Brucellosis (Undulant Fever, Bangs Disease, Malta Fever)

Definition

Brucellosis is a rare bacterial disease that causes intermittent fevers. Brucellosis is primarily passed among animals, but people can acquire this disease from domesticated animals. It results in flu-like symptoms, and may cause long-lasting symptoms. There are only about 100 to 200 cases of brucellosis in humans in the US each year.

Causes

Brucellosis is caused by the bacterium Brucella. This bacterium infects domesticated animals. It can be spread to humans through:

  • Drinking unpasteurized milk
  • Eating dairy foods from infected cows, sheep, or goats
  • Having direct contact with the secretions, excretions, or carcasses of infected animals
  • Inhaling the bacteria
  • Breastfeeding (passed from mother to infant)
  • Sexual transmission
  • Tissue transplantation

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for brucellosis include:

  • Eating or drinking unpasteurized dairy foods, especially when traveling
  • Working with domesticated animals and livestock, especially sheep, goats, cattle, deer, elk, and pigs, or their excretions, secretions, or carcasses
  • Sex: male (possibly due to occupational exposure among farmers, ranchers, veterinarians, people working in tanneries, and slaughterhouse workers)

Symptoms Symptoms of brucellosis usually appear within two weeks of infection. Symptoms can appear from five days to several months after infection. In early stage, symptoms may include: Malaise Lethargy Headache Muscle pain Fever Chills Severe headache and backache Nausea, vomiting, and diarrhea As it progresses, brucellosis causes a severe fever (104 F to 105 F). This fever occurs in the evening along with severe sweating. It becomes normal or near normal in the morning, and usually begins again at night. This intermittent fever usually lasts 1 to 5 weeks, after which symptoms usually subside or disappear for two days to two weeks. Then the fever recurs. In some patients, this fever recurs only once. In others, the disease becomes chronic, and the fever recurs, subsides, and then recurs again repeatedly over months or years. In later stages, brucellosis can cause: Loss of appetite Weight loss Abdominal pains Headache Backache Joint pain Weakness Irritability Insomnia Patients usually recover within 2 to 5 weeks. Rarely, complications can develop. These may include: Abscesses within the liver or spleen Enlargement of the liver, spleen, or lymph nodes Inflammation and infection of organs in the body, such as: Heart ( endocarditis ) Brain and brain lining( meningitis ) Bones ( osteomyelitis ), especially the spine Endocarditis 2008 Nucleus Medical Art, Inc.
Brucellosis is also believed to cause a high rate of miscarriage during early pregnancy in infected women. Diagnosis Your doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include the following: Blood, urine, bone marrow, or tissue teststo look for Brucella bacteria Blood testto look for antibodies against the bacteria Imaging tests ( x-ray , CT scan , MRI scan )to reveal abscesses, calcifications, or enlargement of the liver, spleen, or vertebrae Treatment Many patients recover from brucellosis on their own. However, early diagnosis and treatment can reduce the risk of complications and infection. Talk with your doctor about the best treatment plan for you. Treatment options include: Antibiotics Your doctor may prescribe one or more antibiotics (usually doxycycline and rifampin) to control and prevent relapses of brucellosis. Antibiotics are given for up to six weeks. Prevention To help reduce your chances of getting brucellosis, take the following steps: Avoid eating or drinking unpasteurized milk and dairy foods. If you are unsure if a dairy product is pasteurized, dont eat it. Wear rubber gloves and goggles, and securely cover open wounds when handling domesticated animals including their secretions, excretions, or carcasses. Wear a protective mask when dealing with brucellosis cultures in the laboratory. Have cattle and bison that live in areas heavily infected with brucellosis vaccinated by an accredited veterinarian or government health official (the vaccine contains a live virus and is dangerous to humans). For best results, calves should be vaccinated when they are 4-6 months old. There is no brucellosis vaccine for humans as of yet. RESOURCES:
Centers for Disease Control and Prevention http://www.cdc.gov National Foundation for Infectious Diseases http://www.nfid.org United States Department of Agriculture http://www.usda.gov CANADIAN RESOURCES: Communicable Disease Control Unit http://www.gov.mb.ca/health/publichealth/cdc/index.html Public Health Agency of Canada http://www.phac-aspc.gc.ca References: Brucellosis. Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/brucellosis_g.htm#top . Accessed February 14, 2007. Brucellosis. Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/brucellosis_g.html . Accessed November 11, 2005. Facts about brucellosis. US Department of Agriculture website. Available at: http://www.aphis.usda.gov/vs/nahps/brucellosis/ . Accessed Accessed February 14, 2007. Facts about brucellosis. US Department of Agriculture website. Available at: http://www.aphis.usda.gov/vs/nahps/brucellosis/ . Accessed November 11, 2005. The Merck Manual of Medical Information . Simon and Schuster, Inc.; 2000.
Last reviewed February 2008 by David L. Horn, MD, FACP Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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