Boletim epidemiológico: perfil epidemiológico dos casos de brucelose humana em Goiás entre 2018 e abril de 2023 / Epidemiological bulletin: epidemiological profile of cases of human brucellosis in Goiás between 2018 and April 2023

Boletim que tem como objetivo demosntrar qual é o perfil epidemiológico dos casos humanos de brucelose no estado de Goiás, além de fazer o comparativo dos municípios com focos da doença em animais , haja vista que se trata de uma zoonose de ampla distribuição mundial e que gera impactos econômicos e sociais. Trata-se de um estudo desenvolvido baseado no banco de dados do Sistema de Agravos e Notificação (SINAN-NET), do Gerenciador de Ambiente Laboratorial (GAL), de dados fornecidos pela agência Goiana de Defesa Agropecuária (AGRODEFESA) e da Coordenação Estadual de Zoonoses da Gerência de Vigilância Epidemiológica de Doenças Transmissíveis GVEDT/SUVISA-SES-GO da Secretaria de Estado da Saúde de Goiás (SES/GO). É um estudo de caráter quantitativo, descritivo e retrospectivo entre janeiro de 2018 e abril de 2023, com dados analisados baseados em casos notificados e confirmados de brucelose humana por município de residência

Bulletin that aims to demonstrate the epidemiological profile of human cases of brucellosis in the state of Goiás, in addition to comparing municipalities with outbreaks of the disease in animals, given that it is a zoonosis with a wide worldwide distribution and that generates economic and social impacts. This is a study developed based on the database of the Diseases and Notification System (SINAN-NET), the Laboratory Environment Manager (GAL), data provided by the Goiana Agricultural Defense agency (AGRODEFESA) and the State Coordination of Zoonoses of the Epidemiological Surveillance of Communicable Diseases Management GVEDT/SUVISA-SES-GO of the State Department of Health of Goiás (SES/GO). It is a quantitative, descriptive and retrospective study between January 2018 and April 2023, with analyzed data based on reported and confirmed cases of human brucellosis by municipality of residence

An uncommon case of brucellosis with ocular presentation / Um caso incomum de brucelose com apresentação ocular

ABSTRACT We report an unusual case of brucellosis presented with headache, diminished vision, papillitis and multiple peripapillary hemorrhages accompanied by subretinal fluid extending up to macula. Diagnosis of brucellosis was made based on positive polymerase chain reaction of cerebrospinal fluid sample for Brucella species DNA, accompanied by a raised titer of anti-brucella antibodies. Patient showed remarkable improvement on triple drug therapy in form of doxycycline, rifampicin and ceftriaxone.

RESUMO Relatamos um caso incomum de brucelose apresentada com cefaleia, visão diminuída, papilite e múltiplas hemorragias peripapilares acompanhadas por fluido sub-retinal, estendendo-se até a mácula. O diagnóstico de brucelose foi feito com base na reação em cadeia da polimerase positiva de amostra de líquido cefalorraquidiano para DNA de espécies de Brucella, acompanhada por um título elevado de anticorpos antibrucela. O paciente apresentou melhora notável com a terapia tripla com drogas na forma de doxiciclina, rifampicina e ceftriaxona.

Periprosthetic knee infection with Brucella species - a case report

A 63-year-old female patient presented for infected total knee prosthesis by brucella spp. several years after undergoing knee replacement arthroplasty. She underwent a two-stage revision surgery and was treated wih gentamicin, rifampicin and doxycycline for a total duration of four months

Guidelines for the management of human brucellosis in the State of Paraná, Brazil

Abstract Human brucellosis is a re-emerging disease with the potential for bioterrorism. The number of cases in Brazil has increased; however, the ideal management has not been established. These guidelines are intended for use by clinicians and other health-care workers providing medical care for patients with suspected brucellosis in the State of Paraná. We included a brief description of the epidemiology, clinical presentation, diagnosis, prevention of exposure, prevention of disease by chemoprophylaxis, treatment of disease, monitoring of adverse effects during treatment, management of treatment failure and relapse cases.

