Brucellosis

Brucellosis is an infectious bacterial disease that occurs from contact with animals carrying Brucella species.^[1] Alternative names include Bang's disease, Mediterranean gastric remittent fever, Malta fever, Mediterranean fever, undulant fever, rock fever, Cyprus fever and Gibraltar fever. Brucella was first isolated by a British Army physician, David Bruce from the spleens of 5 patients with fatal cases on Malta.^[2]

Epidemiology

Brucellosis is very common worldwide and believed to be under-reported. In Nigeria 55% of the population were found to be seropositive. Brucellosis is more frequently recorded in agrarian societies. Central and Southwest Asia are having large increase in cases. Approximately,  0.04 per 100,000 people are affected in USA. The disease is rare in UK but a high index of suspicion should be maintained for people travelling from endemic areas. Areas considered high-risk for the disease include Middle East, Portugal, Spain, Southern France, Italy, Greece, Turkey and North Africa.^[2]         

Causes

Brucella can infect animals such as cattle, goats, camels, dogs, and pigs. The bacteria can spread to humans during contact with infected meat or the placenta of infected animals, or by eating or drinking unpasteurized milk or cheese. People at risk include whose jobs need contact with animals or meat such as slaughterhouse workers, farmers, and veterinarians.^[3] Inhaling airborne agents is also thought to cause the disease.^[1]

Symptoms

Symptoms may develop from days to months after the initial exposure to the organism. The most common finding is intermittent and relapsing fever. Other symptoms are sweating, body aches, joint pain, fatigue, dizziness, headache, depression, irritability, loss of appetite, weight loss, cough, difficulty breathing, pain in the chest and abdomen, and enlargement of liver and spleen.^[4]

Diagnosis

Inquiry on the history especially the occupation and travel details of the patient and conducting physical examination are important. Presumptive diagnosis is supported by Rose Bengal test (RBT) for screening. In diagnosing brucellosis, antibody testing is the most reliable method. Other tests may include blood and cerebrospinal (CSF) culture, liver or bone marrow biopsy, CT or MRI scans and serology.^[2]

Treatment

Antibiotics are given. If there are complications, longer course of therapy and in rare cases, surgery may be required.^[4]

References:

1. http://www.who.int/topics/brucellosis/en/
2. http://www.patient.co.uk/doctor/Brucellosis.htm
3. http://www.nlm.nih.gov/medlineplus/ency/article/000597.htm
4. http://www.medicinenet.com/brucellosis/page3.htm#symptoms