Brucella melitensis - Revision history

Aidan: /* Management */

2026-02-23T21:10:01Z

Management

← Older revision		Revision as of 21:10, 23 February 2026
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	*Uncomplicated infection		*Uncomplicated infection
	**First-line: [[Is treated by::doxycycline]] 100 mg PO bid for 6+ weeks, plus [[Is treated by::streptomycin]] 1 g IM daily for 2 to 3 weeks		**First-line: [[Is treated by::doxycycline]] 100 mg p.o. bid for 6+ weeks, plus [[Is treated by::streptomycin]] 1 g IM daily for 2 to 3 weeks
	**Alternative: [[doxycycline]] 100 mg Pp bid for 6+ weeks, plus [[gentamicin]] 5 mg/kg IM daily for 1 week		**Alternative: [[doxycycline]] 100 mg p.o. bid for 6+ weeks, plus [[gentamicin]] 5 mg/kg IM daily for 1 week
	**Alternative: [[doxycycline]] 100 mg PO bid plus [[rifampin]] 600 to 900 mg (15 mg/kg) PO daily for 6+ weeks		**Alternative: [[doxycycline]] 100 mg p.o. bid plus [[rifampin]] 600 to 900 mg (15 mg/kg) p.o. daily for 6+ weeks
	*Neurobrucellosis:		*Neurobrucellosis:
	**First-line: [[ceftriaxone]] 2 g IV q12h for 1+ month, plus [[doxycycline]] 100 gm PO bid and [[rifampin]] 600 to 900 mg (15 mg/kg) PO daily for 4-5 months		**First-line: [[ceftriaxone]] 2 g IV q12h for 1+ month, plus [[doxycycline]] 100 gm p.o. bid and [[rifampin]] 600 to 900 mg (15 mg/kg) p.o. daily for 4-5 months
	**Alternative: [[TMP-SMX]] 160/800 mg PO bid, plus [[doxycycline]] 100 mg PO bid, plus [[rifampin]] 600 to 900 mg (15 mg/kg) PO daily for 5 to 6 months		**Alternative: [[TMP-SMX]] 160/800 mg p.o. bid, plus [[doxycycline]] 100 mg p.o. bid, plus [[rifampin]] 600 to 900 mg (15 mg/kg) p.o. daily for 5 to 6 months
	*Pregnancy		*Pregnancy
	**[[Rifampin]] 900 mg PO daily for 6+ weeks, ± [[TMP-SMX]] between the 13th and 36th weeks of gestational		**[[Rifampin]] 900 mg p.o. daily for 6+ weeks, ± [[TMP-SMX]] between the 13th and 36th weeks of gestational

	==Prevention==		==Prevention==

Aidan: /* Clinical Manifestations */

2022-08-17T16:27:28Z

Clinical Manifestations

← Older revision		Revision as of 16:27, 17 August 2022
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	*Exposure to unpasteurized milk products or animals		*Exposure to unpasteurized milk products or animals
	*A common cause of fever without a focus in endemic countries		*A common cause of fever without a focus in endemic countries
			*Incubation period is usually [[Usual incubation period::2-4 weeks]] (range [[Incubation period range::5 days to 6 months]])
	*Undulating fever		*Undulating fever
	*Headache, arthralgia, night sweats, fatigue, anorexia		*Headache, arthralgia, night sweats, fatigue, anorexia

Aidan: Text replacement - "[[Cellular shape::" to "[[Shape::"

2020-10-14T12:39:45Z

Text replacement - "[[Cellular shape::" to "[[Shape::"

← Older revision		Revision as of 12:39, 14 October 2020
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	===Microbiology===		===Microbiology===

	*Facultative intracellular, [[Stain::Gram-negative]] [[~~Cellular shape~~::coccobacillus]]		*Facultative intracellular, [[Stain::Gram-negative]] [[Shape::coccobacillus]]
	*Catalase [[Catalase::positive]], oxidase [[Oxidase::positive]], nitrate [[Nitrate::positive]], and urease [[Urease::positive]]		*Catalase [[Catalase::positive]], oxidase [[Oxidase::positive]], nitrate [[Nitrate::positive]], and urease [[Urease::positive]]
	*Non-motile		*Non-motile

