Brucellosis
Also called: undulant fever, Malta fever, Mediterranean fever, Brucella infection
Brucellosis is a bacterial infection that people catch from farm animals, mostly through raw milk, unpasteurised dairy or contact with infected meat. It causes fever that comes and goes, sweats, tiredness and joint pain. A long course of two antibiotics together usually cures it.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Brucellosis is an infection caused by Brucella bacteria. These germs live in animals such as cattle, goats, sheep, camels, dogs and pigs. People catch it from infected animals or their products: by drinking raw (unpasteurised) milk, eating unpasteurised cheese, or touching infected meat or the afterbirth (placenta) of an animal. It is a zoonosis (a disease passed from animals to people). It is also called undulant fever, Malta fever or Mediterranean fever.
The illness often starts like flu, with fever, chills, heavy sweating, tiredness, headache and aching joints and muscles. The fever often rises in the afternoon and goes up and down in waves, which is where the name undulant (wave-like) fever comes from. If it is not treated properly, it can last for months or years and can come back after a long time without symptoms. It can sometimes look like tuberculosis.
Brucellosis is still common in parts of the Middle East, south and central Asia, Africa, the Mediterranean and Latin America, where the infection persists in farm animals. It is often missed and under-reported. Treatment is a combination of antibiotics taken for several weeks. Recovery can take from a few weeks to several months, and death is rare.
In Pakistan
In a 2016 Punjab study, 16 in 100 people tested had signs of past or current brucellosis, with higher rates in rural people and those keeping animals at home, and drinking raw milk was the strongest risk. In Quetta, 4 of 193 livestock workers, butchers and vets tested positive, and the authors called for awareness programmes and milk pasteurisation.
Symptoms
- Fever and chills, often worse in the afternoon
- Fever that rises and falls in waves over days or weeks
- Heavy sweating
- Tiredness and weakness
- Headache
- Joint and muscle pain
- Back pain or stomach (abdominal) pain
- Loss of appetite and weight loss
- Swollen glands (lymph nodes)
Causes and risk factors
Causes
- Infection with Brucella bacteria, such as Brucella melitensis, carried by cattle, goats, sheep, camels, dogs and pigs
- Drinking raw (unpasteurised) milk or eating unpasteurised cheese and other dairy products
- Handling infected meat, or the afterbirth (placenta) of an infected animal, especially with cuts on the skin
- Infection that remains in farm animals in many regions, so it keeps passing to people
What makes it more likely
- Work with animals or meat: farmers, livestock workers, butchers, slaughterhouse workers and vets
- Drinking raw milk
- Keeping animals at home
- Living in a rural area
- Contact with goats and sheep (small ruminants) or cattle
- Living in or travelling from an area where brucellosis is common in animals
Complications
Without full treatment, brucellosis can become a chronic (long-lasting) illness, with symptoms that come and go for years. It can also return after a long period without symptoms. The germ can spread to the bones and joints and damage them. Less often it causes meningitis (infection of the coverings of the brain and spinal cord), encephalitis (swelling of the brain) or infective endocarditis (infection of the inner lining and valves of the heart). Recovery may take weeks to months, depending on how early treatment starts and how severe the illness is. Death is rare, in no more than 2 in 100 people.
When to see a doctor
- Fever, sweats and joint pain after drinking raw milk or working with animals or meat: see a doctor and mention the exposure
- Severe headache, confusion or unusual drowsiness: get emergency care, as the infection may have reached the brain or its coverings
- Severe or worsening back pain, or a painful, swollen joint
- Symptoms that get worse or do not improve during treatment
- New symptoms or fever returning after treatment has finished (possible relapse)
- Fever with possible brucellosis exposure in a pregnant woman, or in someone with a weak immune system
Are you a PMDC-registered doctor who treats Brucellosis? List your profile free.
Diagnosis
The doctor will examine you and ask about contact with animals or meat and whether you have drunk raw milk or eaten unpasteurised dairy. Because the illness can look like flu or tuberculosis, these questions are important. A doctor should confirm brucellosis before treatment starts.
A blood test can find antibodies (proteins the body makes against the germ). Rapid screening tests such as the Rose Bengal test, and ELISA blood tests, have been used in Pakistani studies. The germ itself can be grown (cultured) from blood, bone marrow, urine or spinal fluid. If an organ such as a bone or joint seems affected, a small tissue sample (biopsy) may be taken and cultured.
