Brucella Peritonitis in a Patient on Peritoneal Dialysis: Case Report and Literature Review

Brucellosis-induced peritonitis and abdominal aortitis in a non-endemic area patient on peritoneal dialysis: a case report and literature review

Background

Brucella infection is uncommon among peritoneal dialysis (PD) patients in non-endemic areas, and the occurrence of both peritonitis and abdominal aortitis is rare.

Case presentation

In December 2023, a 63-year-old male patient undergoing PD was admitted to Shaoxing Second Hospital due to fever, abdominal pain, and cloudy dialysate. Upon physical examination, diffuse mild abdominal pain and tenderness were observed. Subsequent investigation into the patient's medical history revealed consumption of freshly slaughtered lamb from local farmers 3 days prior to the onset of symptoms. Various diagnostic tests, including routine blood tests, procalcitonin levels, and PD fluid analysis, indicated the presence of infection. Abdominal computed tomography (CT) imaging revealed localized lumen widening of the abdominal aorta with surrounding exudative changes. On the sixth day in the hospital, blood and PD fluid cultures confirmed Brucella melitensis infection. The patient was diagnosed with brucella-associated peritonitis and aortitis. Treatment was adjusted to include rifampin and doxycycline for 6 weeks, and the decision was made to keep the PD catheter. Remarkably, the patient exhibited resolution of peritonitis and abdominal aortitis within the initial week of the adjusted treatment. Currently, the patient continues to receive ongoing clinical monitoring.

Conclusion

Brucella is rare but can cause PD-associated peritonitis and arteritis. Prompt diagnosis and treatment can lead to a good outcome in PD patients. Dual therapy is effective, but the need for catheter removal is unclear. Consider international guidelines and patient factors when deciding on catheter removal.

Brucella Peritonitis in a Patient on Peritoneal Dialysis: A Case Report and Review of Literature

Peritoneal dialysis (PD)-associated peritonitis is the most common cause of morbidity, mortality, and treatment failure in patients on PD. Brucellosis is a worldwide zoonotic infectious disease caused by gram-negative bacteria of the genus Brucella. It is a major public issue in some regions. According to the World Health Organization report in 2011, the Kingdom of Saudi Arabia is considered endemic for brucellosis. Brucella peritonitis is one of the rarest presentations of Brucella. We report a case of a 14-year-old girl known to have end-stage renal disease, secondary to the autosomal recessive polycystic kidney. She had congenital hepatic fibrosis and pancytopenia. She had been undergoing automated PD for the past seven years and presented with abdominal pain, seizure, and poor feeding. There was no history of ingestion of unpasteurized milk or contact with raw infected animal products. The color of PD fluid was turbid with leukocytosis, predominantly neutrophils. The peritoneal fluid culture was positive for methicillin-resistant Staphylococcus aureus. The patient was started on intraperitoneal vancomycin, which showed slow improvement. The second culture of the peritoneal fluid showed Brucella species after a few days. Blood culture and serum serology titer for Brucella showed negative results. An anti-Brucella regimen, including rifampin and doxycycline, was initiated. She was treated with this regimen for six weeks. After the initiation of the anti-Brucella regimen, she showed marked improvement. To the best of our knowledge, only a small number of cases of Brucella peritonitis in PD patients have been reported. Despite the rarity of Brucella as a peritonitis-causing organism, it should be considered as a relevant pathogen in peritonitis cases, especially in endemic regions. PD-associated Brucella peritonitis is rare, and PD catheter saving may be considered if there is a response to anti-Brucella treatment.

First confirmed reports of the isolation of Brucella ceti from a Risso's dolphin Grampus griseus and a killer whale Orcinus orca

Brucella ceti has been recovered from a number species of cetaceans worldwide over the last 25 yr. Here we report, for the first time, the recovery of B. ceti from a Risso's dolphin Grampus griseus and a killer whale Orcinus orca. Recovery from an abdominal mass in the dolphin provides further evidence of the systemic pathogenic potential for B. ceti infection in cetaceans. The isolation of B. ceti ST23 (porpoise cluster) from a killer whale from a group known to eat other marine mammals raises the possibility of infection via ingestion. This report takes the number of cetacean species in UK coastal waters from which B. ceti has been isolated to 11 and highlights the value of routine, comprehensive and specific screening for significant pathogens such as Brucella sp. by strandings networks.

Brucella pelvic tubo-ovarian abscess with a history of chronic brucellosis

Brucellosis is a zoonotic disease located especially in Central and South America, India, the Mediterranean and the Middle East. Human brucellosis occurs as a systemic infectious disease with various clinical manifestations. We present a case of 45-year-old female patient, nulliparous, not sexually active, with a previous medical history of a treated brucellosis, and no surgical or gynecological history. The patient presented with a history of fever for 7 days of 39 degrees Celsius, chills and acute abdominal pain. She was diagnosed with diffuse peritonitis with left tubo-ovarian abscess and was admitted for an urgent diagnostic laparoscopy. A left adnexectomy was performed. The diagnosis of genital brucellosis was made. This case report discusses an unusual complication of brucellosis represented by a tubo-ovarian abscess associated with acute peritonitis, treated by a laparoscopic adnexectomy and antimicrobials. Acute peritonitis associated with a tubo-ovarian abscess is an unusual complication of brucellosis.