Mediterranean Fever, (Brucellosis) A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

Most people have heard of Mediterranean Diet but have they heard of Mediterranean Fever?
Mediterranean fever or Brucellosis can be used as a bioterrorism weapon.
Brucellosis is a disease produced by a group of bacteria from the genus Brucella.
These bacteria can cause infection in both humans and animals.
Brucellosis often spread to people who eat contaminated food, which can be raw meat and un-pasteurized milk.
The bacteria can also infect through the air or contact with an open wound.
Brucellosis is an infectious disease that happens from contact with animals carrying brucella bacteria.
The disease derives its names from both its course (undulant fever) and location (Mediterranean Fever, Malta fever, Crimean fever)
Brucella bacteria can be passed to humans if they make contact with infected meat or the placenta of infected animals (cattle, goats, camels, dogs and pigs), or if the human eats or drinks un-pasteurized milk or cheese.
Most cases are produced by the Brucellosis melitensis bacteria.
People working in occupations where they often make contact with animals or meat such as slaughterhouse workers, farmers, and veterinarians are at higher risk.
Luckily, brucellosis is seldom spread from one human to another.
It can be spread through breastfeeding or blood transfusion or sexual contact (rare).
Infection is infrequent without contact with blood or tissue.
Inhalation
Skin or mucosa contact
Consumption of infected or contaminated food
Symptoms are normally non-specific:
Fever
Arthralgia
Back pain
Weakness
Abdominal pain
High fever spikes often happen every afternoon
Fever rises and falls in waves (undulant)
Diagnosis is defined by:
Rose Bengal test (RBT) or serum agglutination test
Isolation of Brucella from blood, bone marrow and liver
Blood brucellosis antigen
Treatment:
Antibiotics, such as doxycycline, streptomycin, gentamicin, and rifampin, are given to treat the infection and stop it from coming back.
Frequently, the patient needs to take the drugs for 6 weeks.
If there are complications from brucellosis, the patient will likely need to take the drugs for a longer period.
Doxycycline-rifampicin-aminoglycoside (triple drug regimen) and longer treatment regimes (>6 weeks) have the least rates of failure.

One study of the treatment of brucellar spondylitis documented that six months of triple therapy were needed to prevent recurrences.
Pregnant Women
Co-trimoxazole has been used in pregnant women with reported success.
Children
In pediatric patients older than 12 years, doxycycline (5 mg/kg/day for three weeks) plus gentamicin (5 mg/kg/day IM for the first five days) is the advised therapy.
For children younger than 12 years, trimethoprim/sulfamethoxazole (TMP-SMZ) for three weeks and a five-day course of gentamicin are most efficacious.
Adults
Doxycycline (100 mg PO bd for six weeks) is the most suitable monotherapy in simple infection; but relapse rates may reach 40% for monotherapy treatment.
Rifampicin (600-900 mg/day) is typically added to doxycycline for a full six-week course.
Doxycycline (six weeks) plus streptomycin (two or three weeks) was a more successful regimen than doxycycline plus rifampicin (six weeks).
Streptomycin requires daily intramuscular injections and is more costly than rifampicin.
In patients with spondylitis or sacroiliitis, doxycycline plus streptomycin (1 g/day IM for three weeks) was found to be more effective than the doxycycline and rifampicin combination.
The quinolone plus rifampicin (6 weeks) regime is somewhat better endured than doxycycline plus rifampicin but there was no difference in efficacy.
Corticosteroids may be indicated in CNS infection.
Most patients resolve completely if treated early.

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