Aidan at 22:57, 21 September 2020

2020-09-21T22:57:08Z

← Older revision		Revision as of 22:57, 21 September 2020
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	==Management==		==Management==

			*Uncomplicated infection
	*[[Is treated by::Gentamicin]], [[Is treated by::streptomycin]], [[Is treated by::doxycycline]], [[Is treated by::TMP-SMX]]
			**First-line: [[Is treated by::doxycycline]] 100 mg PO bid for 6+ weeks, plus [[Is treated by::streptomycin]] 1 g IM daily for 2 to 3 weeks
			**Alternative: [[doxycycline]] 100 mg Pp bid for 6+ weeks, plus [[gentamicin]] 5 mg/kg IM daily for 1 week
			**Alternative: [[doxycycline]] 100 mg PO bid plus [[rifampin]] 600 to 900 mg (15 mg/kg) PO daily for 6+ weeks
			*Neurobrucellosis:
			**First-line: [[ceftriaxone]] 2 g IV q12h for 1+ month, plus [[doxycycline]] 100 gm PO bid and [[rifampin]] 600 to 900 mg (15 mg/kg) PO daily for 4-5 months
			**Alternative: [[TMP-SMX]] 160/800 mg PO bid, plus [[doxycycline]] 100 mg PO bid, plus [[rifampin]] 600 to 900 mg (15 mg/kg) PO daily for 5 to 6 months
			*Pregnancy
			**[[Rifampin]] 900 mg PO daily for 6+ weeks, ± [[TMP-SMX]] between the 13th and 36th weeks of gestational

	==Prevention==		==Prevention==

Aidan: /* Lab Safety */

2020-09-12T18:21:28Z

Lab Safety

Aidan at 18:17, 12 September 2020

2020-09-12T18:17:33Z

← Older revision		Revision as of 18:17, 12 September 2020
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	==Clinical Manifestations==		==Clinical Manifestations==

	=== Brucellosis ===		===Brucellosis===

	*Exposure to unpasteurized milk products or animals		*Exposure to unpasteurized milk products or animals
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	*Can have mild pancytopenia		*Can have mild pancytopenia

	=== Relapsed Brucellosis ===		===Relapsed Brucellosis===

	* Occurs within six months of completing treatment in about 10% of patients		*Occurs within six months of completing treatment in about 10% of patients

	== Diagnosis ==		==Diagnosis==

	* Culture		*Culture
	** May be isolated from blood culture, but only intermittent and is a fastidious organism		**May be isolated from blood culture, but only intermittent and is a fastidious organism
	*** Sensitivity is 50-70%		***Sensitivity is 50-70%
	*** Cultures should be held for 10 days		***Cultures should be held for 10 days
	** Grows slowly on blood and chocolate agar; better on ''Brucella'' agar		**Grows slowly on blood and chocolate agar; better on ''Brucella'' agar
	** On gram stain, the small coccobacilli look like fine grains of sand		**On gram stain, the small coccobacilli look like fine grains of sand
	* Serology		*Serology
	** Acute and convalescent serology showing a fourfold rise in titres		**Acute and convalescent serology showing a fourfold rise in titres
	** Serum agglutination test titres of 1:160 or greater in the right clinical context		**Serum agglutination test titres of 1:160 or greater in the right clinical context
	*** Cross-reacts with [[Francisella tularensis]] and [[Vibrio cholerae]]		***Cross-reacts with [[Francisella tularensis]] and [[Vibrio cholerae]]

	==Management==		==Management==
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	*[[Is treated by::Gentamicin]], [[Is treated by::streptomycin]], [[Is treated by::doxycycline]], [[Is treated by::TMP-SMX]]		*[[Is treated by::Gentamicin]], [[Is treated by::streptomycin]], [[Is treated by::doxycycline]], [[Is treated by::TMP-SMX]]

