rifampin and Brucellosis

Abdominal pain represents a frequent symptom for referral to emergency departments and/or internal medicine outpatient setting. Similarly, fever, fatigue and weight loss are non-specific manifestations of disease. The present case describes the diagnostic process in a patient with abdominal pain and a palpable abdominal mass. Abdominal ultrasonography confirmed the presence of a mass in the mesogastrium. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans oriented toward calcific lymphadenopathies with increased metabolism in the positron emission tomography-computed tomography (PET-CT) scan. Laboratory examinations were inconclusive, although serology for Brucella and the Quantiferon test were positive. After multidisciplinary discussion, the patient underwent surgical excision of the abdominal mass. Histological examination excluded malignancies and oriented toward brucellosis in a patient with latent tuberculosis. The patient was treated with rifampin 600 mg qd and doxycycline 100 mg bid for 6 weeks with resolution of the symptoms. In addition, rifampin was continued for a total of 6 months in order to treat latent tuberculosis. This case underlines the need for a multidisciplinary approach in the diagnostic approach to abdominal lymphadenopathies.

Topics: Abdominal Pain; Brucellosis; Humans; Latent Tuberculosis; Lymphadenopathy; Lymphoma; Positron Emission Tomography Computed Tomography; Rifampin; Tuberculosis

To develop the 'Stronger Towns Index': a deprivation index that took into account characteristics of areas encompassing towns that may be eligible for redevelopment funding and explore how this index was associated with self-rated health and migration within England between 2001 and 2011.. There were areas in the lowest deciles of Town Strength who did not receive funding. After multiple adjustment, LS members living in areas with higher deciles were significantly more likely (7% to 38%) to report good health than those in the lowest decile in 2001. Remaining in the same decile between 2001 and 2011 was associated with 7% lower odds of good self-rated health in 2011.. It is important to consider health in towns when allocating funding. Areas in the Midlands may have missed out on funding which might help mitigate poor health.. Ferritin levels <30µg/L were associated with unexplained infertility and might be screened in the future. Further studies with a focus on iron deficiency and iron treatment on women with unexplained infertility are warranted.. This EGM provides a valuable resource for researchers, policy-makers and the public to access the available evidence on the determinants of various COVID-19 health-related behaviours. The map can also be used to help guide research commissioning, by evidence synthesis teams and evidence intermediaries to inform policy during the ongoing pandemic and potential future outbreaks of COVID-19 or other respiratory infections. Evidence included in the map will be explored further through a series of systematic reviews examining the strength of the associations between malleable determinants and the uptake and maintenance of individual protective behaviours.. Patients with polymicrobial bloodstream infections are typically critically ill and harbor multidrug-resistant bacteria. Thus, to minimize mortality rate in critically ill patients, changes in infectious flora should be monitored, antibiotics selected reasonably, and invasive procedures reduced.. Altogether, these findings clearly revealed the great potential of the in vitro biological activity of linseed extract as a safe source for combatting multidrug-resistant. In this work, the capture of carbon dioxide using a dense hollow fiber membrane was studied experimentally and theoretically. The factors affecting the flux and recovery of carbon dioxide were studied using a lab-scale system. Experiments were conducted using a mixture of methane and carbon dioxide to simulate natural gas. The effect of changing the CO. Persistent gender and racial disparities in high-impact medical and critical care journals underscore the need to revise policies and strategies to encourage greater diversity in critical care research.. Thirty evaluable patients were enrolled. Median age was 60.5 years. Median follow-up for all patients was 17 months. Ten patients (33%) experienced grade ≥ 3 treatment-related adverse events, the most common being neutropenia and diarrhea; 50% required ≥ 1 dose reduction. The disease control rate was 90% (progressive disease: 10%, partial response: 23%, stable disease: 67%). There was zero treatment-related mortality. Twenty-two patients (73%, 90% CI 57-86; p = 0.008) completed all chemotherapy and surgery. Two patients (9%) who successfully underwent resection had minor postoperative complications. Median length of hospital stay was 4 days. Median RFS was 7.1 months. Median OS for the entire cohort was 24 months and was not reached in patients who underwent surgical resection.. Neoadjuvant treatment with gemcitabine, cisplatin, and nab-paclitaxel is feasible and safe prior to resection of intrahepatic cholangiocarcinoma and does not adversely impact perioperative outcomes.

