SAT (Almuneef and Memish 2003; Ariza et al. 1992; Khateeb et al. 1990; Lulu et al. 1988) and may be positive when other tests are negative. In evaluating people for neurobrucellosis when the SAT is negative, an ELISA should be performed (Araj et al. 1988). If neurobrucellosis is considered and serum antibody tests and microbiologic cultures are negative, cerebral spinal fluid can be evaluated for the presence of antibrucella antibodies (Kochar et al. 2000a; McLean et al. 1992).
Treatment of people for brucellosis usually involves administration of tetracyclines (usually doxycycline) with rifampin for 6 weeks (WHO 1986). However, a regimen of oral doxycycline for 6 weeks and streptomycin for 2-3 weeks is more effective (Solera et al. 1995). Streptomycin may be replaced with gentamicin. Administration of aminoglycoside antibiotics is associated with renal and cranial VIIIth nerve toxicity, although if aminoglycosides are appropriately administered during short-course therapy, such complications are rare and often transient.
Although Brucella spp. are intracellular pathogens, there has been no apparent increase in morbidity and mortality during coinfection with brucellae and other intracellular pathogens or infections that disrupt the cellular immune system, such as HIV infection.
Acute brucellosis may be a nonspecific flu-like illness, so a specific diagnosis might not be made. People with untreated brucellosis are at risk for the relapsing and chronic health outcomes described below. In addition, antimicrobial therapy is not 100% effective, and even treated people are at risk for relapse and chronic disease. Clinical manifestations due to relapsing or chronic brucellosis usually are evident within 2-6 months of acute illness and if untreated can persist for years or decades (Spink 1951). Manifestations may be protean and nonspecific. Focal infections have also been reported up to 30 years after probable acute disease (Ariza et al. 2001; Colmenero et al. 2002; Martin et al. 1961; Mousa et al. 1986; Norton 1984; Williams and Crossley 1982; Zinneman et al. 1961).
Diagnosis during chronic brucellosis is similar to that during acute disease. During chronic brucellosis, bacteriologic confirmation may include detecting the organism in a bone marrow sample or in a focal infectious process or abscess. Serologic evaluation is usually positive. Isolated involvement of the central nervous system is rare and is usually diagnosed with serologic analysis or antibody analysis of cerebral spinal fluid.
The major manifestations of relapsing or chronic brucellosis include the following conditions and organ systems.