Summary
Definition
History and exam
Key diagnostic factors
- presencia de factores de riesgo
- antecedentes de contacto con personas infectadas
- fiebre o escalofríos moderados
- síntomas constitucionales
- artralgia
- inflamación y sensibilidad de la articulación a la palpación
- hepatomegalia y/o esplenomegalia
Other diagnostic factors
- náuseas, vómitos, dolor abdominal, estreñimiento, diarrea
- palidez
- linfadenopatía
- tos seca
- signos en el tórax
- dolor testicular
- rigidez de nuca
- parálisis del nervio craneal o déficit focal del sistema nervioso central
- matidez a la percusión, disminución de la entrada de aire, crepitaciones
- ojo rojo
- erupciones cutáneas
Risk factors
- ingesta de alimentos contaminados
- exposición a productos infectados de origen animal
- inhalación de aerosoles infectados
- contacto conjuntival con material infectado
- ocupación con potencial de exposición a las especies de Brucella
- viajar a una zona endémica
- cortes o abrasiones en la piel
- contacto sexual con un individuo infectado
- recién nacido o lactante de madre infectada
- receptor de hemoderivados o de un trasplante de órgano o tejido
Diagnostic tests
1st tests to order
- hemocultivo
- pruebas serológicas
- análisis de líquido cefalorraquídeo (LCR)
- cultivo de líquido cefalorraquídeo (LCR)
- análisis del líquido sinovial
- cultivo del líquido sinovial
- hemograma completo (HC)
- pruebas de función hepática
- electrolitos séricos
Tests to consider
- cultivo de médula ósea
- biopsia de tejido
- radiografías simples de las articulaciones afectadas
- radiografía de tórax
- gammagrafía ósea
- exploración por tomografía computarizada (TC) o resonancia magnética (IRM) de la columna
- exploración por tomografía computarizada (TC) o resonancia magnética (IRM) de la cabeza
Emerging tests
- reacción en cadena de la polimerasa (PCR) para la detección y diagnóstico de especies de Brucella
- espectrometría de masas desorción/ionización por láser asistida por matriz con analizador de tiempo de vuelo (MALDI-TOF MS)
Treatment algorithm
enfermedad no complicada
enfermedad complicada
Contributors
Authors
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
Liverpool
UK
Disclosures
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
Liverpool
UK
Disclosures
AG is an author of several references cited in this topic.
Sherine Thomas, MBChB, MRCP, DTMH
Consultant in Infectious Diseases
Whipps Cross Hospital
London
UK
Disclosures
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
Petah-Tikva
Israel
Disclosures
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
Houston
TX
Disclosures
EJY declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
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.Full text Abstract
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.Full text Abstract
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.Full text Abstract
Yousefi-Nooraie R, Mortaz-Hejri S, Mehrani M, et al. Antibiotics for treating human brucellosis. Cochrane Database Syst Rev. 2012 Oct 17;10:CD007179.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Tuberculosis
- Infección por malaria
- Infección tifoidea
More DifferentialsGuidelines
- Yellow Book: health information for international travel: brucellosis
- CDC Yellow Book: health information for international travel: brucellosis
More Guidelines
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