Respiratory System Infections

Respiratory tract involvement with brucellosis may include pneumonia, pleural effusion, lung nodules or abscesses, miliary lesions, and thoracic lymphadenopathy (Pappas et al. 2003; Wortmann 2004).

The committee concludes that there is sufficient evidence of an association between brucellosis and respiratory system infections.

Other Symptoms

People who have chronic brucellosis often report fatigue, inattention, amnesia, and depression (Gokul et al. 2000; Imboden et al. 1959; Khateeb et al. 1990; Martin et al. 1961; Sacks and Van Rensburg 1976; Spink 1951).

The committee concludes that there is limited or suggestive evidence of an association between brucellosis and fatigue, inattention, amnesia, and depression.


Leishmaniasis is an intracellular infection caused by a diverse group of protozoa in the genus Leishmania. It affects an estimated 12 million people worldwide; there are 1-1.5 million new infections each year.

Leishmaniasis presents as one of three major clinical syndromes: visceral leishmaniasis (VL, also known as kala-azar), cutaneous leishmaniasis (CL) and (infrequently) mucocutaneous leishmaniasis (MCL). About 90% of VL cases occur in India, Bangladesh, Sudan, and Brazil; 90% of CL cases in Afghanistan, Brazil, Iran, Peru, Saudi Arabia, and Syria; and 90% of MCL cases, in Bolivia, Brazil, and Peru (Desjeux 2004; Murray et al. 2005). The three syndromes have been divided into a complex taxonomic and etiologic scheme that is explained briefly here (Table 5.3).

CL is divided into Old World CL (referring to occurrences in southern Europe, the Middle East, and parts of southwest Asia and Africa) and New World CL (southern United States and Latin America). L. tropica, L. major and L. aethiopica occasionally disseminate to cause diffuse cutaneous leishmaniasis (DCL). L. braziliensis can cause mucosal leishmaniasis.

TABLE 5.3 Clinical Syndromes Caused by Leishmania Species and Their Geographic Distribution

Clinical Syndromes

Leishmania species


Visceral leishmaniasis:



Kala-azar; generalized involvement of reticuloendothelial system (spleen, bone marrow, liver)

L. donovani

Indian subcontinent, northern and eastern China, Pakistan, Nepal

L. infantum

Middle East, Mediterranean littoral, Balkans, central and southwestern Asia, northern and northwestern China, northern and sub-Saharan Africa

L. donovani (archiba)

Sudan, Kenya, Ethiopia

L. chagasi

Latin America

L. amazonensis

Brazil (Bahia state)

L. tropica

Israel, India; viscerotropic form of disease in Saudi Arabia (US troops)

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