Brucelosis en Chile: descripción de una serie de 13 casos / Brucellosis in Chile: description of a series of 13 cases

Introduction: Brucellosis is a zoonosis caused by Brucella spp. It may be acquired by consuming unpasteurized dairy products. Brucellosis has a low incidence in Chile, thus, we have a scarce data. Aim: To report and to characterize the first series of clinical cases of adult patients diagnosed with brucellosis in Chile. Methods: We describe a series of 13 clinical cases in patients diagnosed between 2000 and 2016 in three different centers in the Metropolitan Region, Chile. A retrospective analysis was performed on clinical presentation, laboratory, antibiotic treatment, morbidity and mortality. Results: The mean age was 50 years old. Eight cases had a record of consumption of unpasteurized dairy products. The most frequently reported complaints were fever. The most frequent focal point involved was the spine. Only one patient had a positive blood culture, while the diagnosis was made using serological techniques in the other part of the group. The most indicated antibiotic regimens were doxycycline-rifampicin and doxycycline-gentamicin. The hospital stay was 20 days approximately as an average. Clinical cure was achieved in all cases. Conclusions: Brucellosis is an infrequent zoonosis in Chile, and it produces a nonspecific clinical picture, so it is necessary to have high suspicion to make the diagnosis based in the antecedent of consumption of unpasteurized dairy or raw meat.

Introducción: La brucelosis es una zoonosis provocada por Brucella spp, cuyo principal mecanismo de transmisión es mediante el consumo de lácteos no pasteurizados. Es de baja ocurrencia en Chile, por lo que los datos locales son escasos. Objetivo: Reportar y caracterizar la primera serie de casos clínicos de pacientes adultos con diagnóstico de brucelosis en Chile. Material y Método: Se describe una serie de 13 casos clínicos en pacientes diagnosticados entre el año 2000 y el 2016 en tres centros de la Región Metropolitana, Chile. Se realizó un análisis retrospectivo acerca de la presentación clínica, laboratorio, tratamiento antimicrobiano y morbi-mortalidad. Resultados: El promedio de edad fue 50 años. Ocho casos tenían antecedente de consumo de lácteos no pasteurizados. El motivo de consulta más frecuente fue sensación febril. El compromiso focal más frecuente fue el de columna vertebral. Sólo en un paciente se encontró hemocultivo positivo; en el resto el diagnóstico se hizo mediante técnicas serológicas. Los esquemas antimicrobianos más indicados fueron doxiciclina-rifampicina y doxiciclina-gentamicina. La estadía hospitalaria fue en promedio de 20 días. En todos los casos se logró curación clínica. Conclusiones: La brucelosis es una zoonosis infrecuente en Chile, produce un cuadro clínico inespecífico, por lo que se debe tener una alta sospecha para realizar el diagnóstico, basada en el antecedente del consumo de productos lácteos no pasteurizados o de carne mal cocida.

Ampliação de uso dos medicamentos doxiciclina, estreptomicina e rifampicina para o tratamento da brucelose humana / Extension of use of the drugs doxycycline, streptomycin and rifampicin for the treatment of human brucellosis

