Splenic abscess due to acute brucellosis

Research progress on complications of Brucellosis

Brucellosis is a common zoonotic disease that is widely spread worldwide and poses a major threat to human health. Clinically, it often presents with non-specific symptoms such as fever, excessive sweating, malaise, myalgia, arthralgia, loss of appetite, weight loss, and enlarged liver, spleen and lymph nodes. The disease has a long and recurrent course, often accumulating in multiple systems and organs. Of these, osteoarticular involvement is the most common complication, with a prevalence of approximately 2-77%, usually manifesting as spondylitis, sacroiliac arthritis and peripheral arthritis. Hepatosplenomegaly is seen in about 50% of patients with brucellosis, and gastrointestinal disturbances such as abdominal pain, nausea, and vomiting are common. Although respiratory involvement is less common, pneumonia, pleurisy, pleural effusion, and pulmonary nodules have been reported. Besides, approximately 2-20% of cases involve infections of the male genitourinary system, mainly manifesting as unilateral epididymal-orchitis and orchitis. The most serious complication facing brucellosis is cardiovascular involvement, and although the overall mortality rate of brucellosis is about 1% and the incidence of brucellosis endocarditis is less than 2%, more than 80% of deaths are associated with endocarditis. Furthermore, brucellosis is complicated by hematologic disease, with anemia occurring in approximately 20-53% of children during the acute phase. In addition, the neurological incidence of brucellosis is about 0.5-25%, mainly manifested as meningitis. In this study, we review the multisystem complications of brucellosis with the aim of improving early diagnosis, timely treatment and prevention of long-term complications.

Hepatosplenic brucella abscesses on computed tomography and magnetic resonance imaging: Case series

INTRODUCTION

Because of its infrequent and the lack of clinical data and image finding, the management of acute infections with the hepatosplenic brucella abscesses is challenging.

METHODS

There were 10 serologically diagnosed cases with this brucella infection. All patients had fever, 50% patients had upper abdominal pain. Ninety percent patients lived in an urban environment. The localization of lesions included: 30% hepatosplenic, 30% liver, and 40% spleen.

RESULTS

Abdominal computed tomography (CT) scans and magnetic resonance imaging (MRI) demonstrated hepatosplenomegaly, with multiple small abscess lesions of various sizes in the acute stage of brucellosis, with the largest diameter of 1.5 cm in the liver. After contrast-enhanced CT and MRI findings, the arterial phase in which the enhancing area of lesions was thick, revealed multifocal hypodense or hypointense lesions of various sizes. These lesions manifested distinct boundary, which was intensified obviously in portal venous phase.

CONCLUSION

Our results indicate that early CT or MRI dynamic contrast enhancement of suspected cases could improve rapid diagnosis. However, diagnostic criteria remain problematic and diagnosis is mostly based on a combination of clinical suspicion, serologic markers, and radiologic findings.

Isolated splenic abscess in brucellosis

Brucellosis is a zoonotic infectious disease, which can attack any organ of the body but mainly involves lymphoreticular system. Our case report describes isolated splenic abscess diagnosed in a 50-year-old individual who is a milk vendor by occupation and has the habit of consuming raw milk. He was admitted with pain abdomen, high-grade fever with chills, generalized malaise, night sweats and weight loss. Ultrasound and computerized tomography of the abdomen showed splenomegaly and hypodense, nonenhancing lesion measuring 3.2 × 2.8 × 2.8 cm. Brucella slide and tube agglutination tests (Wright, at 1/640) were positive. The patient was successfully treated with percutaneous drainage along with oral doxycycline (200 mg/day) and rifampin (600 mg/day) for 6 weeks. A high index of suspicion is required for early detection, prompt treatment and prevention of complications of brucellosis, especially in endemic areas. Patients with fever of unknown origin should be evaluated for brucellosis.