Undulant Fever (Human Brucellosis)

Undulant fever—also called brucellosis or Malta fever—is a bacterial infection you can get from contact with infected animals or from eating or drinking unpasteurized milk, cheese, or undercooked meat. The illness often starts like the flu (fever, sweats, tiredness, headache, body aches) and can come and go (undulate) for weeks to months. If not treated correctly, it can involve the bones and joints (like the spine), the heart (endocarditis), the brain coverings (meningitis), or other organs. Brucellosis is a zoonotic disease—meaning it spreads from animals to humans—and is preventable by avoiding risky foods and using proper protections around animals. CDC+1

Brucellosis incubation typically ranges from 5 days to 6 months (often 2–4 weeks). Symptoms include fever, night sweats (often with a “moldy” odor), fatigue, anorexia, weight loss, joint pains, and sometimes enlarged liver or spleen. Chronic or complicated cases may show recurrent fever, arthritis/spondylitis, endocarditis, or neurobrucellosis. CDC

Undulant fever is another name for brucellosis, an infection caused by Brucella bacteria that live in many farm and wild animals, especially goats, sheep, cattle, pigs, and dogs. People usually get sick after drinking raw (unpasteurized) milk or soft cheese made from infected animals, touching infected animal tissues or blood during work, or breathing in tiny droplets carrying the bacteria (for example, in a lab or slaughterhouse). The illness can be mild or serious. Fever often “comes and goes” in waves—this pattern is why it is called “undulant”—and people commonly feel very tired, sweat a lot at night, and have muscle or joint pains. In some people, the bacteria settle in a body part like the spine, joints, heart, liver, or nervous system and cause long-lasting problems if not treated correctly. Brucellosis is found around the world, is reportable in many countries, and person-to-person spread is rare. Pasteurizing dairy products and using protective measures with animals prevent most infections. CDC+1

Other names

Undulant fever has several traditional names. It is also called brucellosis (the modern medical name), Malta fever, and Mediterranean fever. These names came from places where the disease was common in the past and from the “up-and-down” (undulating) fever pattern. Wikipedia+1

Types

By bacteria species (common human types):

1. Brucella melitensis (from goats and sheep) is the most severe and most common in people worldwide.
2. Brucella abortus (from cattle) tends to be less severe than B. melitensis.
3. Brucella suis (from pigs and feral swine) can be serious and may form abscesses.
4. Brucella canis (from dogs) can infect people, especially breeders and lab workers. msdmanuals.com+2CDC+2

By illness pattern:

1. Acute brucellosis (weeks to a few months): flu-like illness with undulating fever, sweats, fatigue, and aches.
2. Subacute to chronic brucellosis (months to years): persistent or relapsing symptoms; may involve one body site such as the spine (spondylitis), sacroiliac joints, liver, or genitourinary tract.
3. Focal brucellosis: infection targets a specific organ, such as the spine, heart valves (endocarditis), liver/spleen, testicles/epididymis, or nervous system (neurobrucellosis). NCBI+1

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Causes

1. Drinking raw milk: The most common cause is drinking unpasteurized milk or milkshakes. Pasteurization kills Brucella; raw milk can carry it. World Health Organization

2. Eating soft cheeses from raw milk: Fresh cheeses (for example, from goat or sheep milk) made without pasteurization can contain Brucella. World Health Organization

3. Eating other unpasteurized dairy foods: Creams, yogurts, and ice creams made from raw milk can be contaminated. CDC

4. Handling infected animals: Farmers, herders, veterinarians, abattoir workers, hunters, and wildlife officers get exposed through skin cuts or mucous membranes. CDC

5. Contact with birthing tissues: Placenta, fetal membranes, and aborted fetuses from infected animals are highly infectious. World Health Organization

6. Breathing contaminated aerosols: In slaughterhouses, dairies, barns, or labs, tiny airborne droplets can carry Brucella. CDC

7. Laboratory accidents: Brucella is a well-known lab-acquired infection; handling cultures without proper biosafety can cause illness. CDC

8. Hunting or butchering feral swine: Field dressing wild pigs can expose people to B. suis through cuts. CDC

9. Dog breeding/kennels: Exposure to B. canis may occur during whelping or handling secretions from infected dogs. CDC

10. Travel to endemic areas: Visiting regions where raw dairy is common or animal control programs are limited increases risk. World Health Organization

