Sharif Alireza, Heravi Mansooreh Momen, Barahimi Elham, Mirazimi Seyed Mohammad Ali, Dashti Fatemeh
Dept of infectious disease, Kashan School of medicine, kashan university of medical sciences, Kashan, Iran.
Dept of infectious disease, Hormozgan School of medicine, Hormozgan university of medical sciences, Hormozgan, Iran.
IDCases. 2022 May 20;29:e01519. doi: 10.1016/j.idcr.2022.e01519. eCollection 2022.
Brucellosis is a zoonotic disease endemic to the Middle East and Mediterranean basin. It has gained diagnostic challenge recently due to its increasingly non-specific and vague manifestations at presentation. Here, we report a 53-year-old man presenting with undulating fever and shaking chills and frequency, dysuria, hesitancy and malodorous urine. He had prior complicated urinary tract infection treated with intravenous antibiotics. Further evaluation revealed negative urine culture, intra-hepatic cholestasis due to underlying infection, elevated acute phase reactants and pancytopenia.The diagnosis of brucella was established as blood cultures grew Brucella melitensis and serum serology for Brucellosis returned positive. Following initiation of anti- brucella drugs, fever and laboratory abnormalities gradually returned to normal. Brucellosis should be always considered in the differential diagnosis of patients presenting with sepsis in endemic regions or when empiric antibiotic therapy fails to improve clinical and laboratory abnormalities. Diagnosis requires high level of suspicious based on the clinical history and constellation of symptoms.
布鲁氏菌病是一种中东和地中海盆地特有的人畜共患疾病。由于其在发病时表现出越来越多的非特异性和模糊症状，最近在诊断方面带来了挑战。在此，我们报告一名53岁男性，表现为波状热、寒战以及尿频、尿痛、排尿犹豫和尿液恶臭。他曾因复杂性尿路感染接受静脉抗生素治疗。进一步检查发现尿培养阴性、因潜在感染导致肝内胆汁淤积、急性期反应物升高和全血细胞减少。血培养生长出羊种布鲁氏菌且布鲁氏菌病血清学检查呈阳性，从而确诊为布鲁氏菌病。开始使用抗布鲁氏菌药物治疗后，发热和实验室异常逐渐恢复正常。在流行地区，对于出现败血症的患者，或经验性抗生素治疗未能改善临床和实验室异常情况时，鉴别诊断中应始终考虑布鲁氏菌病。诊断需要根据临床病史和症状组合保持高度怀疑。
