Brucellosis laboratory findings: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Brucellosis}} | {{Brucellosis}} | ||
{{CMG}}; {{AE}} {{RT}} {{DL}} | {{CMG}}; {{AE}} {{RT}} {{DL}}{{VD}} | ||
==Overview== | ==Overview== | ||
The diagnosis of brucellosis can be confirmed by either a positive [[Bacterial cultures|bacterial culture]] or a positive titer of anti-[[Brucella|b''rucella'']] [[antibodies]] on serological testing. | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
==== | Laboratory findings of brucellosis include the following:<ref name="g" /><ref name=":0">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><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 name=":1">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" | |||
! colspan="3" |Laboratory findings in Brucellosis | |||
|- | |||
| rowspan="7" |Blood | |||
|[[Complete blood count]] | |||
|Complete [[Blood]] Count may reveal: | |||
*Mild [[leukopenia]] | *Mild [[leukopenia]] | ||
*Mild [[anemia]] | *Mild [[anemia]] | ||
*[[Lymphocytosis|Relative lymphocytosis]] | *[[Lymphocytosis|Relative lymphocytosis]] | ||
*[[Thrombocytopenia]] | *[[Thrombocytopenia]] | ||
|- | |||
|[[Erythrocyte sedimentation rate|ESR]] | |||
|Normal or raised | |||
|- | |||
|[[CRP]] | |||
|Normal or raised | |||
|- | |||
|[[Liver function tests|Liver function test]] | |||
|Liver function test may reveal: | |||
*Mild increase in [[hepatic]] [[enzymes]] | |||
*Mild increase in [[bilirubin]] | |||
|- | |||
|Culture | |||
| | |||
*The isolation and identification of [[Brucella|''Brucella'']] can confirm a diagnosis of brucellosis. | *The isolation and identification of [[Brucella|''Brucella'']] can confirm a diagnosis of brucellosis. | ||
*[[Brucella|''Brucella'']] is most commonly isolated from blood cultures | *[[Brucella|''Brucella'']] is most commonly isolated from blood cultures (blood cultures are positive between the 7th and 21st day) | ||
*It can also, however, be isolated from: | *It can also, however, be isolated from: | ||
**[[Bone marrow]] | **[[Bone marrow]] ([[gold standard (test)|Gold standard test]]) | ||
**[[Cerebrospinal fluid]] | **[[Cerebrospinal fluid]] | ||
**Wounds | **[[Wounds]] | ||
**[[Purulent]] [[discharge]] | **[[Purulent]] [[discharge]] | ||
**[[Synovial fluid|Joint fluid]] | **[[Synovial fluid|Joint fluid]]<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><ref name="g">Brucellosis. CDC. http://www.cdc.gov/brucellosis/clinicians/bacterial-isolation.html. Accessed on February 4, 2016</ref> | ||
|- | |||
|Serological tests | |||
|Serological Tests | |||
*'''There are two types of serological tests, based on:''' | *'''There are two types of serological tests, based on:''' | ||
** | **Antibody production against [[lipopolysaccharide]] | ||
** | **Antibody production against other [[bacterial]] [[antigens]] | ||
*'''For a diagnosis to be made using serology, two serum samples are required:''' | *'''For a diagnosis to be made using serology, two serum samples are required:''' | ||
**The first serum sample should be taken when a person is acutely ill (≤7 days after symptom onset) | **The first [[serum]] sample should be taken when a person is acutely ill (≤7 days after symptom onset) | ||
**The second serum sample should be drawn 2-4 weeks later to check for a rise in antibodies (a fourfold or greater rise in antibodies would bean an individual is positive for brucellosis). | **The second serum sample should be drawn 2-4 weeks later to check for a rise in [[antibodies]] (a fourfold or greater rise in antibodies would bean an individual is positive for brucellosis). | ||
**If submission of paired sera is not possible, a probable diagnosis can be made with a single serum sample. | **If submission of paired sera is not possible, a probable diagnosis can be made with a single serum sample. | ||
*'''Brucella microagglutination test (BMAT) | *'''Brucella microagglutination test (BMAT)''' | ||