11. Occupational exposure in tanneries or rendering plants: Handling animal hides or carcasses can expose workers. CDC

12. Home cheese-making with raw milk: Using unpasteurized goat or sheep milk at home may transmit infection. World Health Organization

13. Accidental self-inoculation with animal vaccines: Animal vaccine strains (e.g., B. abortus RB51) can infect humans if accidentally injected or splashed. CDC

14. Eating undercooked meat or liver from infected animals: Less common than dairy, but possible if tissues contain bacteria. CDC

15. Living near abattoirs or unregulated dairies: Environmental aerosols or informal dairy sales can be a source. CDC

16. Contaminated hands to mouth/eyes: Touching the face during animal work can transfer bacteria to mucous membranes. CDC

17. Spillovers from wildlife (bison, elk, caribou, wild hogs): Contact during field work or carcass handling can transmit infection. CDC

18. Consumption of raw camel milk: In some regions, raw camel milk is a known source. (General mechanism: unpasteurized dairy risk.) World Health Organization

19. Shared family exposures: Household members who share raw dairy may become infected around the same time. CDC

20. Rare transfusion/transplant-related exposure: Uncommon, but possible if donors are bacteremic; prevention relies on screening and low prevalence. (Mechanism inferred from general bloodstream pathogen risks; primary transmission is zoonotic.) CDC

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Symptoms

1. Undulating fever: Fever rises for several days, then falls, then returns. This wave-like pattern gives the disease its “undulant” name. odh.ohio.gov

2. Profuse night sweats: Many people wake soaked at night. Sweats may have a musty smell and often come with chills. Mayo Clinic

3. Severe tiredness (fatigue): People feel drained and weak, even after rest. Fatigue can last weeks or months without treatment. Mayo Clinic

4. Aches in muscles and joints: Generalized body aches are common. Large joints, spine, and sacroiliac joints are often painful. msdmanuals.com

5. Headache: Dull or throbbing headaches can occur, sometimes with light sensitivity if the nervous system is involved. NCBI

6. Loss of appetite and weight loss: Ongoing sickness reduces appetite; weight often drops over time. World Health Organization

7. Back pain: Infection can inflame the spine (spondylitis). Pain worsens with movement and may radiate to the legs. ajronline.org

8. Abdominal discomfort: The liver and spleen may enlarge, causing fullness or discomfort under the ribs. msdmanuals.com

9. Cough or chest discomfort: Less common; may appear if there is lung involvement or chest wall pain. NCBI

10. Irritability or low mood: Chronic infection and poor sleep can lead to depression or irritability. NCBI

11. Lymph node swelling: Glands in the neck, armpits, or groin can enlarge as the immune system reacts. msdmanuals.com

12. Testicular or scrotal pain: Men can develop epididymo-orchitis (painful swelling of the epididymis and testicle). msdmanuals.com

13. Prolonged low-grade fever after activity: Some people notice fevers flare after physical work or stress. NCBI

14. Neurologic symptoms (rare): Neurobrucellosis can cause confusion, neck stiffness, vision changes, or nerve problems if the brain or nerves are affected. msdmanuals.com

15. Heart-related symptoms (rare but serious): Shortness of breath, chest pain, or new murmur can suggest endocarditis, the most dangerous complication. PubMed

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Diagnostic tests

A) Physical examination

1. Temperature and general appearance: Repeated fevers with sweats and malaise raise suspicion—especially with relevant exposures (raw dairy, animal work). CDC

2. Pulse, blood pressure, and heart exam: Doctors listen for a new heart murmur and check for signs of endocarditis or heart failure if severe illness is present. msdmanuals.com

3. Abdominal exam for liver and spleen: Gentle palpation may reveal enlarged liver (hepatomegaly) or spleen (splenomegaly), which are common in brucellosis. msdmanuals.com

4. Joint and spine exam: Tender sacroiliac joints or limited spine motion hint at osteoarticular brucellosis. ajronline.org

5. Lymph node exam and skin check: Swollen nodes and inspection for animal-related cuts help support the clinical picture and exposure history. msdmanuals.com

B) Manual tests and bedside maneuvers

6. Sacroiliac stress tests (FABER/Patrick’s test): Placing the ankle on the opposite knee and gently pressing may reproduce SI joint pain when these joints are inflamed. This bedside sign supports osteoarticular involvement. (General ortho exam principle applied to brucellosis-related sacroiliitis.) ajronline.org

7. Gaenslen’s maneuver: Extension of one hip while the other hip flexes stresses the SI joint; pain suggests sacroiliitis. Useful when back pain is a main complaint. ajronline.org

