Spontaneous peritonitis due to Brucella melitensis in a patient with cirrhosis

Acute Brucellosis and Cirrhosis: The Triggering Event of Fatal Liver Decompensation

Cirrhotic patients are known to be particularly susceptible to infectious complications that may vary according to regional endemic patterns. Brucellosis, a common zoonosis with worldwide distribution, exhibits a predilection for the reticuloendothelial system and thus resulting in hepatic involvement. We describe three cirrhotic patients in whom acute brucellosis and/or its treatment served as the triggering factor of hepatic decompensation, with deleterious effects. The patients suffered from alcoholic cirrhosis and culture-proven brucellosis. All patients came from an area endemic to brucellosis. The first patient exhibited a relapsing brucellosis course with progressive deterioration of his fragile liver function. The second patient progressed rapidly to jaundice, possibly partly attributed to antibiotic pharmacotoxicity, and died during liver transplantation. The third patient eventually succumbed to diffuse intravascular coagulation. Brucellosis can be a triggering event of fatal liver decompensation in cirrhotic patients. Enhancing health literacy of the patients, particularly in endemic areas, is of paramount importance for prevention of exposure to similar pathogens.

Spontaneous bacterial peritonitis: an unusual manifestation of brucellosis in a previous healthy male patient

Brucellosis is a common zoonotic disease with worldwide distribution and protean clinical manifestations. Therefore, its prompt and timely diagnosis is still challenging. Among several complications of brucellosis, spontaneous bacterial peritonitis (SBP) in previously healthy participants is rarely recognised, although this condition can be fatal if misdiagnosed and untreated. We present a case of a 69-year-old previously healthy stockbreeder who suffered from back pain along with abdominal pain and distension because of ascites of 6-8 weeks duration. Cultures of ascitic fluid and peripheral blood specimens revealed Brucella spp as the causative agent of ascites and spondylodiscitis, which was then confirmed by MRI findings. After appropriate treatment for 4.5 months (streptomycin 1 g/day for 3 weeks intramuscularly, doxycycline 100 mg twice a day orally and rifampicin 900 mg/day orally), the patient fully recovered. Conclusively, in the appropriate epidemiological and clinical setting, the consideration of brucellosis in the differential diagnosis of SBP could be rational as well as life-saving.

Unusual clinical presentations of brucellosis

The purpose of this paper is to draw attention to atypical presentations of brucellosis. A prospective study identified 240 consecutive patients with brucellosis admitted to our department between December 1999 and July 2002. From these cases we present 11 patients with unusual clinical presentations. Neurobrucellosis, peritonitis, pericarditis, pancytopenia, and uveitis were diagnosed in 2 patients each and 1 presented with epididymo-orchitis.

Spontaneous bacterial peritonitis caused by Brucella melitensis

This report presents a case of blood and ascitic fluid culture-proven spontaneous bacterial peritonitis caused by Brucella melitensis in a 67-y-old male with congestive heart failure. Ten cases of reported previously brucella peritonitis are reviewed, 3 of which were ascitic fluid culture negative.

Spontaneous bacterial peritonitis due to Brucella melitensis

Peritonitis is an extremely rare complication of brucellosis. A case is reported of blood and ascitic culture-proven spontaneous bacterial peritonitis caused by Brucella melitensis, in a patient who had also cirrhosis.

Brucellosis and the gastrointestinal tract. The odd couple

Though pathogenetically qualifying as an enteric fever, the gastroenterological manifestations of Brucella in humans are relatively uncommon. We present a typical case of Brucellosis with gastrointestinal symptoms and review these by organ involvement, ranging from the mild nonspecific, such as diarrhea and abdominal pain, to the pathologically distinct hepatic lesions, and to the rare colonic, pancreatic, and peritoneal involvement. The limited indications for diagnostic procedures, such as endoscopy and liver biopsy are discussed.