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__NOTOC__
{{CMG}}; {{AE}} {{RT}} {{DL}} {{VD}}
{{Brucellosis}}
{{Brucellosis}}
{{CMG}}; {{AE}} {{RT}} {{DL}}
==Overview==
==Overview==
Patients with brucellosis are usually well-appearing.<ref name=aa>Madkour M. Madkour's Brucellosis. Springer Science & Business Media; 2012.</ref> Common physical examination findings include hepatomegaly, splenomegaly, and lymphadenopathy.<ref name="pmid15930423">{{cite journal| author=Pappas G, Akritidis N, Bosilkovski M, Tsianos E| title=Brucellosis. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 22 | pages= 2325-36 | pmid=15930423 | doi=10.1056/NEJMra050570 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15930423  }} </ref>
Patients with brucellosis are usually well-appearing. Physical examination usually reveal combination of  several non-specific findings.
 
==Physical Examination==
==Physical Examination==
===Appearance of the Patient===
Patients with brucellosis are usually well-appearing. Physical examination usually reveal combination of several non-specific findings, which include:<ref>Brucellosis "Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo"Harrison's Principles of Internal Medicine, 19e Accessed on December 9th, 2017
*Patients are usually well-appearing<ref name=aa>Madkour M. Madkour's Brucellosis. Springer Science & Business Media; 2012.</ref>
</ref><ref>Colmenero JD, Reguera JM, Martos F, Sánchez-De-Mora D, Delgado M, Causse M; et al. (1996). [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8699960 "Complications associated with Brucella melitensis infection: a study of 530 cases."]. ''Medicine (Baltimore)''. '''75''' (4): 195–211. PMID [http://www.ncbi.nlm.nih.gov/pubmed/8699960 8699960]</ref><ref>Mantur BG, Amarnath SK, Shinde RS (2007). [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17901634 "Review of clinical and laboratory features of human brucellosis."]. ''Indian J Med Microbiol''. '''25''' (3): 188–202. PMID [http://www.ncbi.nlm.nih.gov/pubmed/17901634 17901634]</ref><ref>Pappas G, Akritidis N, Bosilkovski M, Tsianos E (2005). [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15930423 "Brucellosis."]. ''N Engl J Med''. '''352''' (22): 2325–36. PMID [http://www.ncbi.nlm.nih.gov/pubmed/15930423 15930423]. </ref><ref name="pmid23236528">{{cite journal| author=Dean AS, Crump L, Greter H, Hattendorf J, Schelling E, Zinsstag J| title=Clinical manifestations of human brucellosis: a systematic review and meta-analysis. | journal=PLoS Negl Trop Dis | year= 2012 | volume= 6 | issue= 12 | pages= e1929 | pmid=23236528 | doi=10.1371/journal.pntd.0001929 | pmc=3516581 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23236528  }}</ref><ref>Young EJ (1995). [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7546364 "Brucellosis: current epidemiology, diagnosis, and management."]. ''Curr Clin Top Infect Dis''. '''15''': 115–28. PMID [http://www.ncbi.nlm.nih.gov/pubmed/7546364 7546364]</ref><ref>Aygen B, Doganay M, Sumerkan B, et al. Clinical manifestations, complications and treatment of brucellosis: a retrospective evaluation of 480 patients. Med Malad Infect 2002; 32:485.</ref><ref name="pmid21623056">{{cite journal| author=Zamani A, Kooraki S, Mohazab RA, Zamani N, Matloob R, Hayatbakhsh MR et al.| title=Epidemiological and clinical features of Brucella arthritis in 24 children. | journal=Ann Saudi Med | year= 2011 | volume= 31 | issue= 3 | pages= 270-3 | pmid=21623056 | doi=10.4103/0256-4947.81543 | pmc=3119967 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21623056  }}</ref><ref>Mousa AM, Bahar RH, Araj GF, Koshy TS, Muhtaseb SA, al-Mudallal DS; et al. (1990). [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2330811 "Neurological complications of brucella spondylitis."]. ''Acta Neurol Scand''. '''81''' (1): 16–23. PMID [http://www.ncbi.nlm.nih.gov/pubmed/2330811 2330811]</ref><ref>Pappas G, Bosilkovski M, Akritidis N, Mastora M, Krteva L, Tsianos E (2003). [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13130417 "Brucellosis and the respiratory system."]. ''Clin Infect Dis''. '''37''' (7): e95–9. PMID [http://www.ncbi.nlm.nih.gov/pubmed/13130417 13130417]. [[Digital object identifier|doi]]:[http://dx.doi.org/10.1086%2F378125 10.1086/378125]</ref><ref>Herrick JA, Lederman RJ, Sullivan B, et al. Brucella arteritis: clinical manifestations, treatment, and prognosis. Lancet Infect Dis 2014; 14:520.</ref><ref name="pmid18162038">{{cite journal| author=Ariza J, Bosilkovski M, Cascio A, Colmenero JD, Corbel MJ, Falagas ME et al.| title=Perspectives for the treatment of brucellosis in the 21st century: the Ioannina recommendations. | journal=PLoS Med | year= 2007 | volume= 4 | issue= 12 | pages= e317 | pmid=18162038 | doi=10.1371/journal.pmed.0040317 | pmc=2222927 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18162038  }}</ref>
{| class="wikitable"
{| class="wikitable"
!Examination findings
!Brucellosis physical examination
|-
|Appearance of patient
|Patients are usually well-appearing
|-
|Vital Signs
|[[Pulse rate]]-Normal/[[Tachycardia]] with regular [[rhythm]], normal volume
[[Temperature]]- Normal or elevated


