Brucellosis: An Outpatient Non-Probability Retrospective Study of 199 Patients

Background: A descriptive study of the characteristics of brucellosis patients in Jordan and antimicrobial therapy. Methods: In an outpatient study, records were reviewed between July 2016 and April 2024 and electronically saved. Brucella diagnosis was based on epidemiological factors, risk factors, the standard tube agglutination test (STA), and blood or tissue cultures. Records were uploaded into a spreadsheet and imported into the R-Program. A 2-sample Kruskal-Wallis rank sum tested the equality of proportions between two treatment regimens for all available and spondylodiscitis, P Results: Two hundred patients with Brucellosis were analyzed;males 106 (53%) with a mean age of 46.8 years, and females 94 (47%) with a mean age of 48.1 years. Patients from Jordan were 159 (79.9%), and the Arabian Peninsula 25 (12.6%). Brucellosis was a non-focal presentation in 121 (60.50%) patients, spondylodiscitis in 64 (32.0%), and sacroiliitis in 7 (3.5%). Spondylodiscitis involved lumbar 48 (75.0%), thoracic 11 (17.20%), and cervical 5 (7.8%). STA was a common diagnostic method (188, 94%). Risk factors included cheese 80 (47.3%), cattle, small ruminants, and she-camel milk 37 (21.89%), dairy products 28 (16.57%), meat 9 (05.33%), and working with cattle 10 (05.92%). ESR was highest in spondylodiscitis (mean of 54.5). Imaging studies commonly requested were MRI and Bone scans. Doxycycline/Rifampin were mostly prescribed antimicrobials. Conclusion: There is no clear guidance on brucella treatment. In endemic areas, brucella is still a concern. Population education must be a priority. Support for randomized trials addressing antimicrobials and durations is extremely needed.

Intravoxel incoherent motion and dynamic contrast-enhanced MRI for assessing abnormalities of brucellosis spondylitis without conventional MRI changes

Objective To observe the value of intravoxel incoherent motion(IVIM)and dynamic contrast-enhanced MRI(DCE-MRI)for assessing abnormalities of brucellosis spondylitis(BS)without conventional MRI changes.Methods Data of 36 brucellosis patients with definite spinal lesions displayed on conventional MRI(BS 1 group),14 cases without brucellosis infection nor abnormal spinal signals on MRI(control group)and 36 brucellosis patients without definite spinal lesions on conventional MRI(BS 2 group)were retrospectively analyzed.The values of IVIM parameters,including perfusion fraction(f),pure water diffusion coefficient(D)and pseudo-diffusion coefficient(D*),also of DCE-MRI parameters,including time-intensity curve(TIC)type,volume transport constant(K trans),the rate constant(K ep)and volume fraction of extravascular extracellular space per unit tissue volume(V e)were compared among groups.Univariate and multivariate logistic regression were used to screen independent factors for discriminating BS 1 and BS 2.Receiver operating characteristic curves were drawn,and the areas under the curve(AUC)were calculated to evaluate the efficiency of the above parameters for discriminating BS 1 and BS 2.Results Among IVIM parameters,compared with control group,D*values decreased but D values increased in BS 1 group,while D*values increased in BS 2 group(all adjusted P<0.05).Compared with BS 2 group,BS 1 group had higher values of f and D and lower D*(all adjusted P<0.05).In BS 1 group,the TIC types were predominantly typeⅠ(23/36,63.89%),which were wholly or predominantly typeⅢin BS 2 group and control group,and of the former was significantly different with latter 2(both adjusted P<0.05).Compared with control group,K trans increased progressively in both BS 1 and BS 2 groups(both adjusted P<0.05).BS 1 group had lower K ep and higher V e than BS 2 and control groups(all adjusted P<0.05).Among univariate logistic regression models,the model including only f had lower capability for discriminating BS 1 and BS 2(AUC=0.759)than those including D,K trans and V e(AUC=0.951,0.833,0.894,all P<0.05).No significant different was found among multivariate logistic regression model including f and D,model including K trans and V e nor model including all above parameters(all P>0.05).Conclusion Both IVIM and DCE-MRI could be used to evaluate BS abnormality without conventional MRI changes.

