eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Brucellosis: Follow-up

Author: Nicholas John Bennett, MBBCh, PhD, Staff Physician, Department of Pediatrics, State University of New York Upstate Medical University
Coauthor(s): Joseph Domachowske, MD, Associate Professor, Department of Pediatrics, Division of Infectious Diseases, State University of New York-Upstate Medical University; Walid Abuhammour, MD, FAAP, Associate Professor of Pediatrics, Michigan State University; Director of Pediatric Infectious Disease, Department of Pediatrics, Hurley Medical Center; Khaled Nashar, MD, Instructor of Clinical Internal Medicine, Section of Hospitalist Medicine, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh Medical Center
Contributor Information and Disclosures

Updated: Jan 25, 2008

Follow-up

Further Outpatient Care

  • Further outpatient care is essential in brucellosis to enhance patient compliance in taking the medicine and to ensure that response to treatment is good and antibody titers are decreasing.
  • Continue outpatient care until the infection is cured and laboratory findings return to reference ranges.

Deterrence/Prevention

  • Prevention of brucellosis in humans depends on eradication or control of the disease in animals. Pasteurization of milk and diary products for human consumption is an important element of disease prevention in children. In endemic areas, immunization, surveillance, and testing are needed in all animals. Public awareness and education play major roles in prevention of the disease.
  • Live attenuated vaccine strains are available for B abortus and B melitensis11 but can cause infection in humans and are not recommended.

Complications

  • Arthritis12 and osteomyelitis
  • Meningoencephalitis, myelitis, and cranial neuropathy
  • Hepatic abscesses and peritonitis
  • Epididymoorchitis
  • Infective endocarditis, pericarditis, and myocarditis
  • Pneumonia and empyema
  • Aneurysms of the aorta and cerebral vessels
  • Uveitis

Prognosis

  • Complete recovery after specific therapy is by far the most common outcome in patients with brucellosis; however, some patients may have relapse with recurrence of symptoms.
  • In the vast majority of patients, relapse is not the result of emergence of antibiotic resistance; therefore, careful long-term follow-up monitoring is recommended.
  • The case-fatality rate in patients who go untreated is approximately 3%.

Patient Education

Education should address the following issues:

  • The nature of the disease, routes of transmission, and preventive measures
  • Symptoms, complications, and relapse of the disease if the patient does not receive adequate treatment
  • The importance of taking the medications as prescribed, completing the full course of treatment, and scheduling outpatient visits
  • Potential adverse effects of the medications

Miscellaneous

Medicolegal Pitfalls

  • Signs and symptoms of brucellosis can be nonspecific and can mimic many other diseases; therefore, meticulous attention is needed in making the diagnosis and in treating patients.
  • Advise laboratory personnel to maintain cultures for at least 4 weeks, otherwise, negative results are reported.
  • Repeated serologic testing is recommended if the initial titer is low.
  • False-negative results can result from sera with high titers; therefore, dilution is recommended if the clinical index of suspicion is high.
  • Use of a combination of antibiotics, a prolonged treatment course, and follow-up care are recommended.
 


More on Brucellosis

Overview: Brucellosis
Differential Diagnoses & Workup: Brucellosis
Treatment & Medication: Brucellosis
Follow-up: Brucellosis
References
[ CLOSE WINDOW ]

References

  1. Doyle TJ, Bryan RT. Infectious disease morbidity in the US region bordering Mexico, 1990-1998. J Infect Dis. Nov 2000;182(5):1503-10. [Medline].

  2. Pappas G, Papadimitriou P, Akritidis N, Christou L, Tsianos EV. The new global map of human brucellosis. Lancet Infect Dis. Feb 2006;6(2):91-9. [Medline]. [Full Text].

  3. Shakir RA. Neurobrucellosis. Postgrad Med J. Dec 1986;62(734):1077-9. [Medline].

  4. Tena D, Gonzalez-Praetorius A, Lopez-Alonso A, et al. Acute meningitis due to Brucella spp. Eur J Pediatr. May 12 2006;[Medline].

  5. al-Eissa YA, Kambal AM, al-Nasser MN, et al. Childhood brucellosis: a study of 102 cases. Pediatr Infect Dis J. Feb 1990;9(2):74-9. [Medline].

