Cases reported "Brucellosis"

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1/53. Systemic brucellosis with chronic meningitis: A case report.

    A young adult presenting with 11 months history of fever, headache, vomiting was found to have CSF lymphocytic pleocytosis with increased protein. His serum tested strongly positive for Brucella (standard tube agglutination titre 1: 320) whereas CSF was weakly positive. He became asymptomatic on treatment with tetracycline, rifampicin and streptomycin with significant CSF response. This case is reported because of its rarity.
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2/53. Brucella spondylitis: an important treatable cause of low backache.

    OBJECTIVES: This study was undertaken to see if brucella spondylitis existed as a cause of backache in Mumbai and to identify the clinical setting in patients of backache where brucella serology is indicated. methods: In 18 months (June 1996-Dec. 1997) we performed tube agglutination test (TAT) for brucella melitensis and abortus on 72 patients of low backache from Orthopaedics Department of a teritary health centre. All 72 patients satisfied the inclusion and exclusion criteria designed to exclude radiologically detectable congenital or degenerative cause of backache. RESULTS: Six out of 72 patients were seropositive for brucellosis. All six patients had either history of animal contact or ingestion of raw milk or milk product (cheese or paneer). The lumbosacral backache was severe, radiating to the legs and straight leg raising test was significantly positive, they had marked tenderness on spinous process of lower lumbar vertebrae. Changes of brucella spondylitis were present on plain radiogram of lumbosacral spine in three patients. Four patients had abnormalities on bone scintigraphy. CONCLUSION: Low backache of brucella spondylitis closely simulates pain of prolapsed intervertebral disc. Serologic testing for brucellosis is an important step in management of such patients, especially when history of animal contact or raw milk or milk product ingestion is present, as the disease can be eminantly treated with antibiotics.
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3/53. brucellosis: unusual presentations in two adolescent boys.

    Two boys presented with variable signs and symptoms of infectious disease that challenged diagnosis. One of the two patients had aortic valve vegetations and lower extremity aneurysms, and the other had calvarial osteomyelitis, epidural abscess, pleural effusions, and pulmonary nodules. Only after a battery of bacterial and fungal agglutination tests was the unsuspected diagnosis made in each of brucellosis from brucella canis.
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4/53. meningoencephalitis in brucellosis.

    Human brucellosis, more specifically neurobrucellosis, is a less commonly reported disease in india; although, animal brucellosis and seroprevalence in specific areas is well reported. We are reporting 4 cases of neurobrucellosis presenting as meningoencephalitis. diagnosis was confirmed by serological test and agglutination titre was > 1:320 in all the patients. All these patients had close contact with animals and history of raw milk ingestion was present in 3 cases. The aim of presenting these cases is to create awareness among physicians while treating meningitis in persons, engaged in occupations related to brucellosis or having a history of ingestion of raw milk or milk product.
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5/53. brucellosis transmitted by bone marrow transplantation.

    We report a unique case of brucellosis transmitted by BMT. An 8-year-old boy with the diagnosis of Fanconi's anemia received an allogeneic BMT from his HLA-identical sibling. Routine culture from the infused marrow suspension grew brucella abortus on day 4 post BMT. Spiking fevers occurred on days 2 and 16. The first febrile episode responded to broad-spectrum antibiotic therapy. However, the second episode did not. B. abortus was isolated from blood cultures taken during the second febrile episode. The Brucella agglutination titer was negative. Antibiotic therapy with oral doxycycline and i.v. gentamycin was successful with no recurrence of infection during 13 months of follow-up. The donor's blood culture was also positive for B. abortus and Brucella antibodies were detectable at 1:320 titer when he presented with fever and hepatosplenomegaly on day 32. We emphasize the need to consider brucellosis in patients undergoing BMT. We suggest that donor and recipient be evaluated for brucellosis especially in countries where the incidence of this infection is relatively high.
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6/53. brucella melitensis dacryoadenitis: a case report.

