Brucellosis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Brucellosis is one of the world's most common zoonoses, particularly in poor rural settings. Most cases in northern Europe and North America are acquired overseas and/or from consuming unpasteurized milk or milk products.
Rarely fatal, but relapse can occur with debilitating and economically devastating effects. It is considered a bioterrorism agent, is easily spread by aerosol, and is a significant hazard in microbiology laboratories.
Can affect any organ system and therefore presents in a variety of ways, especially as a prolonged fever of unknown origin, with associated rheumatic features.
Combination antibiotic therapy is the mainstay of treatment and should be used for prolonged periods to prevent relapse of symptoms. There is disagreement about the optimum treatment regimen.

Small pearly white colonies of Brucella melitensis after prolonged culture on blood agar

From the collection of Dr Nicholas J. Beeching; used with permission

Quick Reference

History & Exam
- Key Factors
- Other Factors
More information...
Diagnostics Tests
More information...
Treatment Options
More information...

Definition

Epidemiology

Etiology

Pathophysiology

Images

Brucella organisms and hosts
Small pearly white colonies of Brucella melitensis after prolonged culture on blood agar

Citations

Key Articles

Pappas G, Papadimitriou P, Akritidis N, et al. The new global map of human brucellosis. Lancet Infect Dis. 2006 Feb;6(2):91-9.[Abstract]
Dean AS, Crump L, Greter H, et al. Global burden of human brucellosis: a systematic review of disease frequency. PLoS Negl Trop Dis. 2012;6(10):e1865.[Abstract][Full Text]
Dean AS, Crump L, Greter H, et al. Clinical manifestations of human brucellosis: a systematic review and meta-analysis. PLoS Negl Trop Dis. 2012;6(12):e1929.[Abstract][Full Text]
Franco MP, Mulder M, Gilman RH, et al. Human brucellosis. Lancet Infect Dis. 2007 Dec;7(12):775-86.[Abstract]
Al Dahouk S, Sprague LD, Neubauer H. New developments in the diagnostic procedures for zoonotic brucellosis in humans. Rev Sci Tech. 2013 Apr;32(1):177-88.[Abstract]
Skalsky K, Yahav D, Bishara J, et al. Treatment of human brucellosis: systematic review and meta-analysis of randomised controlled trials. BMJ. 2008 Mar 29;336(7646):701-4.[Abstract][Full Text]
Yousefi-Nooraie R, Mortaz-Hejri S, Mehrani M, et al. Antibiotics for treating human brucellosis. Cochrane Database Syst Rev. 2012 Oct 17;10:CD007179.[Abstract][Full Text]

Other Online Resources

BMJ talk medicine podcast: Brucellosis, with Drs Nick Beeching and Alessandro Gerada
CDC: assessing laboratory risk level and PEP

