What are the other Names for this Condition? (Also known as/Synonyms)

• Brucellosis Lymphadenitis
• Enlarged Lymph Nodes due to Brucellosis
• Malta Fever Lymphadenopathy

What is Brucellosis Lymphadenopathy? (Definition/Background Information)

• Brucellosis Lymphadenopathy is the inflammation and enlargement of lymph nodes due to underlying Brucellosis, which is caused by a bacteria
• Brucellosis is a bacterial infection caused by the Brucella species. It is transmitted from animals to humans. The bacteria are commonly found in domestic animals including sheep, goat, cattle, pigs, and dogs
• Human infection can occur through direct contact with the infected animals (through open cuts and wounds), inhalation of the bacteria, breastfeeding (from infected mother to child), and through sexual transmission
• Brucellosis can affect individuals with occupations that include farming, veterinary care, workers in slaughterhouse and meat-packing industries, aid workers, and frequent travelers
• Enlarged lymph nodes, due to Brucellosis Lymphadenopathy, are not very commonly observed. The underlying Brucellosis is characterized by chronic symptoms such as fever, joint pain, and tiredness. If left undiagnosed and untreated, several complications as a result of the bacterial infection spreading to vital organs, such as the liver and spleen, may arise
• A healthcare provider may diagnose the condition through symptom assessment, medical history, information from blood tests, CT scans, echocardiograph, and a lymph node biopsy (if necessary)
• Brucellosis Lymphadenopathy is treated using antibiotics for a 6-week period. Depending on the severity and spread of Brucellosis infection, recovery may take from a few weeks to several months, and the prognosis is generally good
• Some preventative measures include wearing gloves while handling infected animals, separating the slaughtering areas from processing areas, thoroughly cooking meat, and avoiding the consumption of unpasteurized dairy products

Who gets Brucellosis Lymphadenopathy? (Age and Sex Distribution)

Brucellosis Lymphadenopathy forms due to underlying Brucellosis infection. Any individual (child or adult) is susceptible to Brucellosis. However, it is more common among the following category of people:

• Individuals who work in slaughterhouses
• Those who are involved in cleaning and butchering livestock (and deer)
• Those who are closely associated with cattle, pigs, sheep, and goats such as farm workers
• Individuals who consume unpasteurized dairy products (that includes raw milk)
• Veterinarians
• People whose occupation involves packing/packaging meat and dairy products
• Travelers, missionaries, and aid workers are generally more prone to Brucellosis

Brucellosis occurs worldwide and all racial and ethnic groups are at risk; no particular preference is observed.

What are the Risk Factors for Brucellosis Lymphadenopathy? (Predisposing Factors)

The main risk factor for Brucellosis Lymphadenopathy is the underlying Brucellosis infection, which may occur due to factors such as:

• Place of living: Some geographical areas in the world have been determined as high-risk, as far as Brucellosis infection is concerned. They include the following regions:
  • Mediterranean basin; near the Persian gulf
  • South and Central America; Latin America
  • Eastern Europe
  • Asia including the Indian subcontinent
  • Africa and the middle East
  • Caribbean islands
• Travelers: Individuals, who travel extensively around the world, are at high risk of contracting this infection. Among travelers, generally it has been observed that eating unpasteurized cheese, known as “village cheese”, is the main source and cause of Brucellosis infection
• Occupations: People with occupations (as below) have a greater risk of getting infected. These include:
  • Veterinarians
  • Dairy farmers
  • Ranchers
  • Slaughterhouse workers
  • Hunters
  • Microbiologists

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Brucellosis Lymphadenopathy? (Etiology)

Brucellosis Lymphadenopathy is caused by Brucella sp (Brucella abortus). Brucellosis is a bacterial infection that is transmitted from animals to humans. The Brucella bacterium commonly infects the following groups of animals:

• Farm animals such as cattle, sheep, goat, and pigs
• Wild animals such as deer
• Pets such as dogs

A transmission to humans can cause Brucellosis, which may occur due to:

• Direct contact with the infected animals; through the mucous membranes
• Cuts and wounds in the skin coming in direct contact with infected animal fluids
• Consuming unpasteurized dairy products including raw milk and cheese
• Breathing-in the bacteria
• Breastfeeding mothers (who are infected) passing bacteria to their infants
• Sexual transmission

What are the Signs and Symptoms of Brucellosis Lymphadenopathy?

Brucellosis Lymphadenopathy can result in the formation of enlarged lymph nodes; however, this is generally not a common occurrence.

• If the lymph node enlargement is confined to a local area, it is called localized Brucellosis Lymphadenopathy
• If the lymph node enlargement occurs all over the body, it is called generalized Brucellosis Lymphadenopathy

The associated signs and symptoms of Brucellosis infection may be grouped as either short-term or long-term.

The short-term symptoms may include:

• Undulant fever, which is fever of variable duration
• Chills, sweating
• Weight loss, loss of appetite
• Vomiting
• Anemia
• Weakness and fatigue; prolonged tiredness
• Joint, muscle, and back pain; headache
• Depression, irritability
• Insomnia (unable to sleep)
• Mental disorders

The long-term symptoms may include:

• Fatigue
• Recurrent fever
• Arthritis and spondylitis
• Infection in the bones and joints
• Infection in various organs such as liver, kidney, spleen, heart valves and lining of the heart
• Infection of the central nervous system (CNS)
• Testicular swelling in males

How is Brucellosis Lymphadenopathy Diagnosed?

