128 - Brucellosis

Summary

Brucellosis is a zoonotic disease found in Latin America, Mediterranean countries (Spain, Italy, Greece), and Arabian countries (Iraq, Kuwait). According to the Centers for Disease Control and Prevention (CDC), the number of cases dropped from 6147 in 1947 to 104 in 1991 with modern bovine brucellosis eradication, mainly by pasteurization of milk or dairy products.

Most cases of brucellosis in the United States are related to occupational exposure to Brucella abortus. The affected are mainly men and occasionally laboratory and technical personnel. However, in Texas and Florida, the ingestion of unpasteurized dairy products is the common mechanism, and the pathogen responsible is Brucella melitensis, attacking men and women in equal proportion and sometimes children. Brucella melitensis produces a more severe clinical pattern and can even produce a chronic form. The attack rate is higher, especially in family outbreaks, with rare subclinical infections. Brucella abortus produces a mild disease with low attack rates (≤10%) and more subclinical cases.

CLINICAL MANIFESTATIONS

Brucellosis is one of the most protean diseases because any system can be involved. We prefer to divide it into three forms: acute, subacute, and chronic.

Acute Brucellosis

Usually, there is high fever, mainly in the evening, with malaise, headache, perspiration, arthralgias, and myalgias. In most cases, constipation, back pain, and loss of weight (as much as 20 pounds in 2 months) are found. Generally, granulomatous hepatitis, hematologic disorders, and articular compromise (especially peripheral arthritis and sacroiliitis) are seen.