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March 1959

Brucellosis: II. Medical Aspects of Delayed Convalescence

Author Affiliations


From the Departments of Medicine and Psychiatry, The Johns Hopkins University School of Medicine, and The Johns Hopkins Hospital. Markle Scholar in the Medical Sciences (Dr. Cluff).

AMA Arch Intern Med. 1959;103(3):398-405. doi:10.1001/archinte.1959.00270030054005

Four clinical types of brucellosis were described by Hughes in his classical monograph on "Mediterranean, Malta, or Undulant Fever." 1 These were characterized as malignant, undulatory, mild or intermittent, and irregular or mixed, depending largely upon the severity, duration, and course of the infection. Although brucellosis, as studied by Hughes, was probably due almost exclusively to Brucella melitensis, his classification and description of the disease became widely accepted regardless of the species of Brucella causing infection. Cases were included in Hughes' studies only if the evidence was sufficient to "prove" the diagnosis. Hughes' classification of brucellosis has been criticized in that he did not describe cases of chronic disability.2 Bassett-Smith, in 1903,3 however, described patients with "chronic brucellosis" who had persistent ill health, with fatigability and inability to carry on normal activities even in the face of a declining or negative agglutinin titer and without physical abnormalities. Acute

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