248 Annals of Tropical Medicine and Public Health | May-Jun 2012 | Vol 5 | Issue 3 248 CASE REPORT Access this article online Quick Response Code: Website: www.atmph.org DOI: 10.4103/1755-6783.98629 Acute brucellosis in a young adult Girija Subramanian, Jeyakumari Duraipandian 1 , Gopal Rangasamy 1 , Chand Pavan 1 Departments of Medicine and 1 Microbiology, Sri Manakula Vinayagar Medical College and Hospital, Madagadipet, Puducherry University, Puducherry, India ABSTRACT Brucellosis is a zoonotic disease primarily affecting cattle, goats, sheep and other animals occasionally transmitted to man. The clinical manifestations are protean and often missed. A case of acute brucellosis in a young adult male who presented primarily with loss of weight, malaise, fatigue and with no known risk factors is reported here. Brucella melitensis was isolated from blood culture and confirmed by polymerase chain reaction (PCR). Brucella IgM antibodies were detected by ELISA test and the patient was treated successfully with injection Amikacin for two weeks and oral Doxycycline for a period of six weeks. Key words: Brucella melitensis, infection, young adult Correspondence: Dr. Jeyakumari Duraipandian, Department of Microbiology, Sri Manakula Vinayagar Medical College and Hospital, Madagadipet, Puducherry – 605 107, India. E-mail: karailabscuddalore@yahoo.co.in Introduction Brucellosis is a zoonotic disease caused by a small gram negative Coccobacillus primarily affecting cattles, goats and sheep. [1] Human infection arises through contact with infected animals, consumption of unpasteurized infected milk or milk products, ingestion of raw meat or direct contact with the infected meat or excreta, products of conception or inhalation of infective aerosols. [2] Brucellosis can be caused by any of the six species of the genus Brucella. [3] The most common species associated with human disease include Brucella melitensis, B. abortus, B. suis and B. canis. The clinical presentation includes an acute, subacute or chronic form of illness. The most common symptoms are fever with evening rise of temperature, nocturnal sweating, fatigue and loss of body weight. About 30–40% of patients have reactive asymmetric polyarthritis. [4] Untreated cases may develop a variety of complications involving the central nervous system, cardiovascular system, gastrointestinal, genitourinary tract, respiratory and musculoskeletal systems. [5] Brucellosis can be diagnosed in the acute phase by serology and blood or bone marrow culture. A high index of clinical suspicion is necessary for early diagnosis as the clinical manifestation is protean in nature. With appropriate antimicrobial treatment most of the cases resolve with six or eight weeks of therapy, while chronic cases are difficult to treat. Case Report A 21-year-old male, student by occupation presented with complaints of fever, malaise, fatigue, profuse sweating and severe myalgia, polyarthralgia, intermittent abdominal pain and loss of appetite of four weeks duration. The patient had lost 6 kg of body weight over the past two months. There was an evening rise of temperature reaching a peak of 101°F and increased sweating in the night. The patient had been treated with antimalarials and various antibiotics before visiting our hospital. On examination the patient was apparently sick. All vital signs were normal. Routine blood tests like hemoglobin, total and differential white blood cell counts were normal. No parasites were seen in peripheral smear. Erythrocyte sedimentation rate was 40 mm at one hour. Tests for HIV antibodies, rheumatoid factor, antinuclear antibodies and Widal test were negative. Mantoux test was negative and chest X-ray was normal. Urine routine was normal and culture was sterile. Ultrasound of the abdomen showed mild splenomegaly. There was no evidence of lymphadenopathy. No other abnormality was detected clinically. ELISA test for Brucella IgM antibodies was positive. Blood culture yielded a pure growth of gram- negative coccobacillus after eight days of incubation and identified as B. melitensis by standard tests for identification [6] [Figure 1a and b] and confirmed by