    PURPOSE: To present a case of brucellosis-related unilateral dacryoadenitis. methods: A 16-year-old boy had unilateral lacrimal gland enlargement, shown by magnetic resonance imaging of the orbits. Clinical findings, tube agglutination, the culture of a lacrimal gland aspirate, and histopathological examination confirmed the diagnosis of brucellosis. RESULTS: Tube agglutination testing for brucellosis gave a titer of over 1/640. The aspirate from the lacrimal glands grew brucella melitensis and histopathological findings were consistent with brucellosis. CONCLUSIONS: Dacryoadenitis may occur in the course of systemic brucellosis caused by brucella melitensis.
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7/53. Sonographic findings in brucellar hepatic abscess.

    Brucellar hepatic abscesses are rare; to our knowledge, only 41 cases have been described in the literature. We report the case of a 29-year-old Spanish woman who was hospitalized because of fever, weakness, and weight loss. Abdominal sonography showed a hypoechoic lesion with central calcification. Brucella spp. were not isolated from an aspirate of the liver or blood cultures. The diagnosis was based on the association of characteristic sonographic features (central calcification and peripheral necrotic areas) and positive Brucella agglutination tests. The patient improved rapidly with antibiotic treatment.
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8/53. Brucella endocarditis complicated by acute glomerulonephritis--early surgical intervention.

    brucellosis, a zoonotic disease, occurs most frequently in areas of the middle east and Mediterranean-bordering countries. endocarditis, which occurs in less than 2% of all cases of brucellosis, accounts for most brucellosis-related deaths.The patient described here had Brucella endocarditis in a bicuspid aortic valve complicated by acute glomerulonephritis, which was successfully treated with urgent aortic valve replacement and intensive medical therapy. The diagnosis was made initially by a high agglutination titer and later confirmed with positive blood culture.
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9/53. Brucella spondylitis with paravertebral abscess due to brucella melitensis infection: a case report.

    This report describes the case of a 45-year-old woman with a 5-month history of fever, generalized malaise, myalgia, lower back pain and difficulty in walking. Serodiagnosis for brucella, carried out at the onset of symptoms 5 months previously, was negative. When the patient was admitted to our hospital there was contracture of the paraspinal muscles but no peripheral nerve damage. Laboratory tests showed positive agglutination for Brucella and an increase in the rate of dilution from 1/160 to 1/640 over 2 weeks. Radiographs and a computed tomography scan of the spine revealed bone erosion in the posterior borders of the L4-L5 vertebral end plates and a soft tissue mass surrounding the interposed disc and protruding into the spinal canal. magnetic resonance imaging confirmed the presence of a paraspinal abscess around the affected disc and tissue edema. culture tests of the blood and abscess tissue, taken by biopsy, were negative. Rifampicin treatment (600 mg daily), combined with a bust cast to immobilize the spine, led to clinical healing without the need for surgery. Because onset symptoms are nonspecific and insidious, in nonrisk subjects a diagnosis of brucellosis may sometimes be suspected only if there are local symptoms. The phenomenon of the absence of positivity in patients with a high antibody titer should also be considered Cases such as that described herein demonstrate the need for culture tests and serodiagnosis, even in nonrisk patients with persistent fever and arthralgia, to prevent the later complications of brucellosis.
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10/53. Bone marrow hypoplasia during Brucella infection.

    pancytopenia, although mainly reported in adults, has also been described in children with brucellosis. However, bone marrow hypoplasia is a rare feature of the infection. An 11-year-old boy was admitted with fever, vomiting, and abdominal pain of 10 days' duration. On physical examination, pallor and high fever were detected in the absence of lymphadenopathy and hepatosplenomegaly. His hemoglobin was 8.6 g/dL, white blood cell count 1,100/mm(3), neutrophil count 500/mm(3), platelets 56,000/mm(3), and reticulocytes 0.1%. Hypocellular bone marrow was found by aspiration, and bone marrow biopsy revealed hypocellularity. The agglutination titer was greater than 1/640. trimethoprim/sulfamethoxazole was prescribed. His fever subsided and pancytopenia subsequently improved. pancytopenia associated with brucellosis is attributed to hypersplenism, hemophagocytosis, and granulomatous lesions of the bone marrow, which is usually hypercellular. Bone marrow hypoplasia is rarely reported and should be kept in mind in the etiology of aplastic anemia in a country where brucellosis is frequently encountered.
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