Brucellosis

Brucellosis - Acute

 

Definition  

A multisystem bacterial zoonotic infection caused by brucella species infective in humans .

 

Medical History  

* Ingestion of Contaminated Food

* Occupational Exposure

* Victim of bio-terrorism

 

Findings  

* Heart murmur

* Arthralgia

* Backache

* Focal neurological signs

* Splenomegaly

* Abdominal pain - Acute

* Depression

* Hepatomegaly - Acute

* Lymphadenopathy - Acute

* Persistent testicular pain

* Reduced visual acuity

* Asthenia

* Brucella spondylitis

* Diaphoresis

* Effusion of joint

* Fever

* Headache

* Loss of appetite

* Low back pain - Acute

* Malaise

* Myalgia

* Shivering

* Weight loss

 

Tests  

 

Suspected acute, chronic or relapsing brucellosis  

* Brucella antibody assay: Serologic tests for brucellosis may provide a fast presumptive diagnosis or confirm the diagnosis, and provide information about disease status .

 

Suspected brucella arthritis  

* Brucella species culture: Isolation of Brucella species from synovial fluid culture is diagnostically definitive for brucella arthritis .

 

Suspected Brucellosis  

* Brucella species culture: Positive culture for Brucella species is diagnostically definitive for brucellosis .

 

Suspected and known brucellosis  

* Polymerase chain reaction analysis, Brucella: Positive polymerase chain reaction (PCR) results are highly suggestive of active brucellosis disease, and treatment is most likely indicated in PCR reactive patients who have not been previously treated .

 

Suspected brucellosis  

* Monocyte count: Monocytosis and mild anemia are the most common hematologic abnormalities in children admitted with brucellosis .

 

Suspected and known brucella spondylitis  

* Magnetic resonance imaging of spine: MRI of the spine is the preferred imaging method for diagnosing brucellar spondylitis .

 

Suspected and known osteoarticular brucellosis  

* Radioisotope scan of bone: Bone scintigraphy is superior to radiography for the detection of osteoarticular brucellosis , and is equally sensitive to MRI for detecting acute spondylitis .

 

Suspected brucella arthritis  

* Joint X-ray: A variety of abnormal findings are found in patients with osteoarticular brucellosis; normal radiographic findings may also be observed .

 

Suspected acute epididymo-orchitis  

* Scrotal ultrasound: Ultrasonography in scrotal brucellosis typically reveals a nonhomogenous hypoechogenicity of the infected testis and epididymis .

 

Suspected and known neurobrucellosis  

* Cerebrospinal fluid examination: CSF findings in CNS brucellosis include lymphocytic pleocytosis, reduced CSF/plasma glucose ratio, elevated protein, oligoclonal bands, increased gamma-globulin values, elevated IgG levels, positive or negative culture, and normal or low glucose .

 

Suspected brucella arthritis  

* Synovial fluid analysis: Synovial fluid findings in brucella infectious arthritis include elevated protein, normal glucose, and normal or elevated WBC and polymorphonuclear cell counts . Culture may be positive or negative .

 

Differential Diagnosis  

* Malaria - Acute

* Influenza

* Lyme disease - Acute

* Typhoid fever

* Typhus group rickettsial disease

* Tularemia - Acute

* Tuberculosis - Chronic

* Infectious mononucleosis - Acute

* Rheumatic fever - Acute

* Syphilis - Acute

* HIV infection

* Q fever

 

Treatment  

 

Drug Therapy  

 

Brucellosis in adults  

 

DOXYCYCLINE - GENTAMICIN SULFATE  

Adults: Doxycycline 100 mg orally twice daily for 6 weeks AND gentamicin 5 mg/kg/day IV in 3 divided doses for 5-7 days

 

DOXYCYCLINE - STREPTOMYCIN SULFATE  

Adults: Doxycycline 100 mg twice daily for 6 weeks AND streptomycin 15 mg/kg IM for 2-3 weeks

 

DOXYCYCLINE - RIFAMPIN  

Adults: Doxycycline 100 mg orally twice daily for 6 weeks AND rifampin 600-1200 orally mg/day for 6 weeks

 

DOXYCYCLINE - CIPROFLOXACIN  

Adults: Doxycycline 100 mg orally twice daily for 6 weeks AND ciprofloxacin 500 mg orally twice daily for 6 weeks

 

