Pulmonary Involvement in Brucellosis, a Rare Complication of Renal Transplant: Case Report and Brief Review

Seroprevalence and Associated Risk Factors of Brucellosis Among Human Population in Duhok City, Iraq

Purpose

Brucellosis is a zoonotic disease that contributes to severe global health and economic issues. In this study, the Rose Bengal Test (RBT), a crucial diagnostic tool for brucellosis in Duhok city, was evaluated in order to offer updated epidemiological data on this disease.

Patients and Methods

A total of 339 patients suffered from fever and seeking medical attention in the private medical health center in Duhok city, Iraq, were enrolled after taking ethical approval from committee at Faculty of Sciences, University of Zakho and a verbal consent from each enrolled patient for using his/her blood and data. The blood specimens were tested for Brucella spp. Antibodies using the RBT and blood cultures, followed by spp. determination. A questionnaire form was designed to detect the associated risk factors.

Results

Prevalence of brucellosis was 12.6% among participants with a probable diagnosis and 10.3% among those with a confirmed diagnosis (positive blood culture). Most of the positive cases were between the ages of 20 to 40 years. A highly significant (P < 0.0001) association was found between brucellosis with both consuming raw milk and having contact with cattle. The most common species identified were Brucella melitensis (57.1%) and Brucella abortus (42.7%).

Conclusion

Brucellosis is a significant cause of fever in the current study and can be detected using the RBT. Human brucellosis can be reduced by minimizing the chances of contact with cattle and consuming boiled or pasteurized milk.

Brucellosis Mimicking COVID-19: A Point of View on Differential Diagnosis in Patients With Fever, Dry Cough, Arthralgia, and Hepatosplenomegaly

The novel Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome Coronavirus-2, emerged in China in late 2019, and a variety of clinical symptoms and signs were reported following patients’ clinical presentation. By contrast, human Brucellosis is a worldwide zoonosis that may present with general symptoms including fever, dry cough, malaise, and arthralgia, making it indistinguishable from other causes of respiratory infection. Here, an 18-year-old man who was hospitalized with a suspected COVID-19 infection, but finally confirmed as having Brucellosis with positive blood culture for Brucella melitensis is presented. This case is a reminder for healthcare workers to consider the diagnosis of Brucellosis in patients exhibiting febrile syndromes in endemic regions during the COVID-19 pandemic.

Brucella: Reservoirs and Niches in Animals and Humans

Brucella is an intracellular bacterium that causes abortion, reproduction failure in livestock and leads to a debilitating flu-like illness with serious chronic complications if untreated in humans. As a successful intracellular pathogen, Brucella has developed strategies to avoid recognition by the immune system of the host and promote its survival and replication. In vivo, Brucellae reside mostly within phagocytes and other cells including trophoblasts, where they establish a preferred replicative niche inside the endoplasmic reticulum. This process is central as it gives Brucella the ability to maintain replicating-surviving cycles for long periods of time, even at low bacterial numbers, in its cellular niches. In this review, we propose that Brucella takes advantage of the environment provided by the cellular niches in which it resides to generate reservoirs and disseminate to other organs. We will discuss how the favored cellular niches for Brucella infection in the host give rise to anatomical reservoirs that may lead to chronic infections or persistence in asymptomatic subjects, and which may be considered as a threat for further contamination. A special emphasis will be put on bone marrow, lymph nodes, reproductive and for the first time adipose tissues, as well as wildlife reservoirs.

First Case of Brucella Pneumonia in a Lung Transplant Patient: Case Report and Review of the Literature

Brucella is one of the most common zoonotic diseases worldwide. It is endemic in the Mediterranean basin. Brucella pneumonia is a rare complication of brucellosis that can present with a variety of clinical and radiological manifestations. It was described only once previously in the setting of solid organ transplant.

A 32-year-old female from Saudi Arabia with cystic fibrosis and bronchiectasis presented five weeks after a bilateral lung transplant with fever and cough. Investigation showed high inflammatory markers in addition to a pulmonary infiltrate in the chest imaging. All microbiological workups were negative including bronchoalveolar lavage cultures. Brucella serology was positive and she was started on anti-Brucella therapy which resulted in complete resolution of her symptoms and radiological changes. This case demonstrates an unusual presentation of Brucellosis. It highlights the importance of epidemiology in evaluating post-transplant infections. We reviewed and summarized the literature on brucellosis post solid organ transplant and the various treatment regimens for Brucella pneumonia.

This is the first case report of Brucella pneumonia in a lung transplant patient. Brucella is a rare complication post solid organ transplant but it has a good prognosis.

Brucellosis in renal transplant recipients: a comparative review of 5 cases

Although brucellosis in renal transplant recipients is rare, we studied the clinical characteristics of this infection in this patient population due to the significantly increased number of renal transplantations performed over the past few decades. We report one case from our experience and undertake a review of the previously reported cases retrieved from the PubMed. A total of 5 cases of brucellosis in renal transplant recipients were found to date. The mean time from transplantation to diagnosis of brucellosis was 4.7 years (range, 4 months to 13 years). Blood culture and detection of anti-Brucella antibodies were frequently used diagnostic investigations. Treatment with appropriate antibiotic regimen led to a clinical cure and marked improvement in Brucella titre in all the patients. This review illustrates that clinicians should remain vigilant for this infectious aetiology following renal transplantation. Further studies are required to delineate the magnitude and scope of this association.

Treatment of pulmonary brucellosis: a systematic review

INTRODUCTION

Pulmonary involvement is a rare, focal complication of human brucellosis. The aim of this review is to describe clinical and radiologic features, treatment administered and clinical course of these patients. Areas covered: We conducted a systematic search of scientific reports of brucellosis with pulmonary involvement published from January 1985 to July 2016. Four main patterns of disease were observed: pneumonia, pleural effusion, nodules and interstitial pattern. Cough and fever were the most common symptoms. Brucella spp. culture was obtained from blood (50%) or pleural fluid. Treatment is based on the same antibiotics and combinations of antibiotics as for patients with acute no complicated brucellosis. The most frequent antimicrobial combination was doxycycline and rifampin for six weeks. The clinical course was favorable in most reports, and mortality was remarkably low (<1%). Expert commentary: Non-specific clinical and radiological manifestations were the main reason for the delay in proper treatment. Difficulty in distinguishing Brucellosis from other pulmonary infections, such as tuberculosis, sometimes posed an added diagnostic challenge.