title: Acute brucellosis: presentation, diagnosis, and treatment of 144 cases.
abstract: OBJECTIVE
  Brucellosis, whether in an endemic region or not, remains a diagnostic puzzle due to occasional misleading unusual presentations and non-specific symptoms. Presented herein is our 14-year experience with acute brucellosis at Sparta General Hospital, Lakonia, Greece.
  
  
  METHODS
  A case series of 144 patients admitted to the internal medicine, pediatrics, and urology departments, through evaluation of history, occupational data, serological tests, cultures of blood and other body fluids, and imaging studies. Patients were treated with a 21-day course of intramuscular streptomycin and a prolonged two-month course of doxycycline with a six-month follow-up.
  
  
  RESULTS
  Infected patients had a relevant occupational history in fewer than 20% of cases. Clinical manifestations included non-specific symptoms (fever, malaise, sweats, arthralgias, lower back pain, headache), findings such as splenomegaly (51%), osteoarticular involvement (42%), cervical lymphadenitis (31%), hepatomegaly (25%), genitourinary involvement (13% of men), cholecystitis (2%), breast abscess (0.7%), and acute abdomen (0.7%). Ninety-five percent of the patients had a serological titer > or =1/160 with culture-proven brucellosis. Overall, 82% of blood cultures and 100% of other body fluid cultures (synovial, bile) were positive. Ninety-seven percent of the patients were cured. Relapse in the follow-up period was observed in four patients who had not complied with treatment.
  
  
  CONCLUSIONS
  Brucellosis is an infection with multiple presentations, and whether in an endemic region or not, a thorough history of exposure and clinical suspicion are required since thresholds in serological evaluation may lead to misdiagnosis and withholding of adequate treatment.
authors.affiliation: Gytheio Health Care Centre, Gytheio Lakonia 23200, Greece. ermanitari@hotmail.com
authors.forename: Panos
authors.initials: P
authors.lastname: Andriopoulos
authors.forename: Maria
authors.initials: M
authors.lastname: Tsironi
authors.forename: Spiros
authors.initials: S
authors.lastname: Deftereos
authors.forename: Athanassios
authors.initials: A
authors.lastname: Aessopos
authors.forename: Giorgos
authors.initials: G
authors.lastname: Assimakopoulos
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002006:Brucellosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D013307:Streptomycin / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D013307:Streptomycin