Zoonosis en grupo familiar. Revisión bibliográfica a propósito de un brote Informe de casos / ZOONOSIS IN A FAMILY GROUP: LITERATURE REVIEW OF AN OUTBREAK

Brucelosis es una zoonosis de distribución mundial. Argentina notifica 300 casos anuales. Entre agosto y octubre de 2015 diagnosticamos tres casos en un grupo familiar

The aim of the present report was to describe an outbreak of Brucellosis in a family group due to its unfrequency and etiological value. The infection caused by Brucella is a disease of animals (zoonoses) , and humans are accidental hosts. The major determinant of a human risk of acquiring the disease is the contact with infected animals. The genus Brucella contains four species pathogenic for humans: B. melitensis, B. abortus, B. suis and B. canis. Brucella are intracellular bacteria and among the species pathogenic for humans, B. melitensis are the most virulent. The organisms commonly enter the body through cuts in the skin of people handing infected animals or through their blood or secretions, and also the entry can include the respiratory or gastrointestinal tracts. Brucellosis exists worldwide, and Argentina reports 300 cases annually. Between August and October 2015, we diagnosed four cases in a family group: these cases are reported in the article.

Ampliação de uso dos medicamentos doxiciclina, estreptomicina e rifampicina para o tratamento da brucelose humana / Expansion 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. 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 1 e 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.

Treatment of a subdural empyema complicated by intracerebral abscess due to Brucella infection

A 55-year-old male presented with fever, stupor, aphasia, and left hemiparesis. A history of head trauma 3 months before was also reported. Cranial magnetic resonance imaging revealed slight contrast enhancement of lesions under the right frontal skull plate and right frontal lobe. Because of deterioration in nutritional status and intracranial hypertension, the patient was prepared for burr hole surgery. A subdural empyema (SDE) recurred after simple drainage. After detection of Brucella species in SDE, craniotomy combined with antibiotic treatment was undertaken. The patient received antibiotic therapy for 6 months (two doses of 2 g ceftriaxone, two doses of 100 mg doxycycline, and 700 mg rifapentine for 6 months) that resulted in complete cure of the infection. Thus, it was speculated that the preexisting subdural hematoma was formed after head trauma, which was followed by a hematogenous infection caused by Brucella species.

Treatment of brucellosis in a young child with trimethoprim/sulfamethoxazole anaphylaxis

Brucellosis is a common zoonotic disease throughout the world. Brucella spp. transmit to humans through contact with fluids of infected animals, especially sheep, cattle, and goats. It is also transmitted by ingestion of fluid-derived products of infected animals, such as unpasteurized milk and cheese. Brucella spp. changes pH level of intracellular environment, so the first treatment approach is to administer antibiotics that have activity in acidic conditions. Anti-brucellosis treatment regimens include doxycycline for children older than eight years old and rifampicin and trimethoprim/sulfamethoxazole [TMP-SMX] combination therapy for children under eight years old, which may be able to act intracellularly under acidic conditions. A TMP-SMX allergy causing anaphylaxis has been reported previously. No alternative anti-brucellosis treatments have been reported in the literature for patients under eight years old with a TMP-SMX allergy. Here, we report a case of a child with brucellosis and a TMP-SMX allergy who was under eight years old at the time of diagnosis and was successfully treated with rifampicin, ciprofloxacin, and gentamicin

Brucellosis with kidney failure

Brucellosis is a multisystem disease that may present with a broad spectrum of clinical manifestations. The most frequent symptoms are constitutional symptoms. While involvement of the bones, joints, and liver is not rare, brucellosis may rarely involve the kidney. We present a case of brucellosis with hepatitis, pancytopenia, peripheral arthritis, and kidney failure

