Last reviewed: March 2019
Last updated: March  2018



History and exam

Key diagnostic factors

  • hx 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, diarrhea
  • pallor
  • lymphadenopathy
  • dry cough
  • chest signs
  • testicular pain
  • neck stiffness
  • cranial nerve palsy or focal CNS 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 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
  • serologic tests
  • CSF analysis
  • CSF culture
  • synovial fluid analysis
  • synovial fluid culture
  • CBC
  • LFTs
Full details

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
Full details

Emerging tests

  • PCR for detection and diagnosis of Brucella species
  • matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS)
Full details

Treatment algorithm


Authors VIEW ALL

Senior Lecturer (Honorary Consultant)

Liverpool School of Tropical Medicine and Royal Liverpool University Hospital




NJB is an author of several references cited in this monograph. 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. He is affiliated with the Liverpool School of Tropical Medicine. Views expressed in this monograph 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.

Specialist Trainee in Clinical Microbiology

Royal Liverpool University Hospital




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

Consultant in Infectious Diseases

Whipps Cross Hospital




ST declares that she has no competing interests.

Peer reviewers VIEW ALL

Infectious Diseases Consultant

Unit of Infectious Diseases

Rabin Medical Center

Beilinson Hospital




MP declares that she has no competing interests.

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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