Risk Assessment of Diary Cattle Brucellosis Based on Systematic Multilevel Grey Relation Entropy Method

[Objective] The study was to explore the major factors affecting diary cattle brucellosis risk assessment,as well as their strong-to-weak sequence,so as to provide theoretical basis for assessing diary cattle brucellosis risk level in different regions.[Method] From 4 dimensions of feeding and importing,breeding,housing and polyculture situation,an evaluation index system was set up,and diary cattle brucellosis risk survey was conducted in 3 typical regions.Finally,systematic multilevel grey relation entropy method was applied to perform data analysis.[Result] The strong-to-weak sequence of Level 1 impact factor of diary cattle brucellosis was as follows：feeding and importinghousingpolyculture situationbreeding;the sequence of Level 2 impact factor was U32〉U12〉U11〉U31〉U21〉U42〉U43〉U23〉U22〉U41;the risk level sequence of 3 typical regions was Province A（County A1,A2,A3）Province B（County B1,B2,B3）Province C（County C1,C2,C3）.[Conclusion] According to the weight of Level 1 index strata,administrative departments at all levels and dairy cattle farmers should lay emphasis on the aspects of feeding,importing and housing;viewed from the perspective of Level 2 index strata,dairy cattle farmers should value the siting of cattle field,the brucellosis surveillance before importing and milking modes most.According to the diary cattle brucellosis risk level of 3 typical regions,if administrative departments at all levels strengthen peoples＇ awareness of their personal health and increase investment in this area,with new healthy cultured atmosphere built,the risk level of diary cattle brucellosis will surly decline.

Epidemiological, laboratory, diagnostic and public health aspects of human brucellosis in western Iran

Objective:To determine brucellosis's epidemiologic,laboratory,diagnostic and public health features considering brucellosis is endemic in Azna County,western Iran.Methods:This descriptive cross-sectional study was investigated on 43 patients with brucellosis in Azna County. The subjects were the patients with symptoms correspondent with brucellosis and positive Wright and 2ME tests. A questionnaire about demographic,epidemiological and laboratory findings was filled in. Afterwards,patients were treated using usual antimicrobial drugs regimen. The collected data were analyzed by SPSS software version 16.Results:Forty-three subjects were found to be positive in laboratory tests. Incidence of Brucellosis was 59.31 per hundred thousand population. About 34.9% of patients were female and 65.1%male. Nearly 95.2% of human cases were living in rural and 4.8%in urban areas. Around 20.9%of patients had history of animal contact. The commonest transmission was unpasteurized dairy products(79.1%). The most contagious seasons were summer and spring(60.3%). The most common age group was 15-24(27.9%),and about 60.5%of the patients were between 15-44 years old. Disease was more common among housewives(30.2%) and farmers(20.9%). The majority of the patients had Wright test titre=1:320(54.1%) and 2ME test titre=1:160(56.1%) in serological titration.Doxycycline with Rifampin was used for treatment of the greatest of patients(60.4%).Conclusions:In order to control this zoonotic disease,close cooperation of health and veterinary organizations is necessary.

Osteoarticular manifestations of human brucellosis:A review

Brucellosis is a common global zoonotic disease, which is responsible for a range of clinical manifestations. Fever, sweating and musculoskeletal pains are observed in most patients. The most frequent complication of brucellosis is osteoarticular involvement, with 10% to 85% of patients affected. The sacroiliac(up to 80%) and spinal joints(up to 54%) are the most common affected sites.Spondylitis and spondylodiscitis are the most frequent complications of brucellar spinal involvement. Peripheral arthritis, osteomyelitis, discitis, bursitis and tenosynovitis are other osteoarticular manifestations, but with a lower prevalence. Spinal brucellosis has two forms: focal and diffuse. Epidural abscess is a rare complication of spinal brucellosis but can lead to permanent neurological deficits or even death if not treated promptly. Spondylodiscitis is the most severe form of osteoarticular involvement by brucellosis, and can have single-or multifocal involvement. Early and appropriate diagnosis and treatment of the disease is important in order to have a successful management of the patients with osteoarticular brucellosis. Brucellosis should be considered as a differential diagnosis for sciatic and back pain, especially in endemic regions. Patients with septic arthritis living in endemic areas also need to be evaluated in terms of brucellosis. Physical examination, laboratory tests and imaging techniques are needed to diagnose the disease. Radiography, computed tomography, magnetic resonance imaging(MRI) and bone scintigraphy are imaging techniques for the diagnosis of osteoarticular brucellosis. MRI is helpful to differentiate between pyogenic spondylitis and brucellar spondylitis. Drug medications(antibiotics)and surgery are the only two options for the treatment and cure of osteoarticular brucellosis.