===Neck===
[[Blood pressure]]- Normal
*Cervical lymphadenopathy


===Lungs===
[[Respiratory rate]]-Normal/[[tachypnea]] ([[pneumonia]]/[[lung]] involvement)
*Increased tactile fremitus
*Dullness on percussion
*Decreased breath sounds
*Bronchial breath sounds
*Rhonchi
*Crackles, Rales
*Increased vocal fremitus
****May be present in lobar pneumonia


===Heart===
[[Oxygen saturation]]- usually normal but some cases may have low oxygen saturation (lung involvement).
*Heart murmurs
**May be present in infective endocarditis


===Abdomen===
[[Blood glucose|Blood glucose level]]- normal
*Hepatomegaly
|-
*Splenomegaly
|[[Skin]]
*Lymphadenopaty
|Skin examination may be normal or reveal the following:
*[[Maculopapular rash]]
*[[Erythema nodosum]] like eruptions and [[ulceration]]
*[[Abscesses]]
|-
|HEENT
|Eye examination is usually normal but signs of [[uveitis]] may be present in few patients
|-
|Neck
|Neck examination is usually normal but [[cervical]] [[lymphadenopathy]] may be present in few patients
|-
|[[Lungs]]
|Brucellosis involving [[lung]], may reveal multiple findings depending on the kind of involvement(it could be [[pneumonia]], [[bronchitis]], [[pleural effusion]] or [[empyema]] or combination of these). Based on the involvement, lung examination may reveal:
*Increased [[tactile fremitus]]
*Dullness on [[Percussion of the lungs|percussion]]
*Decreased [[breath sounds]]
*Bronchial [[breath sounds]]
*[[Rhonchi]]
*[[Crackles]], [[Rales]]
*Increased vocal [[fremitus]]
|-
|[[Heart]]
|Heart examination may reveal [[murmurs]] on auscultation ([[endocarditis]])
|-
|[[Abdomen]]
|Abdominal examination may elicit:
*[[Tenderness]]


===Genitourinary===
*[[Hepatomegaly]]*
*Inguinal lymphadenopathy
*[[Splenomegaly]]*
*Positive Prehn's sign
*[[Lymphadenopathy]]*
**May be present in epididymitis
|-
*Swollen testicle or testicles
|Back
**May be present in orchitis
|Back examination is usually normal
 
|-
===Extremities===
|[[Genitourinary]]
*Knee, hips, ankles and wrists:
|[[Genitourinary]] examination may reveal:
**Fluid around a joint
*[[Inguinal]] [[lymphadenopathy]]
*Positive [[Prehn's sign]]
**May be present in [[epididymitis]]
*Swollen [[testicle]] or testicles
**May be present in [[orchitis]]
|-
|[[Extremities]]
|
*Examination of [[knee]], [[hips]], [[Ankle|ankles]] and [[Wrist|wrists]] may reveal:
**[[Fluid]] around a [[joint]]
**Warm, red, tender joints
**Warm, red, tender joints
**Difficulty moving a joint (called "limited range of motion")
**Difficulty moving a [[joint]] (called "limited range of motion")
**May be present in peripheral arthritis
**May be present in peripheral [[arthritis]]
*Pain around sacroiliac joints
*Palpation of [[Sacroiliac joint|sacroiliac]] [[joints]] may reveal pain indicating  [[sacroiliitis]]
**May be present in sacroiliitis
*Positive [[Schober's test]](indicative of [[spondylitis]])
*Positive Schober test
|-
**May be present in spondilitis
|[[Neuromuscular]]
|
* Meningial signs of [[irritation]]  [[Nuchal rigidity]], [[Kernig's sign]] and [[Brudzinski's sign]] can be ilicited in cases with neurological involvement ([[meningitis]] or [[meningoencephalitis]]).
* Signs of [[Neuropathy|neuropathies]] involving individual pheripheral nerve or [[cranial nerve]] can be ilicited
|-
| colspan="2" |*Commonly observed 
|}
==Reference==
{{reflist|2}}__NOTOC__
<references />


===Neuromuscular===
[[Category:Disease]]
*Nuchal rigidity
[[Category:Up-To-Date]]
*Kernig's sign
[[Category:Pulmonology]]
*Brudzinski's signs
[[Category:Hepatology]]
**May be present in meningitis<ref name="pmid15930423">{{cite journal| author=Pappas G, Akritidis N, Bosilkovski M, Tsianos E| title=Brucellosis. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 22 | pages= 2325-36 | pmid=15930423 | doi=10.1056/NEJMra050570 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15930423  }} </ref>
[[Category:Rheumatology]]
 
[[Category:Nephrology]]
==Reference==
[[Category:Emergency medicine]]
{{reflist|2}}
[[Category:Bacterial diseases]]
[[Category:Occupational diseases]]
[[Category:Zoonoses]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Biological weapons]]
[[Category:Disease]]
{{WH}}
{{WS}}

Latest revision as of 20:45, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2] Danitza Lukac Vishal Devarkonda, M.B.B.S[3]

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Overview

Patients with brucellosis are usually well-appearing. Physical examination usually reveal combination of several non-specific findings.

