We describe the clinical case of an italian, 37 year old woman. She arrived to our first aid for Fever from about two weeks, not responsive to antibiotic and antipyretic therapies and associated with diarrhea, weight loss and amenorrhea (for two months with negative BETA HCG). At the laboratory tests we found mild anemia (Hb 11.2 g/dl), increase VES (52 mm/h), PCR (5.1 mg/dl) and fibrinogen (489 mg/dl). Serology for HIV, Mycoplasma Pneumoniae, Chlamydia Pneumoniae, EBV and Widal-Wright were negative, CMV IgG were positive. Strumental exams showed: normal ECG, normal chest X-ray and normal ultrasound abdomen. Eight sets of blood cultures were performed, all positive for a Gram negative, difficult to identify. To rule out bacterial endocarditis, transthoracic and transesophageal echocardiogram were executed, that showed mild mitral regurgitation in absence of valvular vegetations. Later microbiological lab has identified the gram-negative bacilli as Brucella Melitensis. Brucellosis is a bacterial zoonotic transmitted directly or indirectly from infected animals, ruminants and domestic pigs. It’s also known as undulant fever. Although it is commonly present with acute febrile symptoms, its clinical manifestations can be highly variable, and other signs of infection may lack. So the clinical diagnosis must be supported by the results of bacteriological and serological tests1. In this case we were ‘‘lucky’’ to experience the presence of microorganism in blood-culture before serological positivization, in fact, a subsequent Widal-Wright was positive (1:400). The patient was treated according to the guidelines with rifampicin and doxycycline with prompt resolution of symptoms, negativization of inflammatory markers and good general clinical condition. Our serological investigations have been oriented by a positive history for ingestion of unpasteurized handmade cheese in the previous weeks. Although B. Melitensis is included in the diagnostic flow-chart for FUO, nowadays it is underestimated because of high microbiological control in food processing chain, which has decreased the brucellosis’ prevalence.
Sometimes they come back…
L. Falsetti;
2011
Abstract
We describe the clinical case of an italian, 37 year old woman. She arrived to our first aid for Fever from about two weeks, not responsive to antibiotic and antipyretic therapies and associated with diarrhea, weight loss and amenorrhea (for two months with negative BETA HCG). At the laboratory tests we found mild anemia (Hb 11.2 g/dl), increase VES (52 mm/h), PCR (5.1 mg/dl) and fibrinogen (489 mg/dl). Serology for HIV, Mycoplasma Pneumoniae, Chlamydia Pneumoniae, EBV and Widal-Wright were negative, CMV IgG were positive. Strumental exams showed: normal ECG, normal chest X-ray and normal ultrasound abdomen. Eight sets of blood cultures were performed, all positive for a Gram negative, difficult to identify. To rule out bacterial endocarditis, transthoracic and transesophageal echocardiogram were executed, that showed mild mitral regurgitation in absence of valvular vegetations. Later microbiological lab has identified the gram-negative bacilli as Brucella Melitensis. Brucellosis is a bacterial zoonotic transmitted directly or indirectly from infected animals, ruminants and domestic pigs. It’s also known as undulant fever. Although it is commonly present with acute febrile symptoms, its clinical manifestations can be highly variable, and other signs of infection may lack. So the clinical diagnosis must be supported by the results of bacteriological and serological tests1. In this case we were ‘‘lucky’’ to experience the presence of microorganism in blood-culture before serological positivization, in fact, a subsequent Widal-Wright was positive (1:400). The patient was treated according to the guidelines with rifampicin and doxycycline with prompt resolution of symptoms, negativization of inflammatory markers and good general clinical condition. Our serological investigations have been oriented by a positive history for ingestion of unpasteurized handmade cheese in the previous weeks. Although B. Melitensis is included in the diagnostic flow-chart for FUO, nowadays it is underestimated because of high microbiological control in food processing chain, which has decreased the brucellosis’ prevalence.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