CONTEXTO: No período de 2013 a 2016 foram registrados no Sistema de Informação de Agravos de Notificação (SINAN), 1.493 notificações de brucelose humana e observou-se que a partir de 2015, houve um aumento considerável no número de notificações. Esse comportamento crescente reforça a necessidade de implementação de ações específicas, incluindo a implantação de um sistema de vigilância e a garantia de acesso a diagnóstico e tratamento adequados e oportunos. Considerando que o Ministério da Saúde já adquire doxiciclina, rifampicina e estreptomicina para atender à demanda de outros programas (tuberculose e hanseníase, por exemplo), este relatório visa avaliar a ampliação de uso dos referidos medicamentos no SUS, para tratamento da brucelose humana. TECNOLOGIAS: Doxiciclina 100mg comprimido; sulfato de estreptomicina 1g pó para solução injetável; rifampicina 300mg cápsula; e rifampicina 20mg/mL suspensão oral. INDICAÇÃO: Brucelose humana. PERGUNTA: O uso da doxiciclina, rifampicina e estreptomicina é eficaz e seguro para o tratamento de pacientes com brucelose humana? EVIDÊNCIAS CIENTÍFICAS: Foram selecionadas três revisões sistemáticas que embasaram a recomendação de ampliação de uso dos medicamentos avaliados e, em geral, os resultados demonstraram que, na comparação de doxiciclina+rifampicina versus doxiciclina+estreptomicina, para os desfechos avaliados, não houve diferença entre os grupos. AVALIAÇÃO DE IMPACTO ORÇAMENTÁRIO: O impacto orçamentário da ampliação de uso dos tratamentos analisados para a brucelose humana será entre R$ 26.046,72 e R$ 31.473,12 por ano, dependendo da percentagem de pacientes que seguirá cada um dos esquemas de tratamento analisados. Estes valores representam um aumento de 2,9% a 3,5% nos valores gastos na última compra feita pelo Ministério da Saúde. CONSIDERAÇÕES FINAIS: Com base nos resultados das revisões sistemáticas apresentadas, sugere-se que inicialmente seja recomendada a ampliação de uso dos seguintes medicamentos que já estão incluídos na Rename, para tratamento da brucelose humana: (i) doxiciclina 100mg comprimido; (ii) sulfato de estreptomicina 1g pó para solução injetável; (iii) rifampicina 300mg cápsula; e (iv) rifampicina 20mg/mL suspensão oral. RECOMENDAÇÃO DA CONITEC: os membros da CONITEC, presentes na 52ª reunião ordinária, realizada nos dias 1e 2 de fevereiro de 2017, deliberaram por unanimidade recomendar a ampliação de uso dos medicamentos doxiciclina, estreptomicina e rifampicina para tratamento de brucelose humana. DECISÃO: Ampliar o uso dos medicamentos doxiciclina, estreptomicina e rifampicina para tratamento da brucelose humana, no âmbito do Sistema Único de Saúde - SUS. A decisão foi dada pela Portaria SCTIE-MS nº 13 publicada no Diário Oficial da União (DOU) nº 50, de 14 de março de 2017, pág. 53.(AU)

A randomized, comparative study of dual therapy (doxycycline-rifampin) versus triple therapy (doxycycline-rifampin-levofloxacin) for treating acute/subacute brucellosis

Abstract Aim The aim of this study was to compare both the efficacy and safety profile of the WHO-recommended, dual therapy (doxycycline–rifampin) to a quinolone-based, triple therapy (doxycycline–rifampin–levofloxacin) for treating acute/subacute brucellosis. Patients and methods We studied 107 consecutive, naïve patients with acute/subacute brucellosis admitted to Assiut University Hospital. Patients were randomly allocated to receive the dual therapy of doxycycline–rifampin (group-A) or to receive the triple therapy of doxycycline–rifampin–levofloxacin (group-B). Acute/subacute brucellosis was diagnosed based on the presence of: (1) contact with animals or fresh animal products, (2) suggestive clinical manifestations of less than one-year duration, and (3) positive antibody titer (1:160) by standard tube agglutination test. Results There was no significant difference between the two groups regarding their demographic data. Fever was the most frequent manifestation (96.3%). Epigastric pain was the most frequent adverse effect of treatment (12.1%). Group-A patients had a significantly higher relapse rate compared to group-B patients (22.6% versus 9.3%, p-value = 0.01). The rate of treatment adverse effects was higher among group-B patients, although not reaching statistical significance (20.4% versus 11.3%, p-value = 0.059). Conclusions Adding levofloxacin to the dual therapy for acute/subacute brucellosis (doxycycline–rifampin) may increase its efficacy in terms of lowering the relapse rate of the disease. Further, larger scale studies are needed before considering modifying the standard, dual therapy for brucellosis.

