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Brucellosis - A perfect case of under diagnosis!

Posted by ANAND HINDUJA on Sun, Apr 23, 2017  
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Caused by a variety of species of the genus Brucella, Brucellosis remains to be highly under diagnosed and consequently under treated in India. This phenomenon could be attributed to either lack of knowledge amongst treating physicians regarding the disease or sheer ignorance as it is considered to be a rare occurrence.


The disease is transmitted by inadvertent exposure to unpasteurized dairy products and raw meat and because of its elusive presentation, remains undiagnosed for a long time. The seldom question asked by the doctor on the occupational background or eating habits contributes to the problem too. Primarily a zoonotic disease, Brucellosis spreads through infected animals and hence, it's awareness amongst veterinary doctors and animal caregivers is a paramount need.


The disease has an insidious onset and affects multiple organ systems, hence the patient can present with wide ranging symptoms making accurate clinical diagnosis difficult. A chronic backache, nonspecific lymphadenopathy or unexplained weight loss, all are characteristic Brucellosis symptoms and should hence be ignored at one's own peril.


Brucellosis is most commonly suspected in patients with long standing fevers who come back with negative reports for common infectious disease panels. Although pinpoint diagnosis can occur only on culture, most clinicians rely on immunological testing. This is because unless specifically asked for, most microbiology labs dispose off negative blood cultures after 72 hours. Brucella requires atleast a week to grow and success rates of cultures remains low. Immunological tests are hence preferred and provide same day results aiding in diagnosis.


The best part of the story is that once diagnosed, it is relatively simple to treat the disease. A six week course of antibiotics is associated with complete cure in majority patients. Once started on the antibiotic course the patient shows drastic symptomatic improvement in as early as 48 hours. But compliance for six weeks is a challenge as many patients are completely symptom-free in two weeks and they find it difficult to adhere to the course. This unfortunately is fraught with dangers and incomplete treatment leaves patient with chronic resistant Brucellosis.


Patient counselling hence is crucial to ensure complete cure. Another good thing is that prevention is relatively simpler and hence should be stressed on. Consuming unpasteurized milk or raw untreated meat should be avoided at all costs. Vaccination of cattle is the best way to avoid transmission but stringent enforcement should be ensured.


The problem with governmental intervention in this disease is that health systems are already burdened with tuberculosis, malaria , dengue and acute diarrheal diseases. Awareness of these diseases consumes most of the time and budget. Being a relatively rare disease, Brucellosis does not attract concern. In absence of any dedicated programme to fight the disease, the onus lies on the primary care physician to keep a vigilant eye on the occupational background and clinical presentation of the patient.


Timely diagnosis and prompt treatment can ensure complete cure and can help save many people from the multiple morbidities caused by the disease. Maybe this article could remind you what you once read in medical textbooks. Just keep an eye!

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