Control of animal brucellosis: the Malaysian experience

Brucellosis is a zoonotic disease characterized by reproductive failure in animals and undulent fever in humans. In cattle, it is caused by Brucella abortus while in goats by Brucella melitensis, the main cause of brucellosis in humans. Brucellosis in livestock has been associated with importation of animals from breeder herd of unknown disease status. The prevalence of bovine brucellosis Brucella abortus in 2014 ranged between 1%-2% in Thailand and Indonesia, and 4%-5% in Malaysia and Myanmar. Prevalence of goat brucellosis Brucella melitensis is approximately 1% in Malaysia and Thailand. ‘Test-and-slaughter' is the general policy against brucellosis adopted by most ASEAN countries to eradicate the disease. Under this program, the Rose Bengal Plate Test(RBPT) is used as the screening test to identify infected farm/herd while the Complement Fixation Test(CFT) is the confirmatory test. The test-and-slaughter eradication strategy that was implemented since 1979 had managed to keep the prevalence rate to less than 5%, from 3.3% in 1979, 0.23% in 1988, 1% in 1998 and 5% in 2016. The test-and-slaughter program seemed effective in reducing the prevalence of brucellosis but was unable to eradicate the disease due to several factors, which include failure to locate and identify the remaining affected animals and to control their movement, importation of breeder animals from non-brucellosis free countries and lack of participation by the farmers following unrealiable test results. To support the eradication policy, research activities since 1980 s have suggested combinations of serological tests to improve diagnosis while surveillance should be focused on hotspots areas. The prevalence can be further reduced by strictly sourcing breeder animals from brucella-free areas or countries.

牛羊布鲁菌病(brucellosis)的诊断方法

布鲁菌病是一类由各型布鲁菌感染而引起的重要的人畜共患病之一。被感染的动物最常见的临床表现为流产、胎盘炎、附睾炎、睾丸炎等。人感染布鲁菌病后,多呈慢性经过,可损害人体多种器官。虽然病原学鉴定是一种常规有效的诊断布鲁菌病的方法之一,但由于其对操作人员安全以及实验室级别的要求非常严格,加之从患病动物体内分离病原体的过程既耗时又具有危险性,在布鲁菌病临床诊断实践中推广应用困难。布鲁菌病血清学诊断方法显示出较高的特异性和敏感性,但难以鉴别布鲁菌各型野毒株以及疫苗株感染。鉴于上述问题,深入开发和研制更高特异性、敏感性和稳定性的新型布鲁菌病诊断方法在兽医临床实践中势在必行。主要从细菌学、血清学和分子生物学等方面对布鲁菌病诊断方法研究情况进行了综述,以期为相关研究提供参考。

Brucellosis and tuberculosis:Clinical overlap and pitfalls

Objective:To identify characteristic features of tuberculosis in patients with culture proven brucellosis.Methods:A retrospective analysis was performed on patients diagnosed with culture proven brucellosis between January and December 2011,based on review of their medical records.Patients with demonstrable co-infection with tuberculosis were excluded.Clinical features,laboratory parameters and tissue histopathology reports where available were noted.Results:Thirty-two patients with brucellosis were included in the study.Twenty-one(65.63%)patients had chronic fever,thirteen(40.63%)had a productive cough,while significant weight loss,evening rise of temperature and night sweats were reported by eight(25.00%),eleven(34.38%)and five(15.63%)patients respectively.Nine(28.13%)patients had at least three of these symptoms.Lymphadenopathy,hepatomegaly and splenomegaly were noted on examination in seven(21.88%),fifteen(46.88%)and twelve(37.50%)patients respectively.Eight(25.00%)patients had hepatosplenomegaly,of these only two had associated significant lymphadenopathy.Respiratory examination was normal in all patients.Elevated ESR greater than 50 mm/hr was seen in eight(25.00%),it was greater than 100 mm/hr in five(15.63%)patients.Hypergammaglobulinemia was seen in eight(25.00%)cases.Bone marrow biopsy showed non-caseating granulomas in three(9.38%)cases,lymph node biopsy showed granulomas in one case.Overall,three(9.38%)patients had known risk factors for tuberculosis,while six(18.75%)had risk factors for brucellosis.Conclusions:There is a clear overlap between brucellosis and tuberculosis both in terms of clinical presentation and laboratory parameters.It is essential to c-arefully rule out tuberculosis in all cases of suspected or proven brucellosis before initiating antimicrobial therapy,in order to forestall development of drug-resistant tuberculosis.

