[Brucellosis: clinical presentation, diagnosis, complications and therapeutic options]

Brucellosis is a zoonotic disease that causes systemic symptoms and can involve many organs and tissues. The major sources of infection are consumption of unpasteurized diary products and occupational contact. Brucella is a small, gram-negative coccobacillus that grows slowly in vitro. There are four species of brucella that are pathogenic for humans; in Israel Brucella melitensis is still the most frequent organism. There are several methods to identified the organism and make the diagnosis (1) isolation of brucella from blood, tissue specimens, body fluids and bone marrow; (2) agglutination test and (3) polymerase chain reaction (PCR) that has recently been shown to be a promising tool for the diagnosis of acute disease. Involvement of the musculoskeletal system is the most common complication of brucellosis, while meningitis and endocarditis are life-threatening complications. The standard treatment for acute and chronic brucellosis is a combination of doxycycline with a second drug such as rifampicin or gentamicin, in order to cure, prevent complications and relapse. Although the rate of occurrence is ever-decreasing due to vaccination of animals, nonetheless, the disease has not been eradicated in Israel. This review focuses on the clinical presentation, diagnosis, and mainly on complications of brucellosis and the available therapeutic options.