Clinical Manifestations of Brucellosis

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Clinical Manifestations of Brucellosis Shahid
Beheshti University of medical sciences April
2007 By Hatami H. MD. MPH
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Clinical classification
1) Subclinical illness 2) Acute disease 3)
Subacute disease 4) Localized disease 5)
Relapsing disease 6) Chronic disease 7)
Brucellosis like reaction
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1- Subclinical illness

• Children in endemic areas frequently have
  subclinical illness
• Subclinical cases outnumber clinically evident
  cases of brucellosis, by 12 to 1

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23- Acute subacute

• Incubation period several weeks to months (1-3
  weeks)
• May occur as a mild, transient illness or as an
  explosive, toxic disease
• 50 of patients have an abrupt onset
• Symptoms are protean and nonspecific

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23- Acute subacute

• Over 90 of patients experience
• Malaise
• Chills
• Sweats
• Fatigue
• Weakness
• Fever

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23- Acute subacute

• More than 50 of patients have
• Myalgia
• Anorexia
• Weight loss

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23- Acute subacute

• Fewer patients complain of
• Arthralgia
• Cough
• Testicular pain
• Dysuria
• Ocular pain
• Visual blurring

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23- Acute subacute

• Headache, occipital or frontal
• Intense back pain
• Pain in the arms and legs
• Sweats, typically drenching
• Shaking chills, before or after sweats
• Extreme prostration

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23- Acute subacute

• Lassitude is a prominent symptom
• Chest pain worse on breathing
• Palpitation due to an arrhythmia
• Abdominal pain with constipation

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23- Acute subacute

• Confusion with nightmares and somnambulism
• Symptoms especially lassitude, may persist for
  many weeks or months
• Convalescence may be slow

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23- Acute subacute

• Fever often grater than 39-40ºc occurs in 95
• Undulating or intermittent fever pattern is
  unusual
• A relative pulse-temperature deficit may occur

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23- Acute subacute

• Splenomegaly (10-75)
• Lymphadenopathy (14)
• Axillary, cervical, and supraclavicular locations
  are most frequent
• Hepatomegaly is less frequent

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Symptoms of acute brucellosis in patients
admitted in Loghman hospital
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23- Acute subacute

• Laboratory changes
• Serologic response
• Mild anemia
• Lymphopenia
• Lymphocytosis
• Thrombocytopenia
• Pancytopenia

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4- Localized disease

• May localize in almost any organ
• Most common in bone, CNS, heart, spleen, testes,
  liver, gallbladder, kidney, prostate . . .
• May occur simultaneously at multiple sites
• Most often appear in association with a more
  chronic course of illness

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5- Relapsing disease

• Up to 10, after antimicrobial therapy
• Due to intracellular location
• Occur most frequently within months after initial
  infection

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5- Relapsing disease

• May occur as long as 2 years after apparently
  successful treatment
• It is sometimes precipitated by another infection
  or by trauma
• Both relapses and re-infections tend to be milder
  than the initial episode

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6- Chronic brucellosis

• May be manifested as
• An insidious onset
• Recurrent relapses
• Localized disease
• Persistent illness

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6- Chronic brucellosis

• A duration grater than 1 year
• May caused by inadequate treatment
• Symptoms are not associated with clinical,
  microbiologic and serologic evidence of active
  disease

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6- Chronic brucellosis

• Persistent fatigue
• Malaise and insomnia
• Recurrent depression
• Vague pain inertia
• Sexual impotence

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6- Chronic brucellosis

• The onset may be
• - Insidious
• - Follows an acute attack
• It may be due to untreated or inadequately
  treated disease
• Story of recurring flu with lassitude, headache,
  pain, sweats

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6- Chronic brucellosis

• Frontal or retroorbital headache
• Low back pain is common, and unassociated with
  radiological evidence of spondylitis

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6- Chronic brucellosis

• Limb pain or stiffness is more often muscular
  than articular
• Sweats occur especially on effort and also at
  night
• Temperature is usually normal

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7- Brucellosis like reaction

• Recurrent exposure to brucellae in seropositive
  persons may cause hypersensitivity reactions
• These reactions can mimic brucellosis and
  manifested with chills and fever within minutes
  to hours and last 24-48 hours

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7- Brucellosis like reaction

• Patients with chronic brucellosis may also be
  hypersensitive to brucella antigen.
• Persons hypersensitive to brucellar antigen need
  not be suffering from chronic brucellosis
• Distinction must be made between chronic
  brucellosis and hypersensitivity

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Clinical differences

• Br. Abortus infection are much milder and run a
  shorter course
• Br. Melitensis infection may be very persistent,
  lasting over one year or more
• Br. Suis causes suppurating complications and a
  chronic
• state of debility

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