Neurobrucellosis and venous sinus thrombosis: an uncommon association

Abstract: Brucellosis is a commonly diagnosed zoonosis and neurological involvement is rare. A 30-year-old woman presented with a pulsatile headache that was exacerbated by the Valsalva maneuver and refractory to analgesic therapy. The patient also had nausea, cough, and coryza that evolved over 7 days. The neurological examination was unremarkable. Thrombosis of the lateral and sigmoid sinus and ipsilateral internal jugular vein were diagnosed and anticoagulation therapy was started. Brucella spp was identified in a sample of cerebrospinal fluid (CSF); five months after treatment with rifampicin and doxycycline, CSF was sterile. Cerebral venous thrombosis is a very uncommon sign of brucellosis.

Seguimiento clínico, serológico y mediante la reacción de polimerasa en cadena de una familia con brucelosis / Clinical, serological and polymerase chain reaction follow-up of a family with brucellosis

Introduction: Human brucellosis diagnosis is based on isolation of Brucella spp. from blood or tissue cultures with a positivity rate of 40-70% and serology techniques are used as complementary tools; recently molecular biology diagnostic techniques have been developed intending to optimize the etiological confirmation. Aim: The main objective of this work was to compare the polymerase chain reaction (PCR), against serological diagnostic tests during the clinical follow-up of a family presenting brucellosis. Methods: Seven family members who lived in the urban area of Mexico City, were monitored using the Rose Bengal test, the agglutination test as well as agglutination with 2 mecapto ethanol, blood cultures and serum PCR for a period of 27 months. The suspected source of infection was fresh goat cheese from a known endemic zone. Results: Brucella melitensis was isolated from the blood cultures of two patients. All of the patients were positive in serological and PCR tests at the beginning of this follow-up. At the end of the study, three patients responded well to the treatment and showed negative results in the serological and PCR tests. While two patients with diabetes mellitus type 2, showed positive results in the serological and PCR tests as well as persistent symptoms. Conclusion: Clinical follow-up of patients with brucellosis is of great importance, to properly evaluate the given treatment. In this sense the PCR is a great supporting tool in diagnostic testing.

Introducción: El diagnóstico de brucelosis humana es difícil pues los cultivos de sangre y tejidos tienen un rendimiento limitado (40-70%) y usualmente se recurre a la serología como recurso complementario; últimamente se han desarrollado técnicas de biología molecular que intentan optimizar la confirmación etiológica. Objetivo: Comparar la reacción de la polimerasa en cadena (RPC) con las pruebas de diagnóstico serológicas en el seguimiento clínico de una familia con brucelosis. Métodos: Siete integrantes de una familia con brucelosis que habitaban la zona urbana de Ciudad de México fueron monitoreados mediante aglutinación con antígeno Rosa de Bengala, prueba de aglutinación, aglutinación en presencia de 2 mercapto-etanol, hemocultivos y RPC en suero durante 27 meses. La probable fuente de infección de los pacientes fue el consumo de queso fresco de cabra originario de una zona endémica. Resultados: Brucella melitensis se obtuvo del hemocultivo de dos pacientes. Todos los pacientes fueron positivos a las pruebas serológicas y al RPC al inicio del seguimiento. Tres pacientes respondieron bien al tratamiento y mostraron resultados negativos en serología y RPC al final del estudio. Mientras que en dos pacientes con diabetes mellitus tipo 2 la sintomatología fue persistente, serología positiva y RPC positivos al finalizar el estudio. Conclusión: El seguimiento clínico de pacientes con brucelosis es muy importante para valorar el tratamiento, en este sentido la RPC es una herramienta que puede apoyar a otras pruebas de diagnóstico.

A rare cause of Rhabdomyolysis from Brucella: a case report / Una causa rara de Rabdomiolisis a partir de Brucella: un reporte de caso

Rhabdomyolysis is caused by myocyte necrosis, which results in the release of muscular cell contents into the circulation and extracellular fluid. We present a case of rhabdomyolysis due to brucella infection without any complications. Following the treatment for brucella, creatinine kinase level was significantly reduced. Rhabdomyolysis associated with brucella is rare in children.