Topics: Acetogenins; Acute Disease; Acute Kidney Injury; Administration, Intravenous; Aged; Albumins; Alcoholism; Aldehyde Dehydrogenase; Aldehyde Dehydrogenase, Mitochondrial; alpha-Glucosidases; Anemia; Animals; Anthozoa; Anti-Bacterial Agents; Anti-Infective Agents; Antibodies, Bacterial; Antigens, Bacterial; Antihypertensive Agents; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Antioxidants; Apoptosis; Ascites; Asthma; Bacteria; beta-Lactamases; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Binding Sites; Biological Availability; Biomass; Borderline Personality Disorder; Brain; Brucella abortus; Brucella melitensis; Brucellosis; Calcium; Carbapenems; Case-Control Studies; Caseins; Cattle; CD8-Positive T-Lymphocytes; Ceftaroline; Cell Line; Cell Line, Tumor; Cell Physiological Phenomena; Cell Proliferation; Cephalosporins; Chemotherapy, Adjuvant; China; Chitin; Chlorella; Chlorophyll; Chlorophyll A; Chlorophyta; Cholangiocarcinoma; Cisplatin; Conotoxins; Contrast Media; Conus Snail; Cross-Sectional Studies; Cytokines; Decapodiformes; Deoxycytidine; Diagnostic and Statistical Manual of Mental Disorders; Dietary Fiber; Diterpenes; DNA Methylation; Dogs; Double-Blind Method; Drug Design; Drug Resistance, Bacterial; Drug Resistance, Multiple, Bacterial; Drug Screening Assays, Antitumor; Eicosapentaenoic Acid; Enzyme-Linked Immunosorbent Assay; Epidermis; Escherichia coli; Escherichia coli Infections; Extraintestinal Pathogenic Escherichia coli; Fatty Acids; Fatty Acids, Unsaturated; Fatty Acids, Volatile; Feasibility Studies; Feces; Female; Ferritins; Fluorodeoxyglucose F18; Gastrectomy; Gastrointestinal Microbiome; Gemcitabine; Glomerular Filtration Rate; Glucose; Glycerol; Granulocyte-Macrophage Colony-Stimulating Factor; HeLa Cells; Humans; Hypoxia-Inducible Factor 1, alpha Subunit; Hypoxia-Inducible Factor-Proline Dioxygenases; Immunoassay; Immunoglobulin G; India; Infant, Newborn; Infertility; Inflammation; Intensive Care Units; Iron; Iron Deficiencies; Kidney; Lacticaseibacillus rhamnosus; Laurencia; Leukocytes; Lipids; Liver Cirrhosis; Long Interspersed Nucleotide Elements; Longitudinal Studies; Male; Mesenchymal Stem Cells; Methicillin-Resistant Staphylococcus aureus; Mice; Microalgae; Microbial Sensitivity Tests; Microscopy; Middle Aged; Minerals; Molecular Conformation; Molecular Docking Simulation; Molecular Structure; Mycobacterium tuberculosis; Myeloid Cells; Myeloid-Derived Suppressor Cells; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Nephropidae; Nicotinic Antagonists; Nitrogen; Obesity; Oxaliplatin; Paclitaxel; Panax; Pancreatic Neoplasms; Pancreatitis; Personality; Personality Disorders; Personality Inventory; Photobioreactors; Plant Extracts; Plasmalogens; Plasmids; Polymorphism, Genetic; Polynesia; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prebiotics; Predictive Value of Tests; Prognosis; Prolyl-Hydroxylase Inhibitors; Rabbits; Radiopharmaceuticals; Rats; Rats, Wistar; Receptors, Nicotinic; Recombinant Proteins; Retrospective Studies; Rifampin; Risk Factors; RNA, Ribosomal, 16S; Salinity; Seaweed; Sensitivity and Specificity; Sepsis; Sesquiterpenes; Severity of Illness Index; Shock, Septic; Silicones; Single Photon Emission Computed Tomography Computed Tomography; Skin; Snails; Solubility; Solvents; Sputum; Staphylococcal Infections; Stomach Neoplasms; Stramenopiles; Structure-Activity Relationship; Technetium Tc 99m Exametazime; Technology; Terpenes; Tuberculosis; Tuberculosis, Multidrug-Resistant; Urinary Catheters; Urinary Tract Infections; Vascular Endothelial Growth Factor A; Virulence Factors; Water; Wound Healing

Topics: Brucella abortus; Brucellosis; Humans; Male; Middle Aged; Rifampin; Splenic Infarction; Streptomycin

Pediatric neurobrucellosis represents a common anthropozoonosis in endemic areas but only anecdotal reports are available till date. Using appropriate search terms in the database platforms of MEDLINE, SCOPUS and Web of Sciences, we performed a systematic review of all the cases of pediatric neurobrucellosis published in the medical literature till date, in the light of a case report. The protocol was registered under PROSPERO (CRD42022333907). Our search strategy yielded 187 citations of which 51 citations were included. A total of 119 cases were reviewed. Of these cases, eight of them had insufficient data. The most common presentation was meningitis with or without encephalitis (n = 79, 71.2%). A high prevalence of cranial neuropathies (n = 22, 20.7%) was observed in the pediatric population in which abducens palsy was the most common (n = 9, 8.1%). Diagnosis was based on multimodal investigations including standard agglutination test (n = 44, 39.6%), Rose Bengal test (n = 37, 33.3%), blood culture (n = 23, 20.7%), serology (n = 20, 18.0%) and cerebrospinal fluid (CSF) culture (n = 11, 9.9%). Rifampicin-based triple drug regimen was the most commonly employed (83/102, 81.4%). Pediatric neurobrucellosis was associated with greater frequency of sequalae (5.4%), deafness (2.7%) and mortality (2.7%), when compared to that of general population. Neurobrucellosis mimics neuro-tuberculosis in various aspects. The review highlights several unique aspects of this entity in children. A high index of suspicion can ensure prompt diagnosis, timely initiation of management and favorable outcomes.. Pediatric neurobrucellosis represents a common zoonosis in endemic areas but only anecdotal reports are available till date. Using appropriate search terms in the database platforms of MEDLINE, SCOPUS and Web of Sciences, we performed a systematic review of all the cases of pediatric neurobrucellosis published in the medical literature till date, in the light of a case report. Our search strategy yielded 187 citations of which 51 citations were included. A total of 119 cases were reviewed. When compared to the largest series in neurobrucellosis, a higher frequency of meningitis was observed in the pediatric age group (71.2% vs. 37%). A high prevalence of cranial neuropathies (n = 22, 20.7%) was observed in the pediatric population in which abducens palsy was the most common (n = 9, 8.1%). Diagnosis was based on multimodal investigations including standard agglutination test (n = 44, 39.6%), Rose Bengal test (n = 37, 33.3%), blood culture (n = 23, 20.7%), serology (n = 20, 18.0%) and CSF culture (n = 11, 9.9%). Rifampicin-based triple drug regimen was the most commonly employed (83/102, 81.4%). Our systematic review highlighted the wide and heterogeneous spectrum of manifestations of neurobrucellosis in the pediatric population. A high index of suspicion can ensure prompt diagnosis, timely initiation of management and favorable outcomes.

Topics: Brucellosis; Child; Humans; Meningitis; Rifampin; Tuberculosis

Rickettsia is the pathogen of Q fever, Brucella ovis is the pathogen of brucellosis, and both of them are Gram-negative bacteria which are parasitic in cells. The mixed infection of rickettsia and Brucella ovis is rarely reported in clinic. Early diagnosis and treatment are of great significance to the treatment and prognosis of brucellosis and Q fever. Here, we report a case of co-infection Rickettsia burneti and Brucella melitensis. The patient is a 49-year-old sheepherder, who was hospitalized with left forearm trauma. Three days after admission, the patient developed fever of 39.0°C, accompanied by sweating, fatigue, poor appetite and headache. Indirect immunofluorescence (IFA) was used to detect Rickettsia burneti IgM. After 72 hours of blood culture incubation, bacterial growth was detected in aerobic bottles, Gram-negative bacilli were found in culture medium smear, the colony was identified as Brucella melitensis by mass spectrometry. Patients were treated with doxycycline (100 mg bid, po) and rifampicin (600 mg qd, po) for 4 weeks. After treatment, the symptoms disappeared quickly, and there was no sign of recurrence or chronic infection. Q fever and Brucella may exist in high-risk practitioners, so we should routinely detect these two pathogens to prevent missed diagnosis.

