Isolation of Brucella melitensis from human sperm

Probable sexual transmission of brucellosis

Brucellosis, a bacterial zoonosis, is transmitted directly or indirectly from infected animals (mainly domesticated ruminants and pigs) to humans. People are generally susceptible to brucella, which is mainly transmitted by direct contact, digestive tract and respiratory tract. Since brucella can be discharged from various secretions and feces after human infection, sexual transmission has become a potential mode of transmission. We report a case of highly suspected sexually transmitted brucellosis infection patient, which was discharged after treatment with etimicin + minocycline.

Human to human transmission of Brucella melitensis

Human brucellosis is acquired mainly through contact with infected animal tissues, ingestion of unpasteurized dairy products or infected aerosols. Person to person transmission is still considered uncertain. The case of a woman diagnosed with proven brucellosis after her husband suffered a relapse of bacteremia with Brucella melitensis biotype 3, which was originally acquired abroad by eating goat cheese, is described. It was postulated that person to person spread of brucellosis is a likely mode of transmission in this case.

Exceptionally high titres in atypical presentation of occult epididymo-orchitis due to brucellosis

A male patient of 32 years was referred for surgical drainage and orchidectomy of the right testis following a cycling injury. A Venereal Disease Research Laboratory (VDRL) test was requested by the surgery department to rule out secondary syphilis. Although serum samples gave a negative result in the VDRL test, qualitative screening was performed for Brucella antibodies, as per hospital policy, since brucellosis is endemic in this region. Following a positive reaction, a quantitative standard tube agglutination test was carried out yielding titres that were exceptionally high (STAT = 40 960 IU ml(-1); 2-ME = 1 : 5120). This finding correlated with the patient's history which included a number of predisposing factors for contracting brucellosis including exposure to cattle, consumption of raw milk and assisting in the parturition of cattle. Consequently, surgery was postponed and treatment was changed from injections of ceftriaxone to the WHO regimen for the treatment of brucellosis: 1 g streptomycin once daily, administered intra-muscularly, plus 100 mg doxycycline twice daily, taken orally. Following 3 days of this treatment, the testicular swelling reduced considerably and orchidectomy was not required. Indeed, after a week, swelling was completely resolved and the patient was discharged. To our knowledge, this is the first case of such high titres in a patient as a result of epididymo-orchitis without the typical clinical presentation of fever and joint pain that is normally associated with brucellosis.