Synopsis
Distinguish two livestock-associated zoonoses, protect laboratory staff, identify focal infection and pregnancy risk, and use organism-specific testing, combination treatment and public-health escalation.
- Brucellosis follows unpasteurised dairy, livestock birthing products, abattoir or laboratory exposure, or contact with infected imported dogs, particularly Brucella canis.
- Brucellosis commonly causes prolonged or undulating fever, drenching sweats, fatigue, weight loss, arthralgia and hepatosplenomegaly; bone, neurological and cardiac foci must be sought.
- Before blood cultures, warn the laboratory that Brucella is suspected; request reference serology and PCR with species-specific exposure details.
Key red flags
A new murmur, heart failure, embolic signs or persistently raised inflammatory markers suggests Brucella endocarditis or persistent focal Q fever.
Sacroiliitis, spondylodiscitis, peripheral arthritis, epididymo-orchitis, hepatosplenic lesions, neuroinfection and endocarditis explain localising symptoms or relapse.
Investigation priorities
Separate Brucella from Q fever and identify persistent-infection risk before selecting tests.
Management branches
Prolonged fever follows unpasteurised dairy, livestock, abattoir, laboratory or infected-dog exposure.
- Record species, product, country, dates and occupational contacts, then examine joints, spine, liver, spleen, testes, nervous system and heart.
- Telephone microbiology before culture processing, obtain multiple blood cultures and send reference serology and PCR as advised.
Key medicines
Doxycycline plus rifampicinGive doxycycline 100 mg orally twice daily plus rifampicin 600 to 900 mg orally once daily for six weeks for uncomplicated adult brucellosis under specialist supervision.
Aminoglycoside-containing brucellosis regimenUse gentamicin or streptomycin at weight- and renal-function-adjusted specialist doses alongside doxycycline-based therapy for selected endocarditis, neurobrucellosis, spondylodiscitis or severe disease.