I could smell there was something wrong with him: Clinical case of a decade of chronic undiagnosed brucellosis

Q3 Medicine
F.D. Halstead , E. Tennant , B.P. Wordsworth
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引用次数: 0

Abstract

Background

Brucellosis is a zoonotic infection, typically transmitted by ingestion of unpasteurised dairy products or direct contact with infected animals. It is associated with specific occupations, and travel to endemic countries. There are numerous reports of delayed diagnosis, particularly in non-endemic areas because diagnosis requires a high level of clinical suspicion. However, chronic brucellosis of 10-year duration is rare.

Case report

A 43-year-old previously well sportsman presented to primary care with acute flu-like symptoms and large joint arthralgia following travel to Southern France with his young family. The initial symptoms resolved, but recurred every few months over the subsequent decade with fever, depression, joint pain and malodorous perspiration. Approximately one year into the infection, a diagnosis of inflammatory polyarthritis was made, which was treated with oral corticosteroidssteroids.
However, this treatment was ineffective, and over the next nine years the patient experienced recurrent episodes of acute inflammation associated with extensive synovitis and severe erosive disease involving the left ankle and both knees, which eventually required joint replacement surgery.
Only following further microbiology testing Only during the work up for joint replacement surgery was the diagnosis of septic arthritis established when a small sinus track was identified discharging small amounts of serous fluid. Brucella melitensis was cultured from the ankle and knee joints and confirmed through serology. Following antibiotic treatment joint replacement was undertaken and the patient made an excellent recovery.

Conclusion

Although this patient had clinical features compatible with brucellosis, and relevant travel history, this diagnosis (nor any infective cause) was not considered for nearly a decade. Indeed, the initial steroid treatment could have exacerbated the infection.
We emphasise the importance of considering brucellosis in individuals who present with atypical osteoarticular inflammation, where there is a compatible travel history and for whom conventional microbiology has been negative.
我能感觉到他有些不对劲:十年未确诊的慢性布鲁氏菌病临床病例
背景布鲁氏菌病是一种人畜共患传染病,通常通过摄入未经巴氏消毒的乳制品或直接接触受感染的动物传播。它与特定的职业和前往流行国家有关。由于诊断需要高度的临床怀疑,因此有许多延误诊断的报告,特别是在非流行地区。病例报告 一位 43 岁的运动员在与年轻的家人到法国南部旅行后,因急性流感样症状和大关节痛到初级保健中心就诊。最初的症状缓解了,但在随后的十年中,每隔几个月就会复发一次,并伴有发热、精神萎靡、关节疼痛和恶汗。感染大约一年后,患者被诊断为炎性多关节炎,并接受了口服皮质类固醇类药物的治疗。然而,治疗效果不佳,在接下来的九年里,患者的急性炎症反复发作,并伴有广泛的滑膜炎和严重的侵蚀性疾病,左脚踝和双膝均受累,最终需要接受关节置换手术。在进行关节置换手术前的准备工作中,患者被发现有一个小窦道排出少量浆液性液体,经过进一步的微生物检测后,化脓性关节炎的诊断才得以确立。从踝关节和膝关节中培养出了布鲁氏菌,并通过血清学检查得到了证实。结论虽然该患者的临床特征与布鲁氏菌病相符,并有相关的旅行史,但近十年来一直没有考虑过这一诊断(也没有考虑过任何感染原因)。我们强调,对于出现非典型骨关节炎、有相关旅行史且常规微生物学检查呈阴性的患者,考虑布鲁氏菌病非常重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinical Infection in Practice
Clinical Infection in Practice Medicine-Infectious Diseases
CiteScore
2.10
自引率
0.00%
发文量
95
审稿时长
82 days
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