Last reviewed: 25 Sep 2021
Last updated: 29 Jun 2021



History and exam

Key diagnostic factors

  • presence of risk factors
  • history of contact with infected person
  • fever or chills
  • constitutional symptoms
  • arthralgia
  • joint swelling and tenderness
  • hepatomegaly and/or splenomegaly

Other diagnostic factors

  • nausea, vomiting, abdominal pain, constipation, diarrhoea
  • pallor
  • lymphadenopathy
  • dry cough
  • chest signs
  • testicular pain
  • neck stiffness
  • cranial nerve palsy or focal central nervous system deficit
  • dullness to percussion, decreased air entry, crepitations
  • red eye
  • skin rashes

Risk factors

  • ingestion of contaminated foods
  • exposure to infected animal products
  • inhalation of infected aerosols
  • conjunctival contact with infected material
  • occupation with potential for exposure to Brucella species
  • travel to an endemic area
  • cuts or abrasions in skin
  • sexual contact with infected individual
  • newborn or infant of infected mother
  • recipient of blood products or of organ or tissue transplant

Diagnostic investigations

1st investigations to order

  • blood culture
  • serological tests
  • cerebrospinal fluid (CSF) analysis
  • cerebrospinal fluid (CSF) culture
  • synovial fluid analysis
  • synovial fluid culture
  • FBC
  • liver function tests

Investigations to consider

  • bone marrow culture
  • tissue biopsy
  • plain film x-rays of affected joints
  • chest x-ray
  • bone scan
  • CT or MRI scan of spine
  • CT or MRI scan of head

Emerging tests

  • polymerase chain reaction (PCR) for detection and diagnosis of Brucella species
  • matrix-assisted laser desorption/ionisation time of flight (MALDI-TOF) mass spectrometry

Treatment algorithm



Nicholas J. Beeching, MA, BM BCh, FRCP, FRACP, FFTM RCPS (Glasg), FESCMID, DCH, DTM&H

Consultant and Emeritus Professor of Tropical and Infectious Diseases

Royal Liverpool University Hospital

Liverpool School of Tropical Medicine




NJB is partially supported by the National Institute of Health Research Health Protection Unit in Emerging and Zoonotic Infections at the University of Liverpool and Public Health England. Views expressed in this topic are those of the contributor and do not necessarily represent the official position of the National Health Service, the National Institute for Health Research, the Department of Health, or Public Health England. NJB is an author of references cited in this topic.

Alessandro Gerada, MD, MRCP, FRCPath

Consultant in Clinical Microbiology

Liverpool Clinical Laboratories

Royal Liverpool University Hospital




AG is an author of several references cited in this topic.

Sherine Thomas, MBChB, MRCP, DTMH

Consultant in Infectious Diseases

Whipps Cross Hospital




ST declares that she has no competing interests.

Peer reviewers

Mical Paul, MD

Infectious Diseases Consultant

Unit of Infectious Diseases

Rabin Medical Center

Beilinson Hospital




MP declares that she has no competing interests.

Edward J. Young, MD

Professor of Medicine

Section of Infectious Diseases

Department of Medicine

Baylor College of Medicine




EJY declares that he has no competing interests.

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