Brucellosis physical examination

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:

Common physical examination findings which could be observed include:

• Hepatomegaly
• Splenomegaly
• Lymphadenopathy

Examination findings	Brucellosis
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: 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 Decreased breath sounds Bronchial breath sounds Rhonchi Crackles, Rales Increased vocal fremitus
Heart	Heart examination may reveal murmurs on ascultation(endocarditis)
Abdomen	Abdominal examination may elicit: Tenderness Hepatomegaly* Splenomegaly* Lymphadenopathy*
Back	Back examination is usually normal
Genitourinary	Genitourinary examination may reveal: 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, ankles and wrists may reveal: Fluid around a joint Warm, red, tender joints Difficulty moving a joint (called "limited range of motion") May be present in peripheral arthritis palpation of sacroiliac joints may reveal pain indicating sacroiliitis Positive Schober's test(indicative of spondylitis)
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 neuropathies involving individual pheripheral nerve or cranial nerve can be ilicited
* commonly observed