Fever occurs in all patients at some time during their illness, but it can wax and wane over a period of weeks to months when untreated, hence the term undulant fever. Hepatosplenomegaly and lymphadenopathy are the usual physical findings. Occasionally symptoms related to a single organ predominate, in which case the disease is termed localized. 27-30 Osteoarticular manifestations include peripheral arthritis, sacroiliitis, spondylitis, osteomyelitis, and bursitis. 2,23 Hepatitis probably occurs in most infected patients during the course of their illness, and liver function tests commonly demonstrate hepatic involvement.
Most patients experience nausea, vomiting, anorexia and weight loss.
Rare cases of ileitis, colitis and spontaneous peritonitis have been reported. 26 Cardiovascular localization of Brucella infection can result in endocarditis, myocarditis or pericarditis. The aortic valve has been commonly involved, followed by the mitral valve alone or both valves concurrently. 28-30,32 Psychiatric disturbances seem to be frequent, but they are not clinically recognized. 20 Epididymo-orchitis is the most common genitourinary complication.