			== Prevention ==

			=== Lab Safety ===

			* Assess risk and provide prophylaxis and monitoring per [[CDC guidelines]]
			* Assess risk
			** Minimal risk
			*** Manipulating routine specimen or enriched material in BSL2 with PPE
			*** Being present while someone manipulates a routine specimen in BSL2, or on an open bench without aerosol-generating procedures
			*** Manipulating or being present while someone manipulates enriched material in BSL2
			** Low risk
			*** Being present more than 5 feet from someone manipulating enriched material on an open bench, without aerosol-generating procedures
			** High risk
			*** Manipulating a routine specimen resulting in contact with broken skin or mucous membranes
			*** Being present less than 5 feet from someone manipulating enriched material outside of a BSL2
			*** Manipulating enriched material within a BSL2 without PPE
			*** Being present in the lab during an aerosol-generating procedure
			* Aerosol-generating procedures include centrifuging without sealed carriers, vortexing, sonicating, spillage/splashes
			* Enriched material includes positive blood cultures, and reproductive clinical specimens (amniotic fluid, placental products) should be treated similarly
			* People with high-risk exposures should have post-exposure prophylaxis and follow-up
			** PEP with [[doxycycline]] 100 mg PO bid plus [[rifampin]] 600 mg PO daily for 21 days
			*** Either can be replaced by [[TMP-SMX]] if contraindications exist, but should ensure two effect antibiotics are used
			** Follow-up
			*** Daily fever checks and weekly symptom watch for 24 weeks after last known exposure
			*** Serial serology at 0, 6, 12, 18, and 24 weeks after last known exposure
	{{DISPLAYTITLE:''Brucella melitensis''}}		{{DISPLAYTITLE:''Brucella melitensis''}}
	[[Category:Gram-negative coccobacilli]]		[[Category:Gram-negative coccobacilli]]

Aidan: /* Clinical Manifestations */

2020-09-10T20:18:37Z

Clinical Manifestations

← Older revision		Revision as of 20:18, 10 September 2020
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	==Background==		==Background==

	* Causes '''brucellosis''', also called '''Malta fever'''		*Causes '''brucellosis''', also called '''Malta fever'''

	===Microbiology===		===Microbiology===
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	*Facultative intracellular, [[Stain::Gram-negative]] [[Cellular shape::coccobacillus]]		*Facultative intracellular, [[Stain::Gram-negative]] [[Cellular shape::coccobacillus]]
	*Catalase [[Catalase::positive]], oxidase [[Oxidase::positive]], nitrate [[Nitrate::positive]], and urease [[Urease::positive]]		*Catalase [[Catalase::positive]], oxidase [[Oxidase::positive]], nitrate [[Nitrate::positive]], and urease [[Urease::positive]]
			*Non-motile
	*[[Biosafety risk groups\|Risk group 3 organism]]		*[[Biosafety risk groups\|Risk group 3 organism]]
	*When suspected, plates should be sealed and it should ''not'' be set up for mass spectrometry		*When suspected, plates should be sealed and it should ''not'' be set up for mass spectrometry
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	==Clinical Manifestations==		==Clinical Manifestations==

			=== Brucellosis ===

	*Exposure to unpasteurized milk products or animals		*Exposure to unpasteurized milk products or animals
			*A common cause of fever without a focus in endemic countries
	*Undulating fever		*Undulating fever
	*Headache, arthralgia, night sweats, fatigue, anorexia		*Headache, arthralgia, night sweats, fatigue, anorexia
	*Arthritis, spondylitis, osteomyelitis		*Arthritis, spondylitis (especially sacroiliac and other large lower-extremity joints), osteomyelitis
			*Hepatomegaly, splenomegaly, and lymphadenopathy
	*Orchitis and epididymitis
			*Orchitis and epididymitis, prostatitis, and tubo-ovarian abscess
	*Foul-smelling sweat		*Foul-smelling sweat
			*Can have mild pancytopenia

			=== Relapsed Brucellosis ===

			* Occurs within six months of completing treatment in about 10% of patients

			== Diagnosis ==

			* Culture
			** May be isolated from blood culture, but only intermittent and is a fastidious organism
			*** Sensitivity is 50-70%
			*** Cultures should be held for 10 days
			** Grows slowly on blood and chocolate agar; better on ''Brucella'' agar
			** On gram stain, the small coccobacilli look like fine grains of sand
			* Serology
			** Acute and convalescent serology showing a fourfold rise in titres
			** Serum agglutination test titres of 1:160 or greater in the right clinical context
			*** Cross-reacts with [[Francisella tularensis]] and [[Vibrio cholerae]]

	==Management==		==Management==

Aidan: Text replacement - "\[\[Catalase test::(.?)-(.?)\]\]" to "$1 Catalase::$2"