Referenced Articles

1. Madkour MM. Madkour's brucellosis. 2nd ed. New York, NY: Springer-Verlag; 2001.
2. Pappas G, Akritidis N, Bosilkovski M, et al. Brucellosis. N Engl J Med. 2005 Jun 2;352(22):2325-36.[Abstract]
3. Hasanjani Roushan MR, Moherez M, Smailnejad Gangi SM, et al. Epidemiological features and clinical manifestations in 469 adult patients with brucellosis in Babol, Northern Iran. Epidemiol Infect. 2004 Dec;132(6):1109-14.[Abstract]
4. Andriopoulos P, Tsironi M, Deftereos S, et al. Acute brucellosis: presentation, diagnosis, and treatment of 144 cases. Int J Infect Dis. 2007 Jan;11(1):52-7.[Abstract][Full Text]
5. Pappas G, Papadimitriou P, Akritidis N, et al. The new global map of human brucellosis. Lancet Infect Dis. 2006 Feb;6(2):91-9.[Abstract]
6. Mor SM, Wiethoelter AK, Massey PD, et al. Pigs, pooches and pasteurisation: the changing face of brucellosis in Australia. Aust J Gen Pract. 2018 Mar;47(3):99-103.[Abstract][Full Text]
7. Young EJ. An overview of human brucellosis. Clin Infect Dis. 1995 Aug;21(2):283-9.[Abstract]
8. Pappas G. The changing Brucella ecology: novel reservoirs, new threats. Int J Antimicrob Agents. 2010 Nov;36 Suppl 1:S8-11.[Abstract]
9. Mantur BG, Amarnath SK, Shinde RS. Review of clinical and laboratory features of human brucellosis. Indian J Med Microbiol. 2007 Jul;25(3):188-202.[Abstract]
10. Gwida M, Al Dahouk S, Melzer F, et al. Brucellosis - regionally emerging zoonotic disease? Croat Med J. 2010 Aug;51(4):289-95.[Abstract][Full Text]
11. Campbell JI, Lan NPH, Phuong PM, et al. Human Brucella melitensis infections in southern Vietnam. Clin Microbiol Infect. 2017 Nov;23(11):788-90.[Abstract][Full Text]
12. Guerrier G, Daronat JM, Morisse L, et al. Epidemiological and clinical aspects of human Brucella suis infection in Polynesia. Epidemiol Infect. 2011 Oct;139(10):1621-5.[Abstract]
13. Ekpanyaskul C, Santiwattanakul S, Tantisiriwat W, et al. Factors associated with seropositive antibodies to Brucella melitensis in the Nakhon Nayok, Thailand. J Med Assoc Thai. 2012 Dec;95(suppl 12):S40-6.[Abstract]
14. Lewis JM, Folb J, Kalra S, et al. Brucella melitensis prosthetic joint infection in a traveller returning to the UK from Thailand: case report and review of the literature. Travel Med Infect Dis. 2016 Sep - Oct;14(5):444-50.[Abstract][Full Text]
15. Godfroid J, Cloeckaert A, Liautard JP, et al. From the discovery of the Malta fever's agent to the discovery of a marine mammal reservoir, brucellosis has continuously been a re-emerging zoonosis. Vet Res. 2005 May-Jun;36(3):313-26.[Abstract][Full Text]
16. Zinsstag J, Schelling S, Wyss K, et al. Potential of cooperation between human and animal health to strengthen health systems. Lancet. 2005 Dec 17;366(9503):2142-5.[Abstract]
17. Kunda J, Fitzpatrick J, Kazwala R, et al. Health-seeking behaviour of human brucellosis cases in rural Tanzania. BMC Public Health. 2007 Nov 3;7:315.[Abstract][Full Text]
18. Dean AS, Crump L, Greter H, et al. Global burden of human brucellosis: a systematic review of disease frequency. PLoS Negl Trop Dis. 2012;6(10):e1865.[Abstract][Full Text]
19. Almuneef MA, Memish ZA, Balkhy HH, et al. Importance of screening household members of acute brucellosis cases in endemic areas. Epidemiol Infect. 2004 Jun;132(3):533-40.[Abstract]
20. Mendoza-Núñez M, Mulder M, Franco MP, et al. Brucellosis in household members of Brucella patients residing in a large urban setting in Peru. Am J Trop Med Hyg. 2008 Apr;78(4):595-8[Abstract]
21. Memish ZA, Balkhy HH. Brucellosis and international travel. J Travel Med. 2004 Jan-Feb;11(1):49-55.[Abstract]
22. Dahouk SA, Neubauer H, Hensel A, et al. Changing epidemiology of human brucellosis, Germany, 1962-2005. Emerg Infect Dis. 2007 Dec;13(12):1895-900.[Abstract][Full Text]