8. Straight-leg raise: Raising the leg with the knee straight can reproduce radiating pain if the lumbar spine and nerve roots are inflamed by spondylitis. ajronline.org

9. Spinal percussion tenderness: Gentle tapping over the spinous processes may localize painful levels in vertebral infection. ajronline.org

10. Focused neurologic screen: Checking limb strength, reflexes, and sensation looks for nerve involvement in spine disease or neurobrucellosis. msdmanuals.com

C) Laboratory and pathological tests

11. Complete blood count (CBC): Mild anemia, low white cells, or low platelets can occur, but findings are nonspecific. Helpful for baseline and tracking. msdmanuals.com

12. Inflammatory markers (ESR/CRP): Often elevated and useful to follow response to therapy, but not diagnostic by themselves. msdmanuals.com

13. Liver tests (ALT/AST/ALP, bilirubin): The liver is frequently involved; mild hepatitis patterns are common. msdmanuals.com

14. Blood cultures (notify lab): Cultures can be positive, but growth is slow and the lab must hold bottles longer and use special media; sensitivity is limited. msdmanuals.com

15. Bone marrow culture: Often more sensitive than blood cultures in brucellosis and is considered when blood cultures are negative but suspicion is high. msdmanuals.com

16. Standard agglutination test (SAT/Wright): The most used serologic test in many regions; rising titers or high titers with symptoms support diagnosis. NCBI

17. 2-mercaptoethanol (2-ME) or Coombs anti-Brucella/Brucellacapt: These tests help identify active infection or blocking antibodies when SAT results are unclear. NCBI

18. ELISA (IgM/IgG/IgA): Detects class-specific antibodies; useful in acute and chronic disease and sometimes more sensitive than SAT. Labs define cutoffs. NCBI+1

19. PCR (e.g., targets like bcsp31 or IS711): Detects Brucella DNA quickly from blood or tissue and is helpful when cultures are negative or delayed. msdmanuals.com

D) Electrodiagnostic tests

20. Electrocardiogram (ECG): Done when chest symptoms or murmurs suggest cardiac involvement; looks for rhythm changes or ischemia related to endocarditis/myocarditis. PubMed

21. Nerve conduction studies: Considered when numbness, weakness, or neuropathic pain suggests peripheral nerve involvement from neurobrucellosis or spine disease. (Supportive, case-by-case.) msdmanuals.com

22. Electroencephalogram (EEG): Rarely needed; may be used if seizures or encephalopathy occur in neurobrucellosis to document brain irritation. (Adjunctive.) msdmanuals.com

E) Imaging tests

23. Ultrasound of abdomen: Checks liver, spleen, and abdominal organs for enlargement or abscess; quick and radiation-free. msdmanuals.com

24. MRI of the spine: Best test for early spine involvement (spondylitis and discitis), showing edema, infection spread, and complications. ajronline.org

25. CT scan of abdomen or pelvis: Shows deep abscesses or organ complications when ultrasound is limited. msdmanuals.com

26. Plain X-rays of painful joints or spine: May be normal early but can show later bone or disc changes. Often a first step before advanced imaging. msdmanuals.com

27. Echocardiography (heart ultrasound): Essential if a new murmur or blood culture positivity raises concern for endocarditis; detects valve infection and complications. PubMed

Non-pharmacological treatments (therapies & others)

1. Food and beverage safety (strictly pasteurized dairy; avoid raw milk/soft cheeses; cook meat thoroughly).
   Description: The most powerful “treatment adjuvant” is to stop new exposure. Switch to pasteurized milk and dairy; avoid raw cheeses (feta, queso fresco) unless verified pasteurized; cook meat to safe internal temperatures; avoid organ meats from feral swine or unregulated slaughter. Purpose: Prevent ongoing ingestion of Brucella and lower relapse risk from continued exposure at home/work. Mechanism: Pasteurization and adequate cooking kill Brucella; eliminating exposure reduces bacterial load and the risk of re-infection while antibiotics clear the current infection. CDC+1

2. Occupational exposure control (PPE, hand hygiene, wound protection).
   Description: Farmers, veterinarians, abattoir workers, hunters, and lab staff should wear gloves, eye protection, masks/respirators when appropriate, and avoid aerosol-generating procedures. Cover cuts, wash hands frequently, and decontaminate tools. Purpose: Reduce bacterial entry via skin breaks, mucous membranes, or inhalation. Mechanism: PPE and hygiene lower the chance of aerosol or contact transmission, which is critical because Brucella has a very low infectious dose and is easily aerosolized. CDC

