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Table of Contents   
CASE REPORT  
Year : 2012  |  Volume : 5  |  Issue : 3  |  Page : 248-249
Acute Brucellosis in a young adult


1 Department of Medicine, Sri Manakula Vinayagar Medical College and Hospital, Madagadipet, Puducherry University, Puducherry, India
2 Department of Microbiology, Sri Manakula Vinayagar Medical College and Hospital, Madagadipet, Puducherry University, Puducherry, India

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Date of Web Publication17-Jul-2012
 

   Abstract 

Brucellosis is a zoonotic disease primarily affecting cattle, goats, sheep and other animals occasionally transmitted to man. The clinical manifestations are protean and often missed. A case of acute brucellosis in a young adult male who presented primarily with loss of weight, malaise, fatigue and with no known risk factors is reported here. Brucella melitensis was isolated from blood culture and confirmed by polymerase chain reaction (PCR). Brucella IgM antibodies were detected by ELISA test and the patient was treated successfully with injection Amikacin for two weeks and oral Doxycycline for a period of six weeks.

Keywords: Brucella melitensis , infection, young adult

How to cite this article:
Subramanian G, Duraipandian J, Rangasamy G, Pavan C. Acute Brucellosis in a young adult. Ann Trop Med Public Health 2012;5:248-9

How to cite this URL:
Subramanian G, Duraipandian J, Rangasamy G, Pavan C. Acute Brucellosis in a young adult. Ann Trop Med Public Health [serial online] 2012 [cited 2018 Aug 18];5:248-9. Available from: http://www.atmph.org/text.asp?2012/5/3/248/98629

   Introduction Top


Brucellosis is a zoonotic disease caused by a small gram negative Coccobacillus primarily affecting cattles, goats and sheep. [1] Human infection arises through contact with infected animals, consumption of unpasteurized infected milk or milk products, ingestion of raw meat or direct contact with the infected meat or excreta, products of conception or inhalation of infective aerosols. [2] Brucellosis can be caused by any of the six species of the genus Brucella. [3] The most common species associated with human disease include Brucella melitensis, B. abortus, B. suis and B. canis. The clinical presentation includes an acute, subacute or chronic form of illness. The most common symptoms are fever with evening rise of temperature, nocturnal sweating, fatigue and loss of body weight. About 30-40% of patients have reactive asymmetric polyarthritis. [4] Untreated cases may develop a variety of complications involving the central nervous system, cardiovascular system, gastrointestinal, genitourinary tract, respiratory and musculoskeletal systems. [5] Brucellosis can be diagnosed in the acute phase by serology and blood or bone marrow culture. A high index of clinical suspicion is necessary for early diagnosis as the clinical manifestation is protean in nature. With appropriate antimicrobial treatment most of the cases resolve with six or eight weeks of therapy, while chronic cases are difficult to treat.


   Case Report Top


A 21-year-old male, student by occupation presented with complaints of fever, malaise, fatigue, profuse sweating and severe myalgia, polyarthralgia, intermittent abdominal pain and loss of appetite of four weeks duration. The patient had lost 6 kg of body weight over the past two months. There was an evening rise of temperature reaching a peak of 101°F and increased sweating in the night. The patient had been treated with antimalarials and various antibiotics before visiting our hospital. On examination the patient was apparently sick. All vital signs were normal. Routine blood tests like hemoglobin, total and differential white blood cell counts were normal. No parasites were seen in peripheral smear. Erythrocyte sedimentation rate was 40 mm at one hour. Tests for HIV antibodies, rheumatoid factor, antinuclear antibodies and Widal test were negative. Mantoux test was negative and chest X-ray was normal. Urine routine was normal and culture was sterile. Ultrasound of the abdomen showed mild splenomegaly. There was no evidence of lymphadenopathy. No other abnormality was detected clinically. ELISA test for Brucella IgM antibodies was positive. Blood culture yielded a pure growth of gram-negative coccobacillus after eight days of incubation and identified as B. melitensis by standard tests for identification [6] [Figure 1]a and b and confirmed by polymerase chain reaction (PCR) targeting IS711 sequence at the Center for Animal Health Studies, Chennai. The patient was empirically treated with oral Levofloxacin 500 mg twice a day pending the culture report and switched over to injection Amikacin 750 mg once a day and oral Doxycycline 100 mg twice a day for a total period of six weeks. The patient became asymptomatic after one week of treatment and remained so thereafter until the last review about two months after the completion of the treatment.
Figure 1: (a) Growth on brain heart infusion blood agar plate, (b) Grams stain from the growth, showing gram-negative Coccobacilli

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   Discussion Top


Brucellosis is a zoonosis transmitted to humans from infected animals primarily cattle, goats and sheep by direct contact with infected animals or their carcasses or excreta or products of conception. Ingestion of infected raw meat, unpasteurized milk or products of milk can also lead to Brucellosis as well as inhalation of infective aerosols. The prevalence of Brucellosis in humans is variable depending on the endemicity of the disease in animals in that geographic area. Sporadic cases in humans are reported from both endemic and non-endemic areas. The clinical manifestations of Brucellosis are protean in nature mimicking a number of diseases in particular tuberculosis. [7],[8] The true incidence may be much higher than the reported incidence due to failure to diagnose and under reporting.

