Brucellosis

Brucellosis is a zoonosis caused by several species of Brucella, which have differing but overlapping primary animal hosts worldwide. The geographic range of human infections is increasing, to include countries in Asia and South Asia and with greater recent recognition in East and sub-Saharan Africa. In endemic settings the illness mostly affects rural pastoralists with inadequate access to healthcare and preventive education. Symptoms are protean and typically include prolonged fever and malaise, with musculoskeletal involvement in up to half of all cases. Among a variety of organ localisations, endocarditis and focal brain infections are uncommon but account for most of the low mortality. Confirmation of diagnosis requires correct use of a variety of serological and culture methods that can be time-consuming and may not be available in endemic settings. Tuberculosis is the most important differential diagnosis when deciding on antimicrobial treatment, which should continue for at least 6 weeks and include at least 2 drugs from differing antimicrobial classes to prevent relapse. Brucellosis causes significant human morbidity as well as economic loss. Prevention relies on control of animal disease and reduction of risk activities such as consumption of unpasteurised milk products. This requires prolonged commitment of resources to “one-health” control programmes at national and international levels.