23. Australian Government Department of Health. National Notifiable Diseases Surveillance System. Notifications of a selected disease by month and year, 1991 to present. Brucellosis. Sep 2022 [internet publication].[Full Text]
24. Centers for Disease Control and Prevention. National notifiable infectious diseases tables. May 2023 [internet publication].[Full Text]
25. Centers for Disease Control and Prevention. CDC and Texas health officials warn about illness linked to raw milk from Texas dairy. September 2017 [internet publication].[Full Text]
26. Cossaboom CM, Kharod GA, Salzer JS, et al. Notes from the field: brucella abortus vaccine strain RB51 infection and exposures associated with raw milk consumption - Wise County, Texas, 2017. MMWR Morb Mortal Wkly Rep. 2018 Mar 9;67(9):286.[Abstract][Full Text]
27. Centers for Disease Control and Prevention. People in four states may be drinking contaminated raw milk. November 2017 [internet publication].[Full Text]
28. Centers for Disease Control and Prevention. Health Alert Network (HAN). Third case of rifampin/penicillin-resistant strain of RB51 brucella from consuming raw milk. January 2019 [internet publication].[Full Text]
29. Mia MM, Hasan M, Pory FS. Occupational exposure to livestock and risk of tuberculosis and brucellosis: a systematic review and meta-analysis. One Health. 2022 Dec;15:100432.[Abstract][Full Text]
30. Pike RM. Laboratory-associated infections: summary and analysis of 3921 cases. Health Lab Sci. 1976 Apr;13(2):105-14.[Abstract]
31. Harding AL, Byers KB. Epidemiology of laboratory-associated infections. In: Fleming DO, Hunt DL, eds. Biological safety: principles and practices. 3rd ed. Washington, DC: ASM Press; 2000:35-6.
32. Ergonul O, Celikbas A, Tezeren D, et al. Analysis of risk factors for laboratory-acquired Brucella infections. J Hosp Infect. 2004 Mar;56(3):223-7.[Abstract]
33. Yagupsky P, Baron EJ. Laboratory exposures to brucellae and implications for bioterrorism. Emerg Infect Dis. 2005 Aug;11(8):1180-5.[Abstract]
34. Bouza E, Sanchez-Carrillo C, Hernangomez S, et al. Laboratory-acquired brucellosis: a Spanish national survey. J Hosp Infect. 2005 Sep;61(1):80-3.[Abstract]
35. Centers for Disease Control and Prevention (CDC). Laboratory-acquired brucellosis - Indiana and Minnesota, 2006. MMWR Morb Mortal Wkly Rep. 2008 Jan 18;57(2):39-42.[Abstract][Full Text]
36. Reddy S, Manuel R, Sheridan E, et al. Brucellosis in the United Kingdom - a risk to laboratory workers? Recommendations for prevention and management of laboratory exposure. J Clin Pathol. 2010 Jan;63(1):90-2.[Abstract]
37. Knudsen A, Kronborg G, Dahl Knudsen J, et al. Laboratory exposure to Brucella melitensis in Denmark: a prospective study. J Hosp Infect. 2013 Nov;85(3):237-9.[Abstract]
38. Traxler RM, Lehman MW, Bosserman EA, et al. A literature review of laboratory-acquired brucellosis. J Clin Microbiol. 2013 Sep;51(9):3055-62.[Abstract][Full Text]
39. Estagnasié C, Surgers L, Berdugo K, et al. Recurrence of brucellosis on breast implants. Infect Dis Now. 2023 Mar;53(2):104644.[Abstract][Full Text]
40. Pereira CR, Cotrim de Almeida JVF, Cardoso de Oliveira IR, et al. Occupational exposure to Brucella spp.: a systematic review and meta-analysis. PLoS Negl Trop Dis. 2020 May;14(5):e0008164.[Abstract][Full Text]
41. Beeching NJ. Brucellosis. In Fauci AS, Braunwald E, Kasper DL, et al., eds. Harrison's principles of internal medicine. 20th ed. New York, NY: McGraw-Hill; 2018:1192-6.
42. Beeching NJ, Madkour MM. Brucellosis. In: Farrar J, Hotez P, Junghanss T, et al, eds. Manson's tropical diseases. 23rd ed. London: Elsevier; 2013:371-378, 378.e1.
