Brucellosis (cont.)

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How is brucellosis diagnosed?

Making the diagnosis of brucellosis can sometimes be difficult because of the similar symptoms and signs shared with other febrile illnesses. An accurate history obtained by your health-care provider (including travel history, occupation, animal exposure, etc.) may be very helpful in raising the suspicion of brucellosis as a possible diagnosis.

In general, blood tests and blood/tissue cultures are necessary for making the diagnosis of brucellosis. Common blood tests used to make the diagnosis include testing for antibodies against the bacteria and isolating the organism from blood cultures. A biopsy of body tissue (from the bone marrow or the liver, for example) can also assist in making the diagnosis. Additional blood tests may demonstrate anemia, low platelets, a low white blood cell count, and elevated liver function tests.

Other imaging studies and procedures may also be performed initially depending on the individual's signs and symptoms. These tests may include CT scan, MRI, X-ray, ultrasound, lumbar puncture (spinal tap), joint aspiration, or an electrocardiogram (ECG).

What is the treatment for brucellosis?

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The cornerstone of treatment for brucellosis is antibiotics. Because of the high relapse rate associated with the disease, the use of a multidrug (two or more) antibiotic regimen is recommended. The antimicrobials most commonly used include doxycycline (Vibramycin), streptomycin, rifampin (Rifadin), gentamicin (Garamycin), and trimethoprim-sulfamethoxazole (Bactrim, Septra). The combination of antibiotics used will vary based on disease severity, age and pregnancy.

In general, a full six-week course of antibiotics is recommended, and prompt treatment can lead to an improvement in symptoms and may also prevent the complications associated with brucellosis. However, relapse rates of the disease are still about 5%-10%, even with treatment. Depending on the severity of illness, the associated complications (if any) and the timing of treatment, recovery may take from a few weeks to a few months.

Rarely, surgical intervention may be needed for certain complications associated with brucellosis, such as abscess formation or heart-valve infection. Your health-care provider may need to consult other physicians, including surgeons, infectious disease specialists, or a neurologist.

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