Topics: Brucella melitensis; Brucellosis; Coinfection; Doxycycline; Humans; Male; Middle Aged; Rickettsia; Rickettsia Infections; Rifampin; Treatment Outcome

Human brucellosis during pregnancy is characterized by significantly less pronounced adverse obstetric outcomes than in animals, but with remarkably more adverse obstetric outcomes when compared to healthy pregnant women. Seroprevalence of brucellosis in pregnancy and cumulative incidence of brucellosis cases per 1000 delivered obstetrical discharges in endemic regions were reported to be 1.5-12.2% and 0.42-3.3, respectively. Depending on the region, the frequency of pregnant women in the cohorts of patients with brucellosis was from 1.5% to 16.9%. The most common and the most dramatic unfavorable outcomes during brucellosis in pregnancy are the obstetric ones, manifested as abortions (2.5-54.5%), intrauterine fetal death (0-20.6%), or preterm deliveries (1.2-28.6%), depending on the stage of pregnancy. Other unfavorable outcomes due to brucellosis are addressed to infant (congenital/neonatal brucellosis, low birth weight, development delay, or even death), the clinical course of disease in mother, and delivery team exposure. When diagnosed in pregnant women, brucellosis should be treated as soon as possible. Early administration of adequate therapy significantly reduces the frequency of adverse outcomes. Rifampicin in combination with trimethoprim-sulfamethoxazole for 6 weeks is the most commonly used and recommended regimen, although monotherapies with each of these two drugs are also widely used while waiting for the results from prospective randomized therapeutic trials. As no effective human vaccine exists, screening of pregnant women and education of all women of childbearing age about brucellosis should be compulsory preventive measures in endemic regions.

Topics: Adult; Brucellosis; Female; Humans; Obstetrics; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Prevalence; Preventive Medicine; Rifampin; Seroepidemiologic Studies; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

We aimed to describe the clinical characteristics and prognosis of 22 patients with. We assessed 22 patients with reproductive system injury between 2010 and 2018 at The First Affiliated Hospital of Xinjiang Medical University.. The disease is predominant in men. Male patients had orchitis, erectile dysfunction, prostatitis, and urethral stricture, while female patients had vaginitis and cervicitis. Some patients had laboratory abnormalities and liver injury. Patients received combination therapy of rifampicin and doxycycline. Doxycycline combined with levofloxacin or moxifloxacin was administered to patients with rifampicin intolerance. All patients had received antibiotic therapy for at least 6 weeks. One patient was lost to follow-up, one patient relapsed because of osteoarthropathy, and one patient had dysuria resulting from chronic prostatitis. The clinical symptoms resolved in the other patients, and the overall patient prognosis was good.. Clinicians should pay attention to brucellosis-induced reproductive system damage. The two-drug regimen of rifampicin+doxycycline is recommended for these patients. Doxycycline combined with levofloxacin or moxifloxacin should be used in patients with brucellosis-induced reproductive system damage who have rifampicin intolerance. The treatment course should be at least 6 weeks.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Brucella; Brucellosis; China; Doxycycline; Drug Therapy, Combination; Female; Genitalia; Humans; Levofloxacin; Male; Middle Aged; Moxifloxacin; Retrospective Studies; Rifampin

Acalculous cholecystitis etiologies while numerous, some of them are less-known such as brucellosis. In this report, we elaborate the clinical findings, investigations and management of two female patients presenting acalculous cholecystitis in whom diagnosis of acute brucellosis was retained. Both patients had fever, asthenia and abdominal tenderness. Laboratory results showed evidence of inflammation as well as hepatic cytolysis while cholestasis was noted in one patient. In both cases, ultrasound study and CT confirmed the presence of acalculous cholecystitis. Serology (tube agglutination test) led to the diagnosis of brucellosis. Diagnosis of brucellosis-related acute cholecystitis was established in both cases based on imaging findings as well as serology without resorting to cholecystectomy. Favourable clinical response to specific antibiotic therapy further supported our diagnosis as well as our decision to avoid surgery. Although few cases have been reported, brucellosis must be considered as a cause of acalculous cholecystitis, especially in endemic countries.

Topics: Abdominal Pain; Acalculous Cholecystitis; Acute Disease; Animals; Anti-Bacterial Agents; Brucellosis; C-Reactive Protein; Doxycycline; Female; Food Contamination; Humans; Middle Aged; Milk; Raw Foods; Rifampin; Treatment Outcome; Ultrasonography; Vomiting; Young Adult

Brucellosis is a zoonosis seen all over the world and is still endemic in certain parts of the world. Brucellosis is a systemic infection which involves multiple organs and tissues. Although musculoskeletal system involvement is frequent in brucellosis, bursal involvement is seen rarely. In this article, we present a case of subacromial and subdeltoid brucellar bursitis with positive serology and aspiration culture. Patient achieved complete recovery with rifampicin and doxycycline treatment, without any evidence of relapse. A high clinical suspicion is required for the diagnosis of brucellar bursitis.

Topics: Aged; Anti-Bacterial Agents; Brucellosis; Bursitis; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Humans; Male; Rifampin; Shoulder Joint

A 51-year-old man shepherd presented with mild pain and swelling of the right posterior aspect of his right elbow. In ultrasonography, the affected bursal space had swelling and effusion. Moreover, the aspiration of the affected bursa revealed an inflammatory profile. Brucella melitensis was detected in aspirated fluid and blood cultures. The serum agglutination test (SAT) and 2-mercaptoethanol test for brucellosis were also positive. Therefore, the diagnosis of brucellar olecranon was confirmed. Treatment was initiated using gentamicin for the first 7 days and doxycycline plus rifampicin for 2 months. After treatment, all clinical signs and symptoms were resolved. No relapse was seen after 1 year of the completion of treatment. Clinicians should pay attention to the symptoms of olecranon brucellar bursitis that is similar to that of pyogenic bursitis.