43. De BK, Stauffer L, Koylass MS, et al. Novel Brucella strain (BO1) associated with a prosthetic breast implant infection. J Clin Microbiol. 2008 Jan;46(1):43-9.[Abstract][Full Text]
44. Scholz HC, Nöckler K, Göllner C, et al. Brucella inopinata sp. nov., isolated from a breast implant infection. Int J Syst Evol Microbiol. 2010 Apr;60(Pt 4):801-8.[Abstract][Full Text]
45. Jiménez de Bagüés MP, Iturralde M, Arias MA, et al. The new strains Brucella inopinata BO1 and Brucella species 83-210 behave biologically like classic infectious Brucella species and cause death in murine models of infection. J Infect Dis. 2014 Aug 1;210(3):467-72.[Abstract][Full Text]
46. Sabbaghian H. Fresh white cheese as a cause of Brucella infection. Public Health. 1975 May;89(4):165-9.[Abstract]
47. Entessar F, Ardalan A. Brucella. Geneva: World Health Organization; 1964.
48. Beeching NJ, Erdem H. Brucellosis. In: Cohen J, Powderly WG, Opal SM, eds. Infectious diseases. 4th ed. London: Elsevier Science; 2016:1098-1101.
49. Langer AJ, Ayers T, Grass J, et al. Nonpasteurized dairy products, disease outbreaks, and state laws - United States, 1993-2006. Emerg Infect Dis. 2012 Mar;18(3):385-91.[Abstract][Full Text]
50. Claeys WL, Cardoen S, Daube G, et al. Raw or heated cow milk consumption: review of risks and benefits. Food Control. 2013;31:251-62.
51. Guihot A, Bossi P, Bricaire F. Bioterrorism with brucellosis [in French]. Presse Med. 2004 Jan 31;33(2):119-22.[Abstract]
52. Flynn MP. Human clinical bovine-type brucellosis not derived from milk. Public Health. 1983 May;97(3):149-57.[Abstract]
53. Kaufmann AF, Fox MD, Boyce JM, et al. Airborne spread of brucellosis. Ann N Y Acad Sci. 1980;353:105-14.[Abstract]
54. Mantur BG, Mangalgi SS, Mulimani M. Brucella melitensis - a sexually transmissible agent? Lancet. 1996 Jun 22;347(9017):1763.[Abstract]
55. Rabiei MM, Imanzade F, Hatami F, et al. Brucellosis in transplant recipients: a systematic review. Transpl Infect Dis. 2021 Aug;23(4):e13604.[Abstract]
56. Gross A, Terraza A, Ouahrani-Bettache S, et al. In vitro Brucella suis infection prevents the programmed cell death of human monocytic cells. Infect immun. 2000;68:342-351.[Abstract][Full Text]
57. de Figueiredo P, Ficht TA, Rice-Ficht A, et al. Pathogenesis and immunobiology of brucellosis: review of Brucella-host interactions. Am J Pathol. 2015;185:1505-1517.[Abstract][Full Text]
58. Khan MY, Mah WM, Memish ZA. Brucellosis in pregnant women. Clin Infect Dis. 2001 Apr 15;32(8):1172-7.[Abstract][Full Text]
59. Kurdoglu M, Adali E, Kurdoglu Z, et al. Brucellosis in pregnancy: a 6-year clinical analysis. Arch Gynecol Obstet. 2010 Feb;281(2):201-6.[Abstract]
60. Paul J, Gilks C, Batchelor B, et al. Serologic responses to brucellosis in HIV-seropositive patients. Trans R Soc Trop Med Hyg. 1995;89:228-230.[Abstract]
61. Moreno S, Ariza J, Espinosa FJ, et al. Brucellosis in patients infected with the human immunodeficiency virus. Eur J Clin Microbiol Infect Dis. 1998;17:319-326.[Abstract]
62. Georghiou PR, Young EJ. Prolonged incubation in brucellosis. Lancet. 1991;337:1543.[Abstract]
63. Centers for Disease Control and Prevention. Brucellosis reference guide: exposures, testing and prevention. February 2017 [internet publication].[Full Text]
64. Syrjamaki C, Migliazzo A, Yarbrough JW, et al. Brucella abortus endocarditis following ingestion of cow's blood. Nebr Med J. 1984 May;69(5):141-2.[Abstract]
65. Dadar M, Fakhri Y, Shahali Y, et al. Contamination of milk and dairy products by Brucella species: a global systematic review and meta-analysis. Food Res Int. 2020 Feb;128:108775.[Abstract]
66. Greenfield RA, Drevets DA, Machado LJ, et al. Bacterial pathogens as biological weapons and agents of bioterrorism. Am J Med Sci. 2002 Jun;323(6):299-315.[Abstract]
