Symptoms of brucellosis may show up anytime from a few days to a few months after you're infected with brucella, the bacteria that cause brucellosis. Signs and symptoms are similar to those of the flu and include:

• Fever, often rising to 104 F (40 C) or more in the afternoon — a rising and falling (undulating) fever is one of the hallmarks of the disease
• Chills
• Sweats
• Weakness
• Fatigue
• Joint, muscle and back pain
• Headache

Brucellosis symptoms may disappear for weeks or months and then return. In some people, brucellosis becomes chronic, with symptoms persisting for years, even after treatment. Long-term signs and symptoms include fatigue, fevers, arthritis and spondylitis — an inflammatory arthritis that affects the spine and nearby joints.

When to see a doctor
Brucellosis can be hard to identify, especially in the early stages, when it often resembles the flu. See your doctor if you develop a rapidly rising fever, muscle aches or unusual weakness and have any risk factors for the disease, or if you have a persistent fever.

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Brucellosis affects many wild and domestic animals. Cattle, goats, sheep, pigs, dogs, camels, wild boar and reindeer are especially prone to the disease. A form of brucellosis also affects harbor seals, porpoises and certain whales.

At least six species or strains of bacteria cause brucellosis in animals, but not all produce illness in humans. The bacteria spread from animals to people in three main ways:

• Raw dairy products. Brucella bacteria in the milk of infected animals can spread to humans in unpasteurized milk, ice cream, butter and cheeses. The bacteria can also be transmitted in raw or undercooked meat from infected animals.
• Inhalation. Brucella bacteria spread easily in the air. Farmers, laboratory technicians and slaughterhouse workers can inhale the bacteria.
• Direct contact. Bacteria in the blood, semen or placenta of an infected animal can enter your bloodstream through a cut or other wound. Because normal contact with animals — touching, brushing or playing — doesn't cause infection, people rarely get brucellosis from their pets. Even so, people with weakened immune systems should avoid handling dogs known to have the disease.

Brucellosis normally doesn't spread from person to person, but in a few cases, women have passed the disease to their infants during birth or through their breast milk. Rarely, brucellosis may spread through sexual activity or through contaminated blood or bone marrow transfusions.

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Brucellosis is rare in the United States, with fewer than 200 reported cases each year. These occur mainly in California and Texas.

Other parts of the world have much higher rates of infection, especially the Mediterranean Basin — Portugal, Spain, Italy, Greece, Turkey, the Near East and North Africa — South and Central America, Mexico, parts of Asia and sub-Saharan Africa.

In addition to location, these factors may increase your risk of brucellosis:

• Raw dairy foods. Because the United States has a federal domestic animal health program, the chance of infection from U.S. dairy products is low. Unpasteurized goat milk products imported from Mexico are the main source of brucellosis in the United States. Travelers who eat unpasteurized dairy products in countries where brucellosis is common are at high risk of infection. Soft goat cheeses common in Mediterranean countries are especially likely to contain brucella bacteria. Exotic foods, such as raw camel's milk, sheep placenta and reindeer meat, also may be contaminated. In the United States, people who eat unpasteurized cheeses or who travel to Mexico are at risk of getting brucellosis.
• Animal-related occupation. People who routinely work with animals, including veterinarians, dairy farmers, ranchers and slaughterhouse workers, are at especially high risk.
• Hunting. Hunters may become infected through skin wounds or by eating the undercooked meat of infected animals.
• Laboratory work. Brucellosis is the most common bacterial infection among people who work in laboratories where infectious organisms are grown. Lab workers may accidentally inhale the bacteria or become infected from spilled blood.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Brucellosis can affect almost any part of your body, including your reproductive system, liver, heart and central nervous system. Chronic brucellosis may cause complications in just one organ or throughout your body. Possible complications include:

• Infection of the heart's inner lining (endocarditis). This is one of the most serious complications of brucellosis. Untreated endocarditis can damage or destroy the heart valves and is the leading cause of brucellosis-related deaths.
• Arthritis. Osteoarthritis is marked by pain, stiffness and swelling in your joints, especially the knees, hips, ankles, wrists and spine. Spondylitis — inflammation of the joints between the bones (vertebrae) of your spine or between your spine and pelvis — can be particularly hard to treat and may cause lasting damage.
• Inflammation and infection of the testicles (epididymo-orchitis). The bacteria that cause brucellosis can infect the epididymis, the coiled tube that connects the vas deferens and the testicle. From there, the infection may spread to the testicle itself, causing swelling and pain, which may be severe. Brucellosis can also affect the prostate gland and kidneys.
• Anemia. Anemia, in which you don't have enough healthy red blood cells, can cause pale skin, fatigue and shortness of breath.
• Skin rashes. Rashes and other skin problems are a rare complication of brucellosis.
• Miscarriage. Brucellosis may cause early pregnancy loss in some women.
• Hepatitis. Brucellosis can cause this serious liver disease, which, if not treated, can lead to liver scarring (cirrhosis) and ultimately to liver failure.
• Central nervous system infections. These include potentially life-threatening illnesses such as meningitis, an inflammation of the membranes surrounding the brain and spinal cord, and encephalitis, inflammation of the brain itself.