Unusual presentation of Brucellosis:Afebrile,culture positive Brucellosis and culture positive,seronegative Brucellosis

Objective:To investigate the unusual presentation of brucellosis.Methods:This prospective study was carried out on 46 patients suspected to brucellosis.The diagnosis was made with isolation of brucella species by Bone Marrow culture.Results:Among 40 culture positive patients,there were two unusual presentations of brucellosis: Afebrile culture positive and culture positive seronegative brucellosis.Conclusion:Some brucellosis patients would not match with criteria for diagnosis of brucellosis.Although it is needed to have positive serology or culture for diagnosis of brucellosis but sometimes,it is the clinical experiences,which help to diagnose and treat these kinds of patients.

Brucellosis: Pathophysiology and new promising treatments with medicinal plants and natural antioxidants

Brucellosis is an old, infectious and common zoonosis whose causative agents are Gramnegative bacteria from the Brucella genus. Brucellosis is transmitted through direct contactwith infected animals or using unpasteurized dairy products of goats, pigs, camels, sheep,buffalo and cows. Brucellosis is still the most common zoonosis in the world, with mostof cases occurring in developing countries. Today, an approach to traditional medicine andmedicinal plants, especially with regards to the repeated recommendations of the World HealthOrganization, is a necessity. One-third of chemical drugs are produced by using plants andthere is a high potential to produce more drugs from plants. Medicinal plants are helpful inthe management of various conditions, especially bacterial diseases. Although there is notenough scientific evidence regarding the clinical effectiveness of herbal drugs for the treatmentof brucellosis, there is strong evidence on the antimicrobial effects of herbal drugs to preventinfection. Therefore, this article seeks to describe the antibacterial effects of some plantderived essential oils or extracts, so that they can serve as promising choices to develop newanti-Brucella medications, as suitable alternatives to conventional antibiotics for brucellosis, asmuch as possible, taking into account the benefits of these herbal drugs.

Etiological role of brucellosis in autoimmune hepatitis

To show that brucellosis may trigger autoimmune hepatitis(AIH), in addition to nonspecific liver involvement and toxic hepatitis, due to a class effect of tetracycline family used for treatment. We present a female patient admitted to our hospital due to partially improved fatigue and elevated liver enzymes following doxycycline and streptomycin usage for brucellosis. Brucellosis is endemic in our country, Turkey. It may involve any organ in the body. Liver is frequently involved. Doxycycline used for treatment occasionally may lead to hepatotoxicity. AIH is a necroinflammatory disease of the liver. Certain drugs (e.g. Minocycline), toxins, and viruses (hepatitis B, hepatitis C, EBV, etc.) can trigger AIH. Only one case of AIH probably caused by doxycycline and brucellosis was reported. We discuss the relationship between brucellosis, AIH, and hepatotoxicity of doxycycline. Brucellosis may trigger AIH.

Seroprevalence of <i>Brucella</i>Antibodies and Risk Factors Associated with Human Brucellosis in High-Risk Occupational Groups of the Noun Division in the West Region of Cameroon

Brucellosis is an anthropozoonotic disease with an important public health impact. Although the transmission of Brucella from animals to humans can occur in different epidemiological settings of sub-Saharan African countries, little data has been published on human brucellosis. This study aimed to detect Brucella antibodies and the risk factors associated to brucellosis among high-risk occupational groups of people in the Noun Division of Cameroon. For this study, a structured questionnaire was used to assess risk factors associated with human brucellosis. Thereafter, blood samples were collected from high-risk occupational groups of people in four villages. Plasma was extracted from each sample and Brucella antibodies were detected using Rose Bengal Plate Test (RBPT) and indirect Enzyme-Linked Immunosorbent Assay (i-ELISA). Of the 273 participants enrolled, the overall seroprevalence of Brucella antibodies was 12.45% with RBPT and 10.26% with i-ELISA test. This seroprevalence was significantly (P = 0.04;X2 = 9.73) higher among livestock herdsmen (15.8%), slaughterhouse workers (9.8%), butchers (4.8%), participants having no educational level (14.3%) and those experiencing above 5 years of risky activity (15%). Raw milk consumption (OR: 4.8;P = 0.001), no formal education (OR: 6.4;P = 0.03) and assistance of animal during parturition (OR: 7.2;P < 0.0001) appeared as factors that may increase the risk of Brucella infections. The detection of Brucella antibodies indicates the risk of human brucellosis in some groups of people of the Noun division. Consuming unpasteurized milk, participating in parturition and lacking knowledge on brucellosis appeared as risk factors associated with human brucellosis in western Cameroon. It raises the need of developing and implementing control measures for human and animal brucellosis.