Topics: Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Bursitis; Doxycycline; Drug Therapy, Combination; Gentamicins; Humans; Male; Middle Aged; Olecranon Process; Rifampin; Treatment Outcome; Ultrasonography

Brucellosis is a zoonotic disease with a high morbidity in developing countries, but there the optimal treatment is not yet determined. Therefore, the development of a simple and effective treatment is important. The aim of this study was to summarize the available evidences and compare rifampicin with streptomycin in human brucellosis with doxycycline as background regimen. We systematically searched PubMed, EmBase, and the Cochrane Library from their inception up through December 2016. We included studies with a randomized controlled design that evaluated the effect of streptomycin compared with rifampicin in human brucellosis patients who received doxycycline therapy as background regimen. The overall failure and relapse were summarized using random-effects model. Our meta-analysis included 1,383 patients with brucellosis from 14 trials. We found that patients who received rifampicin therapy had a higher risk of overall failure (RR: 2.36; 95% CI: 1.72-3.23; P<0.001) and relapse (RR: 2.74; 95% CI: 1.80-4.19; P<0.001) compared with streptomycin. Results of the sensitivity analysis were consistent with the overall analysis. Subgroup analysis indicated that mean age of the patients and percentage of male participants might influence the treatment effects. Furthermore, no publication bias was detected. The findings of this study indicated that rifampicin therapy significantly increased the risk of overall failure and relapse compared with streptomycin. Hence, it can be recommended to patients with human brucellosis receiving streptomycin therapy.

Topics: Brucellosis; Humans; Randomized Controlled Trials as Topic; Rifampin; Streptomycin

Brucellosis is the most common worldwide zoonosis which continues to remain a significant worldwide health problem and burden. Transmission usually occurs secondary to direct or indirect exposure to certain animals, but a major mode of transmission is the ingestion ofunpasteurized milk or milk products from infected animals. 'Ihe disease has a geographic distribution including the Mediterranean basin and Arabian Peninsula, India, Mexico, and parts of Central and South America. However, cases are seen in the United States in international travelers or due to ingestion ofusuallyimported, unpasteurized dairyproducts. Systemic infection with Brucella species can affect anyorgan, although focal forms ofbrucellosis do exist. We present a case of brucellar vertebral osteomyelitis.

Topics: Animals; Anti-Bacterial Agents; Brucella; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Gentamicins; Humans; Middle Aged; Osteomyelitis; Rifampin; Treatment Outcome

Brucellosis is a zoonotic disease widely seen in endemic regions and that can lead to systemic involvement. The musculoskeletal system is frequently affected, and the disease can exhibit clinical involvements such as arthritis, spondylitis, spondylodiscitis, osteomyelitis, tenosynovitis and bursitis. Spondylitis and spondylodiscitis, common complications of brucellosis, predominantly affect the lumbar and thoracic vertebrae. Epidural abscess may occur as a rare complication of spondylitis. Spinal brucellosis and development of epidural abscess in the cervical region are rare. Development of epidural abscess affects the duration and success of treatment. Spinal brucellosis should be considered in patients presenting with fever and lower back-neck pain in endemic regions, and treatment must be initiated with early diagnosis in order to prevent potential complications.

Topics: Adult; Animal Husbandry; Animals; Anti-Bacterial Agents; Brucellosis; Cervical Vertebrae; Doxycycline; Epidural Abscess; Humans; Magnetic Resonance Imaging; Male; Occupational Exposure; Rifampin; Spondylitis; Streptomycin

Infection of total knee or hip arthroplasty by Brucella species is a rare complication. We describe the case of a failed hip replacement secondary to infection by Brucella abortus, as well as presentation, treatment course, and 2-year follow-up. In addition, we review the literature for features of periprosthetic Brucella species infections, and we describe the common exposures, clinical presentations, preoperative evaluation, and treatments used in the reported cases. Furthermore, we discuss the risk of transmission to operating room personnel and the appropriate preventative measures to avoid transmission.

Topics: Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Arthroplasty, Replacement, Hip; Brucella abortus; Brucellosis; Debridement; Device Removal; Doxycycline; Female; Humans; Infectious Disease Transmission, Patient-to-Professional; Prosthesis-Related Infections; Reoperation; Rifampin; Risk; Therapeutic Irrigation

Isolated case reports of peritonitis due to Brucella spp. during peritoneal dialysis (PD) continue to surface in the medical literature. However, the optimal treatment regimen for these patients, in particular with regards to the fate of PD catheter, is still largely unknown. We report a case of brucella peritonitis successfully treated with intraperitoneal administration of amikacin, along with oral rifampicin and doxycycline but without catheter removal. Furthermore, we have reviewed the literature up until present day.

Topics: Administration, Oral; Amikacin; Anti-Bacterial Agents; Brucellosis; Catheter-Related Infections; Doxycycline; Follow-Up Studies; Humans; Injections, Intraperitoneal; Male; Middle Aged; Peritoneal Dialysis; Peritonitis; Rifampin; Treatment Outcome

Splenic abscess due to acute brucellosis is a rare event. We report a case of multiple splenic abscesses caused by Brucella melitensis in a 45-year-old woman and review the English language literature based on a PubMed/MEDLINE search of the last 50 years. The majority of the cases published in the literature were due to B. melitensis and a splenectomy was required in half of the cases. Antibiotics alone without surgical intervention can be successful in the treatment of patients with splenic brucellosis in the early stages of the disease.

Topics: Abdominal Abscess; Administration, Oral; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Doxycycline; Female; Humans; Middle Aged; Rifampin; Splenectomy; Splenic Diseases; Treatment Outcome

Brucellosis, a zoonotic infection caused by the genus Brucellae, is an ancient condition linked to the consumption of milk and milk products. The disease has global importance due to its impact. Therapeutic options for brucellosis rely mostly on uncontrolled, nonrandomized, non-blinded studies. The choice and duration of therapy are related to patient characteristics and the presence of a focal disease. The usual therapy of acute brucellosis is a combination of doxycycline plus rifampicin for 6 weeks. An aminoglycoside could be substituted for rifampin for the initial week of combination therapy. Other alternatives include a combination of doxycycline plus trimethoprim-sulfamethoxazole, or a fluoroquinolone plus rifampicin. The presence of spondylitis or endocarditis usually indicates that the required treatment will be of a longer duration or a combination of therapy. The article has the discussion of some recent patents related to antibiotic susceptibility and Brucellosis.