Treatment
- See a doctor for tests; brucellosis should be confirmed before treatment starts
- Treatment uses two antibiotics together, not one, because combinations lower the chance of the illness coming back
- A common choice is doxycycline with rifampicin, taken for at least 6 to 8 weeks
- Another proven choice is doxycycline for about six weeks with streptomycin injections for the first 2 to 3 weeks; in trials this had fewer relapses and treatment failures, and gentamicin may be used in place of streptomycin
- In some adults a fluoroquinolone with rifampicin is used instead; your doctor chooses the medicines and the dose
- Treatment lasts longer if there are complications such as bone, joint, brain or heart infection; children and pregnant women need a plan made by their doctor
- Finish the whole course and go back to the doctor if symptoms return
Medicines in Pakistan
Medicines a doctor may use, by group. Read the role: some are only for special cases. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Tetracycline antibacterials | doxycycline is the main backbone of treatment for adults, always given together with a second antibiotic for several weeks | Doxycycline (80 brands) |
| Rifamycin antibacterials (rifampicin) | common partner for doxycycline, or for a fluoroquinolone, taken by mouth for several weeks; rifampicin is also a key tuberculosis medicine, so it should only be used under a doctor's care | Rifampicin (34 brands) |
| Aminoglycoside antibacterials | injections given with doxycycline for the first weeks of treatment; streptomycin with doxycycline worked better than doxycycline with rifampicin in trials, and gentamicin is an alternative | Streptomycin (1 brand), Gentamicin (67 brands) |
| Fluoroquinolone antibacterials | an alternative partner for rifampicin in adults; slightly better tolerated than doxycycline with rifampicin in low-quality studies, with no clear difference in cure | Ciprofloxacin (761 brands), Ofloxacin (59 brands) |
Self-care and prevention
Self-care
- Take every antibiotic for the full number of weeks, even when you feel better, to lower the chance of relapse
- Tell your doctor if you are pregnant, have a weak immune system, or are allergic to doxycycline or rifampicin
- Expect recovery to take weeks to months, and do not stop treatment early
- Drink and eat only pasteurised milk and dairy products
- When handling meat or animals, wear protective clothing and eye cover, and cover any cuts on the skin
- Go back to your doctor if symptoms get worse, do not improve, or come back after treatment
Prevention
- Drink and eat only pasteurised milk, cheese and other dairy products
- Wear protective clothing and eye cover when handling meat, animals or animal afterbirth, and cover cuts on the skin
- Find and control infection in farm animals; vaccines exist for cattle
- There is no vaccine for people, so safe milk and safe handling of animals are the main protection
- Awareness programmes for rural families and livestock workers
Common questions
How do people catch brucellosis?
Almost always from infected animals or their products. The usual routes are drinking raw milk, eating unpasteurised dairy, or handling infected meat or the afterbirth of an infected animal. Farmers, butchers, slaughterhouse workers and vets are at higher risk.
Can brucellosis be cured?
Yes. A combination of antibiotics taken for several weeks treats the infection and helps stop it returning. Recovery may take a few weeks to several months, depending on how early treatment starts. Death is rare.
Why do I need two antibiotics for so many weeks?
Brucellosis can come back after treatment. Guidelines favour two antibiotics together for several weeks because this lowers the risk of relapse and treatment failure. Your doctor decides which medicines you take and the dose.
Can brucellosis come back?
Yes. Symptoms can come and go for years, and the illness can return after a long time without symptoms. If fever, sweats or joint pain come back after treatment, see your doctor again.
Is there a vaccine for brucellosis?
There is no vaccine for people. Vaccines exist for cattle, and controlling infection in animals helps protect people. The most important step for families is to use only pasteurised milk and dairy.
Sources
- WHO (with FAO and WOAH). Brucellosis in humans and animals (2006).
- CDC. Treatment (2012).
- Cochrane. Antibiotics for treating human brucellosis (2022).
- MedlinePlus. Brucellosis: MedlinePlus Medical Encyclopedia (2025).
- Jundishapur Journal of Microbiology. Epidemiological Investigation of Human Brucellosis in Pakistan (2018).
- Biologia (Lahore). Seroprevalence of Brucellosis in Occupationally Exposed Humans in Quetta, Pakistan (2023).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.
Related conditions
Tuberculosis (TB)Typhoid feverMalariaLow back painOsteoarthritis