Tantisiriwat Woraphot, Buppanharun Wanchai, Santiwatanakul Somchai, Chansiri Kosum
J Med Assoc Thai. 2016 Nov;99 Suppl 8:S158-S165.
To document laboratory transmission of brucellosis and identify the likely mechanism of transmission of brucellosis at Her Royal Highness (HRH) Princess Sirindhorn Medical Center, Thailand.
Using small subunit ribosomal RNA (rRNA) sequencing technique to analyze Brucella melitensis cultured from the first 2 patients of the hospital and an infected laboratory technician, and using brucellosis serologic test to rule out infections in all other involved technicians.
We had encountered the first 2 cases of brucellosis. Both had infected from community exposure with goat. The first case had pancreatic abscess and spinal bone involvement with a positive blood culture. The second case presented with fever of unknown origin and had a positive blood culture. A few weeks later, 1 of our laboratory technicians presented with fever, myalgia and fatigue. Blood culture grew B. melitensis. He never had any associated community-acquired risk factors for brucellosis. The presumed mechanism of transmission was an inhalation while taking photographs of the bacterial plate of the first patient. B. melitensis identified from our laboratory technician and both patients were analyzed based on 16S-23S rRNA intergenic transcribed spacer (ITS) region. Results of 16S-23S rRNA ITS sequence testing confirmed a match from all patients and laboratory technician’s isolate. All other 10 potentially exposed laboratory technicians were asymptomatic. A brucellosis serologic test was negative in all non-infected technicians but was only positive in the 1 infected technician.
This is the first report in Thailand of occupational brucellosis transmitted in microbiologic laboratory. The most likely mechanism is air-borne inhalation of bacterial organisms on culture media in the absence of adequate precautions. Laboratory technicians should handle Brucella cultivation with caution utilizing appropriate measures to prevent inhalation.
记录布鲁氏菌病的实验室传播情况，并确定泰国诗琳通公主殿下医疗中心布鲁氏菌病可能的传播机制。
使用小亚基核糖体RNA（rRNA）测序技术分析从该医院的前两名患者及一名受感染的实验室技术人员身上培养出的羊种布鲁氏菌，并使用布鲁氏菌病血清学检测排除所有其他相关技术人员的感染情况。
我们遇到了首例两例布鲁氏菌病病例。两人均因社区接触山羊而感染。首例病例有胰腺脓肿和脊柱骨受累，血培养呈阳性。第二例表现为不明原因发热，血培养呈阳性。几周后，我们的一名实验室技术人员出现发热、肌痛和疲劳症状。血培养培养出羊种布鲁氏菌。他从未有过任何与社区获得性布鲁氏菌病相关的危险因素。推测的传播机制是在拍摄首例患者的细菌平板照片时吸入。根据16S - 23S rRNA基因间转录间隔区（ITS）区域对从我们的实验室技术人员和两名患者身上鉴定出的羊种布鲁氏菌进行了分析。16S - 23S rRNA ITS序列检测结果证实所有患者和实验室技术人员的分离株匹配。其他所有10名可能接触过的实验室技术人员均无症状。所有未感染的技术人员布鲁氏菌病血清学检测均为阴性，但仅1名感染的技术人员检测呈阳性。
这是泰国关于微生物实验室传播职业性布鲁氏菌病的首例报告。最可能的机制是在没有适当预防措施的情况下，通过空气吸入培养基上的细菌。实验室技术人员应谨慎处理布鲁氏菌培养，采取适当措施防止吸入。