**A modified version of the serum (tube) agglutination test (SAT), that can detect antibodies to [[Brucella|''Brucella'']] species: [[Brucella abortus|abortus]], [[Brucella melitensis|melitensis]] or suis. | **A modified version of the serum (tube) agglutination test (SAT), that can detect antibodies to [[Brucella|''Brucella'']] species: [[Brucella abortus|abortus]], [[Brucella melitensis|melitensis]] or suis. | ||
**There is no serological test available to detect antibodies to [[Brucella canis|''B. canis'']]. | **There is no [[Serological testing|serological test]] available to detect [[antibodies]] to [[Brucella canis|''B. canis'']]. | ||
**An '''''agglutination''''' '''''titre greater than 1:160''''' is considered '''significant in nonendemic areas'''. | **An '''''agglutination''''' '''''titre greater than 1:160''''' is considered '''significant in nonendemic areas'''. | ||
**An '''''agglutination''''' '''''titre greater than 1:320''''' is considered '''significant in endemic areas'''. | **An '''''agglutination''''' '''''titre greater than 1:320''''' is considered '''significant in endemic areas'''. | ||
**Due to the similarity of the O polysaccharide of [[Brucella|''Brucella'']] to that of various other | **Due to the similarity of the O [[polysaccharide]] of [[Brucella|''Brucella'']] to that of various other [[gram-negative bacteria]] (e.g. [[Francisella tularensis]], [[Escherichia coli]], Salmonella urbana, [[Yersinia enterocolitica]], [[Vibrio cholerae]], and [[Stenotrophomonas maltophilia]]) the appearance of cross-reactions of class [[Immunoglobulin M|M immunoglobulins]] may occur. | ||
**False-negative SAT may be caused by the presence of blocking antibodies (the prozone phenomenon) in the α2-globulin ([[IgA]]) and in the α-globulin ([[IgG]]) fractions. | **False-negative SAT may be caused by the presence of blocking [[antibodies]] (the prozone phenomenon) in the α2-globulin ([[IgA]]) and in the α-globulin ([[IgG]]) fractions. | ||
**Serology is not currently available to monitor persons for RB51 vaccine exposure or for [[Brucella canis|''Brucella canis'']] exposure. | **[[Serology]] is not currently available to monitor persons for RB51 vaccine exposure or for [[Brucella canis|''Brucella canis'']] exposure. | ||
*'''Rose Bengal | *'''Rose Bengal''' | ||
**Rose bengal has a positive predictive value is approximately 99% for patients with acute and chronic brucellosis. | **Rose bengal has a positive predictive value is approximately 99% for patients with acute and chronic brucellosis. | ||
**Rose bengal measures [[IgM]] and [[IgG]] antibodies. | **Rose bengal measures [[IgM]] and [[IgG]] antibodies. | ||
*'''2-mercaptoethanol (2-ME) | *'''2-mercaptoethanol (2-ME)''' | ||
**2-ME measures [[IgG]] antibodies | **2-ME measures [[IgG]] [[antibodies]] | ||
*'''Antihuman globulin (Coombs) | *'''Antihuman globulin (Coombs)''' | ||
**Used in chronic brucellosis patients with negative seroagglutination because they have [[IgG]] non-agglutinating antibodies. | **Used in chronic brucellosis patients with negative seroagglutination because they have [[IgG]] non-agglutinating antibodies. | ||
*'''Indirect enzyme linked immunosorbent assay (ELISA)' | *'''Indirect enzyme linked immunosorbent assay (ELISA)''' | ||
