(Undulant fever, malta fever, abortus fever)

A bacterial infection of acute or insidious onset common as an occupational disease among people working with infected livestock or associated fresh animal products, eg. butchers, farmers, abattoir workers

Causes

• Brucella abortus (cattle)
• Brucella canis (dog)
• Brucella melitensis (goats & sheep)
• Brucella suis (pigs)

Clinical features

• Intermittent (fluctuating) fever
• Aches and pains
• Orchitis (inflammation of the testes)
• Osteomyelitis of the vertebrae (uncommon but characteristic)

Differential diagnosis

• Typhoid
• Malaria
• Trypanosomiasis
• Tuberculosis
• Other causes of prolonged fever

Investigations

Blood: for compliment fixation test or agglutination test (where possible)

Isolation of the infectious agent from blood, bone marrow or other tissues by culture

Management

HC4

Adult and child >8 yrs:

doxycycline 100mg every 12 hours for 6 weeks child: 2mg/kg per dose

plus streptomycin 1g IM daily for 2 weeks child: 15mg/kg per dose or gentamicin 5-7mg/kg IV daily for 2 weeks child: 7.5mg/kg daily in 1-3 divided doses

Child ≤ 8yrs:

cotrimoxazole 24mg/kg every 12 hours for 6 weeks

plus gentamicin 7.5mg/kg IV in 1-3 divided doses daily for 2 weeks

Caution

doxycyline, gentamicin: contraindicated in pregnancy

Prevention

• Provide public health education on:

drinking only pasteurised or boiled milk

avoiding handling pigs, goats and cattle if a person has wounds or cuts

searching for infection among domestic animals