3. Activity modification and rest during febrile flares.
   Description: During fever peaks and sweats, rest, hydration, and light meals are recommended; resume activities gradually. Purpose: Minimize symptom worsening and allow immune system recovery. Mechanism: Rest decreases metabolic demand; hydration supports circulation, thermoregulation, and renal clearance of inflammatory by-products while antibiotics work. CDC

4. Hydration and electrolyte replacement.
   Description: Use water, oral rehydration, broths. Purpose: Counter sweats and fever-related fluid loss, reducing headaches and fatigue. Mechanism: Maintains plasma volume and helps temperature control; supports renal function during antimicrobial therapy. CDC

5. Fever comfort measures (cool compresses, tepid sponging, light clothing).
   Description: Non-drug cooling strategies can reduce discomfort. Purpose: Relieve symptomatic distress when antipyretics are minimized or spaced. Mechanism: Improves heat dissipation and patient comfort while the antimicrobial regimen addresses the cause. CDC

6. Nutrition optimization (balanced energy, adequate protein, fruits/vegetables).
   Description: Emphasize safe proteins, whole grains, legumes, and produce (washed, cooked). Purpose: Support immune and tissue repair needs during prolonged therapy (often ≥6 weeks). Mechanism: Provides micronutrients and amino acids needed for immune cell function and healing. cdph.ca.gov

7. Physical therapy in osteoarticular disease.
   Description: If the spine, hips, or knees are involved, a PT plan focuses on posture, core stability, gentle range-of-motion, and progressive strengthening once acute pain subsides. Purpose: Restore function, reduce stiffness, prevent deconditioning. Mechanism: Gradual loading improves joint mechanics and reduces chronic pain after infection control. Medscape

8. Ergonomic protection for spondylitis.
   Description: Lumbar support, neutral-spine strategies, and short, frequent breaks for desk or field work. Purpose: Reduce mechanical stress on inflamed vertebrae/discs. Mechanism: Offloads painful segments and lowers risk of neurological compromise during recovery. idsociety.org

9. Wound and skin care after animal exposure.
   Description: Immediate washing of cuts, antiseptics, and covering with clean dressings after handling animals, placenta, or fluids. Purpose: Decrease inoculum at the entry site. Mechanism: Mechanical removal and antisepsis reduce viable bacteria that could seed infection. CDC

10. Household risk reduction (separate work clothing, decontamination).
    Description: Remove and wash work clothes separately; clean boots/tools. Purpose: Protect family members from indirect exposure. Mechanism: Lowers environmental contamination and secondary transmission. CDC

11. Patient education on relapse prevention and medication adherence.
    Description: Review dosing schedules, food interactions, and what to do if doses are missed; continue antibiotics for the full course. Purpose: Reduce relapse, a known risk if therapy is shortened. Mechanism: Adequate duration and combinations achieve sterilizing activity in intracellular niches where Brucella persists. cdph.ca.gov

12. Surgical source control when indicated (see surgeries below).
    Description: Drain deep abscesses or stabilize the spine when neurological compromise or instability occurs—always plus antibiotics. Purpose: Remove bacterial reservoirs that antibiotics penetrate poorly. Mechanism: Debulking reduces bacterial load and improves drug penetration to infected sites. CDC

13. Pre-operative precautions for brucellosis patients.
    Description: Minimize aerosols, limit personnel, ensure appropriate antibiotic coverage pre-op. Purpose: Protect staff and reduce intraoperative spread. Mechanism: Following CDC operative precautions lowers risk of exposure and recurrence. CDC

14. Occupational health surveillance after lab or surgical exposure.
    Description: Symptom monitoring for up to six months after high-risk exposures; consider post-exposure prophylaxis per public health advice. Purpose: Early detection and prompt treatment if disease develops. Mechanism: Surveillance identifies fever illness early when therapy is most effective. CDC

15. Pregnancy-specific exposure avoidance.
    Description: Pregnant people should strictly avoid unpasteurized dairy and high-risk animal contact; treatment choices differ in pregnancy. Purpose: Prevent maternal illness, fetal risk, and neonatal brucellosis. Mechanism: Avoiding exposures removes primary infection routes; clinicians select antibiotic regimens safe in pregnancy. CDC