67. Pappas G, Panagopoulou P, Christou L, et al. Brucella as a biological weapon. Cell Mol Life Sci. 2006 Oct;63(19-20):2229-36.[Abstract]
68. Williams B. Brucellosis. Practitioner. 1982 Sep;226(1371):1507-17.[Abstract]
69. Gerada A, Beeching NJ. Brucellosis and travel. Travel Med Infect Dis. 2016 May-Jun;14(3):180-1.[Abstract]
70. Norman FF, Monge-Maillo B, Chamorro-Tojeiro S, et al. Imported brucellosis: a case series and literature review. Travel Med Infect Dis. 2016 May-Jun;14(3):182-99.[Abstract]
71. Bosilkovski M, Rodriguez-Morales AJ. Brucellosis and its particularities in children travelers. Recent Pat Antiinfect Drug Discov. 2014;9(3):164-72.[Abstract]
72. Wyatt HV. Brucella melitensis can be transmitted sexually. Lancet. 11996 Aug 31;348(9027):615. [Erratum in: Lancet 1996 Oct 5;348(9032):970.][Abstract]
73. Economidou J, Kalafatas P, Vatopolou D, et al. Brucellosis in two thalassaemic patients infected by blood transfusions from the same donor. Acta Haematol. 1976;55(4):244-9.[Abstract]
74. Martinez-Canseco J, Hernandez-Ramos I, Macias-Hernandez AE, et al. Unjustified disposal of transfusion blood because of antibodies against Brucella [in Spanish]. Rev Invest Clin. 1996 Jul-Aug;48(4):297-300.[Abstract]
75. World Health Organization. Brucellosis in humans and animals. 2006 [internet publication].[Full Text]
76. Luzzi GA, Brindle R, Sockett PN, et al. Brucellosis: imported and laboratory-acquired cases, and an overview of treatment trials. Trans R Soc Trop Med Hyg. 1993 Mar-Apr;87(2):138-41.[Abstract]
77. Centers for Disease Control and Prevention. Brucellosis. Exposure to RB51 through raw milk or milk products: how to reduce risk of infection. September 2017 [internet publication].[Full Text]
78. Robichaud S, Libman M, Behr M, et al. Prevention of laboratory-acquired brucellosis. Clin Infect Dis. 2004 Jun 15;38(12):e119-22.[Abstract][Full Text]
79. Centers for Disease Control and Prevention. Brucellosis: hunters risks. January 2016 [internet publication].[Full Text]
80. Mantur BG, Akki AS, Mangalgi SS, et al. Childhood brucellosis - a microbiological, epidemiological and clinical study. J Trop Pediatr. 2004 Jun;50(3):153-7.[Abstract]
81. Barroso García P, Rodriguez-Contreras Pelayo R, Gil Extremera B, et al. Study of 1,595 brucellosis cases in the Almeria province (1972-1998) based on epidemiological data from disease reporting [in Spanish]. Rev Clin Esp. 2002 Nov;202(11):577-82.[Abstract]
82. Dean AS, Crump L, Greter H, et al. Clinical manifestations of human brucellosis: a systematic review and meta-analysis. PLoS Negl Trop Dis. 2012;6(12):e1929.[Abstract][Full Text]
83. Li F, Du L, Zhen H, et al. Follow-up outcomes of asymptomatic brucellosis: a systematic review and meta-analysis. Emerg Microbes Infect. 2023 Dec;12(1):2185464.[Abstract][Full Text]
84. Franco MP, Mulder M, Gilman RH, et al. Human brucellosis. Lancet Infect Dis. 2007 Dec;7(12):775-86.[Abstract]
85. Colomenero JD, Reguera JM, Martos F, et al. Complications associated with Brucella melitensis infection: a study of 530 cases. Medicine (Baltimore). 1996 Jul;75(4):195-211. [Erratum in: Medicine (Baltimore) 1997 Mar;76(2):139.][Abstract]
86. Uddin MJ, Sanyal SC, Mustafa AS, et al. The role of aggressive medical therapy along with early surgical intervention in the cure of Brucella endocarditis. Ann Thorac Cardiovasc Surg. 1998 Aug;4(4):209-13.[Abstract]
87. Pappas G, Bosilkovski M, Akritidis N, et al. Brucellosis and the respiratory system. Clin Infect Dis. 2003 Oct 1;37(7):e95-9.[Abstract][Full Text]
88. Erdem H, Inan A, Elaldi N, et al. Respiratory system involvement in brucellosis: the results of the Kardelen study. Chest. 2014 Jan;145(1):87-94.[Abstract]
