Spinal brucellosis in a southern California resident

Dynamic changes in patient demography that are currently altering the regional epidemiology of brucellosis attest to the need for physicians to reacquaint themselves with a disease that has been largely forgotten in the United States. This is especially the case in California, which has a large immigrant population and where brucellosis clearly appears to have evolved from an occupational to a food-borne illness. In our recent clinical experiences with several cases of brucellosis, food-borne transmission of the organism is the presumptive cause of the disease, as no causes were associated with occupational risks for exposure to the organism. This suggests that given a clinical history consistent with brucellosis, physicians working with patient groups at risk for food-borne exposure must inquire about the ingestion of unpasteurized dairy products specifically and early during the patient visit. A history of travel to areas endemic for brucellosis may further aid diagnosis. Although a predominance of nonspecific clinical signs and symptoms (such as fevers or arthralgias) often makes the clinical diagnosis difficult, the frequency and characteristic patterns of localized disease should heighten clinicians' index of suspicion and lower the threshold for a serologic investigation. Prominent musculoskeletal complaints (especially back pain) accompanied by constitutional symptoms such as fever, malaise, and weight loss may be consistent with brucellosis and a history of unpasteurized dairy ingestion should be elicited. Radiographic evidence that localizes the source of back pain as caused by sacroiliitis or spondylitis is highly suggestive of brucellosis in appropriate patients. In such cases, serologic tests should be persuaded early if warranted by the clinical impression.