Brucellosis and Travel: Symptoms, Prevention and UK Health Advice

Brucellosis, also known as 'Maltese fever' or 'undulant fever', is a bacterial infection caused by various species of Brucella. While the disease is largely controlled within the UK’s own livestock populations due to strict agricultural regulations, it remains a significant health concern for British travellers visiting rural or developing regions. The infection is zoonotic, meaning it primarily affects animals—such as goats, sheep, cows, and pigs—and spills over into human populations through contaminated food or environmental exposure.

According to National Health Service (NHS) and NICE guidelines, brucellosis is not typically spread from person to person. Instead, it is a disease of accidental exposure. For many UK travellers, the risk arises from consuming local specialities like 'fresh' unpasteurised goat's cheese or raw milk while on holiday. Understanding the risks before you fly can help you make informed decisions about your diet and activities abroad.

When planning your trip, it is important to check the destination-specific health advice from TravelHealthPro (the website of the National Travel Health Network and Centre). Brucellosis is endemic in many popular holiday destinations and regions where British residents frequently visit family, including:

• The Mediterranean Basin: Including rural parts of Greece, Italy, Portugal, Spain, and Turkey.
• The Middle East and North Africa: Countries like Egypt, Saudi Arabia, and Morocco.
• Central and South America: Particularly rural farming communities.
• Central Asia and the Indian Subcontinent.

The risk is generally low for those staying in major cities and eating in regulated hotels. However, travellers engaging in rural tourism, visiting farms, or purchasing food from local markets are at a higher risk of coming into contact with the bacteria.

The incubation period for brucellosis can be highly variable, ranging from one week to several months. This delay often means that patients do not feel unwell until they have returned home to the UK, making it difficult to link the illness to their trip without professional medical guidance. NICE Clinical Knowledge Summaries (CKS) highlight that the condition often presents as a non-specific 'flu-like' illness.

Common symptoms include:

• Undulant Fever: A high temperature that comes and goes, often peaking in the afternoon or evening.
• Profuse Sweating: Specifically drenching night sweats with a distinct odour.
• Fatigue and Malaise: An overwhelming sense of tiredness that does not improve with rest.
• Aches and Pains: Joint, muscle, and back pain are frequently reported.
• Loss of Appetite: Often resulting in unexplained weight loss.

Because these symptoms overlap with other travel-related illnesses such as malaria or typhoid, it is vital to undergo appropriate diagnostic testing, usually involving blood cultures and serology.

Prevention is the most effective way to manage the risk of brucellosis, as there is currently no vaccine available for humans. By following some basic food safety and hygiene rules, you can significantly reduce your chances of infection:

• Avoid Unpasteurised Dairy: Do not consume raw milk or products made from raw milk, such as artisanal cheeses (often labelled as 'queso fresco' or 'village cheese'). Always ensure dairy products have been pasteurised.
• Cook Meat Thoroughly: Ensure all meat, particularly liver and other offal, is cooked to a safe internal temperature to kill any persistent bacteria.
• Practice Hand Hygiene: Wash your hands thoroughly with soap and water after any contact with animals or their environments. This is especially important if you are visiting livestock markets or petting farms.
• Use PPE: If your travel involves working with animals (e.g., veterinary students or agricultural volunteers), ensure you use gloves, goggles, and aprons to prevent the bacteria from entering the body through skin abrasions or mucous membranes.

If you have recently returned from a high-risk region and feel unwell, you may wonder when is the right time to seek professional advice. You can speak to a GP online if you have concerns about your health following your trip. A consultation is particularly useful if you are experiencing a persistent low-grade fever, unexplained joint pain, or fatigue that has lasted more than a few days.

An online doctor can review your symptoms and, crucially, your travel history. Mentioning that you consumed unpasteurised products or visited a farm abroad is vital information that can lead to a quicker diagnosis. If brucellosis is suspected, the GP can advise you on the necessary steps, such as visiting your local NHS trust for specific blood tests. While online doctors do not typically perform the cultures themselves, they provide the essential first step in triaging your symptoms and ensuring you don't dismiss a potentially chronic infection as 'just a travel bug'.

In the UK, brucellosis is a notifiable disease, and its treatment is handled through specialised infectious disease protocols. Once blood tests confirm the presence of Brucella, treatment is typically a long-term course of antibiotics. Unlike a standard chest infection that might require a five-day course, brucellosis often requires a combination of two different antibiotics (such as doxycycline and rifampicin) for a minimum of six to eight weeks.

Adhering to the full course of medication is vital. Shortening the treatment significantly increases the risk of a relapse or the development of chronic brucellosis, which can lead to complications like endocarditis (inflammation of the heart lining), arthritis, or inflammation of the liver and spleen. The NHS emphasizes that with the correct antibiotic regime, most patients make a full recovery.