Brucellosis natural history, complications and prognosis

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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. Common complications of brucellosis include granulomatous hepatitis, arthritis, sacroiliitis, meningitis, orchitis, epididymitis uveitis, and endocarditis. The prognosis of brucellosis is good with treatment. Relapse may occur, and symptoms may continue for years.

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.

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:
  • Infective endocarditis
    • Common cardiovascular complication
    • Frequent cause of death
    • It has been reported in approximately 2% of cases
    • The aortic valve is more commonly affected than the mitral valve
    • 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

• Hepatobiliary complications:
  • Granulomatous hepatitis
    • Due to B. abortus
  • Post-necrotic cirrhosis
    • Very rare
  • Chronic suppurative lesions and hepatic abscesses
    • Due to B. suis

• Genitourinary:
  • Orchitis and epididymitis
    • Frequent genitourinary complications within men

• Neurological:
  • Meningitis or meningoencephalitis
    • Most common frequent complications of neurobrucellosis
  • Brain and epidural abscess
  • Cerebellar ataxia
  • Cerebral vasculitis
  • Guillain-Barré syndrome
  • Haemorrhage
  • Mycotic aneurysm
  • Stroke
  • Neuropathy/radiculopathy
  • Poliomyelitis-like syndrome

• Gastrointestinal:
  • Colitis, ileitis, and spontaneous bacterial peritonitis.
    • Rare cases have been reported.

• Respiratory tract:
  • Bronchopneumonia
  • Empyema
  • Hilar and paratracheal lymphadenopathy
  • Interstitial pneumonitis
  • Lung nodules
  • Pleural effusions

• Pregnancy:
  • Spontaneous abortion

• Cutaneous:
  • Erythema nodosum
  • 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

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. As with tuberculosis, the illness can come back after a long period of time.