Features of acute brucellosis

• incubation period 1-3 weeks

• insidious onset: malaise, headache, weakness

• the classic fever pattern is undulant ( click here for further reference).

Possible:

• lymphadenopathy

• hepatomegaly

• spinal tenderness

• splenomegaly (if severe)

Complications such as epididymo-orchitis, oesteomyelitis and endocarditis can occur. Localised infections in sites such as bones, joints, lungs, CSF, testes and cardiac valves are possible but uncommon.

Symptoms of chronic brucellosis are virtually indistinguishable from the 'chronic fatigue syndrome' and can present with FUO.

Diagnosis

• blood cultures (positive in 50% during acute phase) 6

• Brucella agglutination test (rising titre)

Treatment 1_1

• Adults: doxycycline 100 mg (o) bd for 6 weeks plus either rifampicin 600 mg (o) daily for 6 weeks or gentamicin 5-7 mg/kg/day IV daily for 2 weeks

• Relapses do occur. Prevention and control

Involves eradication of brucellosis in cattle, care handling infected animals and pasteurisation of milk. No vaccine is currently available for use in humans.

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