowest relapse rates):
Doxycycline-Rifampicin (alternative regimen):
Treatment for Complicated Brucellosis
- For brucellar spondylitis, aminoglycoside-containing regimens may be superior to rifampicin-containing ones, and treatment duration may need to be extended beyond the standard 6 weeks 1, 2
- Brucellar endocarditis requires aggressive management with empirical antimicrobials and often surgical intervention 1, 2
- For brucellosis in pregnancy, TMP-SMX alone or in combination with rifampicin is recommended 1
Treatment Monitoring and Outcomes
- Relapse rates range from 5-15% even with appropriate treatment 2
- Relapses are usually milder and can be treated with the same regimens 2
Prevention
- Avoid consumption of unpasteurized dairy products 5
- Use appropriate personal protective equipment when handling potentially infected animals 5
- Follow proper laboratory safety protocols when handling Brucella specimens 5
- Regular symptom monitoring and serologic testing for 24 weeks after exposure is recommended for high-risk individuals 1
Special Considerations
- In regions where brucellosis and tuberculosis coexist, consider the implications of using rifampicin, as this may contribute to mycobacterial resistance 2
- For children and pregnant women, treatment regimens may need modification to avoid potential adverse effects 1, 6
- Brucellosis should be considered in the differential diagnosis for sciatic and back pain, especially in endemic regions 3