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{{Brucellosis}}
{{Brucellosis}}
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==Overview==
==Overview==
If left untreated, patients with brucellosis may progress to develop focal infections, relapses or chronic brucellosis.<ref name="f">Brucellosis. CDC. http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/brucellosis. Accessed on February 3, 2016</ref> Common [[Complication (medicine)|complications]] of brucellosis include [[hepatitis|granulomatous hepatitis]], [[arthritis]], [[sacroiliitis]], [[meningitis]], [[orchitis]], [[epididymitis]]  [[uveitis]], and [[endocarditis]].<ref name="a">Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on February 3, 2016</ref><ref name="abc">FAO/WHO/OIE Brucellosis in humans and animals. WHO (2006). http://www.who.int/csr/resources/publications/Brucellosis.pdf Accessed on February 3, 2016  </ref> The [[prognosis]] of brucellosis is good with treatment. [[Relapse]] may occur, and [[symptoms]] may continue for years.<ref name="a">Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on February 1, 2016</ref><ref name="f">Brucellosis. Medline Plus. https://www.nlm.nih.gov/medlineplus/ency/article/000597.htm. Accessed on February 3, 2016</ref>
If left untreated, patients with [[brucellosis]] may progress to develop focal [[Organ (biology)|organ]] [[complications]], relapses or chronic brucellosis.<ref name="f">Brucellosis. CDC. http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/brucellosis. Accessed on February 3, 2016</ref> Common [[complications]] of brucellosis include [[hepatitis|granulomatous hepatitis]], [[arthritis]], [[sacroiliitis]], [[meningitis]], [[orchitis]], [[epididymitis]]  [[uveitis]], and [[endocarditis]]. The [[prognosis]] of brucellosis is good with adequate treatment.  


==Natural History==
==Natural History==
*[[Incubation period]] is 2–4 weeks (range, 5 days to 5 months).
If left untreated, patients with [[brucellosis]] may progress to develop focal [[Organ (anatomy)|organ]] involvement, [[Relapse|relapses]] and chronic [[brucellosis]].<ref name="d">Brucellosis. CDC. http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/brucellosis. Accessed on February 3, 2016</ref>  
*Initial presentation is nonspecific, including [[fever]], [[muscle aches]], [[fatigue]], [[headache]], and [[night sweats]].
*If left untreated, [[patients]] with brucellosis may progress to develop focal [[infections]], [[Relapse|relapses]] or [[Chronic (medicine)|chronic]] brucellosis.<ref name="f">Brucellosis. CDC. http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/brucellosis. Accessed on February 3, 2016</ref>


==Complications==
==Complications==
*'''Osteoarticular''':
Complications of [[brucellosis]] include the following:<ref name="pmid8699960">{{cite journal| author=Colmenero JD, Reguera JM, Martos F, Sánchez-De-Mora D, Delgado M, Causse M et al.| title=Complications associated with Brucella melitensis infection: a study of 530 cases. | journal=Medicine (Baltimore) | year= 1996 | volume= 75 | issue= 4 | pages= 195-211 | pmid=8699960 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8699960  }}</ref><ref name="pmid17901634">{{cite journal| author=Mantur BG, Amarnath SK, Shinde RS| title=Review of clinical and laboratory features of human brucellosis. | journal=Indian J Med Microbiol | year= 2007 | volume= 25 | issue= 3 | pages= 188-202 | pmid=17901634 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17901634  }}</ref><ref name="pmid159304">{{cite journal| author=Overturf ML, Druihet RE, Fitz A| title=The effects of kallikrein, plasmin, and thrombin on hog kidney renin. | journal=J Biol Chem | year= 1979 | volume= 254 | issue= 23 | pages= 12078-83 | pmid=159304 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=159304  }}</ref><ref>Doganay M, Aygen B. Human brucellosis: An overview. Int J Infect Dis 2003; 7:173.</ref><ref name="pmid7546364">{{cite journal| author=Young EJ| title=Brucellosis: current epidemiology, diagnosis, and management. | journal=Curr Clin Top Infect Dis | year= 1995 | volume= 15 | issue=  | pages= 115-28 | pmid=7546364 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7546364  }}</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 name="pmid2330811">{{cite journal| author=Mousa AM, Bahar RH, Araj GF, Koshy TS, Muhtaseb SA, al-Mudallal DS et al.| title=Neurological complications of brucella spondylitis. | journal=Acta Neurol Scand | year= 1990 | volume= 81 | issue= 1 | pages= 16-23 | pmid=2330811 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2330811  }}</ref><ref name="pmid13130417">{{cite journal| author=Pappas G, Bosilkovski M, Akritidis N, Mastora M, Krteva L, Tsianos E| title=Brucellosis and the respiratory system. | journal=Clin Infect Dis | year= 2003 | volume= 37 | issue= 7 | pages= e95-9 | pmid=13130417 | doi=10.1086/378125 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13130417  }}</ref><ref name="pmid24480149">{{cite journal| author=Herrick JA, Lederman RJ, Sullivan B, Powers JH, Palmore TN| title=Brucella arteritis: clinical manifestations, treatment, and prognosis. | journal=Lancet Infect Dis | year= 2014 | volume= 14 | issue= 6 | pages= 520-6 | pmid=24480149 | doi=10.1016/S1473-3099(13)70270-6 | pmc=4498663 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24480149  }}</ref>
**Bone and joint involvement
{| class="wikitable"
***Most frequent complications
! colspan="2" |Complications of Brucellosis
***The occur in approximately 40% of cases.
|-
****[[Sacroiliitis]]
|'''Osteoarticular'''
*****Most common
| 
****[[Bursitis]]
*Most frequent complications
****Peripheral [[arthritis]]
*Occur in approximately 40% of cases.
****[[Osteomyelitis]]
*[[Sacroiliitis]]
****[[Tenosynovitis]]  
**Most common complication
****[[Spondylitis]]
*[[Bursitis]]
 
