Brucellosis natural history, complications and prognosis

Brucellosis Microchapters
Home
Patient Information
Overview
Historical Perspective
Pathophysiology
Causes
Differentiating Brucellosis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Principles of diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
X-Ray
CT Scan
MRI
Other Diagnostic Studies
Treatment
Medical Therapy
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Brucellosis natural history, complications and prognosis On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Brucellosis natural history, complications and prognosis All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Brucellosis natural history, complications and prognosis
CDC on Brucellosis natural history, complications and prognosis
Brucellosis natural history, complications and prognosis in the news
Blogs on Brucellosis natural history, complications and prognosis
Directions to Hospitals Treating Brucellosis
Risk calculators and risk factors for Brucellosis natural history, complications and prognosis

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 adequate treatment. Relapse may occur, and symptoms may continue for years.

Natural History

• Brucellosis 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

Complications of Brucellosis
Osteoarticular	Most frequent complications Occur in approximately 40% of cases. Sacroiliitis Most common complication 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 prognosis of brucellosis is good with treatment. Without treatment, brucellosis will result in fever of an undulating pattern that persists for weeks before the commencement of an afebrile period that may be followed by relapse. Brucellosis is associated with less than 1% mortality, usually a consequence of cardiac involvement or severe neurologic disease. General well-being and the body weight of the patient are useful guide to estimating the prognosis or chance of relapse.