Brucellosis natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2] Danitza Lukac

Overview

If left untreated, patients with brucellosis may progress to develop focal infections, relapses or chronic brucellosis. Common complications of brucellosis include granulomatous hepatitis, arthritis, sacroiliitis, meningitis, orchitis, epididymitis uveitis, and endocarditis. The prognosis of brucellosis is good with adequate treatment. Relapse may occur, and symptoms may continue for years.

Natural History

• Brucellosis incubation period is 2–4 weeks (range, 5 days to 5 months). If left untreated, patients with brucellosis may progress to develop focal infections, relapses or chronic brucellosis.

Complications

Complications of Brucellosis include the following:

Complications of Brucellosis
Osteoarticular	Most frequent complications Occur in approximately 40% of cases. Sacroiliitis Most common complication Bursitis Peripheral arthritis Osteomyelitis Tenosynovitis Spondylitis
Cardiovascular	Infective endocarditis Common cardiovascular complication Frequent cause of death It has been reported in approximately 2% of cases The aortic valve is more commonly affected than the mitral valve Valve replacement surgery is usually needed apart from the medical therapy Aneurysm of sinus of valsalva Common complication when infection is due to B. suis
Hepatobiliary complications	Granulomatous hepatitis Due to B. abortus Post-necrotic cirrhosis Very rare Chronic suppurative lesions and hepatic abscesses Due to B. suis
Genitourinary	Orchitis and epididymitis Frequent genitourinary complications within men
Neurological	Meningitis or meningoencephalitis Most common frequent complications of neurobrucellosis Brain and epidural abscess Cerebellar ataxia Cerebral vasculitis Guillain-Barré syndrome Haemorrhage Mycotic aneurysm Stroke Neuropathy/radiculopathy Poliomyelitis-like syndrome
Gastrointestinal	Colitis, ileitis, and spontaneous bacterial peritonitis. Rare cases have been reported.
Respiratory tract	Bronchopneumonia Empyema Hilar and paratracheal lymphadenopathy Interstitial pneumonitis Lung nodules Pleural effusions
Pregnancy	Spontaneous abortion
Cutaneous	Erythema nodosum Nodules Papules Petechiae Purpura Rashes Abscesses, cutaneous ulcers, and suppurative lymphangitis Common complication when infection is due to B. suis
Opthalmic	Uveitis Most frequent ophtalmic complications

Prognosis

The prognosis of brucellosis is good with treatment. Mortality is less then 1%, usually a consequence of cardiac involvement or severe neurologic disease. General well-being and the body weight of the patient are useful guide to estimating the prognosis or chance of relapse.