Topics: Anti-Bacterial Agents; Bone Diseases, Infectious; Brucellosis; Doxycycline; Drug Resistance, Bacterial; Drug Therapy, Combination; Endocarditis, Bacterial; Humans; Patents as Topic; Rifampin; Spondylitis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

In endemic regions of brucellosis, childhood brucellosis includes up to one-third of all cases of human brucellosis. The main source of infection in children is consumption of unpasteurized dairy products and traditional local foods containing dairy products. The older boys are more involved in animal care. Boys are more commonly infected than girls. Common symptoms and signs include fever, arthralgia, sweating, peripheral arthritis and splenomegaly. Peripheral arthritis especially monoarthritis is more common and the most commonly affected joints are hip and knee. All organs may involve during the course of the disease. Isolation of Brucella spp. from the blood, bone marrow or other tissue fluids is the hallmark of diagnosis. Serologic tests are the main tools of diagnosis of brucellosis in endemic regions. Standard agglutination test (SAT) with titers > 1:160 and the 2-mercaptoethanol (2ME) test ≥ 1:80 are suggestive of active infection. Children older than 8 years should be treated with doxycycline for 45 days or 8 weeks plus gentamicin for 7 or 5 days respectively or doxycycline for 45 days and streptomycin for 14 days. Also doxycycline plus rifampin or cotrimoxazole plus rifampin for 45 days may be alternative regimens. Cotrimoxazole plus rifampin for six weeks is the regimen of choice for the treatment of patients younger than 8 years old. Gentamicin for 5 days plus cotrimoxazole for six weeks may be a suitable alternative regimen. The article presented few of the patents associated with Brucellosis.

Topics: Adolescent; Agglutination Tests; Anti-Bacterial Agents; Brucellosis; Child; Doxycycline; Drug Therapy, Combination; Gentamicins; Humans; Mercaptoethanol; Patents as Topic; Rifampin; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination

Brucellosis zoonotic infection caused by Brucella spp. In endemic countries, the disease does not spare the pregnant. There is evidence that brucellosis can induce abortion in humans. Positive cultures of brucella from human placenta, aborted fetuses, and other products of conception were reported previously. It is speculated that brucellosis causes fewer spontaneous abortions in humans than animals due to the absence of Erythritol in the human placenta and fetus. In addition, the presence of anti-brucella activity in human amniotic fluid may also play a role. Rifampin is considered the mainstay of treatment of brucellosis during pregnancy, in various combinations. In a retrospective study of brucellosis in pregnancy, antepartum treatment with antimicrobial agents was more protective against the occurrence of abortion than no or inadequate treatment. It seems that the incidence of abortion is not different among patients treated with either trimethoprim-sulfamethoxazole with or without rifampicin. With therapy during pregnancy, the overall success rate resulting in normal delivery is 90%. The article discussed few of the patents associated with brucellosis.

Topics: Abortion, Spontaneous; Anti-Infective Agents; Brucellosis; Female; Humans; Patents as Topic; Pregnancy; Pregnancy Complications, Infectious; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Brucellosis is a persistent health problem in many developing countries throughout the world, and the search for simple and effective treatment continues to be of great importance.. A search was conducted in MEDLINE and in the Cochrane Central Register of Controlled Trials (CENTRAL). Clinical trials published from 1985 to present that assess different antimicrobial regimens in cases of documented acute uncomplicated human brucellosis were included. The primary outcomes were relapse, therapeutic failure, combined variable of relapse and therapeutic failure, and adverse effect rates. A meta-analysis with a fixed effect model was performed and odds ratio with 95% confidence intervals were calculated. A random effect model was used when significant heterogeneity between studies was verified. Comparison of combined doxycycline and rifampicin with a combination of doxycycline and streptomycin favors the latter regimen (OR = 3.17; CI95% = 2.05-4.91). There were no significant differences between combined doxycycline-streptomycin and combined doxycycline-gentamicin (OR = 1.89; CI95% = 0.81-4.39). Treatment with rifampicin and quinolones was similar to combined doxycycline-rifampicin (OR = 1.23; CI95% = 0.63-2.40). Only one study assessed triple therapy with aminoglycoside-doxycycline-rifampicin and only included patients with uncomplicated brucellosis. Thus this approach cannot be considered the therapy of choice until further studies have been performed. Combined doxycycline/co-trimoxazole or doxycycline monotherapy could represent a cost-effective alternative in certain patient groups, and further studies are needed in the future.. Although the preferred treatment in uncomplicated human brucellosis is doxycycline-aminoglycoside combination, other treatments based on oral regimens or monotherapy should not be rejected until they are better studied. Triple therapy should not be considered the current treatment of choice.

Topics: Aminoglycosides; Anti-Bacterial Agents; Brucellosis; Cost-Benefit Analysis; Doxycycline; Drug Costs; Drug Therapy, Combination; Female; Humans; Male; Odds Ratio; Quinolones; Randomized Controlled Trials as Topic; Rifampin; Streptomycin; Treatment Outcome

Brucellosis is the most common zoonotic infection in the world. Several antibiotics, separately or in combination, have been tried for treatment of human brucellosis. The inconsistencies between different treatment regimens warrants the need for a systematic review to inform clinical practice and future research.. To evaluate the effects of various antibiotic regimens, monotherapy or in combination with other antibiotics, for treating human brucellosis.. We searched the Cochrane Infectious Diseases Group Specialized Register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and LILACS until May 2012. We browsed the abstract books of several international infectious diseases conferences. We also checked the reference lists of all studies identified. We included the randomized controlled trials on the pharmaceutical interventions in treatment of acute, chronic, non-complicated, and complicated human brucellosis. The outcomes of interest were relapse, persistence of symptoms at the end of treatment, and adverse drug effects.. Two authors independently assessed the studies for inclusion, risk of bias, and extracted relevant data using pre-designed extraction forms. The findings of homogenous studies were pooled using fixed-effect meta-analysis.. In total we included 25 studies comparing various antibiotic regimens. Methods of allocation and concealment were inadequately described in half the studies, and only three were blinded. In comparisons of doxycycline plus rifampicin versus doxycycline plus streptomycin we found eight studies with 694 participants. For treatment failure, the doxycycline plus rifampicin regimen was less effective (risk ratio (RR) 1.91, 95% confidence interval (CI) 1.07 to 3.42, seven studies, 567 participants), relapse (RR 2.39, 95% CI 1.17 to 4.86), and minor adverse drug reactions (RR 1.38, 95% CI 0.99 to 1.92). In comparisons of doxycycline plus rifampicin against quinolone (ciprofloxacin or ofloxacin) plus rifampicin we found five studies of 336 participants. The pooled analysis did not demonstrate any significant difference between two regimens in terms of relapse and symptom persistence, but showed a non-significant higher risk of minor adverse reactions in doxycycline plus rifampicin (RR 1.80, 95% CI 0.78 to 4.18). Other comparisons were reported in a few heterogenous studies, and the pooled analyses, where applied, did not show any significant difference.. Doxycycline (six weeks) plus streptomycin (two or three weeks) regimen is more effective regimen than doxycycline plus rifampicin (six weeks) regimen. Since it needs daily intramuscular (IM) injection, access to care and cost are important factors in deciding between two choices. Quinolone plus rifampicin (six weeks) regimen is slightly better tolerated than doxycycline plus rifampicin, and low quality evidence did not show any difference in overall effectiveness.

