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.
Presentation
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.
Rarely prostatitis or sacroillitis, epididymo-orchitis, pneumonia, hepatitis, endocarditis, uveitis, dermatitis and meningitis.
Diagnosis
Blood culture in 20-80%
Serology, PCR testing
Leucocytopenia, lymphocytosis, thrombocytopenia or anaemia
Treatment
Gentamycin for 7 days + doxycycline
Rifampin + doxy
Cipro + doxy
References
https://webarchive.nationalarchives.gov.uk/20140714100821/http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1195733811188
http://southlondonem.blogspot.com/2014/07/fever-in-returning-traveller.html
http://klossandbruce.com/graphic-guide-to-infectious-disease/
https://www.who.int/news-room/fact-sheets/detail/brucellosis
https://en.wikipedia.org/wiki/Brucellosis
