Brucellosis natural history, complications and prognosis: Difference between revisions

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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 complications of brucellosis include [[hepatitis|granulomatous hepatitis]], [[arthritis]], [[sacroiliitis]], [[meningitis]], [[orchitis]], [[epididymitis]]  [[uveitis]], and [[endocarditis]]. The prognosis of brucellosis is good with adequate treatment. [[Relapse]] may occur, and [[symptoms]] may continue for years.<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><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 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 complications of brucellosis include [[hepatitis|granulomatous hepatitis]], [[arthritis]], [[sacroiliitis]], [[meningitis]], [[orchitis]], [[epididymitis]]  [[uveitis]], and [[endocarditis]]. The prognosis of brucellosis is good with adequate treatment. Relapse may occur, and symptoms may continue for years.<ref name="f">Brucellosis. Medline Plus. https://www.nlm.nih.gov/medlineplus/ency/article/000597.htm. 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><ref name="a">Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on February 1, 2016</ref>


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


==Complications==
==Complications==
*'''Osteoarticular''':
**Bone and joint involvement
***Most frequent complications
***The occur in approximately 40% of cases.
****[[Sacroiliitis]]
*****Most common
****[[Bursitis]]
****Peripheral [[arthritis]]
****[[Osteomyelitis]]
****[[Tenosynovitis]]
****[[Spondylitis]]


*'''Cardiovascular''':
=== '''Osteoarticular''': ===
**[[Infective endocarditis]]
*Bone and joint involvement
***Common cardiovascular complication
**Most frequent complications
***Frequent cause of death
**The occur in approximately 40% of cases.
***It has been reported in approximately 2% of cases
***[[Sacroiliitis]]
***The [[aortic valve]] is more commonly affected than the [[mitral valve]]
****Most common
***[[Valve]] replacement [[surgery]] is usually needed apart from the medical therapy
***[[Bursitis]]
**[[Aneurysm of sinus of valsalva]]  
***Peripheral [[arthritis]]
***Common complication when [[infection]] is due to ''B. suis''
***[[Osteomyelitis]]
***[[Tenosynovitis]]  
***[[Spondylitis]]


*'''Hepatobiliary complications:'''
=== '''Cardiovascular''': ===
**[[Granulomatous hepatitis]]
*[[Infective endocarditis]]
***Due to ''[[Brucella abortus|B. abortus]]''
**Common cardiovascular complication
**Post-necrotic [[cirrhosis]]
**Frequent cause of death
***Very rare
**It has been reported in approximately 2% of cases
** Chronic suppurative lesions and [[Hepatic abscess|hepatic abscesses]]
**The [[aortic valve]] is more commonly affected than the [[mitral valve]]
***Due to B. suis
**[[Valve]] replacement [[surgery]] is usually needed apart from the medical therapy
*[[Aneurysm of sinus of valsalva]]
**Common complication when [[infection]] is due to ''B. suis''


*'''Genitourinary''':
=== '''Hepatobiliary complications:''' ===
**[[Orchitis]] and [[epididymitis]]  
*[[Granulomatous hepatitis]]
***Frequent [[Genitourinary system|genitourinary]] complications within men
**Due to ''[[Brucella abortus|B. abortus]]''
*Post-necrotic [[cirrhosis]]
**Very rare
* Chronic suppurative lesions and [[Hepatic abscess|hepatic abscesses]]
**Due to B. suis


*'''Neurological''':
=== '''Genitourinary''': ===
**[[Meningitis]] or [[meningoencephalitis]]
*[[Orchitis]] and [[epididymitis]]  
***Most common frequent complications of neurobrucellosis
**Frequent [[Genitourinary system|genitourinary]] complications within men
**[[Brain abscess|Brain]] and [[epidural abscess]]
**[[Cerebellar ataxia]]
**[[Cerebral vasculitis]]
**[[Guillain-Barré syndrome]]
**[[Haemorrhage]]
**[[Mycotic aneurysm]]
**[[Stroke]]
**[[Neuropathy]]/[[radiculopathy]]
**[[Poliomyelitis]]-like syndrome