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If you suspect that you have brucellosis, you're likely to start by seeing your family doctor or a general practitioner. You may be referred to an infectious disease specialist. A diagnosis of brucellosis depends on understanding if, how and when you were exposed to the bacteria that cause the disease. You can help your doctor by being prepared with as much information as possible.

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any recent travel outside the United States, consumption of unpasteurized dairy products or other suspected exposures.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing questions ahead of time will help you make the most of your time together. List your questions from most important to least important in case time runs out.

What to expect from your doctor
Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have you eaten raw (unpasteurized) dairy products, such as goat cheese?
• Does your job involve contact with cattle, goats, pigs or other animals or with animal tissues?
• Have you traveled outside the United States in the past year?
• Do you work in a lab where infectious organisms are present?
• Have you gone hunting recently?

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Doctors usually confirm a diagnosis of brucellosis by testing a sample of blood or bone marrow for the brucella bacteria or by testing blood for antibodies to the bacteria. Several different tests can be used. All have drawbacks, such as a lengthy wait for results or the chance of a false result. A test called polymerase chain reaction (PCR), which looks for the genetic material of the brucella bacteria, is quick and can be performed on any type of tissue. But PCR is not yet widely used for brucellosis.

To help detect complications of brucellosis, you may have additional tests, including:

• X-rays. X-rays can reveal changes in your bones and joints.
• Computerized tomography (CT) scan or magnetic resonance imaging (MRI). These imaging tests help identify inflammation or abscesses in the brain or other tissues.
• Cerebrospinal fluid culture. This checks a small sample of the fluid that surrounds your brain and spinal cord for infections such as meningitis and encephalitis.
• Echocardiography. This test uses sound waves to create images of your heart to check for signs of infection or damage to your heart.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Treatment for brucellosis aims to relieve symptoms, prevent a relapse of the disease and avoid complications. You'll need to take medications for at least six weeks, and your symptoms may not go away completely for several months. The disease can also return and may become chronic.

Antibiotics
The standard treatment for brucellosis is a combination of two or three antibiotic medications, usually doxycycline in combination with streptomycin, rifampin or gentamicin. You'll take these drugs for six weeks or longer. If brucellosis has affected your central nervous system, you may need to take three antibiotics for as long as three months. Children and pregnant women can't take certain antibiotics, so their treatment may involve just one antibiotic or a different combination of drugs.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

To reduce the risk of getting brucellosis, take these precautions:

• Avoid unpasteurized dairy foods. In recent years in the United States, few cases of brucellosis have been linked to raw dairy products from domestic herds. Still, it's probably best to avoid unpasteurized milk, cheese and ice cream, no matter what their origin. Travelers to other countries should avoid all raw dairy foods. If you're not sure whether a product is pasteurized, don't take chances.
• Cook meat thoroughly. All meat should be cooked until it reaches an internal temperature of 145 to 165 F (63 to 74 C). When eating out, order beef and pork at least medium-well. It's unlikely that domestic meat in the United States contains brucella bacteria, but proper cooking destroys other harmful bacteria such as salmonella and E. coli. When traveling abroad, avoid buying meat from street vendors and order all meat well-done.
• Wear gloves. Veterinarians, farmers, hunters and slaughterhouse workers should wear rubber gloves when handling sick or dead animals or animal tissue or when assisting an animal giving birth.
• Take safety precautions in high-risk workplaces. Laboratory workers should handle all specimens under appropriate biosafety conditions. Workers who have been exposed should be treated promptly. Slaughterhouses should also follow protective measures, such as separation of the killing floor from other processing areas and use of protective clothing.
• Immunize domestic animals. In the United States, an aggressive vaccination program has nearly eliminated brucellosis in livestock herds. Milk is tested two to four times a year for signs of the bacteria. Because the brucellosis vaccine is live, it can cause disease in people. Anyone who has an accidental needle stick while vaccinating an animal should be treated.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.