*Peripheral [[arthritis]]
*'''Cardiovascular''':
*[[Osteomyelitis]]
**[[Infective endocarditis]]
*[[Tenosynovitis]]  
***Common cardiovascular complication
*[[Spondylitis]]
***Frequent cause of death
|-
***It has been reported in approximately 2% of cases
|'''[[Cardiovascular]]'''
***The [[aortic valve]] is more commonly affected than the [[mitral valve]]
|
***[[Valve]] replacement [[surgery]] is usually needed apart from the medical therapy
*[[Infective endocarditis]]
**[[Aneurysm of sinus of valsalva]]  
**Common [[cardiovascular]] complication
***Common complication when [[infection]] is due to ''B. suis''
**Frequent cause of death
 
**It has been reported in approximately 2% of cases
*'''Hepatobiliary complications:'''
**The [[aortic valve]] is more commonly affected than the [[mitral valve]]
**[[Granulomatous hepatitis]]
**[[Valve]] replacement [[surgery]] is usually needed apart from the medical therapy
***Due to ''[[Brucella abortus|B. abortus]]''
*[[Aneurysm of sinus of valsalva]]  
**Post-necrotic [[cirrhosis]]
**Common complication when [[infection]] is due to ''B.suis''
***Very rare
|-
** Chronic suppurative lesions and [[Hepatic abscess|hepatic abscesses]]
|'''[[Hepatobiliary system|Hepatobiliary complications]]'''
***Due to B. suis
|
 
*[[Granulomatous hepatitis]]
*'''Genitourinary''':
**Due to ''[[Brucella abortus|B. abortus]]''
**[[Orchitis]] and [[epididymitis]]  
*Post-necrotic [[cirrhosis]]
***Frequent [[Genitourinary system|genitourinary]] complications within men
**Very rare
 
* Chronic suppurative lesions and [[Hepatic abscess|hepatic abscesses]]
*'''Neurological''':
**Due to B. suis
**[[Meningitis]] or [[meningoencephalitis]]
|-
***Most common frequent complications of neurobrucellosis
|'''[[Genitourinary]]'''
**[[Brain abscess|Brain]] and [[epidural abscess]]
|[[Orchitis]] and [[epididymitis]]
**[[Cerebellar ataxia]]
*Frequent [[Genitourinary system|genitourinary]] complications within men
**[[Cerebral vasculitis]]
|-
**[[Guillain-Barré syndrome]]
|'''[[Neurology|Neurological]]'''
**[[Haemorrhage]]
|
**[[Mycotic aneurysm]]
*[[Meningitis]] or [[meningoencephalitis]]
**[[Stroke]]
**Most common frequent complications of neurobrucellosis
**[[Neuropathy]]/[[radiculopathy]]
*[[Brain abscess|Brain]] and [[epidural abscess]]
**[[Poliomyelitis]]-like syndrome
*[[Cerebellar ataxia]]
 
*[[Cerebral vasculitis]]
*'''Gastrointestinal''':
*[[Guillain-Barré syndrome]]
**[[Colitis]], [[ileitis]], and [[spontaneous bacterial peritonitis]].
*[[Haemorrhage]]
***Rare cases have been reported.
*[[Mycotic aneurysm]]
 
*[[Stroke]]
*'''Respiratory tract:'''
*[[Neuropathy]]/[[radiculopathy]]
**[[Bronchopneumonia]]  
*[[Poliomyelitis]]-like syndrome
**[[Empyema]]
|-
**[[Hilar]] and [[Paratracheal lymph nodes|paratracheal lymphadenopathy]]
|'''[[Gastrointestinal]]'''
**[[Interstitial pneumonitis]]
|[[Colitis]], [[ileitis]], and [[spontaneous bacterial peritonitis]].
**[[Lung nodule|Lung nodules]]
*Rare cases have been reported.
**[[Pleural effusions]]
|-
 
|'''[[Respiratory tract]]'''
* '''Pregnancy''':
|
**[[Spontaneous abortion]]
*[[Bronchopneumonia]]  
 