Human brucellosis is more often an occupational disease seen in persons at risk by virtue of their occupation like people rearing cattle, goats, sheep etc., veterinarians, butchers, laboratory workers and workers in leather goods industry. Sporadic cases are reported in persons without any known occupational risk or history of consumption of raw milk or meat. The most probable source in these cases could be consumption of unpasteurized dairy products like cheese, butter, ice creams, milk sweets etc., as is probably the case in our patient. The most common presenting symptom is fever and joint pains [9] as was true in our patient. Isolation of the organism is difficult, time consuming and hazardous. Significantly raised level of brucella agglutinins is diagnostic of brucellosis and is a useful screening test for early diagnosis. [5] Brucella IgM antibodies were positive in our patient as well as culture and PCR.

Enlargement of the liver, spleen and lymph nodes may occur [10] as was seen in our patient who had splenomegaly. Human brucellosis can be treated successfully with a combination of antibiotics like Rifampicin or Aminoglycosides and Doxycycline for a minimum of six weeks. A high index of suspicion among the clinicians and microbiologists is necessary for early diagnosis and appropriate treatment to prevent the long-term complications, which can be disabling and fatal.


   Acknowledgment Top


Director, Tamilnadu Veterinary and Animal Sciences University, Chennai - 51, for confirming the isolate by PCR technique.

 
   References Top

1.Ananthanarayanan, Paniker. Brucella. In: Panicker CK, editor. Textbook of Microbiology. 7 th ed. Noida: University Press Pvt Ltd; 2009. p. 41-6.  Back to cited text no. 1
    
2.Corbel MJ. Brucella. In: Greenwood D, Slack RC, Peutherer JF, editors. Medical Microbiology, 16 th ed. London: Churchill Livingstone; 2003. p. 322-5.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Walker ST. Brucella. In: Walker ST, Walker S, Schmitt W, editors. Microbiology: Saunders Text and Review Series. 9 th ed. USA: WB Saunders Company; 1998. p. 210-3.  Back to cited text no. 3
    
4.Corbel MJ, Beeching NJ. Brucellosis. In: Kasper DL, Fanci AS, editors. Harrison's infectious diseases. 1 st ed. New York: McGraw Hill; 2010. p. 547-51.  Back to cited text no. 4
    
5.Strohl WA, Rouse H, Fisher BD. Brucella. In: Harvey RA, Champe PC, editors. Lippincotts illustrated reviews: Microbiology. 1 st ed. New Delhi: Lippincot Williams and Wilkins; 2001. p. 201-2.  Back to cited text no. 5
    
6.Farrell ID. Brucella. In: Collee JG, Duguid JP, Fraser AG, Marmion BP, editors. Mackie and MacCartney. Practical Medical Microbiology. 14 th ed. London: Churchill Livingstone; 1996. p. 473-8.  Back to cited text no. 6
    
7.Sehgal S, Bhatia R. Zoonosis in India. Commun Dis 1990;22:227-35.  Back to cited text no. 7
[PUBMED]    
8.Mantur BG, Biradar MS, Bidri RC, Mulimani MS, Veerappa, Kariholu P, et al. Protean clinical manifestations and diagnostic challenges of human brucellosis in adults: 16 years experience in an endemic area. J Med Microbiol 2006;55:897-903.  Back to cited text no. 8
[PUBMED]  [FULLTEXT]  
9.Kochar DK, Gupta BK, Gupta A, Kalla A, Nayak KC, Purohit SK. Hospital based case series of 175 cases of serologically confirmed Brucellosis in Bikener. J Assoc Physicians India 2007;55:271-5.  Back to cited text no. 9
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10.Gogie A, Duggal L, Dutta S. An unusual etiology of PUO. J Assoc Physicians India 2011;59:47-8.  Back to cited text no. 10
    

Top
Correspondence Address:
Jeyakumari Duraipandian
Department of Microbiology, Sri Manakula Vinayagar Medical College and Hospital, Madagadipet, Puducherry - 605 107
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.98629

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   Introduction
   Case Report
   Discussion
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