Topics: Anti-Bacterial Agents; Brucellosis; Ciprofloxacin; Doxycycline; Humans; Ofloxacin; Randomized Controlled Trials as Topic; Rifampin; Streptomycin

Brucellosis is a worldwide zoonosis with a huge economic impact on animal husbandry and public health. The diagnosis of human brucellosis can be protracted because the disease primarily presents as fever of unknown origin with unspecific clinical signs and symptoms. The isolation rate of the fastidious etiologic agent from blood cultures is low, and therefore laboratory diagnosis is mainly based on serologic and molecular testing. However, seronegative brucellosis patients have been described, and antibody titers of diagnostic significance are difficult to define. Whether the molecular detection of Brucella DNA in clinical samples should be followed by long-term antibiotic treatment or not is also a matter of debate. The aim of this article is to review and discuss the implications of laboratory test results in the diagnosis of human brucellosis on disease therapy.

Topics: Animals; Antibodies, Bacterial; Bacterial Typing Techniques; Brucella; Brucellosis; Cattle; Cattle Diseases; DNA, Bacterial; Doxycycline; Drug Combinations; Enzyme-Linked Immunosorbent Assay; Humans; Polymerase Chain Reaction; Rifampin; Serologic Tests; Streptomycin

Topics: Adult; Bacteremia; Brucellosis; Female; Humans; Mastitis; Pregnancy; Pregnancy Complications, Infectious; Rifampin; RNA, Ribosomal, 16S; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography

To determine and quantify differences in efficacy between treatment regimens for brucellosis.. Systematic review and meta-analysis of randomised controlled trials assessing different antibiotic regimens and durations of treatment for human brucellosis.. PubMed, CENTRAL, Lilacs, conference proceedings, and bibliographies with no restrictions on language, study year, or publication status. Review methods Search, application of inclusion and exclusion criteria, data extraction, and assessment of methodological quality independently performed in duplicate. Primary outcomes were relapse and overall failure resulting from primary failure or relapse. Relative risks with 95% confidence intervals were calculated and pooled with a fixed effect model.. 30 trials and 77 treatment arms were included. Overall failure was significantly higher with doxycycline-rifampicin compared to doxycycline-streptomycin, mainly due to a higher rate of relapse (relative risk 2.80, 95% confidence interval 1.81 to 4.36; 13 trials, without heterogeneity). Results were consistent among patients with bacteraemia and complicated brucellosis. Doxycycline-streptomycin resulted in a significantly higher rate of failure than doxycycline-rifampicin-aminoglycoside (triple drug regimen) (2.50, 1.26 to 5.00; two trials). Gentamicin was not inferior to streptomycin (1.45, 0.52 to 4.00 for failure; two trials). Quinolones combined with rifampicin were significantly less effective than doxycycline combined with rifampicin or streptomycin (1.83, 1.11 to 3.02, for failure; five trials). Monotherapy was associated with a higher risk of failure than combined treatment when administered for a similar duration (2.56, 1.55 to 4.23; five trials). Treatment for six weeks or more offered an advantage over shorter treatment durations.. There are significant differences in effectiveness between currently recommended treatment regimens for brucellosis. The preferred treatment should be with dual or triple regimens including an aminoglycoside.

Topics: Aminoglycosides; Anti-Bacterial Agents; Brucellosis; Doxycycline; Drug Administration Schedule; Drug Therapy, Combination; Humans; Quinolones; Randomized Controlled Trials as Topic; Rifampin; Streptomycin; Tetracycline

The case of a woman with splenic abscess due to Brucella is reported. There was no response with antibiotics and surgical treatment was required. On the basis of this case and the literature review we consider that surgical treatment must be considered in patients with splenic abscess due to Brucella infection.

Topics: Adult; Anti-Bacterial Agents; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Humans; Rifampin; Serologic Tests; Splenectomy; Splenic Diseases; Splenomegaly; Streptomycin

Neurological involvement is one of the most perplexing and diverse presentation complications of brucellosis, a worldwide prevalent zoonosis. This review presents the current knowledge available from medical literature and discusses the shortcomings of the existing data. A proposed regimen should include doxycycline and rifampicin and, with the benefit of doubt, ceftriaxone, since its high concentration in the cerebrospinal fluid may offer significant efficacy against the pathogen. Corticosteroids have been used in specialized situations. The use of streptomycin is discouraged owing to its questionable ability to penetrate into the cerebrospinal fluid and its potential neurotoxicity that may perplex the clinical presentation. Treatment duration should be individualized in the absence of an adequate cut-off index.

Topics: Anti-Bacterial Agents; Brucellosis; Ceftriaxone; Central Nervous System Bacterial Infections; Doxycycline; Drug Administration Schedule; Humans; Rifampin; Streptomycin

Topics: Antibodies, Bacterial; Brucella; Brucella melitensis; Brucellosis; Dairy Products; Doxycycline; Drug Therapy, Combination; Genome, Bacterial; Humans; Prevalence; Recurrence; Rifampin; Streptomycin

Acute cholecystitis is a very rare complication of Brucella infections. We report 2 cases of acute cholecystitis due to Brucella and review previously reported cases.

