Keywords

Brucellosis, pyrexia of unknown origin, pericarditis, positive brucella IgM

Assistant ProfessorProfessor and Head2nd Year Resident Dept. of Medicine, GG Hospital, Jamnagar, GujaratAddress for correspondenceDr Manish N MehtaShripati Apt.,Valkeshwari Nagri, Jamnagar, GujaratE-mail: mnmehta1968@yahoo.com

Brucellosis is a bacterial zoonosis transmitted directly or indirectly to humans from infected animals, predominantly domesticated ruminants and swine. The disease is known colloquially as undulant fever because of its remittent character. Its distribution is worldwide apart from the few countries where it has been eradicated from the animal reservoir.

Although brucellosis commonly presents as an acute febrile illness, its clinical manifestations vary widely and definitive signs indicative of the diagnosis may be lacking. Thus, the clinical diagnosis usually must be supported by the results of bacteriologic and/or serologic tests.1

CASE REPORT

A 24-year-old Hindu Indian patient, by occupation a farmer, came to our institute with chief complaints of high-grade fever with chills and rigor. Fever was intermittent and relieved after taking some drug. He was having fever since 15 days. Fever was associated with severe multiple joint pain, which led to severe disability. Patient was mainly having knee joint pain, which was swollen and tender. Patient gave history of ingestion of raw milk. With all above mentioned complains, patient was referred to us as a case of pyrexia of unknown origin with all basic reports done, which are given in Table 1. We suspected brucellosis. For that brucella IgM (immunoglobulin M) antibody testing was done, which was found to be positive. At same time, the patient was complaining of chest pain with breathlessness at rest.

On examination, there was tachypnea and tachycardia. We had ECG of the patient done which showed ST-segment elevation with concavity upward in all chest leads. 2D echocardiography of patient revealed mild pericardial effusion with pericarditis, which responded to injectable furosemide with injectable hydrocortisone given for 5 days. Patient was given capsule doxycycline 200 mg b.i.d. for 6 weeks and injection streptomycin o.d. for 2 weeks. Patient’s fever subsided completely but the joint pain was still so severe that he could not move. For that, we started injectable methylprednisolone for 5 days. Patient improved completely and was discharged.

DISCUSSION

Human brucellosis is caused by strains of Brucella, a bacterial genus that was previously suggested, on genetic grounds, to comprise a single species, Brucella melitensis, with a number of biologic variants exhibiting particular host preferences. All brucellae are small, Gram-negative, unencapsulated, nonsporulating, nonmotile rods or coccobacilli. They grow aerobically on peptone-based medium incubated at 37°C; the growth of some types is improved by supplementary CO2. In vivo, brucellae behave as facultative intracellular parasites.

The organisms are sensitive to sunlight, ionizing radiation and moderate heat; they are killed by boiling and pasteurization but are resistant to freezing and drying. Their resistance to drying renders brucellae stable in aerosol form, facilitating airborne transmission.1 Brucellosis can involve almost any organ of the body and can lead to multiorgan dysfunction.2 Our patient was a case of brucella pericarditis. Cardiac complications from brucellosis are unusual, occurring in 0-2% of patients and usually manifest as endocarditis.2-4 Here patient was referred to us as a case of pyrexia of unknown origin as patient has went on all investigations except brucella titer before presenting to our institute.5

CONCLUSION

Brucella is rare cause of pericarditis but should be considered as one of the cause of bacterial pericarditis.

REFERENCES

1. White NJ, Bremen JG. Malaria (Chapter 157). In: Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo et al (Eds.). Harrison’s Principles of Internal Medicine. 18th Edition, New York: McGraw-Hill; 2012.
2. Khorvash F, Keshteli AH, Behjati M, Salehi M, Emami Naeini A. An unusual presentation of brucellosis, involving multiple organ systems, with low agglutinating titers: a case report. J Med Case Rep. 2007;1:53.
3. Jubber AS, Gunawardana DR, Lulu AR. Acute pulmonary edema in Brucella myocarditis and interstitial pneumonitis. Chest. 1990;97(4):1008-9.
4. García de Lucas MD, Castillo Domínguez JC, Martínez González MS. Brucella myopericarditis. Rev Esp Cardiol. 2004;57(7):709.
5. Hadda V, Khilnani G, Kedia S. Brucellosis presenting as pyrexia of unknown origin in an international traveller: a case report. Cases J. 2009;2:7969.