A Review on Ruminant and Human Brucellosis in Somalia

This review article aims to describe the prevalence of brucellosis in ruminants and humans in Somalia and also guides policy makers to draw sound decisions regarding brucellosis control policies. It is concluded that brucellosis is of no public health importance in Somalia. Nevertheless, it is suggested that a stronger inter-sectoral collaboration among veterinary, medical and public health professionals at the federal and country level in terms of one-health approach should be promoted.

Analysis of a multi-patch dynamical model about cattle brucellosis

The dissemination of cattle brucellosis in Zhejiang province of China can be attributed to the transport of cattle between cities within the province. In this paper,an n-patch dynamical model is proposed to study the effect of cattle dispersal on brucellosis spread. Theoretically,we analyze the dynamical behavior of the muti-patch model. For the 2-patch submodel,sensitivity analyses of the basic reproduction number R0 and the number of the infectious cattle in term of model parameters are carried out. By numerical analysis,it is obtained that the dispersal of susceptible cattle between patches and the centralization of infected cattle to the large scale patch can alleviate the epidemic and are in favor of the control of disease in the whole region.

Current Methods of Human and Animal Brucellosis Diagnostics

Brucellosis is an urgent infectious disease of livestock and wild animals and the commonest human zoonosis. Diagnosis of brucellosis is rather complicated and it has to be obligatorily confirmed by laboratory testing. Direct bacteriological and molecular methods and indirect serological tests are used for brucellosis diagnostics. The choice of the diagnostic tools depends on the overall epidemiological situation in the region and the objectives of the study: validation of the diagnosis, screening (monitoring), cross-sectional studies or confirmation of brucellosis-free status of the region. The review describes current bacteriological, serological and molecular methods, routinely used for the diagnosis of brucellosis in humans and animals. The perspectives of brucellosis diagnostics are also discussed.

Brucellosis of unknown origin with haemophagocytic syndrome:A case report

BACKGROUND Brucellosis is a contagious bacterial disease caused by Brucella species,which is a leading zoonotic disease worldwide.Most patients with brucellosis have a clear infection source;however,our case had a rare presentation of secondary haemophagocytic lymphohistiocytosis without any epidemiological history.CASE SUMMARY A 50-year-old man was admitted to our hospital with a fever of unknown origin.After laboratory examinations,such as blood culture and bone marrow biopsy,the patient was diagnosed with brucellosis and secondary haemophagocytic lymphohistiocytosis.After antibiotic therapy,the patient was afebrile,and his haemogram recovered to normal,after which he was discharged.CONCLUSION Brucellosis cannot be excluded in patients with clinically unexplained fever,even in those without epidemiologic history.

Brucellosis as the Cause of Pediatric Fever of Unknown Origin

Brucellosis is the most common zoonotic infection that causes diseases in humans and is continuously a gross public health issue worldwide. Generally, physical examinations are normal or only minimally abnormal and the diagnosis is made on the basis of the history and serologic studies. Disease can be mild and self-limited or fulminant with severe complications. Here is reported a case of a seven years old boy hospitalized for Fever of Unknown Origin. He had no clues on medical history and physical examination. No changes were found on laboratory parameters;normal blood count and normal inflammatory indicators resulted. After a careful investigation, the diagnose of Brucellosis was concluded. Persistent or prolonged fever may be the only presenting symptom in children. The growing phenomena of international tourism and migration have directed interest in Brucellosis as it is increasingly recorded in non-endemic countries.