Topics: Adult; Anti-Bacterial Agents; Brucella; Brucellosis; Cholecystitis, Acute; Doxycycline; Female; Gallbladder; Humans; Male; Middle Aged; Rifampin

Topics: Animals; Brucella melitensis; Brucellosis; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Humans; Prognosis; Rifampin; Serologic Tests; Streptomycin; Zoonoses

To review the clinical and laboratory features and response to treatment of patients with acute brucellar epididymo-orchitis reporting to a tertiary care hospital in Riyadh, and to compare these with other cases reported previously.. In this retrospective study, records of all 26 adult patients with brucellosis, who presented with epididymitis or epididymo-orchitis at a tertiary hospital in Riyadh from 1983 to 2000, were reviewed. Positive blood culture or high agglutination titres of > or = 1 : 320 and positive clinical manifestations of brucellosis were the main criteria for diagnosing brucellosis. Among these cases, epididymitis or epididymo-orchitis was diagnosed on the basis of a typical history of gradual onset of scrotal pain and findings of enlarged tender testes and/or epididymis.. Epididymo-orchitis occurred in 1.6% of all patients with brucellosis. Most (58%) were 25--44 years old; approximately 77% of the patients presented with acute symptoms of < 2 weeks' duration. All patients complained of swollen painful testicles. Other presenting symptoms included undulant fever (96%), chills (54%) and arthralgia (23%). Four patients had dysuria and one haematuria. Ten patients gave a positive history of ingestion of raw milk and milk products; one patient had laboratory-acquired brucellosis. Six patients had unilateral epididymo-orchitis (two with features of florid presentation); the remaining 20 had only orchitis (bilateral in two, right in 10 and left in eight). Leucocytosis was present in six patients; 25 had initial agglutination titres of > 1 : 320 and the remaining patient had a positive blood culture. All patients received combined therapy with streptomycin for the first 2 weeks (or oral rifampicin for 6 weeks) with doxycycline or tetracycline for 6 weeks. All showed improvement, fever subsided in 2--5 days and the scrotal enlargement and tenderness regressed. Only one patient had a relapse within one year.. In brucellosis-endemic areas, clinicians encountering epididymo-orchitis should consider the likelihood of brucellosis. A careful history, a meticulous physical examination and a rapid laboratory evaluation help in diagnosis. Clinical and serological data are sufficient for diagnosis. Leucocytosis is not an atypical feature of brucellar epididymo-orchitis and so cannot be used for differentiating it from the nonspecific variety. Conservative management with combination antibiotic therapy is adequate for managing brucellar epididymo-orchitis.

Topics: Adolescent; Adult; Aged; Brucellosis; Doxycycline; Drug Therapy, Combination; Epididymitis; Fever; Humans; Length of Stay; Male; Middle Aged; Orchitis; Retrospective Studies; Rifampin; Saudi Arabia; Streptomycin; Tetracycline

Neonatal brucellosis following blood transfusion has not previously been reported. A premature male infant born at 24 weeks gestation developed low grade fever and decreased activity and showed poor weight gain at 45 weeks post-menstrual age. Blood culture grew Brucella melitensis and the brucella antibody titre was positive. He received a 6-week course of septrin and rifampicin and made a full recovery. The infant had received a blood transfusion 5 days prior to his illness. The blood donor had symptoms suggestive of brucellosis, and it was suspected that the blood transfusion was the source of infection but this could not be confirmed as the donor was not traceable. It is suggested that, in areas endemic for brucellosis, prospective blood donors should be questioned about symptoms of brucellosis, and serological tests to screen for brucellosis might be indicated.

Topics: Agglutination Tests; Anti-Bacterial Agents; Antibiotics, Antitubercular; Bacteremia; Brucella melitensis; Brucellosis; Erythrocyte Transfusion; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Rifampin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

We report two new cases of hepatic brucelloma in addition to the 22 previously reported cases in the literature. Our analysis of these cases reveals certain characteristics. Hepatic brucelloma is a rare localization that follows previously undetected acute brucellosis. Brucelloma is a result of caseification of a granulomatous reaction induced by persistent Brucella in macrophages. Clinical manifestations can mimic malignant liver tumors or pyogenic, amebic liver abscess. Diagnosis is based on the association of characteristic imaging features (central calcification and peripheral necrotic areas), positive serology and hepatic granulomas. Brucella is rarely isolated in the blood or liver. Awareness of this clinical variant can prevent unnecessary laparotomy. Treatment should begin with rifampicine (900 mg per day) and doxycyclin (200 mg per day) for 3 months. If medical treatment is unsuccessful, percutaneous or surgical drainage should be performed. A cure should be achieved in all cases.

Topics: Anti-Bacterial Agents; Brucellosis; Diagnosis, Differential; Doxycycline; Granuloma; Humans; Liver Diseases; Macrophages; Male; Middle Aged; Rifampin

Because of the increasing number of renal transplantations performed and the rarity of reported cases of infective endocarditis in these patients, we studied the clinical characteristics of this infection in this population. We report on two cases from our experience and review reported cases of infective endocarditis in renal transplant recipients retrieved from the MEDLINE system. In addition, we reviewed a large series of infective endocarditis looking for patients with renal transplants. In addition to our 2 cases, 12 previously reported cases were found. The mean time from transplantation to diagnosis of infective endocarditis was 3.5 years (range 2 months to 15 years). Causative organisms included fungi, Staphylococcus aureus (3 cases each), Corynebacterium sp. (2 cases), Streptococcus viridans, VRE, Brucella sp., Clostridium sp., Nocardia sp. and Erysipelothrix sp. (one case each). Skin manifestations of endocarditis and/or splenomegaly were not reported in these patients. Septic emboli and mycotic aneurysms were relatively common. The overall mortality rate was 50% (7 of 14 patients died). Infective endocarditis seems to be rare in renal transplant recipients. The few reported cases are characterized by unusual causative micro-organisms and atypical clinical presentation. Further studies are needed to delineate the magnitude and scope of this association.

Topics: Adult; Brucella melitensis; Brucellosis; Ceftriaxone; Cephalosporins; Doxycycline; Drug Therapy, Combination; Endocarditis, Bacterial; Erysipelothrix; Erysipelothrix Infections; Female; Humans; Kidney Transplantation; Male; MEDLINE; Postoperative Complications; Rifampin

A 35-year-old man presented a case of recurrent episcleritis revealing brucellosis. No concurrent diagnosis other than brucellosis could account for the episcleritis. Moreover his status was dramatically improved by specific antibiotherapy. A review of the literature showed that uveitis and optic neuropathies are the most common ocular manifestations of brucellosis. To the best of our knowledge, this is the first case of episcleritis associated with brucellosis.

