Answer 46
Brucellosis
False a. is caused by a Gram positive bacillus
True b. causes spondylitis
True c. is treated with tetracycline
True d. is a recognised cause if chronic depression
True e. is contracted from unpasteurised milk
The causative organism is a Gram negative bacillus: Brucella abortus (from cows), Brucella suis (from pigs) and Brucella militensis (from goats)
Transmission is by oral ingestion of unpasteurised dairy produce. Inhalation of organisms is also an important mode of transmission amongst those dealing with livestock.
The incubation period is about 1-3 weeks but may be much longer.
Clinical presentation. The disease may present non-specifically and some complications may arise months after infection.
Table 46.1
| Common presenting features of brucellosis |
fever
body pains
positive exposure history
malaise
sweating |
Table 46.2
| Late complications of brucella infection |
spondylitis
orchitis
arthritis
endocarditis
depression
menigo-encephalitis |
Diagnosis: Blood culture, marrow culture, liver biopsy and culture. Detection of raised Brucella agglutinins
Treatment: Doxycycline plus an aminoglycoside for 4 weeks and then doxycycline plus rifampicin for a further 8 weeks.
