Intended for healthcare professionals

Practice Easily Missed?

Human brucellosis

BMJ 2010; 341 doi: (Published 10 September 2010) Cite this as: BMJ 2010;341:c4545
  1. Brodie Ramin, family medicine resident 1,
  2. Paul MacPherson, associate professor2
  1. 1Ottawa Hospital, University of Ottawa, Ottawa, Canada, K1H 8L6
  2. 2Division of Infectious Diseases, Ottawa Hospital, Ottawa Health Research Institute, University of Ottawa, Canada
  1. Correspondence to: Brodie Ramin bramin{at}
  • Accepted 12 August 2010

Brucellosis is the most common bacterial zoonosis, with over 500 000 new cases globally every year.1 Human brucellosis is transmitted primarily through unpasteurised dairy products derived from infected animals. The disease has also been known as “Malta fever” and “Mediterranean fever.”2 Brucella species are small Gram negative coccobacilli that are facultative intracellular pathogens for humans; the most common animal reservoirs for human disease are sheep and goats.3

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How common is human brucellosis?

Case scenario

A 38 year old woman presents to her general practitioner complaining of 10 weeks of fatigue and joint pains. She had returned from Turkey three months before, and while there she had had a one week episode of fevers. When questioned about food consumption abroad, she admits eating local cheese while travelling in rural Turkey. On examination, she has mild hepatomegaly, but there are no other findings. Serology tests confirm human brucellosis.

Why is brucellosis missed?

Case reports have shown delays of several months in the diagnosis of brucellosis, increasing the morbidity for affected patients.3 Brucellosis is missed for two reasons. Firstly, like tuberculosis and syphilis, the disease is a great “imitator” and can present with non-specific features in any organ system.4 Secondly, brucellosis is rare in western Europe and North America and so is often not considered in the differential diagnosis, …

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