**[[ELISA test|ELISA]] typically uses cytoplasmic proteins as antigens. | **[[ELISA test|ELISA]] typically uses cytoplasmic [[proteins]] as [[antigens]]. | ||
**[[ELISA test|ELISA]] measures [[IgM]], [[IgG]], and [[IgA]] with better [[Sensitivity (tests)|sensitivity]] and [[Specificity (tests)|specificity]] than the SAT in most recent comparative studies. | **[[ELISA test|ELISA]] measures [[IgM]], [[IgG]], and [[IgA]] with better [[Sensitivity (tests)|sensitivity]] and [[Specificity (tests)|specificity]] than the SAT in most recent comparative studies. | ||
*'''Dipstick assays | *'''Dipstick assays''' | ||
**New and promising, based on the binding of [[Brucella|''Brucella'']] [[IgM]] antibodies, and found to be simple, accurate | **New and promising, based on the binding of [[Brucella|''Brucella'']] [[IgM]] [[antibodies]], and found to be simple, accurate and rapid. | ||
*'''Brucellacapt test | *'''Brucellacapt test''' | ||
**A single-step immunocapture assay for the detection of total anti-[[Brucella|''Brucella'']] antibodies, is an increasingly used adjunctive test when resources permit. | **A single-step immunocapture assay for the detection of total anti-[[Brucella|''Brucella'']] antibodies, is an increasingly used adjunctive test when resources permit. | ||
|- | |||
* | |Molecular tests | ||
|'''PCR''' | |||
*[[PCR]] is a fast and specific diagnostic tool to confirm the diagnosis of brucellosis | |||
*Many varieties of [[PCR]] have been developed (e.g. nested [[PCR]], realtime [[PCR]] and [[PCR]]-[[ELISA test|ELISA]]) and found to have superior [[Specificity (tests)|specificity]] and [[Sensitivity (tests)|sensitivity]] in detecting both primary infection and relapse after treatment. | |||
*Unfortunately, these have yet to be standardized for routine use, and some centres have reported persistent [[PCR]] positivity after clinically successful treatment, fuelling the controversy about the existence of prolonged [[Chronic (medicine)|chronic]] brucellosis.<ref name="pmid15930423" /><ref name="b">Brucellosis. CDC. http://www.cdc.gov/brucellosis/transmission/index.html. Accessed on February 1, 2016</ref><ref name="a">Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on January 29, 2016</ref><ref name="aa">Brucelosis. Wikipedia. https://es.wikipedia.org/wiki/Brucelosis. Accessed on February 2, 2016</ref> | |||
|} | |||
==== Tissue Biopsy ==== | |||
[[Liver]] and [[lymph node]] biopsy may reveal non-[[Caseous necrosis|caseating]] [[granuloma]].<ref name=":0" /><ref name=":1" /> | |||
==== CSF analysis ==== | |||
[[CSF analysis]] may reveal [[lymphocytosis]] and low glucose level.<ref name=":0" /><ref name=":1" /> | |||
==== Synovial fluid analysis ==== | |||
[[Synovial fluid]] analysis may reveal [[lymphocytic]] predominate with [[granulocyte]] count which does not generally exceed 15,000 cells/microL and low [[glucose]] levels.<ref name=":0" /><ref name=":1" /> | |||
==Gallery== | ==Gallery== | ||
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==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Pulmonology]] | |||
[[Category:Hepatology]] | |||
[[Category:Rheumatology]] | |||
[[Category:Nephrology]] | |||
[[Category:Emergency medicine]] | |||
[[Category:Infectious disease]] |
Latest revision as of 20:44, 29 July 2020
Brucellosis Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Brucellosis laboratory findings On the Web |
American Roentgen Ray Society Images of Brucellosis laboratory findings |
Risk calculators and risk factors for Brucellosis laboratory findings |
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
The diagnosis of brucellosis can be confirmed by either a positive bacterial culture or a positive titer of anti-brucella antibodies on serological testing.
