Mostly from non UK sources, with incubation 5-30 days, but maybe up to 6 months. Comes from unpasteurised dairy products - eating or inhaling airborne components. Take a thorough travel history.
Previously called Maltese fever.
May be asymptomatic.
Fever (74%) may wax and wane
Constitutional (26%) - fever, malaise, weakness, fatigue, headache, dizziness, myalgia, arthralgia and night sweats.
Hepatomegaly and splenomegaly (33%)
Maloderous perspiration - almost pathognomic
Peripheral neuropathy, pleural effusions, pneumonia and endocarditis can also be present.
Blood culture in 20-80%
Serology, PCR testing
Leucocytopenia, lymphocytosis, thrombocytopenia or anaemia
Gentamycin for 7 days + doxycycline
Rifampin + doxy
Cipro + doxy