DOXYCYCLINE - STREPTOMYCIN SULFATE - RIFAMPIN  

Adults: Doxycycline 100 mg orally twice daily for 6 weeks AND rifampin 600-1200 mg/day orally for 6 weeks AND streptomycin 15 mg/kg IM for 2-3 weeks

 

DOXYCYCLINE - STREPTOMYCIN SULFATE - SULFAMETHOXAZOLE/TRIMETHOPRIM  

Adults: Doxycycline 100 mg orally twice daily for 6 weeks AND trimethoprim-sulfamethoxazole 960 mg orally twice daily for 6 weeks AND streptomycin 15 mg/kg IM for 2-3 weeks

 

DOXYCYCLINE - RIFAMPIN - SULFAMETHOXAZOLE/TRIMETHOPRIM  

Adults: Doxycycline 100 mg orally twice daily for 6 weeks AND trimethoprim-sulfamethoxazole 960 mg orally twice daily for 6 weeks AND rifampin 600-1200 mg/day orally for 6 weeks

 

RIFAMPIN - OFLOXACIN  

Adults: Rifampin 600-1200 mg/day orally for 6 weeks AND ofloxacin 400 mg orally twice daily for 6 weeks

 

RIFAMPIN - CIPROFLOXACIN  

Adults: Rifampin 600-1200 mg/day orally for 6 weeks AND ciprofloxacin 500 mg orally twice daily for 6 weeks

 

SULFAMETHOXAZOLE/TRIMETHOPRIM - GENTAMICIN SULFATE  

Adults: Trimethoprim-sulfamethoxazole 1 double-strength tablet (160 mg trimethoprim) orally four times daily for 6 weeks AND gentamicin [2 mg/kg load, then 1.7 mg/kg every 8 hours or 5.1 mg/kg once daily or 7 mg/kg once daily if critically ill for 2 weeks]

 

 

Children less than the age of 8 with brucellosis  

 

GENTAMICIN SULFATE - SULFAMETHOXAZOLE/TRIMETHOPRIM  

Pediatrics (<8 years): Trimethoprim-sulfamethoxazole 5 mg/kg trimethoprim orally every 12 hours for 6 weeks AND gentamicin 2 mg/kg every 8 hours IV or IM for 2 weeks

 

 

Acute pain  

 

ACETAMINOPHEN

Adults: 650 to 1,000 mg orally every 4 to 6 hours as needed (maximum 4 g/day)

Pediatrics: 10 to 15 mg/kg orally or rectally every 4 to 6 hours as needed (maximum 5 doses or 4 g/day)

Neonates: 10 to 15 mg/kg orally or rectally every 6 to 8 hours as needed

 

IBUPROFEN

Adults: 200 to 800 mg orally every 6 to 8 hours as needed (maximum 3.2 g/day)

Pediatrics: 5 to 10 mg/kg orally every 6 to 8 hours as needed (maximum, lesser of 40 mg/kg/day or 2.4 g/day)

 

ACETAMINOPHEN/OXYCODONE HYDROCHLORIDE  

Adults: Oxycodone 5 to 20 mg/acetaminophen 325 to 1,000 mg orally every 4 hours as needed (maximum 4 g acetaminophen/day)

Pediatrics: 0.05 to 0.15 mg/kg of the oxycodone ingredient orally every 4 hours as needed

 

ACETAMINOPHEN/CODEINE PHOSPHATE  

Adults: Codeine 15 to 60 mg/acetaminophen 325 to 1,000 mg orally every 4 hours as needed (maximum 360 mg codeine and 4 g acetaminophen/day)

Pediatrics (3-6 years): 5 mL (12 mg codeine/120 mg acetaminophen per 5 mL) orally every 6 to 8 hours as needed

Pediatrics (7-12 years): 10 mL (12 mg codeine/120 mg acetaminophen per 5 mL) orally every 6 to 8 hours as needed

 

 

Severe or complicated brucellosis, including those with disseminated intravascular coagulation (DIC); neurobrucellosis with papilledema, myelopathy, polyneuropathy and cranial nerve palsy; and chronic brucellosis with iritis  

 

METHYLPREDNISOLONE  

Adults: 10-40 mg IV repeated up to six times daily

 

PREDNISONE  

Adults: 20 mg orally two or three times daily for up to 5 days

 

Procedural Therapy  

 

Dehydration  

* Intravenous fluid replacement: Intravenous fluid replacement is indicated for patients with dehydration when oral replacement cannot be accomplished .