16. Hunter safety (feral swine, game).
    Description: Wear gloves/eye protection when field dressing; cook game meat thoroughly; follow local advisories. Purpose: Prevent B. suis transmission common in feral swine. Mechanism: Barrier protection and heat inactivation reduce inoculation/inhalation risks. CDC

17. Breastfeeding and neonatal precautions when maternal brucellosis is suspected.
    Description: Seek specialist guidance; consider expressing/discarding milk until effective therapy established if high concern. Purpose: Protect the newborn. Mechanism: Reduces potential neonatal exposure when maternal bacteremia is present. CDC

18. Travel precautions to endemic areas.
    Description: Eat pasteurized dairy; avoid fresh soft cheeses of unknown origin; observe farm/market hygiene. Purpose: Reduce travel-related brucellosis. Mechanism: Exposure avoidance eliminates ingestion risk. World Health Organization

19. Public health reporting and follow-up.
    Description: Brucellosis is nationally notifiable in the U.S.; coordinate with public health for contact tracing and source investigation. Purpose: Prevent clusters and ongoing exposure in communities. Mechanism: Surveillance identifies linked exposures (e.g., a raw-milk source) for control actions. CDC

20. Animal-health collaboration (One Health).
    Description: Although this is human care, counseling about animal vaccination/testing and safe herd practices helps break transmission. Purpose: Cut human re-exposure from infected herds. Mechanism: Control in animals is the most effective prevention for people. World Health Organization+1

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Drug treatments

Brucellosis requires combination antibiotics for at least 6 weeks in uncomplicated cases; longer for complicated disease (e.g., endocarditis, neurobrucellosis, spondylitis). Exact choices depend on age, pregnancy, severity, and drug availability/resistance. Always follow local infectious-disease guidance. CDC

Important note about FDA labels: Some antibiotics (e.g., doxycycline) explicitly list brucellosis in U.S. labeling, often “in conjunction with streptomycin.” Others (e.g., rifampin, gentamicin, TMP-SMX) are widely used in combination based on authoritative guidelines, even if brucellosis is not listed as a labeled indication. Below, each drug includes the FDA label link (for core safety/dosing data) and an authoritative brucellosis regimen reference. FDA Access Data+1

1. Doxycycline (tetracycline class).
   Description (150 words): First-line oral backbone for adults with brucellosis, typically 100 mg twice daily for ≥6 weeks, combined with rifampin or with an aminoglycoside for the first 1–2 weeks in complicated cases. Food can reduce GI upset; avoid with calcium/iron close to dosing. Major cautions: photosensitivity, esophagitis (take with water), pregnancy/young children concerns. In U.S. labeling, brucellosis appears as an indication with streptomycin. In guidelines, doxycycline + rifampin for ≥6 weeks reduces relapse; add streptomycin or gentamicin initially for severe focal disease. Class: Tetracycline. Usual adult dose/time: 100 mg PO q12h, ≥6 weeks (longer if complicated). Purpose: Eradicate intracellular Brucella. Mechanism: Inhibits bacterial protein synthesis (30S). Side effects: GI upset, photosensitivity, pill esophagitis; rare hepatotoxicity. FDA Access Data+2FDA Access Data+2

2. Rifampin (rifamycin class).
   Description: Commonly paired with doxycycline (600–900 mg/day in 1–2 doses) for ≥6 weeks; improves outcomes and reduces relapse. Potent enzyme inducer (CYP interactions: OCPs, warfarin, many others). Class: Rifamycin. Dose/time: 600 mg PO daily (range 600–900 mg) ≥6 weeks; longer in complications. Purpose: Partner drug to doxycycline or TMP-SMX; penetrates intracellular sites. Mechanism: Inhibits bacterial RNA polymerase. Side effects: Orange secretions, hepatotoxicity, drug interactions. FDA label (TB, carriers of N. meningitidis) shows safety/dosing; brucellosis use guided by CDC tables. FDA Access Data+2FDA Access Data+2

3. Streptomycin (aminoglycoside).
   Description: Classic partner early in therapy (e.g., 1 g IM daily for 7–14 days) with doxycycline for severe/complicated brucellosis (spondylitis, endocarditis). Monitor renal function and hearing. Class: Aminoglycoside. Dose/time: 1 g IM daily (typical) for 1–2 weeks at start of regimen. Purpose: Rapid bactericidal activity to reduce bacterial burden. Mechanism: 30S ribosome binding; concentration-dependent killing. Side effects: Ototoxicity, nephrotoxicity. Label includes “Brucella.” FDA Access Data+1

