Last Updated: 2020-08-12

Author(s): Anzengruber F., Navarini A.

ICD11: 1B95

  • Marston 1861
  • Bruce 1887

  • Brucella melitensis: Malta fever, Mediterranean fever, Febris undulans melitensis, Febris mediterranea,
  • Wave fever, Bruce septicaemia
  • Brucella abortus: Febris undulans bovina
  • Brucella suis (pig brucellosis suis): the main host is the pig

Notifiable infection with Brucella, small gram-negative rod bacteria.

  • Veterinarians, animal keepers and workers in the meat industry are particularly affected
  • Brucella melitensis: Mediterranean, Africa, South America
  • B. abortus: occurs worldwide, especially in warm and tropical areas where cattle breeding is practised
  • B. suis: North America

  • Pathogen
    • In particular Brucella melitensis, B. abortus, B. ovis, B. suis
  • Hosts
    • Brucella melitensis: goats (Malta fever)
    • B. abortus: cattle (M. Bang)
    • B. ovis: Sheep
    • B. suis: pigs ( pig brucellosis)
  • Transmission
    • Through contaminated food (raw milk), smear infection or direct contact with animals (cattle, pigs, goats, sheep), inhalation, transmission from person to person is unusual

  • Incubation period: 2-6 weeks
  • The pathogens nest in the macrophages and in the reticuloendothelial system. Exotoxins then trigger disease symptoms. After the stage of bacteremia with undulating fever, development of granulomatous inflammation, especially in lymph nodes, spleen and liver, and arthritis of the ileosacral, intervertebral and hip joints.

  • Non-specific prodromal stage
  • Stage of bacteremia: Chronic recurrent fever attacks (Febris undulans) often lasting for months. Wavelike temperature rise and fall over 5-7 days
  • Additional symptoms are cephalgias, nausea, vomiting, diarrhoea, hepatosplenomegaly, maculopapular, partly EEM-like exanthema
  • Granuloma formation in multiple organs
  • Skin: ulcerating, ecthymata-like nodules

  • Medical history (contact with animals? drunk raw milk? travel history)
  • Pathogen detection (Bact. smear, blood, sample biopsy)
  • Serological antibody detection

  • With delayed diagnosis and therapy often recurrence and chronic course
  • Recurrence does not automatically mean resistance to antibiotics

If therapy is started early, the chances of recovery are almost 100%, otherwise chronic, years-long progressions can occur.

  1. Metin A, Akdeniz H, Buzgan T , Delice I. Cutaneous findings encountered in brucellosis and review of the literature. International Journal of Dermatology 2001;40:434-8.
  2. Milionis H, Christou L , Elisaf M. Cutaneous Manifestations in Brucellosis: Case Report and Review of the Literature. Infection 2000;28:124-6.
  3. Pappas G, Akritidis N, Bosilkovski M , Tsianos E. Brucellosis. New England Journal of Medicine 2005;352:2325-36.
  4. Solera J, Martinez-Alfaro E , Espinosa A. Recognition and optimum treatment of brucellosis. Drugs 1997;53:245-56.
  5. Pappas G, Papadimitriou P, Christou L , Akritidis N. Future trends in human brucellosis treatment. Expert Opin Investig Drugs 2006;15:1141-9.
  6. Akova M, Uzun O, Akalin HE, Hayran M, Unal S , Gur D. Quinolones in treatment of human brucellosis: comparative trial of ofloxacin-rifampin versus doxycycline-rifampin. Antimicrob Agents Chemother 1993;37:1831-4.
  7. Karabay O, Sencan I, Kayas D , Sahin I. Ofloxacin plus rifampicin versus doxycycline plus rifampicin in the treatment of brucellosis: a randomized clinical trial [ISRCTN11871179]. BMC Infect Dis 2004;4:18.
  8. Falagas ME , Bliziotis IA. Quinolones for treatment of human brucellosis: critical review of the evidence from microbiological and clinical studies. Antimicrob Agents Chemother 2006;50:22-33.
  9. Hasanjani Roushan MR, Mohraz M, Hajiahmadi M, Ramzani A , Valayati AA. Efficacy of gentamicin plus doxycycline versus streptomycin plus doxycycline in the treatment of brucellosis in humans. Clin Infect Dis 2006;42:1075-80.
  10. Ariza J, Bosilkovski M, Cascio A, Colmenero JD, Corbel MJ, Falagas ME et al. Perspectives for the treatment of brucellosis in the 21st century: the Ioannina recommendations. PLoS Med 2007;4:e317.
  11. Solera J, Rodriguez-Zapata M, Geijo P, Largo J, Paulino J, Saez L et al. Doxycycline-rifampin versus doxycycline-streptomycin in treatment of human brucellosis due to Brucella melitensis. The GECMEI Group. Grupo de Estudio de Castilla-la Mancha de Enfermedades Infecciosas. Antimicrob Agents Chemother 1995;39:2061-7.
  12. Solera J, Martinez-Alfaro E , Saez L. [Meta-analysis of the efficacy of the combination of +rifampicin and doxycycline in the treatment of human brucellosis]. Med Clin (Barc) 1994;102:731-8.
  13. Skalsky K, Yahav D, Bishara J, Pitlik S, Leibovici L , Paul M. Treatment of human brucellosis: systematic review and meta-analysis of randomised controlled trials. BMJ 2008;336:701-4.