2020-08-21T11:46:50Z

Text replacement - "\[\[Catalase test::(.*?)-(.*?)\]\]" to "$1 Catalase::$2"

← Older revision		Revision as of 11:46, 21 August 2020
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	*Facultative intracellular, [[Stain::Gram-negative]] [[Cellular shape::coccobacillus]]		*Facultative intracellular, [[Stain::Gram-negative]] [[Cellular shape::coccobacillus]]
	*[[Catalase ~~test~~::~~Catalase-~~positive]], oxidase [[Oxidase::positive]], nitrate [[Nitrate::positive]], and urease [[Urease::positive]]		*Catalase [[Catalase::positive]], oxidase [[Oxidase::positive]], nitrate [[Nitrate::positive]], and urease [[Urease::positive]]
	*[[Biosafety risk groups\|Risk group 3 organism]]		*[[Biosafety risk groups\|Risk group 3 organism]]
	*When suspected, plates should be sealed and it should ''not'' be set up for mass spectrometry		*When suspected, plates should be sealed and it should ''not'' be set up for mass spectrometry

Aidan: Text replacement - "\[\[Oxidase test::(.?)-(.?)\]\]" to "$1 Oxidase::$2"

2020-08-21T11:15:29Z

Text replacement - "\[\[Oxidase test::(.*?)-(.*?)\]\]" to "$1 Oxidase::$2"

← Older revision		Revision as of 11:15, 21 August 2020
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	*Facultative intracellular, [[Stain::Gram-negative]] [[Cellular shape::coccobacillus]]		*Facultative intracellular, [[Stain::Gram-negative]] [[Cellular shape::coccobacillus]]
	*[[Catalase test::Catalase-positive]], [[Oxidase ~~test~~::~~oxidase-~~positive]], nitrate [[Nitrate::positive]], and urease [[Urease::positive]]		*[[Catalase test::Catalase-positive]], oxidase [[Oxidase::positive]], nitrate [[Nitrate::positive]], and urease [[Urease::positive]]
	*[[Biosafety risk groups\|Risk group 3 organism]]		*[[Biosafety risk groups\|Risk group 3 organism]]
	*When suspected, plates should be sealed and it should ''not'' be set up for mass spectrometry		*When suspected, plates should be sealed and it should ''not'' be set up for mass spectrometry

Aidan: Text replacement - "\[\[Nitrate test::(.?)-(.?)\]\]" to "$1 Nitrate::$2"

2020-08-20T19:11:38Z

Text replacement - "\[\[Nitrate test::(.*?)-(.*?)\]\]" to "$1 Nitrate::$2"

← Older revision		Revision as of 19:11, 20 August 2020
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	*Facultative intracellular, [[Stain::Gram-negative]] [[Cellular shape::coccobacillus]]		*Facultative intracellular, [[Stain::Gram-negative]] [[Cellular shape::coccobacillus]]
	*[[Catalase test::Catalase-positive]], [[Oxidase test::oxidase-positive]], [[Nitrate ~~test~~::~~nitrate-~~positive]], and urease [[Urease::positive]]		*[[Catalase test::Catalase-positive]], [[Oxidase test::oxidase-positive]], nitrate [[Nitrate::positive]], and urease [[Urease::positive]]
	*[[Biosafety risk groups\|Risk group 3 organism]]		*[[Biosafety risk groups\|Risk group 3 organism]]
	*When suspected, plates should be sealed and it should ''not'' be set up for mass spectrometry		*When suspected, plates should be sealed and it should ''not'' be set up for mass spectrometry

← Older revision		Revision as of 18:21, 12 September 2020
Line 50:		Line 50:
	*[[Is treated by::Gentamicin]], [[Is treated by::streptomycin]], [[Is treated by::doxycycline]], [[Is treated by::TMP-SMX]]		*[[Is treated by::Gentamicin]], [[Is treated by::streptomycin]], [[Is treated by::doxycycline]], [[Is treated by::TMP-SMX]]