4. Gentamicin (aminoglycoside).
   Description: Alternative to streptomycin when availability or resistance is an issue; typical adult dosing 5 mg/kg/day IV/IM (once daily or divided) for 7–14 days combined with doxycycline ± rifampin. Class: Aminoglycoside. Dose/time: 5 mg/kg/day for 1–2 weeks initially. Purpose: Early bactericidal “kick-start.” Mechanism: 30S ribosomal binding. Side effects: Nephrotoxicity, ototoxicity; monitor drug levels if prolonged course. FDA Access Data+1

5. Trimethoprim-sulfamethoxazole (TMP-SMX).
   Description: Option when tetracyclines are contraindicated (e.g., children <8 years, some pregnancy contexts under specialist care). Adults often use DS 160/800 mg q12h with rifampin for ≥6 weeks; children dosed by weight. Class: Antifolate combination. Dose/time: 160/800 mg PO q12h (adults) ≥6 weeks. Purpose: Alternative backbone with good tissue penetration. Mechanism: Sequential inhibition of folate synthesis. Side effects: Rash, hyperkalemia, cytopenias; avoid near term pregnancy (kernicterus risk). FDA Access Data+2FDA Access Data+2

6. Tetracycline (immediate-release, where doxycycline unavailable).
   Description: 500 mg QID paired with rifampin for ≥6 weeks per traditional regimens; more GI side effects than doxycycline. Class: Tetracycline. Purpose/Mechanism/Side effects: Similar to doxycycline; higher dosing burden. CDC

7. Azithromycin (macrolide; limited role).
   Description: Studied combinations (e.g., azithro + gentamicin) showed higher failure rates, so not preferred first-line; reserve for intolerance scenarios with ID input. Class: Macrolide. Purpose: Alternative only when standard options unsuitable. Mechanism: 50S ribosomal inhibition. Side effects: GI upset, QT risk. OUP Academic

8. Ciprofloxacin (fluoroquinolone; salvage in selected cases).
   Description: Mixed evidence and higher relapse if used alone; may be combined with rifampin in intolerance scenarios with specialist oversight. Class: Fluoroquinolone. Dose/time: Typical adult 500–750 mg PO q12h in combinations. Side effects: Tendon injury, neuropathy, QT. Medscape

9. Levofloxacin (fluoroquinolone; similar caveats).
   Description: Consider only with ID guidance when first-line agents contraindicated; preferably in combination. Mechanism/risks: As class above. Medscape

10. Doxycycline DR (brand DORYX).
    Description: Same active drug; labeling also lists brucellosis with streptomycin; used for the same durations as doxycycline base, with potentially improved GI tolerability. Class/Dose: As doxycycline. Side effects: As doxycycline. FDA Access Data

11. Rifampin (additional safety labeling sources).
    Description: Multiple FDA labels detail pharmacology/interactions crucial for long courses; enzyme induction may lower levels of many drugs (e.g., OCPs). Implementation: Reconcile meds to avoid failures. FDA Access Data+1

12. TMP-SMX (additional labeling sources).
    Description: Adult DS tablet q12h; monitor kidneys, potassium, blood counts on prolonged therapy. Counsel: Hydrate well. FDA Access Data+1

13. Gentamicin (additional labeling/clinical info).
    Description: Use therapeutic drug monitoring if beyond a short initial course; avoid with other nephrotoxins. clinicalinfo.hiv-stage.od.nih.gov+1

14. Streptomycin (FDA interpretive criteria resource).
    Description: FDA technical pages outline susceptibility criteria; availability can be limited in some regions. U.S. Food and Drug Administration

15. Combination principle: doxycycline + rifampin (uncomplicated adults).
    Description: Standard 6-week combination lowers relapse compared with monotherapy; extend longer for focal complications per specialist advice. CDC

16. Add an aminoglycoside at start for severe disease.
    Description: In endocarditis, neurobrucellosis, or spondylitis, add streptomycin or gentamicin for the first 7–14 days to intensify early killing. CDC

17. Pediatric regimens.
    Description: Children >8 years: doxycycline + rifampin; <8 years: TMP-SMX ± rifampin (avoid tetracyclines). Dosing by weight and age. CDC

18. Pregnancy.
    Description: Avoid tetracyclines; specialist consult for rifampin- or TMP-SMX-based regimens; avoid TMP-SMX near term because of kernicterus risk. CDC

19. Post-exposure prophylaxis (selected high-risk exposures).
    Description: Public-health-guided PEP options (often doxycycline + rifampin) may be used; specifics individualized. CDC

20. Duration and relapse prevention.
    Description: At least 6 weeks for uncomplicated disease; 3 months or more for spinal brucellosis; longer for endocarditis with surgery consideration. Do not stop early. cdph.ca.gov+1

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Dietary molecular supplements

No supplement cures brucellosis. The items below are adjunctive for general nutrition/immune support only; discuss with your clinician to avoid interactions (e.g., rifampin) or over-supplementation.

