Annals of Tropical Medicine and Public Health

CASE REPORT
Year
: 2012  |  Volume : 5  |  Issue : 3  |  Page : 248--249

Acute Brucellosis in a young adult


Girija Subramanian1, Jeyakumari Duraipandian2, Gopal Rangasamy2, Chand Pavan2,  
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

Correspondence Address:
Jeyakumari Duraipandian
Department of Microbiology, Sri Manakula Vinayagar Medical College and Hospital, Madagadipet, Puducherry - 605 107
India

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.



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;5:248-249


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 2020 Sep 23 ];5:248-249
Available from: http://www.atmph.org/text.asp?2012/5/3/248/98629


Full Text

 Introduction



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



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}

 Discussion



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



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

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