La rabdomiolisis es causada por necrosis del miocito, que resulta de la liberación de los contenidos de la célula muscular en la circulación y el líquido extracelular. Presentamos un caso de rabdomiolisis debido a infección por brucella sin complicaciones. Tras el tratamiento aplicado por brucella, se redujo significativamente el nivel de creatinina kinasa. La rabdomiólisis asociada a brucella es rara en niños.

Endocarditis por Brucella canis: primer caso documentado en un paciente adulto en Argentina / [Brucella canis endocarditis: first documented case in Argentina].

We herein present the case of an adult male patient who consulted for lower extremity edema, a 2- month history of fever and oppressive chest pain radiating to the left arm. He referred neither contact with breeding animals nor consumption of unpasteurized dairy products. A diagnosis of endocarditis was confirmed by cardiac studies. Since the empirical treatment with cephalotin, ampicillin and gentamicin failed, the patient underwent aortic valve replacement. A total of four blood cultures were positive with a gram-negative rod. Bacterial identification was performed using the API 20 NE technique (bioMÞrieux), the Phoenix automated method (BD) and conventional biochemical tests which were unable to classify the isolate as to genus and species. The strain was sent to the INEI-ANLIS "Dr. Carlos G. Malbrán" where it was identified as Brucella canis. The antimicrobial treatment was switched to doxycycline, rifampicin and trimethoprim-sulfamethoxazole with good evolution of the patient. The clinical significance of this case report lies in the possible failure of the empiric antibiotic therapy administered for endocarditis, since B. canis did not respond to the conventional antimicrobial treatment for this pathology.

Neurobrucellosis: clinical, diagnostic, therapeutic features and outcome. Unusual clinical presentations in an endemic region

Brucellosis is a zoonotic infection and has endemic characteristics. Neurobrucellosis is an uncommon complication of this infection. The aim of this study was to present unusual clinical manifestations and to discuss the management and outcome of a series of 18 neurobrucellosis cases. Initial clinical manifestations consist of pseudotumor cerebri in one case, white matter lesions and demyelinating syndrome in three cases, intracranial granuloma in one case, transverse myelitis in two cases, sagittal sinus thrombosis in one case, spinal arachnoiditis in one case, intracranial vasculitis in one case, in addition to meningitis in all cases. Eleven patients were male and seven were female. The most prevalent symptoms were headache (83 percent) and fever (44 percent). All patients were treated with rifampicin, doxycycline plus trimethoprim-sulfamethoxazole or ceftriaxone. Duration of treatment (varied 3-12 months) was determined on basis of the CSF response. In four patients presented with left mild sequelae including aphasia, hearing loss, hemiparesis. In conclusion, although mortality is rare in neurobrucellosis, its sequelae are significant. In neurobrucellosis various clinical and neuroradiologic signs and symptoms can be confused with other neurologic diseases. In inhabitants or visitors of endemic areas, neurobrucellosis should be kept in mind in cases that have unusual neurological manifestations.

Epidemiological and clinical features of Brucella arthritis in 24 children

Brucellosis is considered the leading zoonotic disease of the Middle East. The disease has a wide spectrum of clinical manifestations and can result in complications with severe morbidity. The aim of this study was to evaluate the frequency, distribution and characteristics of arthritis in Iranian children with brucellosis. A retrospective descriptive study conducted in a referral children center in Tehran from 1997 to 2005. Arthritis in children with brucellosis who were admitted to a specialized hospital was detected by clinical signs of the involved joint [s] and characteristics of joint fluid aspiration. Socio-demographic information was recorded. Of 96 patients diagnosed with brucellosis, 24 [25%] had Brucella arthritis 14 [58.3%] males and 10 [41.7%] females. Most common manifestations were fever in 21 patients [87.5%] and fatigue in 18 patients [75%]. Monoarthritis was recorded in 15 patients [62.5%] of the cases with involvement of the knee in 8 [45%] and hip in 5 [29%], the ankle in 2 [8%] patients while 9 [37.5%] patients suffered from polyarthritis. None of the patients had axial joints involvement. Seventy-five percent of the subjects [18 patients] were from urban areas and 66.7% [16 patients] had consumed un-pasteurized cheese. Recurrence was not seen in any of the 24 patients who received a combination of co-trimoxazole for 6 weeks and gentamicin for 5 days. Childhood brucellosis is a challenging disease in Iran that has serious complications like arthritis. Therefore all physicians who work in endemic areas should be familiar with this disease and consider the possibility of brucellosis in all children who present with arthritis and arthralgia

