CBRNE - Brucellosis Treatment & Management

  • Author: Gerald E Maloney Jr, DO, FAAEM; Chief Editor: Robert G Darling, MD, FACEP   more...
 
Updated: Apr 29, 2009
 

Prehospital Care

Prehospital care for brucellosis is supportive.

  • As the symptoms generally are vague and presentation rarely life threatening, emergency medical service (EMS) care should focus on stabilization, as needed, and transport.
  • If a proximate bioterrorist attack is known or strongly suggested at the time of patient contact, appropriately decontaminate the patient. In the event of a covert undiscovered attack, patients may become symptomatic well after the time that decontamination is necessary.
  • As in the care of any patient with a potentially transmissible disease, use appropriate precautions (eg, gloves, mask, gown).
  • If the patient presents as part of a known, immediately proximate bioterrorism incident, EMS providers should notify the hospital to undertake appropriate decontamination and isolation measures.
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Emergency Department Care

Given the nonspecific patient complaints, a diagnosis of brucellosis is unlikely in the ED. With an appropriate history, an astute clinician may suspect it.

  • Respiratory isolation usually is not necessary, as long as close contact with the respiratory tract is not made. Wear masks for intubation, suctioning, or other maneuvers that may expose the caregiver to a large concentration of aerosolized particles.
  • The appropriate antibiotic therapy for brucellosis is combination therapy with doxycycline and rifampin or streptomycin. If brucellosis is strongly suggested, consult a specialist to determine the proper antibiotic regimen. There is some evidence of growing resistance to rifampin in some areas, though ciprofloxacin and aminoglycosides maintain good coverage.
  • Provide supportive care for any specific symptoms and obtain appropriate tests targeted to affected organ systems as determined by history and physical.
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Consultations

  • The primary specialist to consult is an infectious disease specialist. Determine proper serologic tests, cultures, further diagnostic evaluations, and the correct antibiotic therapy in conjunction with the infectious disease specialist.
  • Depending on the degree of damage to individual organ systems, contact the appropriate specialist (eg, cardiology for endocarditis).
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Contributor Information and Disclosures
Author

Gerald E Maloney Jr, DO, FAAEM  Senior Instructor, Department of Emergency Medicine, Case Western Reserve University School of Medicine; Director of Medical Toxicology, Department of Emergency Medicine; Associate Medical Director, MetroLifeFlight, MetroHealth Medical Center, Cleveland, OH

Gerald E Maloney Jr, DO, FAAEM is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, American College of Osteopathic Emergency Physicians, American Osteopathic Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Jerry L Mothershead, MD  Medical Readiness Consultant, Medical Readiness and Response Group, Battelle Memorial Institute; Advisor, Technical Advisory Committee, Emergency Management Strategic Healthcare Group, Veteran's Health Administration; Adjunct Associate Professor, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences

Jerry L Mothershead, MD is a member of the following medical societies: American College of Emergency Physicians and National Association of EMS Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Rick Kulkarni, MD  Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert G Darling, MD, FACEP  Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Associate Director, Center for Disaster and Humanitarian Assistance Medicine

Robert G Darling, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

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