Brucellosis physical examination

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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

Patients with brucellosis are usually well-appearing. Common physical examination findings include hepatomegaly, splenomegaly, and lymphadenopathy.

Physical Examination

• • {| class="wikitable" !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) Oxygen saturation- usually normal but some cases may have low oxygen saturation(lung involvement). Blood glucose level- normal |- |Skin |Skin examination may reveal the following: Maculppapular rash Erythema nodosum like eruptions and ulceration abscesses |- |HEENT |Usually Normal |- |Neck |Cervical lymphadenopathy may be present |- |Lungs |Lung involvement 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 pheripheral and cranial nerve neuropathies can be ilicited |}