Brucellosis: difficulties in diagnosis and a report on 38 cases

We have reviewed 38 patients with brucellosis who were admitted to the Chaim Sheba Medical Center between 1955 and 1977, i.e. during a 23-year period. The clinical manifestations varied greatly. Diagnosis was easy when brucellosis was suspected, as in cases presenting with fever of unknown origin. In nine of the 38 cases diagnosis was difficult and delayed for several weeks since brucellosis was not suspected. Some of these cases will be described in detail. The diagnosis was established in 16 patients by isolating Brucella melitensis and in the other 22 by serological tests. There were no relapses in the 26 patients treated with a combination of streptomycin and tetracycline; two of the 12 patients treated with tetracycline alone relapsed. Brucellosis should be considered when clinical manifestations are puzzling.