The Hidden Threat of “Undulant Fever” in Nigeria

When individuals seek medical attention for symptoms such as fever, weakness, headache, joint and muscle pain, and stomach pain, healthcare professionals often jump to the conclusion of malaria or typhoid without considering other possible conditions. Typically, treatment is administered based solely on these assumptions, without conducting further laboratory tests to confirm the initial diagnosis. This approach reflects the limited knowledge or dedication of our healthcare personnel, who fail to consider a comprehensive range of differential diagnoses. While malaria and typhoid are indeed significant public health challenges, particularly in tropical regions like sub-Saharan Africa, it is crucial to expand the investigation to include other potential conditions. One of such condition that demands attention is brucellosis, also known as “Undulant Fever.”

Base World Health Organization’s Technical Report Series №971 (2012), brucellosis is top on the list as a marginalized infectious disease of poverty. It is classified as a neglected zoonotic disease, meaning it is transmissible from animals to humans and disproportionately affects marginalized populations living impoverished. Brucellosis is caused by intracellular bacteria belonging to the genus Brucella. Among the six species known to cause disease in terrestrial animals, Brucella melitensis, Brucella abortus, and Brucella suis are the most virulent. These bacteria can infect various domestic animals, including goats, cattle, camels, sheep, and pigs. Humans typically contract the disease through the consumption of unpasteurized dairy products or by coming into contact with the fluids and secretions of infected animals, particularly during abortions or the delivery of fetuses. Inhalation of aerosols containing the bacteria can also lead to infection (Bosilkovski et al., 2018). Brucellosis is a debilitating disease characterized by prolonged waves of fever, earning it the name “undulant fever.” It presents with a range of nonspecific symptoms, including headache, malaise, back pain, myalgia, and widespread pains, in addition to gynecological and obstetric complications (problems during pregnancy and childbirth) which all can compound confusing it with malaria or typhoid fever.

In Nigeria, with a rural population of 46.48% according to the World Bank collection of development indicators (2023), agricultural activities play a central role in the livelihoods of rural communities. Animal rearing, breeding, and trade are prevalent in these areas, making them vulnerable to the stealthy enemy known as Brucella. Inadequate veterinary services in rural areas and the lack of hygiene practices and disease diagnosis, monitoring, surveillance, and reporting exacerbate the situation. Therefore, it is only a fair fight to consider brucellosis as a potential diagnosis in cases presenting with nonspecific signs and symptoms, particularly among individuals involved in the livestock and meat industry and those living in rural areas.

A study conducted by MM Madkour and outlined in the book “Madkour’s Brucellosis, 2nd edition” reported signs and symptoms in 500 brucellosis patients that I see would be readily confused with those associated with malaria and typhoid fever. These symptoms included fever (93% of cases), chills (82% of cases), aches (91% of cases), lack of energy (95% of cases), joint and back pain (86% of cases), loss of appetite (78% of cases), arthritis (40% of cases), constipation (47% of cases), abdominal pain (45% of cases), diarrhea (7% of cases), and testicular pain/epididymo-orchitis (21% of cases in 290 males). Although the incidence and prevalence of brucellosis in pregnant is widely unknown, numerous earlier reports including those of Vecchio (1938), De Carle (1931), as well as Al-Tawfiq et al. (2013) have reported cases of brucellosis leading to obstetric complications such as preterm delivery, spontaneous abortion, and congenital brucellosis. These findings suggest a potential link between brucellosis and the high rates of abortions and fetal loss observed in rural areas, often falsely attributed to supernatural causes or witches. Some ailments, particularly in the country’s north, are recognised by local names such as “sanyi,” “zafi,” or “rana,” and are treated with unproved traditional medicines; nevertheless, research into these illnesses is severely inadequate, and I suspect that brucellosis is implicated. Also, a rural man’s go-to treatment for any headache, weakness, or body ache is paracetamol, diclofenac, or ibuprofen, which supports my claim that painkillers and anti-fever drugs are routinely abused, thereby masking symptoms, complicating correct disease diagnosis, and aggravating other health issues.

Early reports by Reyburn et al. (2004) and Thakur et al. (2007) indicated that the nonspecific clinical presentation of brucellosis leads to widespread misdiagnosis and underreporting, especially in malaria-endemic areas like Nigeria. Lack of knowledge about the disease among healthcare professionals and the general public, variability in the performance and sensitivity of serological diagnostic tests, and delays in seeking medical attention further compound the problem. With its nonspecific clinical picture in both animals and humans, along with the prolonged duration of effective medication, brucellosis not only poses a hidden threat to public health but also undermines the rural economy.

To address the stealthy threat of brucellosis, adopting a “One Health” approach is paramount. This approach involves close collaboration between veterinarians and healthcare professionals to improve diagnosis, surveillance, monitoring, information sharing, and public awareness, particularly in rural settings. Additionally, integrating veterinarians into the primary healthcare system to oversee meat, milk, and environmental hygiene, as well as sanitation in animal farmhouses, is crucial. Ultimately, it all boils down to whether the relevant authorities are ready to address our health challenges and whether we, as a society, are truly committed to prioritizing our collective health

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