Because of the COVID19 pandemic, you are practicing telemedicine. You see a case of
a 42-year-old man who has had recurrent fevers and joint pains for the past several
months. You are shown a graph of his temperatures and a nucleotide scan of his skeleton
(see below).
What is your diagnosis, what test(s) do you recommend to confirm your suspicions,
and what treatment, if any, do you recommend? What do you think this man does for
a living?
DIAGNOSIS: Osteoarticular brucellosis in an abettoire worker. The main clue in this
case is the presence of a chaotic relapsing fever that tends to return to normal or
near normal every 10 days or so. Fever is so characteristic of chronic brucellosis
that the disease is is known as undulant fever, remitting fever, Mediterranean fever,
Maltese fever, Gibraltar fever, Crimean fever, and goat fever.
The other diagnostic clue in the presented case is the extensive inflammation of
his skeletal system as seen on the nucleotide scan. Osteoarticular brucellosis occurs
in up to 77% of patients with the most common clinical forms being osteomyelitis,
spondylitis, sacroiliitis, arthritis and bursitis.
The diagnosis of brucellosis can be confirmed by performing serological tests (agglutination,
ELISA), PCR, and by obtaining blood and/or tissue cultures which will usually yield
positive results in ∼ 5-7 days. There is also a rapid point-of-care dipstick assay.
Antibiotics commonly used to treat osteoarticular brucellosis include doxycycline,
streptomycin, gentamicin, trimethoprim/sulfamethoxazole and rifampin in a regimen
that includes two or three drug combinations.
The figure below shows the zoonotic potential of the various Brucella species. The
colors and arrow sizes represent the zoonotic risk displayed by each species isolated
from its preferred host (from Suarez-Esquivel, M.; Chaves-Olarte,E.; Moreno, E.; Guzman-Verri,
C. Brucella genomics: macro and micro evolution. Int. J. Mol. Sci. 2020,21,7749).