Laboratory Findings
Laboratory findings of brucellosis include the following:[1][2][3][4][5][6][7][8][9][10][11][12][13]
Laboratory findings in Brucellosis | ||
---|---|---|
Blood | Complete blood count | Complete Blood Count may reveal: |
ESR | Normal or raised | |
CRP | Normal or raised | |
Liver function test | Liver function test may reveal: | |
Culture | ||
Serological tests | Serological Tests
| |
Molecular tests | PCR
|
Tissue Biopsy
Liver and lymph node biopsy may reveal non-caseating granuloma.[2][4]
CSF analysis
CSF analysis may reveal lymphocytosis and low glucose level.[2][4]
Synovial fluid analysis
Synovial fluid analysis may reveal lymphocytic predominate with granulocyte count which does not generally exceed 15,000 cells/microL and low glucose levels.[2][4]
Gallery
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Brucella abortus bacteria grown on a medium of sheep’s blood agar (SBA) 72hrs. From Public Health Image Library (PHIL). [18]
-
Brucella abortus bacteria grown on a medium of sheep’s blood agar (SBA) 72hrs. From Public Health Image Library (PHIL). [18]
-
Brucella abortus bacteria grown on a medium of sheep’s blood agar (SBA) 72hrs. From Public Health Image Library (PHIL). [18]
-
Brucella suis bacteria grown on chocolate medium 72hrs. From Public Health Image Library (PHIL). [18]
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Brucella sis bacteria grown on chocolate medium 72hrs. From Public Health Image Library (PHIL). [18]
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Brucella bacteria grown on MacConkey agar (MAC) medium 24hrs (10x mag). From Public Health Image Library (PHIL). [18]
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Brucella suis bacteria cultured on chocolate agar medium 48hrs (10x mag). From Public Health Image Library (PHIL). [18]
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Brucella suis bacteria cultured on SBA 24hrs (10x mag). From Public Health Image Library (PHIL). [18]
-
Brucella suis bacteria cultured on SBA 72hrs (10x mag). From Public Health Image Library (PHIL). [18]
-
Brucella suis bacteria cultured on SBA 48hrs (10x mag). From Public Health Image Library (PHIL). [18]
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Brucella suis bacteria cultured on Thayer-Martin (TM) agar medium 48hrs (10x mag). From Public Health Image Library (PHIL). [18]
-
Brucella suis bacteria cultured on chocolate agar medium 24hrs (10x mag). From Public Health Image Library (PHIL). [18]
References
- ↑ 1.0 1.1 Brucellosis. CDC. http://www.cdc.gov/brucellosis/clinicians/bacterial-isolation.html. Accessed on February 4, 2016
- ↑ 2.0 2.1 2.2 2.3 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
- ↑ 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
- ↑ 4.0 4.1 4.2 4.3 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
- ↑ Pappas G, Akritidis N, Bosilkovski M, Tsianos E (2005). "Brucellosis.". N Engl J Med. 352 (22): 2325–36. PMID 15930423.
- ↑ 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.
- ↑ Young EJ (1995). "Brucellosis: current epidemiology, diagnosis, and management.". Curr Clin Top Infect Dis. 15: 115–28. PMID 7546364
- ↑ 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.
- ↑ 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.
- ↑ 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
- ↑ 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
- ↑ Herrick JA, Lederman RJ, Sullivan B, et al. Brucella arteritis: clinical manifestations, treatment, and prognosis. Lancet Infect Dis 2014; 14:520.
- ↑ 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.
- ↑ 14.0 14.1 Pappas G, Akritidis N, Bosilkovski M, Tsianos E (2005). "Brucellosis". N Engl J Med. 352 (22): 2325–36. doi:10.1056/NEJMra050570. PMID 15930423.
- ↑ Brucellosis. CDC. http://www.cdc.gov/brucellosis/transmission/index.html. Accessed on February 1, 2016
- ↑ Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on January 29, 2016
- ↑ Brucelosis. Wikipedia. https://es.wikipedia.org/wiki/Brucelosis. Accessed on February 2, 2016
- ↑ 18.00 18.01 18.02 18.03 18.04 18.05 18.06 18.07 18.08 18.09 18.10 18.11 "Public Health Image Library (PHIL)".