Jebmh.com Original Research Article J. Evid. Based Med. Healthc., pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 4/Issue 43/May 29, 2017 Page 2598 ARE WE SEEING THE TIP OF AN ICEBERG? A FIVE YEAR STUDY OF HUMAN BRUCELLOSIS FROM A TERTIARY CARE HOSPITAL IN BANGALORE Vijayashree Thyagaraj 1 , Tharanath Shankar 2 , Sujatha K.J 3 , Ronak Ajmera 4 1 Associate Professor, Department of General Medicine, Ramaiah Medical College and Hospital, Bangalore. 2 Senior Resident, Department of General Medicine, Ramaiah Medical College and Hospital, Bangalore. 3 Senior Resident, Department of General Medicine, Ramaiah Medical College and Hospital, Bangalore. 4 Junior Resident, Department of General Medicine, Ramaiah Medical College and Hospital, Bangalore. ABSTRACT BACKGROUND Brucellosis is a common zoonotic disease that exists worldwide. In India where agriculture is the predominant occupation, people are exposed to livestock and are prone to be infected. The non-specific symptoms that overlap with other diseases make it difficult for the clinician to diagnose, apart from the patient himself presenting late due to mild, non-aggressive symptoms. Brucellosis can also present as a well localized infection. There are not many studies from India focusing on the clinical presentation or other unusual manifestations of the disease and hence the need for this study. The aim of the study was to evaluate the protean manifestations of Brucellosis with special emphasis on organ / localized involvement and to analyze the various lab parameters and treatment practices. MATERIALS AND METHODS This was a retrospective study done during 2012 to 2016 at MS Ramaiah Medical College and Hospitals, Bangalore. Patients diagnosed with brucellosis during this period were included in the study. Their records were analysed for information regarding history, occupation, clinical features, investigations, treatment received and course in the Hospital. RESULTS Records of sixteen patients were selected and studied. The average age of the subjects was 47.75 ± 16.5years. There were 13 (81.25%) male and 3 (18.75%) female patients. There was history of occupational exposure among 8(50%) patients. All subjects had history of fever. Ten (62.5%) had musculoskeletal symptoms. Neurological manifestations were present in 5 (31.25%) subjects. Abdominal examination revealed hepatomegaly (n=2, 12.5%), splenomegaly (n=5, 31.25), hepatosplenomegaly (n=1, 6.25%) and in one (6.25%) patient ascites. Two (12.5%) patients presented with multiple organ involvement. Blood investigations revealed anemia in 13 (81.25%), thrombocytopenia in 9 (56.25%) and elevated ESR in 7 (43.75%) patients. There were eleven (68.75%) patients with an abnormal LFT. Chest X ray was abnormal in 5 (31.25%) patients. Mean Brucella IgM titre was 4.18 ± 3.46 IU/ml. Different treatment protocols were followed. All patients recovered except for one who expired. CONCLUSION Brucellosis may present with multiple non- specific symptoms and signs or with localized organ involvement, often confusing the treating physician. A high index of suspicion is necessary to diagnose this condition. KEYWORDS Brucellosis, Organ Involvement, Treatment, Unusual Manifestation. HOW TO CITE THIS ARTICLE: Thyagaraj V, Shankar T, Sujatha KJ, et al. Are we seeing the tip of an iceberg? a five year study of human brucellosis from a tertiary care hospital in Bangalore. J. Evid. Based Med. Healthc. 2017; 4(43), 2598-2603. DOI: 10.18410/jebmh/2017/514 BACKGROUND Brucellosis is the most common bacterial zoonosis prevalent in many parts of the world like the Mediterranean basin, Middle East and parts of Asia. 1 Data regarding incidence and prevalence of human disease in India is limited. 2, 3 Human disease is most commonly caused by Brucella melitensis followed by B. abort us and B. suis. Brucellosis causes more than 500,000 infections per year worldwide. 4 It is known by various names such as Mediterranean fever, undulant fever, Malta fever and gastric remittent fever. Brucella were first discovered in 1887 in a patient in Malta and are small, non-motile, gram negative intracellular coccobacilli. 5 The primary hosts are animals such as sheep, goat, camel and cows. Man is an accidental host. The disease is common in people from agrarian background who handle infected animals or consume unpasteurised dairy Financial or Other, Competing Interest: None. Submission 18-05-2017, Peer Review 21-05-2017, Acceptance 25-05-2017, Published 26-05-2017. Corresponding Author: Dr. Vijayashree Thyagaraj, No. 524, 4 th A Main, 1 st Stage, 4 th Block, HBR Layout, Bangalore-560043. E-mail: vijiadisudha@gmail.com DOI: 10.18410/jebmh/2017/514