89. Milionis H, Christou L, Elisaf M. Cutaneous manifestations in brucellosis: case report and review of the literature. Infection. 2000 Mar-Apr;28(2):124-6.[Abstract]
90. Al Dahouk S, Sprague LD, Neubauer H. New developments in the diagnostic procedures for zoonotic brucellosis in humans. Rev Sci Tech. 2013 Apr;32(1):177-88.[Abstract]
91. Gotuzzo E, Carrilo C, Guerra J, et al. An evaluation of diagnostic methods for brucellosis - the value of bone marrow culture. J Infect Dis. 1986 Jan;153(1):122-5.[Abstract]
92. Doganay M, Aygen B. Human brucellosis: an overview. Int J Infect Dis. 2003;7:173-82.
93. Yagupsky P. Detection of brucellae in blood cultures. J Clin Microbiol. 1999 Nov;37(11):3437-42.[Abstract][Full Text]
94. Gómez MC, Nieto JA, Rosa C, et al. Evaluation of seven tests for diagnosis of human brucellosis in an area where the disease is endemic. Clin Vaccine Immunol. 2008 Jun;15(6):1031-3.[Abstract][Full Text]
95. Ruiz-Mesa JD, Sanchez-Gonzalez J, Reguera JM, et al. Rose Bengal test: diagnostic yield and use for the rapid diagnosis of human brucellosis in emergency departments in endemic areas. Clin Microbiol Infect. 2005 Mar;11(3):221-5.[Abstract]
96. Araj GF, Lulu AR, Mustafa MY, et al. Evaluation of ELISA in the diagnosis of acute and chronic brucellosis in human beings. J Hyg (Lond). 1986 Dec;97(3):457-69.[Abstract]
97. Abdoel TH, Smits HL. Rapid latex agglutination test for the serodiagnosis of human brucellosis. Diagn Microbiol Infect Dis. 2007 Feb;57(2):123-8.[Abstract]
98. Nielson K, Smith P, Widdison J, et al. Serological relationship between cattle exposed to Brucella abortus, Yersinia enterocolitica O:9 and Escherichia coli O157:H7. Vet Microbiol. 2004 May 20;100(1-2):25-30.[Abstract]
99. Ariza J, Pellicer T, Pallares R, et al. Specific antibody profile in human brucellosis. Clin Infect Dis. 1992 Jan;14(1):131-40.[Abstract]
100. Lucero NE, Escobar GI, Ayala SM, et al. Diagnosis of human brucellosis caused by Brucella canis. J Med Microbiol. 2005 May;54(Pt 5):457-61.[Abstract][Full Text]
101. Ashford DA, di Pietra J, Lingappa J, et al. Adverse events in humans associated with accidental exposure to the livestock brucellosis vaccine RB51. Vaccine. 2004 Sep 3;22(25-26):3435-9.[Abstract]
102. Queipo-Ortuño MI, Morata P, Ocón P, et al. Rapid diagnosis of human brucellosis by peripheral-blood PCR assay. J Clin Microbiol. 1997 Nov;35(11):2927-30.[Abstract][Full Text]
103. Mitka S, Anetakis C, Souliou E, et al. Evaluation of different PCR assays for early detection of acute and relapsing brucellosis in humans in comparison with conventional methods. J Clin Microbiol. 2007 Apr;45(4):1211-8.[Abstract][Full Text]
104. Vrioni G, Pappas G, Priavali E, et al. An eternal microbe: Brucella DNA load persists for years after clinical cure. Clin Infect Dis. 2008 Jun 15;46(12):e131-6.[Abstract][Full Text]
105. Lista F, Reubsaet FA, De Santis R, et al. Reliable identification at the species level of Brucella isolates with MALDI-TOF-MS. BMC Microbiol. 2011 Dec 23;11:267.[Abstract][Full Text]
106. Ferreira L, Vega Castaño S, Sánchez-Juanes F, et al. Identification of Brucella by MALDI-TOF mass spectrometry: fast and reliable identification from agar plates and blood cultures. PLoS One. 2010 Dec 6;5(12):e14235.[Abstract][Full Text]
107. Karger A, Melzer F, Timke M, et al. Interlaboratory comparison of intact-cell matrix-assisted laser desorption ionization-time of flight mass spectrometry results for identification and differentiation of Brucella spp. J Clin Microbiol. 2013 Sep;51(9):3123-6.[Abstract][Full Text]
