Signs and Symptoms:
Illness, when manifest, typically presents with fever,
headache, myalgias, arthralgias, back pain, sweats, chills, and generalized
malaise. Other manifestations include depression, mental status changes, and
osteoarticular findings (ie. Sacroiliitis, vertebral osteomyelitis). Fatalities are
Diagnosis requires a high index of suspicion, since many infections
present as non-specific febrile illnesses or are asymptomatic. Laboratory
diagnosis can be made by blood culture with prolonged incubation. Bone
marrow cultures produce a higher yield. Confirmation requires phage-typing,
oxidative metabolism, or genotyping procedures. ELISA, followed by Western
blot are available.
Antibiotic therapy with doxycycline + rifampin or doxycycline in
combination with other medications for six weeks is usually sufficient in most
cases. More prolonged regimens may be required for patients with complications
of meningoencephalitis, endocarditis, or osteomyelitis.
There is no human vaccine available against brucellosis, although
animal vaccines exist. Chemoprophylaxis is not recommended after possible
exposure to endemic disease. Treatment should be considered for high-risk
exposure to the veterinary vaccine, inadvertent laboratory exposure, or confirmed
biological warfare exposure.
Isolation and Decontamination:
Standard precautions are appropriate for
healthcare workers. Person-to-person transmission has been reported via tissue
transplantation and sexual contact. Environmental decontamination can be
accomplished with a 0.5% hypochlorite solution.
[ US Army Medical Research Institute of Infectious Disease; USAMRIID's MEDICAL MANAGEMENT OF BIOLOGICAL CASUALTIES HANDBOOK Fourth Edition February 2001