1. Vitamin D (e.g., 600–800 IU/day typical adult intake; individualized). Supports immune modulation and musculoskeletal health during prolonged recovery. Excess can cause hypercalcemia—stay within safe limits and clinician guidance. Office of Dietary Supplements

2. Vitamin C (e.g., 75–120 mg/day typical intake; higher short-term intakes used cautiously). Antioxidant that supports immune function and iron absorption; high doses may cause GI upset or increase kidney stone risk in susceptible people. Office of Dietary Supplements

3. Zinc (e.g., 8–11 mg/day intake; avoid chronic high doses). Important for immune cells and wound healing; excessive zinc can cause copper deficiency. Office of Dietary Supplements

4. Omega-3 fatty acids (EPA/DHA from fish oil; dosing varies—commonly 1 g/day of EPA+DHA in general nutrition). Anti-inflammatory support for joint symptoms; monitor bleeding risk with anticoagulants. Office of Dietary Supplements

5. Probiotics (strain/dose vary; discuss if immunocompromised). May support GI tolerance during antibiotics; safety depends on host factors. Office of Dietary Supplements

6. Calcium (paired thoughtfully if vitamin D is used). Bone support when activity is reduced; avoid excess and time away from doxycycline doses to reduce chelation. Office of Dietary Supplements

7. B-complex (general nutritional support). May help with appetite recovery and energy metabolism; do not exceed ULs. digitalmedia.hhs.gov

8. Iron (only if iron-deficient). Correcting deficiency may improve fatigue; avoid unnecessary iron which can worsen GI side effects. digitalmedia.hhs.gov

9. Magnesium (dietary or supplement within RDA). Supports muscle/nerve function; separate from doxycycline to avoid absorption interference. digitalmedia.hhs.gov

10. Protein supplementation (diet first; add whey/plant protein if needed). Helps meet higher protein needs during prolonged illness/rehab. Coordinate with clinician if renal issues. Office of Dietary Supplements

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Immunity-booster / regenerative / stem-cell drugs

There are no FDA-approved “immunity booster,” regenerative, or stem-cell drugs for treating brucellosis in humans. Care focuses on antibiotic combinations, source control, and supportive measures. Using unproven immune or stem-cell products can be risky and may delay effective therapy. If you see such claims, discuss them with an infectious-disease specialist and rely on guideline-based antibiotics. CDC

(Instead of listing unapproved agents with doses—which would be unsafe—I’m emphasizing the evidence-based standard of care above.)

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Surgeries (procedures & why they’re done)

1. Drainage of deep abscesses (e.g., liver, spleen, paraspinal).
   Why: Remove pus collections that antibiotics penetrate poorly; reduce bacterial load and pain, speed recovery; often image-guided. CDC

2. Spinal decompression/fusion for brucellar spondylitis with neurological compromise or instability.
   Why: Relieve cord/nerve compression, stabilize the spine, and allow rehabilitation when medical therapy alone is insufficient. idsociety.org

3. Cardiac valve surgery for brucella endocarditis.
   Why: Reduce mortality when vegetations, heart failure, or uncontrolled infection persist despite prolonged multi-drug therapy. Medscape

4. Orchiectomy or surgical drainage for testicular abscess.
   Why: Control focal, persistent infection and relieve pain when antibiotics alone fail. Medscape

5. Operative precautions in known/suspected brucellosis.
   Why: Protect staff and reduce aerosolization; CDC advises minimizing aerosol-generating procedures and limiting personnel. CDC

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Preventions

1. Only pasteurized milk, yogurt, ice cream, and soft cheeses. CDC

2. Cook meat thoroughly; avoid raw/undercooked animal products. CDC

3. Wear gloves/eye protection when handling animal births, placenta, or blood. CDC

4. Wash hands and clean/disinfect tools and surfaces after animal work. CDC

5. Hunters: use PPE when field-dressing game (esp. feral swine); cook game fully. CDC

6. Travelers: avoid unpasteurized dairy and street cheeses of unknown origin. World Health Organization

7. Pregnant people: strictly avoid high-risk exposures and unpasteurized foods. CDC

8. Report suspected brucellosis to public health; follow advice for contacts/PEP. CDC

9. Encourage animal vaccination/testing via veterinary services in endemic areas. World Health Organization

10. Educate family/co-workers; don’t share work clothes; launder separately. CDC

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When to see a doctor (now)

