Case Study:Brucellosis

A 36 yr old veterinary doctor complains of high fever of 3 weeks duration. Fever is accompanied with rigor, sweating, headache, joint and muscle pain. The spleen was enlarged. WBCs count was normal, RBCs slightly decrease in number and platelet count was 70 000

b- Contact - Via abraded skin/m.m - Splashing of amniotic fluid or milk via contact with conjunctiva c- Air borne - inhalation of dust of infected dried excreta d- man to man infection - via semen, blood transfusion, organ transplantation and breast feeding 3- What are the laboratory investigations needed to confirm diagnosis? Lab investigations: A- Blood cultures - Positive in B. melitensis(75-80%), B.abortis(50%) - Bactec system give good isolation rate but if brucellosis is suspected, prolonged incubation is recommended (up to 6 weeks) B- Bone marrow cultures - Give 100% positive but not routinely recommended. - Perform if antibiotic is given before sample is taken. C- Serum agglutinin test - Significant agglutinin titre may persist months/years after recovery - In endemic areas, a single titre of 1/320 or 4 times rise in titre is needed to support a diagnosis of acute infections.

- The test usually takes several weeks to become posistive but should eventually detect 95% of acute infections D- ELISA - Identify IgM(acute, 1st few months of illness),IgG (chronic /prev.inf) 4- What are the complocations of this infection? complications: A- Musculoskletal: - Suppurative arthritis, synovitis, bursitis, osteomyelitis, spinal spondylitis, paravertebral/psoas abcess. B- CNS: - Meningitis, cranial nerves palsies, intracranial/subarachnoid Hge, stroke, myelopathy, radiculopathy. C- Ocular: - Uveitis, retinal thrombophlebitis D- CVS: - Myocarditis, endocarditis 5- What antibiotics do you give to this patient? doxacyclin+streptomycin(4 weeks) doxacyclin+rifampicin(4-8 weeks)

1- What infection do you suspect? Brucellosis, based on the on the job of the patient who may have close contact with farm animals and the clinical picture of prolonged fever, swinging temperature, sweating, rigors and myalgia. 2- How is this infection acquired? causative organisms: a- Brucella melitensis b- Brucella abortis c- Brucella suis d- Brucella canis mode of transmission a- Food borne - Ingestion of infected raw unpasteurized milk or undercooked meat.