Brucellosis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Danitza Lukac Vishal Devarkonda, M.B.B.S[2]

Overview

Brucellosis must be differentiated from Typhoid fever, Malaria, Tuberculosis, Lymphoma, Dengue, Leptospirosis, Rheumatic disease, Epstein-barr virus, Toxoplasmosis, Cytomegalovirus, and HIV.

Differentiating Brucellosis from other Diseases

Brucellosis must be differentiated from Typhoid fever, Malaria, Tuberculosis, Lymphoma, Dengue, Leptospirosis, Rheumatic disease, Epstein-barr virus, Toxoplasmosis, Cytomegalovirus, and HIV.

A detailed clinical history which includes recent travel history, recent camping or hunting, consumption of unpasteurized milk or raw meat products, and occupational history should be obtained, in order to differentiate Brucellosis from other diseases. ✔ !✔/✘ !✔/✘ !✘

Classification of acute abdomen based on etiology		Presentation	Symptoms				Signs			Diagnosis		Additional Findings
			Fever	Abdominal Pain	Diarrhea	Constipation	Guarding	Rebound Tenderness	Bowel sounds	Lab Findings	Imaging Findings
Common causes of Peritonitis	Primary Peritonitis	Spontateous Bacterial Peritonitis	✔	Diffuse	✘	✘	✘	✘	Diminished	Ascitic fluid PMN >250cells/mm³ Culture: Positive for single organism
	Secondary Peritonitis	Perforated gastric and duodenal ulcer	✔	Diffuse	✘	✘	✔	✔	✘	Glucose < 50mg/dl Ascitic fluid LDH > serum LDH Total Protein > 1g/dl
		Acute Cholangitis	✔	RUQ	✘	✘	✘	✘	N	Increased LFT
		Acute Cholecystitis	✔	RUQ	✘	✘	✘	✘	N
		Acute Pancreatitis	✔	Diffuse	✔	✘	✘	✘	N	Increased Amylase / Lipase
		Acute Appendicitis	✔	RLQ	✘	✘	✘	✔	N
		Acute Diverticulitis	✔	LLQ	✔/✘	✔/✘	✘	✘	N
		Acute Salphingitis	✔	LLQ/ RLQ	✘	✘	✔/✘	✔/✘	N
Hollow Viscous Obstruction		Small Intestine obstruction	✘	Diffuse	✘	✔✔	✘	✘	Absent
		Volvulus		LLQ
		Biliary Colic		RUQ
		Renal Colic		Flank Pain
Vascular Disorders	Ischemic causes	Mesentric Ischemia		Periumbilical						Increased AG Acidosis
		Acute Ischemic Colitis
	Hemorrhagic causes	Ruptured Abdominal Aortic Aneurysm		Diffuse
		Intraabdominal or Retroperitoneal Hemorrhage		Diffuse
Gynaecological Causes	Ovarian Cyst Complications	Torsion of the Cyst		RLQ / LLQ
		Cyst Rupture		RLQ / LLQ
	Pregnancy	Ruptured Ectopic Pregnancy		RLQ / LLQ						Positive Urine beta HCG

Differentiating Brucellosis from other diseases
Disease	History of consumption of unpasteurized milk or daily products	History of recent weight loss	Situated in endemic area or travel to endemic area	IV abuse or multiple sexual partners	Fever	Rash	Painless lymphadenopathy	Painful Lymphadenopathy	White patches on the tonsil and back of throat	Keys distinguishing features
Brucellosis	✔	✖	✔	✖	✔	✔	✖	✔	✖
Typhoid fever	✖	✖	✔	✖	✔	✔	✖	✔	✖	Step ladder fever Rash which is salmon-colored and blanching
Malaria	✖	✖	✔	✖	✔	✖	✖	✔	✖	Paroxysms of spike in fever Chills Sweating
Tuberculosis	✖	✔	✔	✖	✔	✖	✖	✔	✖	Night sweats Weight loss Fatigue
Lymphoma	✖	✔	✔	✖	✔	✔	✔	✖	✖	Insidious in nature Painless lymphadenopathy
Epstein-Barr virus	✖	✖	✖	✖	✔	✔	✖	✔	✔	Posterior cervical lymphadenopathy
Toxoplasma	✖	✖	✖	✖	✔	✔	✔	✖	✖	Immunocompromised
Cytomegalovirus	✖	✖	✖	✖	✔	✔	✖	✔	✖	History of Blood transfusion
HIV	✖	✔	✔	✔	✔	✔	✔	✔	✖	History of  highest risk of contracting disease include contaminated blood transfusions, childbirth, needle sharing, and receptive anal intercourse.