Physical Examination

Patients with brucellosis are usually well-appearing. Physical examination usually reveal combination of several non-specific findings, which include:[1][2][3][4][5][6][7][8][9][10][11][12]

Examination findings Brucellosis physical examination
Appearance of patient Patients are usually well-appearing
Vital Signs Pulse rate-Normal/Tachycardia with regular rhythm, normal volume

Temperature- Normal or elevated

Blood pressure- Normal

Respiratory rate-Normal/tachypnea (pneumonia/lung involvement)

Oxygen saturation- usually normal but some cases may have low oxygen saturation (lung involvement).

Blood glucose level- normal

Skin Skin examination may be normal or reveal the following:
HEENT Eye examination is usually normal but signs of uveitis may be present in few patients
Neck Neck examination is usually normal but cervical lymphadenopathy may be present in few patients
Lungs Brucellosis involving lung, may reveal multiple findings depending on the kind of involvement(it could be pneumonia, bronchitis, pleural effusion or empyema or combination of these). Based on the involvement, lung examination may reveal:
Heart Heart examination may reveal murmurs on auscultation (endocarditis)
Abdomen Abdominal examination may elicit:
Back Back examination is usually normal
Genitourinary Genitourinary examination may reveal:
Extremities
Neuromuscular
*Commonly observed

Reference

  1. ↑ Brucellosis "Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo"Harrison's Principles of Internal Medicine, 19e Accessed on December 9th, 2017
  2. ↑ Colmenero JD, Reguera JM, Martos F, Sánchez-De-Mora D, Delgado M, Causse M; et al. (1996). "Complications associated with Brucella melitensis infection: a study of 530 cases.". Medicine (Baltimore). 75 (4): 195–211. PMID 8699960
  3. ↑ Mantur BG, Amarnath SK, Shinde RS (2007). "Review of clinical and laboratory features of human brucellosis.". Indian J Med Microbiol. 25 (3): 188–202. PMID 17901634
  4. ↑ Pappas G, Akritidis N, Bosilkovski M, Tsianos E (2005). "Brucellosis.". N Engl J Med. 352 (22): 2325–36. PMID 15930423. 
  5. ↑ Dean AS, Crump L, Greter H, Hattendorf J, Schelling E, Zinsstag J (2012). "Clinical manifestations of human brucellosis: a systematic review and meta-analysis". PLoS Negl Trop Dis. 6 (12): e1929. doi:10.1371/journal.pntd.0001929. PMC 3516581. PMID 23236528.
  6. ↑ Young EJ (1995). "Brucellosis: current epidemiology, diagnosis, and management.". Curr Clin Top Infect Dis. 15: 115–28. PMID 7546364
  7. ↑ Aygen B, Doganay M, Sumerkan B, et al. Clinical manifestations, complications and treatment of brucellosis: a retrospective evaluation of 480 patients. Med Malad Infect 2002; 32:485.
  8. ↑ Zamani A, Kooraki S, Mohazab RA, Zamani N, Matloob R, Hayatbakhsh MR; et al. (2011). "Epidemiological and clinical features of Brucella arthritis in 24 children". Ann Saudi Med. 31 (3): 270–3. doi:10.4103/0256-4947.81543. PMC 3119967. PMID 21623056.
  9. ↑ Mousa AM, Bahar RH, Araj GF, Koshy TS, Muhtaseb SA, al-Mudallal DS; et al. (1990). "Neurological complications of brucella spondylitis.". Acta Neurol Scand. 81 (1): 16–23. PMID 2330811
  10. ↑ Pappas G, Bosilkovski M, Akritidis N, Mastora M, Krteva L, Tsianos E (2003). "Brucellosis and the respiratory system.". Clin Infect Dis. 37 (7): e95–9. PMID 13130417. doi:10.1086/378125
  11. ↑ Herrick JA, Lederman RJ, Sullivan B, et al. Brucella arteritis: clinical manifestations, treatment, and prognosis. Lancet Infect Dis 2014; 14:520.
  12. ↑ Ariza J, Bosilkovski M, Cascio A, Colmenero JD, Corbel MJ, Falagas ME; et al. (2007). "Perspectives for the treatment of brucellosis in the 21st century: the Ioannina recommendations". PLoS Med. 4 (12): e317. doi:10.1371/journal.pmed.0040317. PMC 2222927. PMID 18162038.
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