Cause:Brucella melitensis(goats), abortus(cattle), suis(pigs)
Pathophys: Intracellular organism; granuloma formation; diffuse systemic infestations can cause osteomyelitis
Via ingestion or contact with infected milk or meat. In rural areas; 4% of all US cattle have. Endemic in Mexico
Sx:
Acute: deep bone pain; fever
Chronic: weakness, aches, anxiety. A great mimicker of all diseases
Si:
Acute: fever, undulating to peaks in pm; deep bone pain; lymphadenopathy (7%); splenomegaly (16%); hepatomegaly (17%)
Chronic: low-grade fever, uniarticular arthritis, epididymitis
Lab:
Bact:Blood culture (16% positive) and reticuloendothelial tissue grow gram-neg bacilli on culture
Hem:ESR low, r/o trichinosis, psittacosis, leptospirosis, CHF; lymphocytosis
Serol:PCR best test; hemagglutination antibody titer increased
Chem:Elevated ALT and AST (25%)
Xray:Osteomyelitis
Rx:
(Ann IM 1992;117:25)
Doxycycline 100 mg po bid + rifampin 15 mg/kg/d po × 6 wk or streptomycin 1 gm qd × 15 d w doxy kept up for 6 wk, w Tm/S; or ciprofloxacin or ofloxacin w rifampin