Endocarditis por Brucella abortus: Sobrevivir a los 74 años de edad / Brucella abortus endocarditis: Survival of a 74 year old patient

Brucellosis is not frequent in Chile but it may present with life threatening complications like endocarditis. The case reported refers to a 74 year old man admitted to the Infectious Diseases Hospital Dr. Lucio Córdova in Santiago. He had been febrile for 3 months with no specific symptoms. The trans-esophageal echocardiography confirmed múltiple large vegetations and important involvement of the aortic valve. Blood cultures yielded Brucella abortus. The patient required cardiac surgery, along with antibiotics, and he had a satisfactory outcome, being alive at the moment of this report???. Brucellosis can be the responsible for prolonged fever of unknown origin. It is necessary to take in mind brucellosis to obtain the specific laboratory tests. For a best prognosis an early treatment with associated antibiotics for at least 4 a 6 weeks is important. If endocarditis is present valve replacement is often necessary.

Brucelosis es una infección poco frecuente en Chile pero que puede presentar algunas complicaciones graves como endocarditis. Se presenta el caso de un paciente de 74 años que ingresa al Hospital de Enfermedades Infecciosas Dr Lucio Córdova (HLC) de Santiago, con un síndrome febril de 3 meses de evolución, sin síntomas específicos. El ecocardiograma trans-esofágico mostró múltiples vegetaciones en válvula aórtica y en los hemo-cultivos se desarrolló Brucella abortus. El paciente recibió tratamiento médico-quirúrgico en el Instituto de Enfermedades Respiratorias y Cirugía de Tórax (INERYCT), evolucionando satisfactoriamente. Ante un paciente con un síndrome febril prolongado debe tenerse presente la posibilidad diagnóstica de brucelosis de modo de solicitar los exámenes específicos en forma oportuna y, si se confirmase, iniciar precozmente el tratamiento. Este debe comprender un esquema asociado de antimicrobianos, que se mantendrá por al menos 4 a 6 semanas. En caso de endocarditis, con frecuencia se requerirá también de reemplazo valvular.

Brucellar epididymo-orchitis in southeastern part of Turkey: an 8 year experience

OBJECTIVE: the different clinical and laboratory features and response to treatment of patients with acute brucellar epididymo-orchitis (BEO) reporting to the reference hospital in Southeastern Anatolia of Turkey. MATERIAL AND METHODS: in this study, 27 male patients with brucellosis, who presented with epididymitis or epididymo-orchitis (EO) at the university hospital in Diyarbakir from 1998 to 2006, were included. They were compared with the other male patients. Positive blood culture or high agglutination titers of > 1/160 and positive clinical manifestations of brucellosis were the main criteria for diagnosing brucellosis. RESULTS: fourteen patients had unilateral EO. Leukocytosis was present in 10 patients; all of them had initial agglutination titers of > 1/160 and 10 patients had a positive blood culture. All patients received combined therapy with streptomycin for the first 21 days (or oral rifampicin for 6-8 weeks) with doxycycline or tetracycline for 6-8 weeks. All showed improvement, fever subsided in 3-7 days, and the scrotal enlargement and tenderness regressed. Only one patient had a relapse within one year. CONCLUSION: in brucellosis-endemic areas, clinicians encountering EO should consider the likelihood of brucellosis. In this study, young age was the most common risk factor, and leukocytosis and high CRP level were the most common laboratory findings. Most cases were unilateral. All patients responded to medical management very well. Conservative management with combination antibiotic therapy was adequate for managing BEO. Conclusively, brucellosis must be considered as a cause of orchitis, especially in endemic regions like Turkey.

