Enteric fever due to Brucella melitensis: a case report

Abstract number: 1733_1017

Erbay A., Bodur H., Akinci E., Bastug A., Cevik M.A.

Objectives: Although pathogenetically qualifying as an enteric fever, the gastrointestinal manifestations of brucellosis in humans are relatively uncommon. Alimentary tract complaints such as anorexia, nausea, vomiting, abdominal pain, diarrhoea or constipation are elicited in patients with brucellosis but systemic symptoms generally are more common than symptoms localised to the gastrointestinal tract. A patient with enteric fever caused by Brucella melitensis is reported.

Case: A previously healthy 16 year old male was admitted with fever, vomiting, diarrhoea and skin rash. His initial complaint was started with fever six days before admission. He was living at a village and had a history of consumption of unpasteurised dairy products. Physical examination revealed an acutely ill boy with a temperature of 39.9°C. Blood pressure was 110/60 mmHg and pulse was 96/min. He had abdominal tenderness and hepatosplenomegaly. Maculopapuler rashes with a diameter of 1–2 mm were present on the trunk and arms. After admission, vomiting, abdominal pain and melena were observed. Pertinent laboratory findings were as follows: white blood cell (WBC) count 3,000/mm3 haemoglobin 12.6 g/dl, platelet count 44,000/mm3, erythrocyte sedimentation rate 9 mm/h, ALT 230 U/L, AST 169 U/L, CRP 77.4 mg/dl. The direct microscopic examination of faecal smear showed prevalent leukocytes. A faecal occult blood test was positive. Initial and follow up Widal tests were negative. Serological tests for acute viral hepatitis were negative. A brucella serum agglutination test was positive, with a titre of 1:1,280. Stool culture revealed no evidence of bacterial pathogens. Brucella melitensis was isolated from the cultures of blood. An upper gastrointestinal endoscopic examination revealed bulbitis. Combined therapy with rifampicin (600 mg/d p.o.) and doxycycline (100 mg p.o., b.i.d.) was started. On the 3rd day of therapy the patient became afebrile. In the following days the patient improved clinically. The faecal occult blood test became negative on the 7th day. A repeated CRP was 18.9 mg/dl. On the 12th day of the therapy laboratory test were as follows; WBC count 5,100/mm3, haemoglobin 12.8 g/dl, platelet count 275,000/mm3, alanine aminotransferase 19 U/L and aspartate aminotransferase 41 U/L. Antibiotic therapy was stopped on day 42.

Conclusion: Brucellosis is an infection with multiple presentations, and in an endemic region a thorough history of exposure and clinical suspicion are required.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Location: ICC, Munich, Germany
Presentation type:
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