Brucellosis in Egyptian female patients

Over six months, 129 consecutive brucellosis cases were diagnosed in females attending the outpatients' clinics the females in Al-Azhar and Ain Shams Universities Hospitals. Their ages ranged between 12-65 years old. 113 [87.6%] gave history of raw milk consumption, 13 [10%] gave history of home slaughtering of sheep, 2 [1.5%] gave history of animal contact, and one patient gave history of abortion, that partner had brucellosis. A total of 61.2% of patients gave serum agglutination test of 1: 640, who suffered acute or subacute infection. Titers of 1:320 [38.8%] were found in the majority of chronic cases. Causes of endemic parasitosis were excluded. Symptoms were fever [79.5%], headache [72.4%], generalized arthralgia [65.3%], sweating [65.3%], chills [63.8%], backache [34.6%], abdominal pain [27.5%], loss of appetite [25.5%] lassitude [17.2%], myalgia [14.2%], monoarthralgia [7.9%]. Spinal involvement was in 15% patients, who had chronic brucellosis. 32/35 were successfully treated with a combination of streptomycin and tetracycline, 17/21 with streptomycin and septrin, 38/43 with tetracycline and septrin, and 26/26 [100%] with rifampicin and tetracycline or septrin, which treated all resistant patients

case of neurobrucellosis mimicking Guillain-barre syndrome

Brucellosis is an infectious disease due to Gram negative bacteria of genus brucella. Involvement of different systems including gastrointestinal tract, the hepatobilliary and skeletal systems has been frequently reported. Involvement of nervous system is not common, and its incidence has been reported to be 3-25% of the cases of generalized brucellosis. In this study, we report a case of Guillain-barre syndrome as an infrequent presentation of neurobrucellosis. A 28-year-old man is reported, who was referred because of acute progressive flaccid paraplegia, ataxia and areflexia. Electrophysiological and cerebrospinal fluid study was identical to Guillain- barre syndrome. Anti- brucella antibody [ELISA] in cerebrospinal fluid, and serum Wright and 2ME tests were positive. The patient underwent plasmaphresis for 7 times with 1.5 lit of plasma per day, but without favorite clinical response. By identification of neurobrucellosis, antimicrobial therapy with Doxycycline, Rifampin and Co-trimoxazole was started. He showed considerable recovery 3 months latter. Brucellosis is considered as a new etiologic agent for Guillain - barre syndrome. In endemic region, neurobrucellosis must be considered in any patient with Guillain- barre syndrome

Monitoring of immune response against brucella melitensis Rev- 1 vaccine following administration of some antibiotics [with 4 tables and 4 figures]

The humoral and cellular immune response in guinea pigs vaccinated with Rev-1 vaccine and simultaneously treated with antibiotics [oxytetracycline, streptomycin or enrofloxacin] or 4 weeks post-vaccination were evaluated in the present study. Groups vaccinated and simultaneously treated with oxytetracycline or 4 weeks post-vaccination showed delayed or abrupt reduction respectively in antibody production, lymphocyte transformation, phagocytic percent and intra-cellular killing one week post administration of this antibiotic while groups vaccinated and simultaneously treated with streptomycin or 4 weeks postúvaccination showed abrupt reduction in antibody titer and moderate reduction in phagocytic percent, intra-cellular killing and lymphocyte transformation. Treatment by enrofloxacin simultaneously with Brucella melitensis Rev-1 vaccine or at peak of vaccination [4 weeks postúvaccination] cause non-significant variation in both humoral and cellular immune response. Therefore oxytetracycline and streptomycin should not be recommended for animal treatment during exposure to Brucella melitensis Rev-1 vaccine. In contrast enrofloxacin exhibited a satisfactory margin of safety upon the humoral and cellular immune responses to Brucella melitensis Rev-1 vaccine

review of gastrointestinal manifestations of brucellosis

Brucellosis is hyperendemic in the Kingdom of Saudi Arabia [KSA] with more than 8,000 cases reported each year to the public health authorities. The disease can affect almost any organ system in the body including the gastrointestinal system. In some instances, gastrointestinal manifestations may be the only presenting features of the disease. These range from milder complaints like diarrhea, vomiting to more serious complications like involvement of the liver, the spleen and the gallbladder to rarely life-threatening complications like colitis, pancreatitis, peritonitis and intestinal obstruction. Recognition of this type of presentation of brucellosis is important because early diagnosis and treatment usually result in complete recovery without complications

