Mucosal Brucella Infection in Human: a case report study during Covid-19 pandemic
Abstract
Brucellosis in human is an uncommon disease in Libya and usually diagnosed by serological assays. The clinical symptoms of this disease in many times are none specific and vague. This report describes a case of clinical human brucellosis in Libya. The patient was a sixteen years old girl, lives in a rural area. She was suffering from intermittent fever for several days associated with chills, mild cough, and headache. The patient had history of occasional drink of goat’s raw milk during the previous two months. She had no history of travel abroad and direct animal contacts. Comprehensive physical examination revealed the patient was generally unwell, pallor and, had tenderness and mild hepatosplenomegaly. Laboratory investigations revealed that the patient had pancytopenia (low number of blood cells count) and a marked increase in C-reactive protein (CRP), Procalcitonin (PCT), Lactate dehydrogenase (LDH), Aspartate transaminase (AST). Viral screen tests were non-reactive for HCV, HBs Ag, HIV and covid-19. Provisional diagnosis on admission time was acute leukemia or aplastic anemia with common microbial infection. Empirical antibiotic (Meropenem 1 gm) was prescribed intravenously every eight hours for seven days. The patient was also given antipyretic, IV fluid hydration, and one unit of packed red blood cells. Following that, bacterial growth in aerobic blood culture was noticed and it was Gram-negative coccobacilli, non-motile. The bacterium was positive for catalase, oxidase and urease tests. It could not clearly be identified by phoenix bacterial identification system. It was provisionally diagnosed Haemophilus spp., but as it was able to growth on blood agar plate, it was finally diagnosed as Brucella spp. and that was confirmed by collection of patient serum and performing Rose-Bengal pate test (RBPT) as was significantly increased (1:640). The patient general condition was improved and blood count recovered over one week. The patient was then discharged and asked for routine follow ups during the next six months.
References
2. Olsen, S.C. and M.V. Palmer, Advancement of knowledge of Brucella over the past 50 years. Vet Pathol, 2014. 51(6): p. 1076-89.
3. López-Santiago, R., et al., Immune Response to Mucosal Brucella Infection. Frontiers in Immunology, 2019. 10(1759).
4. Shaqinah N, M.M., Zamri-Saad M, Hazilawati H, Jasni and S., , In vitro penetration and survival of Brucella melitensis in lymphocytic cells of goats. . . Online J Vet Res 2012. 16(3): 104-110.
5. Kang, S.I., et al., Advanced multiplex PCR assay for differentiation of Brucella species. Appl Environ Microbiol, 2011. 77(18): p. 6726-8.
6. Hartady, T., et al., Clinical human brucellosis in Malaysia: a case report. Asian Pacific Journal of Tropical Disease, 2014. 4(2): p. 150-153.
7. Gameel, S.E.A.M., et al., Prevalence of camel brucellosis in Libya. Tropical Animal Health and Production, 1993. 25(2): p. 91-93.
8. Dean, A.S., et al., Clinical manifestations of human brucellosis: a systematic review and meta-analysis. PLoS Negl Trop Dis, 2012. 6(12): p. e1929.
9. Rolando, I., et al., Ocular manifestations associated with brucellosis: a 26-year experience in Peru. Clin Infect Dis, 2008. 46(9): p. 1338-45.
10. Sari, I., et al., A multicenter retrospective study defining the clinical and hematological manifestations of brucellosis and pancytopenia in a large series: Hematological malignancies, the unusual cause of pancytopenia in patients with brucellosis. Am J Hematol, 2008. 83(4): p. 334-9.
11. Feller, L., et al., Oral mucosal immunity. Oral Surg Oral Med Oral Pathol Oral Radiol, 2013. 116(5): p. 576-83.
12. Meyle, J., et al., The innate host response in caries and periodontitis. J Clin Periodontol, 2017. 44(12): p. 1215-1225.
13. Walker, D.M., Oral mucosal immunology: an overview. Ann Acad Med Singap, 2004. 33(4 Suppl): p. 27-30.
14. Elsaghir, A.A.F. and E.A. James, Misidentification of Brucella melitensis as Ochrobactrum anthropi by API 20NE. J Med Microbiol, 2003. 52(Pt 5): p. 441-442.
15. Batchelor, B.I., et al., Biochemical mis-identification of Brucella melitensis and subsequent laboratory-acquired infections. J Hosp Infect, 1992. 22(2): p. 159-62.
16. DÃaz, R., et al., The Rose Bengal Test in human brucellosis: a neglected test for the diagnosis of a neglected disease. PLoS Negl Trop Dis, 2011. 5(4): p. e950.
17. Maletskaia, O.V., [Efficacy of some new antibiotics in treating experimental brucellosis]. Antibiot Khimioter, 2002. 47(11): p. 13-7.
18. Ertem, M., et al., Brucellosis transmitted by bone marrow transplantation. Bone Marrow Transplant, 2000. 26(2): p. 225-6.
19. Villaverde, M., et al., [Febrile syndrome: myocarditis and brucellosis]. Medicina (B Aires), 1995. 55(2): p. 145-6.
20. Efe, C., et al., A rare complication of Brucella infection: myocarditis and heart failure. Intern Med, 2009. 48(19): p. 1773-4.
21. Figueroa Damian, R., L. Rojas RodrÃguez, and E.S. Marcano Tochon, [Brucellosis in pregnancy: course and perinatal results]. Ginecol Obstet Mex, 1995. 63: p. 190-5.
22. Skalsky, K., et al., Treatment of human brucellosis: systematic review and meta-analysis of randomised controlled trials. Bmj, 2008. 336(7646): p. 701-4.
23. Lubani, M.M., et al., A multicenter therapeutic study of 1100 children with brucellosis. Pediatr Infect Dis J, 1989. 8(2): p. 75-8.
24. Solera, J., E. MartÃnez-Alfaro, and A. Espinosa, Recognition and optimum treatment of brucellosis. Drugs, 1997. 53(2): p. 245-56.
25. Joint FAO/WHO expert committee on brucellosis. World Health Organ Tech Rep Ser, 1986. 740: p. 1-132.
26. Agalar, C., S. Usubutun, and R. Turkyilmaz, Ciprofloxacin and rifampicin versus doxycycline and rifampicin in the treatment of brucellosis. Eur J Clin Microbiol Infect Dis, 1999. 18(8): p. 535-8.
