New aspects in the diagnosis and treatment of Brucella infection

Brucellosis is a zoonosis which is transmitted to humans, almost always, by direct or indirect contact with infected animals or their products. Brucella melitensis continues to be the major cause of human brucellosis worldwide, followed by Brucella abortus and Brucella suis, and rare cases of infection by Brucella canis, as well as by novel Brucella pathogens from marine mammals have also emerged. Brucellosis may be insidious, or may present with atypical manifestations, and elicitation of a careful clinical history is essential for suspicion of the diagnosis. Occupational exposure in an area in which the infection is epidemic raises the possibility of brucellosis. However, the diagnosis of human brucellosis cannot be made solely on clinical grounds, because of the wide variety of clinical manifestations, and laboratory investigation is needed to confirm the presence of the organism or the specific immune response to its antigens. The administration of effective antibiotics for an adequate length of time is essential for the treatment of all forms of human brucellosis. A number of clinical studies have assessed the efficacy of different antibiotics, and the current recommendation is that treatment should consist of dual or triple regimens. Treatment of complications such as spondylitis, osteomyelitis, neurobrucellosis and endocarditis require combination therapy for longer periods. Special situations, such as childhood brucellosis and brucellosis during pregnancy require alternative medications.