108. Araj GF, Lulu AR, Khateeb MI, et al. ELISA versus routine tests in the diagnosis of patients with systemic and neurobrucellosis. APMIS. 1988 Feb;96(2):171-6.[Abstract]
109. Erdem H, Kilic S, Sener B, et al. Diagnosis of chronic brucellar meningitis and meningoencephalitis: the results of the Istanbul-2 study. Clin Microbiol Infect. 2013 Feb;19(2):E80-6.[Abstract]
110. Yagupsky P, Peled N. Use of the Isolator 1.5 microbial tube for detection of Brucella melitensis in synovial fluid. J Clin Microbiol. 2002 Oct;40(10):3878.[Abstract][Full Text]
111. Kokoglu OF, Hosoglu S, Geyik MF, et al. Clinical and laboratory features of brucellosis in two university hospitals in Southeast Turkey. Trop Doct. 2006 Jan;36(1):49-51.[Abstract]
112. Troy SB, Rickman LS, Davis CE. Brucellosis in San Diego: epidemiology and species-related differences in acute clinical presentations. Medicine (Baltimore). 2005 May;84(3):174-87.[Abstract]
113. Mohamed MFH, Ahmed AOE, Habib MB, et al. The prevalence of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) in brucellosis patients: systematic review and meta-analysis. Ann Med Surg (Lond). 2022 Feb;74:103340.[Abstract][Full Text]
114. Al-Shahed MS, Sharif HS, Haddad MC, et al. Imaging features of musculoskeletal brucellosis. Radiographics. 1994 Mar;14(2):333-48.[Abstract]
115. Pourbagher A, Pourbagher MA, Savas L, et al. Epidemiologic, clinical, and imaging findings in brucellosis patients with osteoarticular involvement. AJR Am J Roentgenol. 2006 Oct;187(4):873-80.[Abstract][Full Text]
116. Akkoc G, Tekerek S. Osteoarticular involvement in childhood brucellosis: evaluation of clinical, laboratory and radiologic features of 185 cases. Pediatr Infect Dis J. 2023 May 1;42(5):381-8.[Abstract]
117. Erdem H, Elaldi N, Ak O, et al. Genitourinary brucellosis: results of a multicentric study. Clin Microbiol Infect. 2014 Nov;20(11):O847-53.[Abstract][Full Text]
118. Richman JA, Gelberman RH, Engber WD, et al. Ganglions of the wrist and digits: results of treatment by aspiration and cyst wall puncture. J Hand Surg Am. 1987 Nov;12(6):1041-3.[Abstract]
119. Dhar D, Jaipuriar RS, Mondal MS, et al. Pediatric neurobrucellosis: a systematic review with case report. J Trop Pediatr. 2022 Dec 5;69(1).[Abstract]
120. Xu N, Qu C, Sai L, et al. Evaluating the efficacy of serological testing of clinical specimens collected from patients with suspected brucellosis. PLoS Negl Trop Dis. 2023 Feb;17(2):e0011131.[Abstract][Full Text]
121. Centers for Disease Control and Prevention. Brucellosis (Brucella spp.) 2010 case definition. 2010 [internet publication].[Full Text]
122. Public Health England. Brucella: laboratory and clinical services. December 2020 [internet publication].[Full Text]
123. Rusnak JM, Kortepeter MG, Aldis J, et al. Experience in the medical management of potential laboratory exposures to agents of bioterrorism on the basis of risk assessment at the United States Army Medical Research Institute of Infectious Diseases (USAMRIID). J Occup Environ Med. 2004 Aug;46(8):801-11.[Abstract]
124. Corbel MJ. Brucellosis: an overview. Emerg Infect Dis. 1997 Apr-Jun;3(2):213-21.[Abstract][Full Text]
125. Brown CE, Beeching NJ, Cooke RP. Laboratory acquired brucellosis - a review of published reports 1950-2007. Posters, 18th ECCMID, abstract P1852. Clin Microbiol Infect. 2008;14(suppl 7):S542.[Full Text]
126. Centers for Disease Control and Prevention. CDC Yellow Book 2024: health information for international travel. Section 5: travel-associated infections & diseases - brucellosis. May 2023 [internet publication].[Full Text]
127. Washington State Department of Health. Brucellosis. Dec 2019 [internet publication].[Full Text]
128. Ariza J, Bosilkovski M, Cascio A, et al. Perspectives for the treatment of brucellosis in the 21st century: the Ioannina recommendations. PLoS Med. 2007 Dec;4(12):e317.[Abstract][Full Text]
