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Media Gallery

Well-formed hepatic granuloma from patient with brucellosis.
Brucella species are poorly staining, small gram-negative coccobacilli (0.5-0.7 × 0.6-1.5 µm) and are seen mostly as single cells with an appearance resembling "fine sand."

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Table 1. Currently Recognized Brucella Species ^[3]

Organism	Animal Reservoir	Geographic Distribution
Brucella melitensis	Goats, sheep, camels	Mediterranean, Asia, Latin America, parts of Africa and some southern European countries
Brucella abortus	Cows, buffalo, camels, yaks	Worldwide
Brucella suis	Pigs (biotype 1-3)	South America, Southeast Asia, United States
Brucella canis	Canines	Cosmopolitan
Brucella ovis	Sheep	No known human cases
Brucella neotomae	Rodents	Not known to cause human disease
Brucella pinnipediae and Brucella cetaceae	Marine animals, minke whales, dolphins, seals	Case reports describing some human cases (mainly neurobrucellosis)
Brucella inopinata	unknown	Case report of human infection of a breast implant
Brucella microti	Voles	South Moravia, Czech Republic
Brucella papionis	Baboons	Tanzania
Brucella vulpis	Foxes	Austria

Table 2. Symptoms and Signs of Brucellosis

Study	No. of Patients	Fever or Chills	Arthralgia or Arthritis	Sweating	Constitutional symptoms^*	Hepatomegaly	Splenomegaly
Memish et al (2000)^[16]	160	146 (91.3%)	105 (65.6%)	30 (18.8%)	70 (43.8%)	9 (5.6%)	11 (6.9%)
Kokoglu et al (2006)^[17]	138	108 (78.3%)	107 (77.5%)	100 (72.5%)	98 (71%)	37 (26.8%)	50 (36.2%)
Mantur et al (2006)^[18]	495	417 (84.2%)	117 (23.6%)	19 (3.8%)	6 (1.2%)	56 (11.3%)	95 (19.2%)
Ruiz-Mesa et al (2005)^[19]	711	702 (98.7%)	353 (49.6%)	597 (84%)	533 (75%)	250 (35.2%)	148 (20.8%)
Barroso Garcia et al (2002)^[20]	565	441 (78.1%)	248 (43.9%)	483 (85.5%)	472 (83.5%)	422 (74.7%)	152 (26.9%)
Hasanjani Roushan et al (2004)^[21]	469	314 (67%)	252 (53.7%)	357 (76.1%)	...	...	27 (5.8%)
Pappas et al (2005)^[22]	100	91 (91%)	44 (44%)	..	26 (26%)	7 (7%)	16 (16%)
Troy et al (2005)^[23]	28	25 (89%)	15 (54%)	..	13 (46%)	8 (29%)	5 (18%)
Andriopoulos et al (2007)^[24]	144	144 (100%)	125 (86.8%)	138 (95.8%)	140 (97.2%)	...	74 (51.4%)
Giannakopoulos et al (2006)^[25]	52	42 (81%)	43 (83%)	8 (15%)	7 (13%)	...	...
Mantur et al (2004)^[26]	93	49 (53%)	19 (20%)	...	...	...	...
Tsolia et al (2002)^[27]	39	27 (69%)	27 (69%)	8 (21%)	13 (33%)	11 (28%)	15 (38%)
^* Anorexia, asthenia, fatigue, weakness, malaise.

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Author

Nicholas John Bennett, MBBCh, PhD, FAAP, MA(Cantab) Assistant Professor of Pediatrics, Co-Director of Antimicrobial Stewardship, Medical Director, Division of Pediatric Infectious Diseases and Immunology, Connecticut Children's Medical Center

Nicholas John Bennett, MBBCh, PhD, FAAP, MA(Cantab) is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics

Disclosure: Received research grant from: Cubist<br/>Received income in an amount equal to or greater than $250 from: Horizon Pharmaceuticals, Shire<br/>Medico legal consulting for: Various.

Coauthor(s)

Michelle V Lisgaris, MD Assistant Professor of Medicine, Case Western Reserve University School of Medicine

Michelle V Lisgaris, MD is a member of the following medical societies: American College of Physicians, American Medical Association, Infectious Diseases Society of America, Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Robert A Salata, MD, FACP, FIDSA STERIS Chair of Excellence in Medicine, Professor and Chairman, Department of Medicine, Case Western Reserve University School of Medicine; Physician-in-Chief, Master Clinician in Infectious Diseases, University Hospitals Cleveland Medical Center

Robert A Salata, MD, FACP, FIDSA is a member of the following medical societies: American Association of Immunologists, American Federation for Medical Research, American Medical Association, Central Society for Clinical and Translational Research, Infectious Diseases Society of America, Ohio State Medical Association, Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Wafa Al-Nassir, MBBS Infectious Diseases Consultant, National Guard Health Affairs, Saudi Arabia

Wafa Al-Nassir, MBBS is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgements

Walid Abuhammour, MD, FAAP Professor of Pediatrics, Michigan State University College of Medicine; 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, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society