  6. Sharda DC, Lubani M. A study of brucellosis in childhood. Clin Pediatr (Phila). Oct 1986;25(10):492-5. [Medline].

  7. Mitka S, Anetakis C, Souliou E, Diza E, Kansouzidou A. Evaluation of different PCR assays for early detection of acute and relapsing brucellosis in humans in comparison with conventional methods. J Clin Microbiol. Apr 2007;45(4):1211-8. [Medline].

  8. Young EJ, Tarry A, Genta RM, et al. Thrombocytopenic purpura associated with brucellosis: report of 2 cases and literature review. Clin Infect Dis. Oct 2000;31(4):904-9. [Medline].

  9. Lubani MM, Dudin KI, Sharda DC, et al. A multicenter therapeutic study of 1100 children with brucellosis. Pediatr Infect Dis J. Feb 1989;8(2):75-8. [Medline].

  10. Roushan MR, Mohraz M, Janmohammadi N, Hajiahmadi M. Efficacy of cotrimoxazole and rifampin for 6 or 8 weeks of therapy in childhood brucellosis. Pediatr Infect Dis J. Jun 2006;25(6):544-5. [Medline].

  11. Corbel MJ. Vaccines against bacterial zoonoses. J Med Microbiol. Apr 1997;46(4):267-9. [Medline].

  12. Lubani M, Sharda D, Helin I. Brucella arthritis in children. Infection. Sep-Oct 1986;14(5):233-6. [Medline].

  13. al-Eissa YA, al-Mofada SM. Congenital brucellosis. Pediatr Infect Dis J. Aug 1992;11(8):667-71. [Medline].

  14. Committee on Infectious Diseases. Brucellosis. In: Red Book. 27th Ed. 2006:235-237.

  15. Schultze GE, Jacobs RF. Brucella. In: Behrman RE, Kliegman R, Jenson HB, eds. Nelson Textbook of Pediatrics. 16th ed. Philadelphia, Pa: WB Saunders; 2000:868-9.

  16. Trifiletti RR, Restivo DA, Pavone P, et al. Diabetes insipidus in neurobrucellosis. Clin Neurol Neurosurg. Sep 2000;102(3):163-5. [Medline].

  17. Young EJ. An overview of human brucellosis. Clin Infect Dis. Aug 1995;21(2):283-9; quiz 290. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

brucellosis, Brucella abortus, Brucella melitensis, Brucella suis, Brucella canis, Brucella infection, zoonosis, Mediterranean fever, Malta fever, gastric remittent fever, undulant fever, sarcoidosis, endocarditis, sacroiliitis, epididymoorchitis, meningitis, papilledema, optic neuropathy, radiculopathy, stroke, intracranial hemorrhage, neurobrucellosis, hepatic abscess, splenic abscess, thyroid abscess, epidural abscess, pneumonitis, pleural empyema, uveitis, peritonitis, food-borne brucellosis, failure to thrive, chronic fatigue syndrome, hepatosplenomegaly, lymphadenopathy, arthritis, osteomyelitis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Nicholas John Bennett, MBBCh, PhD, Staff Physician, Department of Pediatrics, State University of New York Upstate Medical University
Nicholas John Bennett, MBBCh, PhD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Coauthor(s)

Joseph Domachowske, MD, Associate Professor, Department of Pediatrics, Division of Infectious Diseases, State University of New York-Upstate Medical University
Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Walid Abuhammour, MD, FAAP, Associate Professor of Pediatrics, Michigan State University; Director of Pediatric Infectious Disease, Department of Pediatrics, Hurley Medical Center
Walid Abuhammour, MD, FAAP is a member of the following medical societies: American Medical Association and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Khaled Nashar, MD, Instructor of Clinical Internal Medicine, Section of Hospitalist Medicine, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh Medical Center
Khaled Nashar, MD is a member of the following medical societies: American College of Physicians, American Medical Association, and American Society of Hypertension
Disclosure: Nothing to disclose.

Medical Editor

Itzhak Brook, MD, MSc, Professor, Department of Pediatrics, Georgetown University School of Medicine
Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Ear, Nose and Throat Advances in Children, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, and Surgical Infection Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Mark R Schleiss, MD, American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota School of Medicine
Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Professor and Vice Chairman, Department of Pediatrics, Head, Division of Infectious Diseases, Louisiana State University Health Sciences Center
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.