Brucellar spondylodiscitis in the cervical region

Diagnosis of brucella infection may be difficult, because it can mimic many other diseases. We report a 57-year old man who had presented with the complaints of radiculopathy, and was diagnosed as cervical spondylodiscitis. The spondylodiscitis was diagnosed via rose bengal test, positive serology, and positive culture results after the initial suspicion with magnetic resonance imaging. Streptomycin for 14 days and doxycycline rifampicin for three months were used for the treatment. Brucellar spondylodiscitis in the cervical region is a rare presentation, beside that prognosis with early diagnosis and adequate treatment is good

Neurobrucellosis: a rare cause for spastic paraparesis

A 41 year old man presented to the outpatient department with a three month history of difficulty in walking. He also had a history of positive sensory symptoms in the form of pins and needle sensation mostly below the waist. His symptoms had been progressive and there was no significant family history. He demonstrated a spastic gait and could only walk with assistance and support. DTR were hypertonic and sensory deficit was observed below twelfth dorsal vertebra. Sphincter abnormalities were present. Plantars were extensor bilaterally. Cerebral and spinal MRI with contrast was unremarkable. Brucella antigen titers were significantly high. CSF report was consistent with neurobrucellosis. After detailed analysis of his history, clinical picture and investigations the diagnosis of neurobrucellosis was made. Combined antimicrobial therapy was started, his neurologic condition gradually improved and he was able to walk without help after three months of treatment. Hence this case showed that neurobrucellosis may present as acquired progressive spastic paraparesis and it should always be borne in mind in patients with spastic paraparesis.

Brucella melitensis: a rarely suspected cause of infections of genitalia and the lower urinary tract

We examined the clinical presentation and outcome of Brucellar infections of genitalia and the lower urinary tract through a review of the medical records of 10 cases of male patients with brucellar infections of the genitalia and lower urinary tract. The mean age of the patients with brucellosis was 49.2, (median 52, range 15-77 years). Eleven out of 17 patients were rural residents, 15 reported that they might have consumed unpasteurized dairy products) and four reported occupational exposure. Symptoms onset was acute in almost all cases. Scrotal pain, epidedimal swelling and fever were the most common symptoms. The Wright test was positive in 13 patients, while Brucella sp. was isolated from blood cultures in six cases. Only two patients were found with abnormal liver ultrasonography. All patients underwent treatment with doxycycline and aminoglycoside for seven days and doxycycline alone for two months. Most of them responded to antibiotic therapy with rapid regression of symptoms. One patient failed to respond to therapy and presented necrotizing orchitis, as well as abscesses, which required orchectomy. Brucellar infections of the genitalia and lower urinary tract have no specific clinical presentation; the usual laboratory examination is not sufficient to diagnose this kind of infection, therefore it could easily be misdiagnosed. An analytical medical history (including overall dietary habits and recent consumption of non-pasteurized dairy products) could indicate Brucelosis as would the persistence of symptoms despite a one-week antibiotic treatment. In general, patients afflicted by brucellar epididymoorchitis respond to Brucellosis antibiotic therapy, except for some rare cases that present necrotizing orchitis and require surgical treatment.

Brucellosis triggering hemolytic anemia in glucose-6-phosphate dehydrogenase deficiency

To present a case of acute brucellosis triggering acute hemolytic anemia in a subject with glucose-6-phosphate dehydrogenase [G6PD] deficiency. A 17-year-old male patient presented with fever, malaise and jaundice. His blood and bone marrow cultures yielded Brucella species. In addition, he was found to have acute hemolytic anemia due to previously undiagnosed G6PD deficiency. He was started on folic acid supplementation and given a combination of doxycycline and rifampicin for 6 weeks. His response to antibiotic therapy was optimal; the hemolytic anemia resolved. There were no further episodes of hemolysis. This case showed that the differential diagnosis of acute hemolytic anemia in subjects with G6PD deficiency should include brucellosis, especially in regions where the infection is endemic