this is from 1954
F E W , IF ANY, infectious diseases have
been the subject of so much controversy and
misunderstanding as has chronic low-grade
brucellosis. Indeed, the very existence of such
a clinical entity still is disputed by some clinicians,
public health, and laboratory workers.
Anything more than a mere suspicion in the
way of a clinical diagnosis is precluded by the
protean symptoms which may be present and
the consequent resemblance to a host of other
illnesses, including the psychoneuroses. The
standard diagnostic laboratory aids seldom give
clear-cut evidence on which the diagnosis may
be either established or ruled out. The only
definitive laboratory test is the isolation of the
organism, which only rarely is possible in the
absence of acute exacerbation of the chronic
illness.
It is important to define clearly what is
meant by "chronic, low-grade brucellosis,"
since the literature contains much confusing
material which may leave the impression that
the agglutination reaction, culture alone, or
both are prerequisite diagnostic criteria. Some
workers consider brucellosis to be "chronic" if
the illness is of more than three months' duration,
regardless of the severity of the illness or
degree of fever at the time of observation.
Others avoid discussion of the low-grade
chronic illness altogether, perhaps because it
is so time-consuming a study, especially under
hospital conditions. In some reports the term
"chronic" has been used to designate current
illness with marked pyrexia, prostration and
the like, in a patient with a history of previous
illness of long duration; in such cases it seems
more appropriate to speak of an "acute exacerbation
of chronic brucellosis." In the present
discussion the term "chronic" is intended
to mean low-grade, slow-going, not acute, of
months' to years' duration, attended by lowgrade
or no febrile reaction, preceding or
following acute illness, or existing as a distinct
clinical entity with no history of acute
illness. That such an "indolent," but nonetheless
active, form of brucellosis does exist has
been amply shown.5' 8> " 19' 20
Fatigue and weakness of variable degree
are common to almost all cases of chronic brucellosis,
but a tremendous range of other subjective
symptoms, in any degree of severity
and in any combination, may occur with few
if any detectable physical findings to account
for them. As in the neurotic patient, there is
hardly a subjective symptom that may not be
attributable to brucellosis. To determine how
these symptoms are shaded by the personality
of the patient is impossible without study of
the patient as a whole
http://www.psychosomaticmedicine.org/cgi/reprint/16/5/414.pdf