The following laboratory exams and tests may be undertaken to diagnose Brucellosis Lymphadenopathy:

• Complete physical examination including evaluation of medical and travel history
• Blood or bone marrow sample tests to check for the presence of Brucella bacteria
• Blood tests may also be conducted to check the level of antibodies present in blood
• X-rays to observe any changes in the bones and joints
• CT or MRI scans to identify the presence and extent of inflammation in the brain and other tissues
• Cerebrospinal fluid culture to check for meningitis and encephalitis
• Echocardiography to check for any damage or infection in the heart

Note: Biopsy of the lymph node is usually not performed. However, if there is a concern for lymphoma or if the infection does not resolve with treatment, then a biopsy may be undertaken.

• Lymph node biopsy: A lymph node biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. The pathologist may use special techniques, such as immunohistochemistry stains, to help reveal the presence of the pathogen
• The lymph node biopsy may be performed through any of the following procedures:
  • Fine needle aspiration biopsy (FNAB): A device called a cannula is used to extract tissue or fluid from the lymph nodes
  • Lymph node core biopsy of the enlarged lymph node
  • Lymph node open biopsy of the enlarged lymph node

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Brucellosis Lymphadenopathy?

Complications due to underlying Brucellosis (causing Lymphadenopathy) that can affect several organs of the human body may include:

• Enlargement of liver (hepatomegaly) and spleen (splenomegaly)
• Endocarditis (infection of the heart’s inner lining) is a very serious complication that can damage the heart valves, if left untreated. It is a major cause for Brucellosis-related deaths
• Arthritis that is characterized by pain, stiffness, and swelling in the joints (knees, hips, ankles, and wrists may be affected)
• Spondylitis: Inflammation in the bones of the spine or between the spine and pelvis
• Epididymo-orchitis (inflammation and infection of the testicles): Brucellosis Lymphadenopathy can damage the coiled tube that connects the vas deferens and the testicle, causing severe swelling and pain
• The prostate gland and the kidneys can also be affected
• Infection of the central nervous system can be life-threatening and may include:
  • Meningitis: Inflammation of the membranes surrounding the brain and spinal cord
  • Encephalitis: Inflammation of the brain

How is Brucellosis Lymphadenopathy Treated?

Brucellosis Lymphadenopathy is treated in the following manner:

• A course of antibiotics for 6 weeks is the recommended treatment
• Symptomatic treatment - addressing the signs and symptoms and reducing the risk of complications
• Preventing relapse or recurrence of the disease

How can Brucellosis Lymphadenopathy be Prevented?

Brucellosis Lymphadenopathy occurs as a consequence of Brucellosis infection. The following preventive measures may be adopted to avoid contracting Brucellosis:

• Avoid unpasteurized dairy foods such as raw milk
• Cook meat to high temperatures (up to 145-165 deg. F) to destroy the bacteria
• Avoid buying meat from unregulated (street) vendors
• Veterinarians, farmers, hunters and slaughterhouse workers should wear gloves while handling sick or dead animals
• Particular care must be taken while handling aborted animal fetuses (including tissue and fluids), while assisting animal birth, or while calving (in cattle); the use of long-armed disposable plastic gloves is advised
• Adhere to safety precautions in high-risk work places that deal with animals
• Lab workers should follow bio-safety considerations while handling specimens
• In slaughterhouses, separating the slaughtering place from the processing area, can help avoid spread of the bacteria
• Have safe sex (use condoms)
• Generally, pregnant women should avoid handling raw meat and meat products, since they can be infected
• Eliminating Brucellosis from livestock by vaccinating domestic animals
• Quarantine infected herds and remove them from the healthy animal stock, since Brucellosis in animals has no treatment

What is the Prognosis of Brucellosis Lymphadenopathy? (Outcomes/Resolutions)

• The prognosis of Brucellosis Lymphadenopathy is based on the severity of the underlying Brucellosis infection, which can be cured with suitable treatment
• Recovery may take from a few weeks to several months, depending on how soon the treatment was started and the severity of the illness
• Generally, the mortality rate from this bacterial infection is reported to be low; though severe complications can result in fatalities

Additional and Relevant Useful Information for Brucellosis Lymphadenopathy:

General information on lymph nodes:

The lymph nodes are part of one’s immune system. The lymph nodes are present throughout the body, usually in groups. In normal healthy adults, one cannot feel (see or touch) the lymph nodes readily. However, if they are enlarged, they can be felt either by the individual himself/herself or by the healthcare provider.

Enlarged lymph nodes can occur in both benign and malignant conditions. Hence, the cause of enlarged lymph nodes should be evaluated. If no obvious cause for enlargement of lymph nodes is found, then the possibility of a lymph node malignancy should be ruled out.

In a majority of individuals, a lymph node swelling is caused by a benign process such as an inflammation or infection. In many cases, swollen lymph nodes are part of other signs and symptoms. This can help a healthcare provider arrive at a list of follow-up tests and ensure an accurate diagnosis. Superficial enlarged lymph nodes can be felt by the healthcare provider through palpation. Enlarged lymph nodes deep in the body are often detected by radiological studies such as X-rays, ultrasound scan, CT and MRI scans.

Some enlarged lymph nodes can be painful, while others may be painless. Depending upon the underlying cause, enlarged lymph nodes can be localized to a particular area of the body, or they can be generalized, meaning that they are present throughout the body.