BRUCELLOSIS FOLLOWING TREATMENT - DIAGNOSIS OF RELAPSE

BACKGROUND: Given the frequency of relapse following treatment of brucellosis as well as the persistence of symptoms the authors attempted to discover a recommendable position for surveillance of patients once treatment has been completed. METHODS: A series of 105 patients treated for brucellosis was prospectively analyzed, 11 of whom had relapse. Post treatment symptoms, serology titers and the results of the cultures between the cured patients and those with relapse were compared. RESULTS: Hemocultures (sensitivity 0.73) and "specific" symptoms (prolonged fever, spondylitis, arthritis, orchitis and others) were the most useful data for diagnosis of relapse. The presence of vague symptoms following treatment was of slight value specially in the first months. Elevation of serology titers following treatment offered little aid in diagnosis (likelihood ratio 1.7). The persistence of high titers of serology several months following completion of treatment offered high likelihood ratios which may aid in therapeutic decision making. CONCLUSIONS: It is recommended that no tests be made on asymptomatic patients following treatment of brucellosis and to treat those patients with "specific" symptoms. Hemocultures are recommended for patients with vague symptoms and if several months have passed serology should be carried out from which the probability of relapse may be calculated.