Brucellosis natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2] Danitza Lukac Vishal Devarkonda, M.B.B.S [3]

Overview

If left untreated, patients with brucellosis may progress to develop focal organ complications, relapses or chronic brucellosis.^[1] Common complications of brucellosis include granulomatous hepatitis, arthritis, sacroiliitis, meningitis, orchitis, epididymitis uveitis, and endocarditis. The prognosis of brucellosis is good with adequate treatment.

Natural History

If left untreated, patients with brucellosis may progress to develop focal organ involvement, relapses and chronic brucellosis.^[2]

Complications

Complications of brucellosis include the following:^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]^[11]

Complications of Brucellosis
Osteoarticular	Most frequent complications Occur in approximately 40% of cases. Sacroiliitis Most common complication Bursitis Peripheral arthritis Osteomyelitis Tenosynovitis Spondylitis
Cardiovascular	Infective endocarditis Common cardiovascular complication Frequent cause of death It has been reported in approximately 2% of cases The aortic valve is more commonly affected than the mitral valve Valve replacement surgery is usually needed apart from the medical therapy Aneurysm of sinus of valsalva Common complication when infection is due to B.suis
Hepatobiliary complications	Granulomatous hepatitis Due to B. abortus Post-necrotic cirrhosis Very rare Chronic suppurative lesions and hepatic abscesses Due to B. suis
Genitourinary	Orchitis and epididymitis Frequent genitourinary complications within men
Neurological	Meningitis or meningoencephalitis Most common frequent complications of neurobrucellosis Brain and epidural abscess Cerebellar ataxia Cerebral vasculitis Guillain-Barré syndrome Haemorrhage Mycotic aneurysm Stroke Neuropathy/radiculopathy Poliomyelitis-like syndrome
Gastrointestinal	Colitis, ileitis, and spontaneous bacterial peritonitis. Rare cases have been reported.
Respiratory tract	Bronchopneumonia Empyema Hilar and paratracheal lymphadenopathy Interstitial pneumonitis Lung nodules Pleural effusions
Pregnancy	Spontaneous abortion
Cutaneous	Erythema nodosum Nodules Papules Petechiae Purpura Rashes Abscesses, cutaneous ulcers, and suppurative lymphangitis Common complication when infection is due to B. suis
Opthalmic	Uveitis Most frequent ophtalmic complications^[12]

Prognosis

The prognosis of brucellosis is good with treatment. Mortality is less then 1%, usually due to consequence of cardiac involvement or severe neurologic disease.^[13]

Reference

↑ Brucellosis. CDC. http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/brucellosis. Accessed on February 3, 2016
↑ Brucellosis. CDC. http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/brucellosis. Accessed on February 3, 2016
↑ Colmenero JD, Reguera JM, Martos F, Sánchez-De-Mora D, Delgado M, Causse M; et al. (1996). “Complications associated with Brucella melitensis infection: a study of 530 cases”. Medicine (Baltimore). 75 (4): 195–211. PMID 8699960.
↑ Mantur BG, Amarnath SK, Shinde RS (2007). “Review of clinical and laboratory features of human brucellosis”. Indian J Med Microbiol. 25 (3): 188–202. PMID 17901634.
↑ Overturf ML, Druihet RE, Fitz A (1979). “The effects of kallikrein, plasmin, and thrombin on hog kidney renin”. J Biol Chem. 254 (23): 12078–83. PMID 159304.
↑ Doganay M, Aygen B. Human brucellosis: An overview. Int J Infect Dis 2003; 7:173.
↑ Young EJ (1995). “Brucellosis: current epidemiology, diagnosis, and management”. Curr Clin Top Infect Dis. 15: 115–28. PMID 7546364.
↑ Zamani A, Kooraki S, Mohazab RA, Zamani N, Matloob R, Hayatbakhsh MR; et al. (2011). “Epidemiological and clinical features of Brucella arthritis in 24 children”. Ann Saudi Med. 31 (3): 270–3. doi:10.4103/0256-4947.81543. PMC 3119967. PMID 21623056.
↑ Mousa AM, Bahar RH, Araj GF, Koshy TS, Muhtaseb SA, al-Mudallal DS; et al. (1990). “Neurological complications of brucella spondylitis”. Acta Neurol Scand. 81 (1): 16–23. PMID 2330811.
↑ Pappas G, Bosilkovski M, Akritidis N, Mastora M, Krteva L, Tsianos E (2003). “Brucellosis and the respiratory system”. Clin Infect Dis. 37 (7): e95–9. doi:10.1086/378125. PMID 13130417.
↑ Herrick JA, Lederman RJ, Sullivan B, Powers JH, Palmore TN (2014). “Brucella arteritis: clinical manifestations, treatment, and prognosis”. Lancet Infect Dis. 14 (6): 520–6. doi:10.1016/S1473-3099(13)70270-6. PMC 4498663. PMID 24480149.
↑ FAO/WHO/OIE Brucellosis in humans and animals. WHO (2006). http://www.who.int/csr/resources/publications/Brucellosis.pdf Accessed on February 3, 2016
↑ Brucellosis “Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo”Harrison’s Principles of Internal Medicine, 19e Accessed on December 9th, 2017

