Type your tag names separated by a space and hit enter

Brucellosis

Brucellosis is a topic covered in the 5-Minute Clinical Consult.

To view the entire topic, please or purchase a subscription.

Medicine Central™ is a quick-consult mobile and web resource that includes diagnosis, treatment, medications, and follow-up information on over 700 diseases and disorders, providing fast answers—anytime, anywhere. Explore these free sample topics:

Medicine Central

-- The first section of this topic is shown below --

Basics

Description

  • Systemic granulomatous bacterial infection caused by Brucella sp. resulting in febrile illness; typically from ingestion of raw milk, unpasteurized milk, infected meat, or contact with secretions from infected animals
  • One of the most common worldwide zoonotic diseases
  • Incubation period usually 1 to 4 weeks but highly variable and may be several months
  • Often presents insidiously with many atypical or nonspecific features
  • Characterized by intermittent or irregular fevers and night sweats. Symptoms can range from subclinical disease to infection of almost any organ system.
  • Bone and joint involvement is common—20–40% (typically spondylodiscitis).
  • Disease may be recurrent, relapsing, or progress to chronic disease.
  • System(s) affected: cardiovascular, endocrine/metabolic, gastrointestinal, musculoskeletal, nervous, pulmonary, renal/urologic, skin/exocrine
  • Synonym(s): undulant fever; Malta fever; Mediterranean fever; Crimean fever; Bang disease
Pediatric Considerations
  • May be mild or subclinical
  • Boys infected more than girls (animal handling)
  • Children often present with refusal to walk or bear weight.
  • Children respond better to antibiotic treatment than do adults.

Alert
High rates of spontaneous abortion (can occur in subclinical cases). Early antibiotic treatment is preventive.

Epidemiology

  • Predominant age: 20 to 45 years (occupational exposure); sometimes children (milk-related outbreaks); can occur at all ages
  • Predominant gender:
    • Male > female (occupational exposure)
    • Female ≥ male (milk exposure)

Incidence
  • >500,000 new cases yearly (likely underreported)
  • <100 U.S. cases reported annually to the CDC
Prevalence
  • Common in developing countries; highest in Turkey, Syria, and Iran; some countries report case rates as high as 10/100,000; present in all inhabited continents
  • Highest rates in the United States are among Hispanic populations along U.S.–Mexico border; also Wyoming, North Carolina, Illinois, Florida, and Iowa
  • Reportable in all states

Etiology and Pathophysiology

  • Brucella ingestion from raw or undercooked tissue or unpasteurized milk products; susceptible to heat and disinfectant but can survive for weeks in frozen food and weeks to months in dust, soil, or water
  • Facultative intracellular parasite: gram-negative, nonmotile, non–spore-forming coccobacillus
  • Four species pathogenic to humans. Most virulent disease: Brucella melitensis, Brucella suis; also Brucella canis, Brucella abortus; can enter via mucous membrane or broken skin; occasionally inhaled
  • Laboratory workers at high risk of infection if specimens handled improperly
  • Person-to-person transmission is rare; sexual, vertical, (possibly) breast milk; blood transfusion
  • Potential airborne biologic weapon
  • Affects most domesticated ungulates (goats, cattle, camels, pigs, sheep), also wild bison and elk. Marine mammals also implicated in zoonotic transmission.
  • Infection increases abortion rate in animals, less so in humans.

Genetics
  • Some evidence for intrauterine transmission; no reported birth defects
  • Some complications may have genetic predisposition.

Risk Factors

  • In the United States, occupational exposure to infected animals (cattle and sheep): veterinarians, meat processors, accidental exposure to vaccine, lab technicians, recent immigrants
  • Consumer exposure to unpasteurized dairy products and cheese
  • Travel to endemic countries (Mediterranean, Middle East, North and East Africa, Central Asia, India, Mexico, Central and South America)
  • Chronically ill and malnourished
  • Potential acceleration of HIV disease
  • Iron deficiency increases susceptibility.
  • Bison and elk are infected with brucellosis near Yellowstone Park.

General Prevention

  • Avoid infected, unpasteurized dairy products.
  • Use caution handling animal vaccines. Use protective goggles and protective gloves when handling tissue.
  • Human vaccine under investigation
  • Postexposure prophylaxis same as treatment

-- To view the remaining sections of this topic, please or purchase a subscription --

Citation

Stephens, Mark B., et al., editors. "Brucellosis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816237/all/Brucellosis.
Brucellosis. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816237/all/Brucellosis. Accessed April 21, 2019.
Brucellosis. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816237/all/Brucellosis
Brucellosis [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 21]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816237/all/Brucellosis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Brucellosis ID - 816237 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816237/all/Brucellosis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -