A bone marrow biopsy showed no evidence of granuloma formation, and all stem cell lines were present. The specimen was sent for routine AFB and fungal cultures, and the laboratory was instructed to hold the cultures until Brucella sp could be ruled out. Shortly thereafter, the bone marrow and peripheral cultures showed tiny gram-negative coccobacilli, which were later confirmed by the Texas Department of Health to be Brucella melitensis. The clinical picture improved remarkably, and the patient was discharged shortly thereafter with a 6-week course of doxycycline and rifampin. The disease is characterized by generalized somatic complaints, which can include fever, sweats, anorexia, fatigue, weight loss, and depression.
Physical findings are few, but the most notable are mild lymphadenopathy and hepatosplenomegaly.
Granulomas can be seen in the bone marrow, as can evidence of hemophagocytosis. The diagnosis is confirmed with isolation of the organism from blood, bone marrow, or other tissues. Diagnosis may be assumed when rising titers of antibodies are seen in the serum. As stated before, cultures should be held for at least 4 weeks. Serum agglutinin tests are currently being used to detect antibodies to B abortus, B melitensis, and B suis.