Title : Diverse clinical presentations of brucellosis in a tertiary care centre
Abstract:
Brucellosis, an endemic zoonosis in many countries, is caused by bacteria of the genus Brucella, a Gram-negative coccobacillus.
The World Health Organisation receives reports of almost half a million cases each year. The most prevalent species, Brucella melitensis, is found mostly in the Mediterranean region. It is followed by Brucella abortus, Brucella suis, and Brucella canis.
Farmers, abattoir employees, and veterinary physicians are at danger of contracting brucellae through the intake of unpasteurised milk or dairy products or direct contact with infected animals.
Brucellosis can emerge as a localised disease that affects any organ system, as a subclinical illness, or as an acute disease with widespread symptoms. Up to 40% of cases result in osteoarticular involvement, making it one of the most frequent consequences. All age groups may be impacted, and it might manifest as osteomyelitis, spondylitis, sacroiliitis, arthritis, or synovitis.
It may cause genitourinary complaints (8.5 %) like pyelonephritis, abscess, and epididymo-orchitis as well as cardiovascular system diseases like endocarditis, which potentially harm the heart
A consequence of a systemic brucellosis infection is neurobrucellosis. According to published reports, the prevalence of neurobrucellosis (5-7%) Encephalitis, meningoencephalitis, radiculitis, myelitis, peripheral and cranial neuropathies, subarachnoid haemorrhage, psychiatric symptoms, brain abscess, and demyelinating syndrome are examples of neurological sequelae.
Here I am presenting the 4 different presentations of brucellosis in a tertiary care hospital
- A 51-year-old female farmer by occupation, he patient had FUO, lower abdominal discomfort, and a normal hemogram. Later, there was a CT Abdomen pelvis s/o right-sided perinephric fat collection and hepatomegaly. The blood culture revealed Brucella melitensis, and the triple antibiotic treatment was effective.
- A 45-year-old male patient farmer by occupation, came with fever with altered mental status, headache with irritability without any neurological deficit. On examination, Neck rigidity was present; hence MRI brain was done s/o Leptomeningeal enhancement on bilateral frontoparietal-temporal region, partial agenesis of the posterior aspect of corpus callosum, CSF studies done ADA-42, Proteins-346, CSF culture s/o Brucella melitensis, hence started on triple antibiotic therapy responded well.
- A 19-year-old male from a remote location came in with a lurching gait, right hip pain, and an unexplained fever that had been present for two months. The examination showed mild splenomegaly (Hackett grade II), tachycardia, and temperature (101°F).
- Prolonged blood cultures and Brucella-IgM ELISA tests came up negative. MRI-HIP- Right-sided sacroiliitis with an abscess that was tracking into the right iliacus muscle. An Immune Capture Agglutination Assay was conducted in light of the cattle exposure history, and the results were highly positive (titre: 1:5120).The patient was placed on a combination antibiotic therapy after that responded well.
- A 28-year-old man migrant from Bihar came with c/o FUO for 15-20 days intermittent in nature, associated with generalised body ache, headache, examination s/o mild splenomegaly (Hackett grade II), Stared on IV antibiotics later came Hep B positive (newly diagnosed) with transaminitis, USG Abdomen +Pelvis - mild splenomegaly with fatty infiltration, Blood culture s/o brucella melitensis. Triple antibiotics was given responded to medical therapy.