Atypical presentation of shoulder brucellosis misdiagnosed as subacromial bursitis:A case report

BACKGROUND Brucella infections in the shoulder joint are uncommon,and few have been reported in the literature.CASE SUMMARY A 26-year-old male was admitted to our hospital with complaint of recurrent pain and limited movement of the right shoulder.The patient reported the pain to have first occurred as an isolated event 6 mo previously and to have reoccurred 5 mo later,when it was accompanied by limited movement of the shoulder.Findings from physical examination and magnetic resonance imaging(referred to as MRI)suggested the diagnosis of subacromial bursitis,and diagnostic paracentesis and arthroscopic debridement were performed.Surprisingly,synovial fluid culture detected brucella,and the finding was confirmed by mass spectrometry of a colony sample.The diagnosis was corrected to brucellosis of the shoulder joint,and antibiotic drug treatment(oral rifampicin and doxycycline)was administrated for 6 wk.The 4-mo postoperative follow-up examination(MRI)yielded normal findings.The 2-year follow-up showed no signs of recurrence.CONCLUSION This rare case of brucellosis infection in shoulder highlights the importance of increasing awareness to help avoid misdiagnosis.

Rare case of brucellosis misdiagnosed as prostate carcinoma with lumbar vertebra metastasis:A case report

BACKGROUND Prostatitis caused by Brucella infection is rare and usually lacks typical lower urinary tract symptoms.However,Brucella infection can cause serum prostatespecific antigen levels to become abnormally elevated.When concurrent with lumbar vertebra infection and erosion,brucellosis can easily be misdiagnosed as prostate cancer with bone metastasis.CASE SUMMARY A 45-year-old man complained of recurrent low back pain and fever for 2 wk.Magnetic resonance imaging of the lumbar vertebrae showed abnormal signs at the rear of the L4–5 vertebral body.Serum prostate-specific antigen level was 17.64 ng/mL,and positron emission tomography/computed tomography suggested the possibility of prostate cancer with liver and lumbar metastases.The patient was transferred to our department for further treatment.He experienced repeated bouts of fever and low back pain during hospitalization.Biopsy results indicated prostatitis.There was no significant increase in white blood cell count or procalcitonin levels.The Mycobacterium tuberculosis smear and antibody detection results were negative.Cefoperazone sulbactam was not effective.Blood culture test results were positive for brucellosis,confirming the diagnosis of brucellosis.After oral anti-infection treatment with doxycycline and rifampicin,the body temperature gradually returned to normal,and lumbago improved.After continuous treatment for 6 mo,the patient recovered.CONCLUSION In patients with low back pain and fever accompanied by elevated prostatespecific antigen levels and lesions of the prostate and lumbar spine,a detailed medical history and blood and urine cultures should be obtained,and attention should be given to the local epidemic infectious disease situation.

Effect of 8-week and 12-week triple therapy (doxycycline, rifampicin, and gentamicin) on brucellosis: A comparative study

Objective:To compare the effect of 8-week and 12-week of triple therapy (doxycycline, rifampicin, and gentamicin) on brucellosis. Methods: This parallel clinical trial was conducted on 339 brucellosis patients who were divided into 2 groups. The first group (175 patients) received doxycycline (100 mg/12 h) for 8 weeks, rifampicin (600 mg/d) for 8 weeks, and gentamicin (5 mg/kg/d) for 7 d, while in the second group (164 patients), doxycycline and rifampicin treatment were prolonged to 12 weeks, along with gentamicin therapy for 7 d. The patients were followed-up for six months after the treatment. Baseline information, clinical manifestations of the patients were collected, and serological tests for brucellosis were performed after the treatment. Results: The mean age of the patients was (45.95 ± 18.65) years, and 56.9% of the patients were male. In total, 73.5% of the patients were residents in rural areas and the majority of them were farmers and ranchers (34.6%). The 3-month relapse rates of the two groups were 11.42% and 6.70%, respectively (P=0.132). Moreover, the 6-month relapse rate of the two groups was 6.3% and 2.4%, respectively (P=0.085). In the two groups, both treatments could reduce serological titers based on Wright and 2ME tests (P<0.05). Conclusions: The efficacy of 8-weeks and 12-weeks triple therapy (doxycycline, rifampicin, and gentamicin) is similar in terms of brucellosis relapse. The 8-week triple therapy including doxycycline, rifampicin, and gentamicin can be considered as an effective approach for the treatment of brucellosis.