Successful treatment of Brucella endocarditis with aortic root abscess

Brucella endocarditis is a rare but fatal complication of Brucellosis, it causes destructive valvular lesions. The aortic valve is the most common affected site. We present a case of Brucella endocarditis with aortic root abscess, the patient received a prolonged combination of antibiotic therapy, and underwent aortic valve replacement. After one and a half years of follow up, the patient is still without signs of recurrence. The high mortality in Brucella endocarditis can be overcome by early diagnosis and aggressive therapy

Brucellosis: estudio clínico hematológico en un Hospital General / Brucellosis: clinical and hematological study at a general hospital

Presentamos el estudio de 58 pacientes con el diagnóstico de brucellosis, internados en el Hospital Nacional Dos de Mayo entre junio de 1994 y junio de 1996. Cuarenta pacientes fueron varones (69 por ciento) y 18 mujeres (31 por ciento), la edad promedio fue de 33,2 años (14-81 años) y 41 pacientes fueron menores de 40 años (70,7 por ciento). Los síntomas más frecuentemente encontrados fueron fiebre (56 pacientes, 96,6 por ciento), compromiso articular en 35 pacientes (60,3 por ciento), esplenomegalia en 32 (55,2 por ciento), linfadenopatía en 30 (51,7 por ciento), hepatomegalia en 28 (48,3 por ciento), cefalea en 24 (41,4 por ciento), palidez en 20 (34,5 por ciento) y complicaciones hemorrágicas en 11 (19 por ciento). Hubo compromiso hepático en 5 pacientes. Los cambios hematológicos encontrados fueron anemia en 43 pacientes (74,1 por ciento), linfopenia en 13 (22,4 por ciento), trombocitopenia en 9 (15,5 por ciento), leucopenia en 6 (10,3 por ciento) y pancitopenia en 2 pacientes (3,5). La médula ósea en 36 pacientes evaluados fue normocelular o hiperplásica, con incremento en el número de histiocitos y leve a moderada citofagocitosis.

Brucelosis en niños: Presentación inusual de dos casos / Brucellosis in children: A report of two inusual cases

Even though burcellosis in our country is an endemic disease, it is more commonly seen over the age of ten years. We here present two cases of children whose ages are eighteen months and two years respectively. It is interesting the way both patients began their disease, with acute pharingitis and exudative amigdalitis, signs that are poorly emphasized in the literature, and that accounts for the fact that many of them are treated initially for a respiratory infection

Brucelosis durante el embarazo: evolución y resultados perinatales / Brucellosis during pregnancy: evolution and perinatal results

La brucelosis es una zoonosis que afecta animales vacunos, caprinos y porcinos, pero en zonas endémicas de la enfermedad el hombre con frecuencia se infecta. En animales el aborto es una complicación bien reconocida, pero el caso de humanos no ha sido establecida su importancia como causa de pérdidas fetales. Se presentan cuatro casos de mujeres embarazadas complicadas con brucelosis, las que fueron tradadas con rifampicina como monoterapia y tuvieron una evolución obstétrica satisfactoria, naciendo todos los productos a término y sanos. Una paciente presentó recaída en el puerperio. En la literatura médica revisada no existe suficiente soporte para atribuir a la brucelosis un efecto causal de aborto en humanos. El tratamiento de la embarazada debe incluir la combinación de rifampicina más antimicrobiano con acción intracelular

Brucelosis: experiencia durante los últimos cinco años en el Hospital Central Militar / Brucellosis: five years experience at the Central Military Hospital

