BMJ 2010: 341: 841 – 96 (23rd October)

Anyone know what the hell Brucellosis is? No, me neither – at least not until this week’s article on the subject enlightened me. It is, in case you were wondering, a bacterial zoonosis (anyone know what the hell a zoonosis is? Oh, never mind) transmitted primarily through unpasteurised dairy products from infected animals, especially raw milk, soft cheese, butter, and ice cream. It’s most common in Middle Eastern countries, central Asia, parts of Latin America, and most Mediterranean countries, and possibly India although we don’t know that for sure.

On to the nitty-gritty – how does it present? Brucellosis is one of those annoying illnesses that’s almost impossible to diagnose because, apart from it being the sort of thing that you vaguely remember hearing about back in your medical school days and forgetting almost immediately, it can present with non-specific features in any organ system. It shows up two to eight weeks after infection, most often with fever (about three-quarters of cases), general symptoms of malaise/anorexia/night sweats (about a quarter), and migratory large-joint arthritis (about a fifth). Examination may show hepatomegaly/splenomegaly (about a third) or lymphadenopathy (7%) but may not show anything of note. Symptoms can also include peripheral neuropathy, meningoencephalopathy, pleural effusions (OK, OK, I know that’s a sign not a symptom), pneumonia, and endocarditis of the aortic valve. About the one thing that’s supposedly almost specific to brucellosis is ‘malodorous perspiration’, at least according to one article in the NEJM. Something tells me the authors weren’t studying a primary care population.

As for diagnosing it, talk to your local microbiologist. Blood cultures are of dubious sensitivity. Obscure-sounding serological tests are available. Frankly, all a bit of a moot point, given the unlikelihood of me picking it up in the first place. Sounds like a topic for a House episode. Come to think of it, it may have been a topic for a House episode for all I know.

The only other point I found noteworthy from this issue is that, while it is still worth taking fish oil supplements in pregnancy to reduce the risk of premature birth, the hoped-for benefits in terms of reduced rates of postpartum depression and increased rates of child development do not appear to have materialised, according to a JAMA article referenced in Short Cuts. Pity.

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About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in BMJ, BMJ 2010, BMJ 341, Infectious Diseases, Pregnancy and Childbirth. Bookmark the permalink.

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