Seek medical care immediately if you have: persistent/recurrent fever and night sweats after animal contact or eating unpasteurized dairy; severe back or joint pain; headaches with stiff neck or confusion; chest pain or shortness of breath; weight loss and fatigue without a clear cause; or if you are pregnant, <8 years old, immunocompromised, or a lab/animal worker with a known exposure. Early combination therapy reduces relapse and complications. CDC+1

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Foods to eat and to avoid

Eat (safe choices):
• Pasteurized milk, yogurt, and cheeses; fortified milks if needed. CDC
• Well-cooked lean meats, poultry, fish, eggs. CDC
• Beans, lentils, tofu (cooked). CDC
• Whole grains (rice, oats, bread). CDC
• Cooked vegetables and well-washed fruits. CDC
• Healthy fats (olive oil; nuts if tolerated). Office of Dietary Supplements
• Plenty of water, broths, oral rehydration when febrile. CDC
• Vitamin- and mineral-rich foods (within safe intakes). Office of Dietary Supplements+2Office of Dietary Supplements+2
• Probiotic-containing foods (pasteurized yogurt with live cultures), if appropriate. Office of Dietary Supplements
• Small, frequent meals for appetite loss. CDC

Avoid (risk foods/behaviors):
• Raw or unpasteurized milk, soft cheeses of unknown origin. CDC
• Undercooked meat or organ meats. CDC
• Cross-contamination of raw and cooked foods. CDC
• Raw dairy products while traveling in endemic regions. World Health Organization
• Handling animal tissues without gloves/eye protection. CDC
• Aerosol-generating tasks around potentially infected animals without PPE. CDC
• Sharing unwashed work clothes/equipment at home. CDC
• Stopping antibiotics early because you “feel better.” cdph.ca.gov
• High-dose supplements without clinician guidance (interactions/toxicity). Office of Dietary Supplements+1
• Self-treating with “immune boosters” instead of antibiotics. CDC

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Frequently asked questions

1. Is undulant fever the same as brucellosis? Yes—two names for the same infection caused by Brucella bacteria. CDC

2. How do people catch it? From infected animals or animal products—especially unpasteurized dairy—or via occupational/lab exposures. CDC

3. Can it spread person-to-person? Rarely; case reports exist (including sexual transmission), but most cases are from animals/food. CDC

4. What are the main symptoms? Fever that comes and goes, sweats (often at night), fatigue, headaches, joint and muscle pains, weight loss. CDC

5. How is it diagnosed? Clinical history plus lab tests: serology (e.g., BMAT, ELISA), blood cultures, and sometimes PCR; imaging for focal disease. CDC

6. Why do doctors use two antibiotics? Combinations (e.g., doxycycline + rifampin) cut relapse by attacking Brucella in different ways and sites. CDC

7. How long is treatment? At least 6 weeks for uncomplicated disease; longer (months) for endocarditis, neurobrucellosis, or spondylitis. cdph.ca.gov+1

8. Do kids and pregnant people get different regimens? Yes—tetracyclines are avoided in children <8 years and usually in pregnancy; specialists select safer options. CDC

9. What if I stop antibiotics early? High risk of relapse; complete the full course exactly as prescribed. cdph.ca.gov

10. Is there a human vaccine? No licensed human vaccine; animal vaccination and herd control protect people. World Health Organization

11. Can brucellosis become chronic? Yes—symptoms can recur, especially if undertreated or with focal infections. Long, combined therapy helps prevent this. CDC

12. Do I need surgery? Only for certain complications (abscesses, spine instability, valve infection). Most people improve with antibiotics alone. CDC

13. Are probiotics or vitamins a cure? No. They may support nutrition or tolerance but do not treat the infection. Antibiotics are essential. Office of Dietary Supplements

14. Is it reportable? Yes in the U.S.; clinicians coordinate with public health to prevent further cases. CDC

15. What’s the outlook? With timely combination therapy and avoidance of new exposures, most patients recover; fatalities are rare (<1%), mainly in severe complications. CDC

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: November 03, 2025.

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