Se revisaron los expedientes clínicos de 11 pacientes con diagnóstico de brucelosis internados de enero de 1990 a junio de 1994 en el Hospital Central Militar. La proporción de sexo masculino y femenino fue de 3.5:1; la edad promedio fue de 43 años. Mediante frotis de sangre periférica, VSG; PCR, biopsia de médula ósea, reacción de Weill-Felix y Huddlesson y hemocultivo se diagnosticó brucelosis en 100 por ciento de los casos. Se encontraron 10 (90.9 por ciento) individuos con síndrome febril, seis (54.5 por ciento) con artralgias en las articulaciones mayores. Once pacientes (100 por ciento) recibieron tratamiento médico. Se consideró como falla del tratamiento cuando hubo poca o nula respuesta al manejo médico, encontrada en tres (27.3 por ciento) sujetos. Dos pacientes se trataron con un esquema de base de tetraciclinas más cloranfenicol y tetraciclinas más AINES con éxito en ambos casos. La mortalidad de los pacientes tratados médicamente fue de 0 por ciento. Uno de los pacientes (9.09 por ciento) resultó con secuelas y el promedio de estancia hospitlaria fue de 13 días

Neurobrucellosis; a clinical experience

The study included 15 patients with neurobrucellosis referred for accurate evaluation of their obscure neurological deficits. Patients were grouped into 8 cases with CNS infection [4 cases with meningitis, 3 cases with encephalitis, 1 case with meningoencephalitis], 2 cases with myelopathy [one suffering from compression myelopathy at C5, and one suffering from myelitis at D11 - 12, 2 cases with isolated mononeuritis [one with III nerve, and with radial nerve affection], 2 cases with polyneuropathy [one with pure motor polyneuropathy and one with sensorimotor affection] and one case with meningovascular brucellosis presented with hemiparesis. ELISA test for blood and CSF seemed to be the most accurate diagnostic tool. A definite therapeutic response was found in all patients using a combination of trimethoprim sulfamethoxasole and rifampicin. Neurobrucellosis should be included in the differential diagnosis of any unexplained neurological syndrome in certain areas of the world including Egypt

Púrpura trombocitopénica asociada a brucelosis / Thrombocytopenic purpura in human brucellosis

Entre los años 1981 a 1990 se estudiaron las características clínicas de la púrpura trombocitopénica asociada a brucelosis. De 1091 pacientes con brucelosis, 27 presentaron púrpura durante la enfermedad, de éstos, 22 (81.5 por ciento) fueron hospitalizados y 5 (18.5 por ciento) evaluados ambulatoriamente. Veintiuno (77.7 por ciento) fueron mujeres y 6 hombres (22.3 por ciento). El rango de edad fluctuó entre 2 y 77 años, promedio de 28.7 años. Presentaron anemia 23 pacientes (85.1 por ciento), leucopenia 10 (37 por ciento) y trombocitopenia 22 (88 por ciento). Se observó pancitopenia en 10 pacientes (37 por ciento). El estudio de médula ósea en 22 pacientes mostró: hipercelularidad en 16 (72.2 por ciento), hiperplasia megacariocítica en 11 (50 por ciento), histiocitofagocitosis en 8 (36.4 por ciento), ausencia de hierro medular en 13 (59.1 por ciento) y granulomas en el coágulo de la médula ósea en 2 pacientes. Se utilizó corticoterapia en todos los pacientes con trombocitopenia severa observándose remisión completa en el 73 por ciento de los casos. Tres pacientes necesitaron esplenectomía por ser refractarios a la corticoterapia. Dos pacientes fallecieron por hemorragia en el sistema nervioso central

Lumbar spines brucellosis: presentation, diagnosis and treatment

Nineteen cases with lumbar spines brucella were studied during a 3 year period. The diagnosis was based on history of exposure, compatible symptoms and signs, plain radiographs, CT [in some cases] and high antibody titre. Combined antibiotic treatment [tetracycline, streptomycin and rifampicim] for long duration [3 months] was considered the most effective tool in the treatment. The adequacy of treatment was best monitored with repeated agglutination titers, and the duration of treatment proved to be more important than the antibiotic agent itself