*'''Gastrointestinal''':
=== '''Neurological''': ===
**[[Colitis]], [[ileitis]], and [[spontaneous bacterial peritonitis]].
*[[Meningitis]] or [[meningoencephalitis]]
***Rare cases have been reported.
**Most common frequent complications of neurobrucellosis
*[[Brain abscess|Brain]] and [[epidural abscess]]
*[[Cerebellar ataxia]]
*[[Cerebral vasculitis]]
*[[Guillain-Barré syndrome]]
*[[Haemorrhage]]
*[[Mycotic aneurysm]]
*[[Stroke]]
*[[Neuropathy]]/[[radiculopathy]]
*[[Poliomyelitis]]-like syndrome


*'''Respiratory tract:'''
=== '''Gastrointestinal''': ===
**[[Bronchopneumonia]]
*[[Colitis]], [[ileitis]], and [[spontaneous bacterial peritonitis]].
**[[Empyema]]
**Rare cases have been reported.
**[[Hilar]] and [[Paratracheal lymph nodes|paratracheal lymphadenopathy]]
**[[Interstitial pneumonitis]]
**[[Lung nodule|Lung nodules]]
**[[Pleural effusions]]


* '''Pregnancy''':
=== '''Respiratory tract:''' ===
**[[Spontaneous abortion]]
*[[Bronchopneumonia]]
*[[Empyema]]
*[[Hilar]] and [[Paratracheal lymph nodes|paratracheal lymphadenopathy]]
*[[Interstitial pneumonitis]]
*[[Lung nodule|Lung nodules]]
*[[Pleural effusions]]


*'''Cutaneous''':
=== '''Pregnancy''': ===
**[[Erythema nodosum]]
*[[Spontaneous abortion]]
**[[Nodules]]
**[[Papules]]
**[[Petechiae]]
**[[Purpura]]
**[[Rashes]]
**[[Abscesses]], cutaneous ulcers, and [[suppurative]] [[lymphangitis]]
***Common complication when infection is due to ''B. suis''


*'''Opthalmic''':
=== '''Cutaneous''': ===
**[[Uveitis]]
*[[Erythema nodosum]]
***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>
*[[Nodules]]
*[[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==

Revision as of 22:03, 8 February 2016

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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 Lukac

Overview

If left untreated, patients with brucellosis may progress to develop focal infections, 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. Relapse may occur, and symptoms may continue for years.[1][2][3]

Natural History

  • Incubation period is 2–4 weeks (range, 5 days to 5 months).
  • 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, relapses or chronic brucellosis.[4]

Complications

Osteoarticular:

Cardiovascular:

Hepatobiliary complications:

Genitourinary:

Neurological:

Gastrointestinal:

Respiratory tract:

Pregnancy:

Cutaneous:

Opthalmic:

Prognosis

  • The mortality of the disease in 1909, as recorded in the British Army and Navy stationed in Malta, was 2%.
  • The most frequent cause of death was endocarditis.
    • Recent advances in antibiotics and surgery have been successful in preventing death due to endocarditis.
  • Relapse may occur, and symptoms may continue for years. Brucellosis can come back after a long period of time.[3][1]

Reference

  1. ↑ 1.0 1.1 1.2 Brucellosis. CDC. http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/brucellosis. Accessed on February 3, 2016
  2. ↑ 2.0 2.1 FAO/WHO/OIE Brucellosis in humans and animals. WHO (2006). http://www.who.int/csr/resources/publications/Brucellosis.pdf Accessed on February 3, 2016
  3. ↑ 3.0 3.1 Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on February 1, 2016
  4. ↑ Brucellosis. CDC. http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/brucellosis. Accessed on February 3, 2016
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