Prognosis[1]

Most patients recover completely without complications, if they receive appropriate antibiotic treatment. The relapse rate is approximately 10%, even with treatment. Mortality is rare (approximately 2%). Death is usually associated with endocarditis. Relapse of infection may occur in 10% of patients.

Complications Complications are rare in the patient who is treated appropriately:

Cardiovascular: the primary complication is the need for valve replacement in the patient with endocarditis. Bone: residual musculoskeletal complaints may be present in the patient with long-term infection, sacroiliitis and osteomyelitis. Genitourinary: especially epididymo-orchitis. Blood: immune thrombocytopenic purpura has been described as a consequence of brucellosis infection. Neurological: mental state, visual, hearing changes (may be the most common cause of acquired hearing loss in endemic areas), cranial and peripheral nerve dysfunction, cerebellar ataxia, spinal syndromes, etc. Abscess formation: most commonly hepatic but also elsewhere. Chronic fatigue syndrome may be seen. Infection in pregnancy may result in abortion, congenital and neonatal infections and infection of the delivery team.[15]

Prevention

This relies on control of the disease in animals, by a combination of surveillance, slaughtering and vaccination. Pasteurisation of milk and avoidance of consumption of unpasteurised milk products, raw or undercooked meat. Education, protective clothing, adequate ventilation and disinfection of premises and safe disposal of offal, for those exposed occupationally. There is no human vaccine available.

rimary Health Care Intervention

In Primary Health Care, the emphasis is on preventing an illness or condition. One of a Nurse's chief duties is Health Education. People must be told to stay away from unpasteurised dairy produce, especially if they intend visiting overseas. A Nurse who gives immunisations and advice to people travelling overseas is ideally placed to discuss Brucellosis prevention, as it is likely she will have to talk to the person about malaria prevention, bilharzia, Listeriosis, dangers of tick bites, tsetse flies and the dangers of water in some parts of the world. Some gourmets prefer "Village" cheese as they say it tastes better. But "Village" cheese has not been pasteurised, and the person should be advised to ask themselves if a transient taste sensation is worth risking years in bed or in a wheelchair.

Secondary Health Care Intervention Secondary Health Care is used to describe what happens after Primary Health Care has failed and the person is acutely ill. In some cases the infection is so severe and the patient so prostrated that the only option is to be given intravenous antibiotics in a hospital. The patient would need a quiet, darkened room as they tend to suffer from hyperacusis and photophobia. They will need full nursing care - being bathed, fed, having fluids pushed, extra support during febrile rigors, and careful observations for complications such as sacroiliitis, which occurs particularly when the patient is infected with the Melitensis strain. There may be cardiac and respiratory involvement, and brain symptoms suggestive of encephalitis or meningitis, the liver and spleen may be affected as well. Frequently, the patient gets pneumonia as a complication. As temperatures can rise above 41.5 degrees, the patient has to be watched for convulsions and dehydration. The Nurse should take care to act immediately the temperature begins to rise. The most dangerous time of day for fever to show itself, for some reason, is late afternoon/early evening. Even with modern antibiotics, treatment and prostration can be prolonged. There are 6 strains of Brucellosis, and if a nurse encounters a patient with Brucellosis, it is likely to be either Abortus or Melitensis or Suis, or a combination of the three. The Melitensis strain is the most severe, with the worst complications and with a greater tendency to become chronic. This strain is usually carried by goats. Although person to person infection with Brucellosis is exceedingly rare, it has been known to happen, so the nurse should take proper care to protect herself from the patient's bodily fluids.

Tertiary Health Care Intervention This is when the patient has been ill and is needing help to adjust to changes. Brucellosis takes a long time - months or years - to recover from, and in some cases, it becomes chronic and the person is unwell for the rest of their lives.

A referral to Social Services may be helpful, as it is likely that the patient's financial status may change for the worse, as they are unlikely to get back to work for several months, if at all. Contact with a lawyer or trade union rep may help, especially in negotiating with the employer and insurance company or with problems paying bills or house repossession if being ill has caused major financial problems.