	== Prevention ==		==Prevention==

	=== Lab Safety ===		===Lab Safety===

	* Assess risk and provide prophylaxis and monitoring per [[CDC guidelines]]		*Assess risk and provide prophylaxis and monitoring per [https://www.cdc.gov/brucellosis/laboratories/risk-level.html CDC guidelines]
	* Assess risk		*Assess risk
	** Minimal risk		**Minimal risk
	*** Manipulating routine specimen or enriched material in BSL2 with PPE		***Manipulating routine specimen or enriched material in BSL2 with PPE
	*** Being present while someone manipulates a routine specimen in BSL2, or on an open bench without aerosol-generating procedures		***Being present while someone manipulates a routine specimen in BSL2, or on an open bench without aerosol-generating procedures
	*** Manipulating or being present while someone manipulates enriched material in BSL2		***Manipulating or being present while someone manipulates enriched material in BSL2
	** Low risk		**Low risk
	*** Being present more than 5 feet from someone manipulating enriched material on an open bench, without aerosol-generating procedures		***Being present more than 5 feet from someone manipulating enriched material on an open bench, without aerosol-generating procedures
	** High risk		**High risk
	*** Manipulating a routine specimen resulting in contact with broken skin or mucous membranes		***Manipulating a routine specimen resulting in contact with broken skin or mucous membranes
	*** Being present less than 5 feet from someone manipulating enriched material outside of a BSL2		***Being present less than 5 feet from someone manipulating enriched material outside of a BSL2
	*** Manipulating enriched material within a BSL2 without PPE		***Manipulating enriched material within a BSL2 without PPE
	*** Being present in the lab during an aerosol-generating procedure		***Being present in the lab during an aerosol-generating procedure
	* Aerosol-generating procedures include centrifuging without sealed carriers, vortexing, sonicating, spillage/splashes		*Aerosol-generating procedures include centrifuging without sealed carriers, vortexing, sonicating, spillage/splashes
	* Enriched material includes positive blood cultures, and reproductive clinical specimens (amniotic fluid, placental products) should be treated similarly		*Enriched material includes positive blood cultures, and reproductive clinical specimens (amniotic fluid, placental products) should be treated similarly
	* People with high-risk exposures should have post-exposure prophylaxis and follow-up		*People with high-risk exposures should have post-exposure prophylaxis and follow-up
	** PEP with [[doxycycline]] 100 mg PO bid plus [[rifampin]] 600 mg PO daily for 21 days		**PEP with [[doxycycline]] 100 mg PO bid plus [[rifampin]] 600 mg PO daily for 21 days
	*** Either can be replaced by [[TMP-SMX]] if contraindications exist, but should ensure two effect antibiotics are used		***Either can be replaced by [[TMP-SMX]] if contraindications exist, but should ensure two effect antibiotics are used
	** Follow-up		**Follow-up
	*** Daily fever checks and weekly symptom watch for 24 weeks after last known exposure		***Daily fever checks and weekly symptom watch for 24 weeks after last known exposure
	*** Serial serology at 0, 6, 12, 18, and 24 weeks after last known exposure		***Serial serology at 0, 6, 12, 18, and 24 weeks after last known exposure
	{{DISPLAYTITLE:''Brucella melitensis''}}		{{DISPLAYTITLE:''Brucella melitensis''}}
	[[Category:Gram-negative coccobacilli]]		[[Category:Gram-negative coccobacilli]]

Brucella melitensis - Revision history

Aidan: /* Management */

Aidan: /* Clinical Manifestations */

Aidan: Text replacement - "[[Cellular shape::" to "[[Shape::"

Aidan at 22:57, 21 September 2020

Aidan: /* Lab Safety */

Aidan at 18:17, 12 September 2020

Aidan: /* Clinical Manifestations */

Aidan: Text replacement - "\[\[Catalase test::(.*?)-(.*?)\]\]" to "$1 Catalase::$2"

Aidan: Text replacement - "\[\[Oxidase test::(.*?)-(.*?)\]\]" to "$1 Oxidase::$2"

Aidan: Text replacement - "\[\[Nitrate test::(.*?)-(.*?)\]\]" to "$1 Nitrate::$2"

Aidan: Text replacement - "\[\[Catalase test::(.?)-(.?)\]\]" to "$1 Catalase::$2"

Aidan: Text replacement - "\[\[Oxidase test::(.?)-(.?)\]\]" to "$1 Oxidase::$2"

Aidan: Text replacement - "\[\[Nitrate test::(.?)-(.?)\]\]" to "$1 Nitrate::$2"