*[[Empyema]]
*'''Cutaneous''':
*[[Hilar]] and [[Paratracheal lymph nodes|paratracheal lymphadenopathy]]
**[[Erythema nodosum]]
*[[Interstitial pneumonitis]]
**[[Nodules]]
*[[Lung nodule|Lung nodules]]
**[[Papules]]
*[[Pleural effusions]]
**[[Petechiae]]
|-
**[[Purpura]]
|'''[[Pregnancy]]'''
**[[Rashes]]
|[[Spontaneous abortion]]
**[[Abscesses]], cutaneous ulcers, and [[suppurative]] [[lymphangitis]]
|-
***Common complication when infection is due to ''B. suis''
|'''[[Cutaneous]]'''
 
| 
*'''Opthalmic''':
*[[Erythema nodosum]]
**[[Uveitis]]
*[[Nodules]]
***Most frequent ophtalmic complications<ref name="abc">FAO/WHO/OIE Brucellosis in humans and animals. WHO (2006). http://www.who.int/csr/resources/publications/Brucellosis.pdf Accessed on February 3, 2016  </ref>
*[[Papules]]
*[[Petechiae]]
*[[Purpura]]
*[[Rashes]]
*[[Abscesses]], cutaneous ulcers, and [[suppurative]] [[lymphangitis]]
**Common complication when infection is due to ''B. suis''
|-
|'''Opthalmic'''
|[[Uveitis]]
*Most frequent ophtalmic complications<ref name="abc">FAO/WHO/OIE Brucellosis in humans and animals. WHO (2006). http://www.who.int/csr/resources/publications/Brucellosis.pdf Accessed on February 3, 2016  </ref>
|}


==Prognosis==
==Prognosis==
*The [[mortality]] of the disease in 1909, as recorded in the British Army and Navy stationed in Malta, was 2%.
The [[prognosis]] of [[brucellosis]] is good with treatment. [[Mortality]] is less then 1%, usually due to consequence of [[cardiac]] involvement or severe [[Neurology|neurologic]] disease.<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</ref>
*The most frequent cause of death was [[endocarditis]].  
**Recent advances in [[antibiotics]] and [[surgery]] have been successful in [[Prevention (medical)|preventing]] death due to [[endocarditis]].
*[[Relapse]] may occur, and [[symptoms]] may continue for years. As with [[tuberculosis]], the [[illness]] can come back after a long period of time.<ref name="a">Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on February 1, 2016</ref><ref name="f">Brucellosis. Medline Plus. https://www.nlm.nih.gov/medlineplus/ency/article/000597.htm. Accessed on February 3, 2016</ref>


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

Overview

If left untreated, patients with brucellosis may progress to develop focal organ complications, relapses or chronic brucellosis.[1] Common complications of brucellosis include granulomatous hepatitis, arthritis, sacroiliitis, meningitis, orchitis, epididymitis uveitis, and endocarditis. The prognosis of brucellosis is good with adequate treatment.

Natural History

If left untreated, patients with brucellosis may progress to develop focal organ involvement, relapses and chronic brucellosis.[2]

Complications

Complications of brucellosis include the following:[3][4][5][6][7][8][9][10][11]

Complications of Brucellosis
Osteoarticular
Cardiovascular
Hepatobiliary complications
Genitourinary Orchitis and epididymitis
Neurological
Gastrointestinal Colitis, ileitis, and spontaneous bacterial peritonitis.
  • Rare cases have been reported.
Respiratory tract
Pregnancy Spontaneous abortion
Cutaneous
Opthalmic Uveitis
  • Most frequent ophtalmic complications[12]

Prognosis

The prognosis of brucellosis is good with treatment. Mortality is less then 1%, usually due to consequence of cardiac involvement or severe neurologic disease.[13]

Reference

  1. ↑ Brucellosis. CDC. http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/brucellosis. Accessed on February 3, 2016
  2. ↑ Brucellosis. CDC. http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/brucellosis. Accessed on February 3, 2016
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ Overturf ML, Druihet RE, Fitz A (1979). "The effects of kallikrein, plasmin, and thrombin on hog kidney renin". J Biol Chem. 254 (23): 12078–83. PMID 159304.
  6. ↑ Doganay M, Aygen B. Human brucellosis: An overview. Int J Infect Dis 2003; 7:173.
  7. ↑ Young EJ (1995). "Brucellosis: current epidemiology, diagnosis, and management". Curr Clin Top Infect Dis. 15: 115–28. PMID 7546364.
  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. doi:10.1086/378125. PMID 13130417.
  11. ↑ Herrick JA, Lederman RJ, Sullivan B, Powers JH, Palmore TN (2014). "Brucella arteritis: clinical manifestations, treatment, and prognosis". Lancet Infect Dis. 14 (6): 520–6. doi:10.1016/S1473-3099(13)70270-6. PMC 4498663. PMID 24480149.
  12. ↑ FAO/WHO/OIE Brucellosis in humans and animals. WHO (2006). http://www.who.int/csr/resources/publications/Brucellosis.pdf Accessed on February 3, 2016
  13. ↑ 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
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