29/09/2026
Brucellosis
---
1️⃣ WHEN SHOULD YOU SUSPECT BRUCELLOSIS?
Think of Brucellosis in a patient with:
🔴 Prolonged / undulating fever
🔴 Drenching night sweats
🔴 Fatigue + malaise
🔴 Headache
🔴 Arthralgia / myalgia
🔴 Back pain
🔴 Weight loss / anorexia
🔴 Hepatosplenomegaly
🚨 The KEY clue = EXPOSURE HISTORY
Ask specifically about:
🥛 Raw / unpasteurized milk or cheese
🐄 Cattle / sheep / goats exposure
🐑 Animal handling or assisting animal delivery
🥩 Slaughterhouse / butcher work
🧑⚕️ Veterinary occupation
🧪 Laboratory exposure
✈️ Recent travel to endemic areas
Clinical manifestations are nonspecific, so exposure history + laboratory confirmation are essential.
➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖
2️⃣ CLINICAL MANIFESTATIONS
🌡️ Constitutional
Fever
Night sweats
Fatigue
Headache
Anorexia
Weight loss
🦴 Musculoskeletal
The most common focal manifestation
Arthralgia
Arthritis
Sacroiliitis
Spondylitis / vertebral involvement
🫀 Cardiovascular
Endocarditis = uncommon but the major cause of mortality
🧠 Neurobrucellosis
Meningitis
Encephalitis
Cranial neuropathies
🫁 Other focal disease
Epididymo-orchitis
Hepatitis
Hepatosplenomegaly
Abscess formation
➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖
3️⃣ LABORATORY CLUES
There is NO pathognomonic CBC or biochemical pattern.
Possible findings:
↓ WBC / leukopenia
Anemia
Thrombocytopenia
↑ AST / ALT
↑ ESR / CRP
⚠️ Normal routine labs do NOT exclude Brucellosis.
➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖
4️⃣ DIAGNOSIS — DON'T RELY ON ONE TEST
🩸 Blood Culture
A definitive diagnosis can be established by isolation of Brucella.
However:
Growth may be slow
Sensitivity is imperfect
Bone marrow culture may be useful in selected cases
🧪 Serology
Depending on local availability:
SAT / Wright agglutination
ELISA
Other validated Brucella antibody assays
Interpret serology in the context of symptoms, exposure and local epidemiology.
🧬 PCR
May provide supportive/rapid evidence where available.
⚠️ IMPORTANT
Always inform the microbiology laboratory that Brucellosis is suspected.
Brucella is an important laboratory-acquired infection risk, particularly during procedures capable of generating aerosols.
➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖
5️⃣ MANAGEMENT ALGORITHM
Suspected Brucellosis
⬇️
Exposure history + compatible clinical syndrome
⬇️
Obtain appropriate cultures + serology
Ideally before antibiotics when feasible
⬇️
Assess for focal / complicated disease
Look specifically for:
🦴 Osteoarticular disease
🧠 Neurobrucellosis
❤️ Endocarditis
♂️ Epididymo-orchitis
🫀 Hepatosplenic involvement
⬇️
Uncomplicated disease
Common adult regimen:
Doxycycline 100 mg BID + Rifampin 600–900 mg/day for ≥6 weeks
Combination therapy is preferred because monotherapy is associated with higher risk of relapse.
Alternative:
Doxycycline + Streptomycin/Gentamicin
Choice depends on disease severity, patient factors, drug interactions and local guidance.
➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖➖
6️⃣ SPECIAL POPULATIONS
🤰 Pregnancy
Do NOT simply use the standard doxycycline regimen.
Treatment requires an alternative regimen and specialist input.
👶 Children
Treatment depends on age and clinical situation; tetracyclines are generally avoided in children