[f-1] Brucellosis. CDC. http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/brucellosis. Accessed on February 3, 2016

[d-2] Brucellosis. CDC. http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/brucellosis. Accessed on February 3, 2016

[pmid8699960-3] Colmenero JD, Reguera JM, Martos F, Sánchez-De-Mora D, Delgado M, Causse M; et al. (1996). “Complications associated with Brucella melitensis infection: a study of 530 cases”. Medicine (Baltimore). 75 (4): 195–211. PMID 8699960.

[pmid17901634-4] Mantur BG, Amarnath SK, Shinde RS (2007). “Review of clinical and laboratory features of human brucellosis”. Indian J Med Microbiol. 25 (3): 188–202. PMID 17901634.

[pmid159304-5] Overturf ML, Druihet RE, Fitz A (1979). “The effects of kallikrein, plasmin, and thrombin on hog kidney renin”. J Biol Chem. 254 (23): 12078–83. PMID 159304.

[6] Doganay M, Aygen B. Human brucellosis: An overview. Int J Infect Dis 2003; 7:173.

[pmid7546364-7] Young EJ (1995). “Brucellosis: current epidemiology, diagnosis, and management”. Curr Clin Top Infect Dis. 15: 115–28. PMID 7546364.

[pmid21623056-8] Zamani A, Kooraki S, Mohazab RA, Zamani N, Matloob R, Hayatbakhsh MR; et al. (2011). “Epidemiological and clinical features of Brucella arthritis in 24 children”. Ann Saudi Med. 31 (3): 270–3. doi:10.4103/0256-4947.81543. PMC 3119967. PMID 21623056.

[pmid2330811-9] Mousa AM, Bahar RH, Araj GF, Koshy TS, Muhtaseb SA, al-Mudallal DS; et al. (1990). “Neurological complications of brucella spondylitis”. Acta Neurol Scand. 81 (1): 16–23. PMID 2330811.

[pmid13130417-10] Pappas G, Bosilkovski M, Akritidis N, Mastora M, Krteva L, Tsianos E (2003). “Brucellosis and the respiratory system”. Clin Infect Dis. 37 (7): e95–9. doi:10.1086/378125. PMID 13130417.

[pmid24480149-11] Herrick JA, Lederman RJ, Sullivan B, Powers JH, Palmore TN (2014). “Brucella arteritis: clinical manifestations, treatment, and prognosis”. Lancet Infect Dis. 14 (6): 520–6. doi:10.1016/S1473-3099(13)70270-6. PMC 4498663. PMID 24480149.

[abc-12] FAO/WHO/OIE Brucellosis in humans and animals. WHO (2006). http://www.who.int/csr/resources/publications/Brucellosis.pdf Accessed on February 3, 2016

[13] Brucellosis “Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo”Harrison’s Principles of Internal Medicine, 19e Accessed on December 9th, 2017

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