129. Skalsky K, Yahav D, Bishara J, et al. Treatment of human brucellosis: systematic review and meta-analysis of randomised controlled trials. BMJ. 2008 Mar 29;336(7646):701-4.[Abstract][Full Text]
130. Solís García del Pozo J, Solera J. Systematic review and meta-analysis of randomized clinical trials in the treatment of human brucellosis. PLoS One. 2012;7(2):e32090.[Abstract][Full Text]
131. Yousefi-Nooraie R, Mortaz-Hejri S, Mehrani M, et al. Antibiotics for treating human brucellosis. Cochrane Database Syst Rev. 2012 Oct 17;10:CD007179.[Abstract][Full Text]
132. Hashemi SH, Gachkar L, Keramat F, et al. Comparison of doxycycline-streptomycin, doxycycline-rifampin, and ofloxacin-rifampin in the treatment of brucellosis: a randomized clinical trial. Int J Infect Dis. 2012 Apr;16(4):e247-51.[Abstract]
133. Pappas G, Christou L, Akritidis N, et al. Quinolones for brucellosis: treating old diseases with new drugs. Clin Microbiol Infect. 2006 Sep;12(9):823-5.[Abstract]
134. Bosilkovski M, Kirova V, Grozdanovski K, et al. Doxycycline-rifampin versus doxycycline-rifampin-gentamicin in treatment of human brucellosis. Trop Doct. 2012 Jan;42(1):13-7.[Abstract]
135. Vrioni G, Bourdakis A, Pappas G, et al. Administration of a triple versus a standard double antimicrobial regimen for human brucellosis more efficiently eliminates bacterial DNA load. Antimicrob Agents Chemother. 2014 Dec;58(12):7541-4.[Abstract][Full Text]
136. Keshtkar-Jahromi M, Razavi SM, Gholamin S, et al. Medical versus medical and surgical treatment for brucella endocarditis. Ann Thorac Surg. 2012 Dec;94(6):2141-6.[Abstract]
137. Pappas G, Akritidis N, Christou L. Treatment of neurobrucellosis: what is known and what remains to be answered. Expert Rev Anti Infect Ther. 2007 Dec;5(6):983-90.[Abstract]
138. Erdem H, Ulu-Kilic A, Kilic S, et al. Efficacy and tolerability of antibiotic combinations in neurobrucellosis: results of the Istanbul study. Antimicrob Agents Chemother. 2012 Mar;56(3):1523-8.[Abstract][Full Text]
139. Tajerian A, Sofian M, Zarinfar N, et al. Manifestations, complications, and treatment of neurobrucellosis: a systematic review and meta-analysis. Int J Neurosci. 2022 Aug 5 [Epub ahead of print].[Abstract][Full Text]
140. Ulu-Kilic A, Karakas A, Erdem H, et al. Update on treatment options for spinal brucellosis. Clin Microbiol Infect. 2014 Feb;20(2):O75-82.[Abstract]
141. Salehi M, Farbod F, Khalili H, et al. Comparing efficacy and safety of high-dose and standard-dose rifampicin in the treatment of brucellosis: a randomized clinical trial. J Antimicrob Chemother. 2023 Apr 3;78(4):1084-91.[Abstract]
142. Majzoobi MM, Hashemi SH, Mamani M, et al. Effect of hydroxychloroquine on treatment and recurrence of acute brucellosis: a single-blind, randomized clinical trial. Int J Antimicrob Agents. 2018 Mar;51(3):365-9.[Abstract]
143. Majzoobi MM, Hashmi SH, Emami K, et al. Combination of doxycycline, streptomycin and hydroxychloroquine for short-course treatment of brucellosis: a single-blind randomized clinical trial. Infection. 2022 Oct;50(5):1267-71.[Abstract][Full Text]
144. Médecins Sans Frontières (MSF). MSF medical guidelines: brucellosis. Sep 2022 [internet publication].[Full Text]
145. Centers for Disease Control and Prevention (CDC). Suspected brucellosis case prompts investigation of possible bioterrorism-related activity - New Hampshire and Massachusetts, 1999. MMWR Morb Mortal Weekly Rep. 2000;49:509-512. [Abstract][Full Text]
146. Public Health England. Management of laboratory exposure to Brucella species: assessing exposure and individual assessment flowchart [Full Text]