Topics: Adult; Anti-Bacterial Agents; Brucellosis; Enzyme Inhibitors; Follow-Up Studies; Humans; Male; Minocycline; Recurrence; Rifampin; Scleritis

The authors report a case of symphysis pubis osteomyelitis due to Brucella. Such localisation seems not to have been reported before. Despite an initially bad observance of antibiotic treatment, evolution has finally been favourable. At two year follow-up, no functional or radiological sequellae was observed.

Topics: Adult; Brucellosis; Doxycycline; Drug Therapy, Combination; Humans; Male; Osteomyelitis; Pubic Symphysis; Radiography; Rifampin

The aim of this study was to determine whether a conclusion could be obtained through meta-analysis of the published trials on the relative efficacy of rifampicin and doxycycline versus streptomycin and doxycycline or another tetracycline (SD).. The comparative and randomized trials identified by a search in the reference data base MEDLINE from 1967 to 1992 and through manual review of the articles cited in these studies or other reviews were included. The evaluation of quality was performed by a standardized scale. The differences in efficacy were expressed as odds ratio and the results were contrasted by the Mantel-Haenszel method. Heterogenicity was graphically analyzed by the Woolf method with an adjustment being made for small subgroups. The confidence intervals were calculated for each trial and for the combined data by the Cornfield method.. Six trials including 581 patients of whom 544 were considered evaluable were analyzed. In the RD treatment group 261 (242 valid) patients were included with 268 (253 valid) being included in the SD group. Five cases of initial therapeutic failure were observed in each group without significant differences. The secondary effects described were very variable. Nonetheless no secondary effects obliging discontinuation of treatment were presented in the RD group with only one in the SD group with no differences between the two groups. Recurrences were presented in 5% and 39% in the RD group and in 0 and 17% in the SD group. In total 37 (16%) in the former group and 13 (5%) in the latter group. The Mantel-Haenszel odds ratio with respect to recurrence was 3.81 (CI 95%, 1.82-8.17; p = 0.00009). The total number of cures was 196 (81%) in the RD group and 232 (92%) in the SD group (Mantel-Haenszel odds ratio 0.36; CI 95%, 1.19-0.64; p = 0.0004). The inclusion of the quality index of the trials did not modify the statistical significance achieved.. In human brucellosis the treatment of rifampicin and doxycycline presents a greater number of recurrence and lower number of cure than the classical treatment with streptomycin and tetracycline drugs.

Topics: Brucellosis; Doxycycline; Drug Therapy, Combination; Humans; Rifampin; Streptomycin; Tetracyclines

Topics: Brucella; Brucellosis; Chronic Disease; Enzyme-Linked Immunosorbent Assay; Humans; Rifampin; Serologic Tests; Streptomycin; Sulfamethoxazole; Tetracycline; Trimethoprim

Topics: Aminoglycosides; Anti-Bacterial Agents; Brucellosis; Drug Combinations; Humans; Recurrence; Rifampin; Sulfamethoxazole; Tetracyclines; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

In a few studies, higher doses of rifampicin improved the outcome of patients with TB. There is no information regarding efficacy and safety of higher doses of rifampicin in patients with brucellosis.. To compare efficacy and safety of higher and standard doses of rifampicin, each with doxycycline, in the treatment of patients with brucellosis.. Within a randomized clinical trial, clinical response and adverse events of high-dose rifampicin (900-1200 mg/day) plus doxycycline 100 mg twice daily were compared with standard-dose rifampicin (600 mg/day) plus doxycycline 100 mg twice daily in 120 patients with brucellosis.. Clinical response occurred in 57 (95%) of patients in the high-dose group and 49 (81.66%) of patients in the standard-dose group (P = 0.04). The most common adverse events of the treatment were nausea (37.5%), skin rash (13.33%), vomiting (10%) and transaminitis (7.22%). Incidence of these events was comparable between the groups.. The rate of clinical response in patients with brucellosis who were treated with high-dose rifampicin plus standard-dose doxycycline was significantly higher than in the patients who received the standard doses of rifampicin and doxycycline, without further adverse events. The high-dose rifampicin therefore improved clinical response in patients with brucellosis with a similar safety profile to the standard dose. If these findings are confirmed in future studies, higher doses of rifampicin may be recommended for treatment of patients with brucellosis.

Topics: Anti-Bacterial Agents; Brucellosis; Doxycycline; Drug Therapy, Combination; Humans; Rifampin

To develop the 'Stronger Towns Index': a deprivation index that took into account characteristics of areas encompassing towns that may be eligible for redevelopment funding and explore how this index was associated with self-rated health and migration within England between 2001 and 2011.. There were areas in the lowest deciles of Town Strength who did not receive funding. After multiple adjustment, LS members living in areas with higher deciles were significantly more likely (7% to 38%) to report good health than those in the lowest decile in 2001. Remaining in the same decile between 2001 and 2011 was associated with 7% lower odds of good self-rated health in 2011.. It is important to consider health in towns when allocating funding. Areas in the Midlands may have missed out on funding which might help mitigate poor health.. Ferritin levels <30µg/L were associated with unexplained infertility and might be screened in the future. Further studies with a focus on iron deficiency and iron treatment on women with unexplained infertility are warranted.. This EGM provides a valuable resource for researchers, policy-makers and the public to access the available evidence on the determinants of various COVID-19 health-related behaviours. The map can also be used to help guide research commissioning, by evidence synthesis teams and evidence intermediaries to inform policy during the ongoing pandemic and potential future outbreaks of COVID-19 or other respiratory infections. Evidence included in the map will be explored further through a series of systematic reviews examining the strength of the associations between malleable determinants and the uptake and maintenance of individual protective behaviours.. Patients with polymicrobial bloodstream infections are typically critically ill and harbor multidrug-resistant bacteria. Thus, to minimize mortality rate in critically ill patients, changes in infectious flora should be monitored, antibiotics selected reasonably, and invasive procedures reduced.. Altogether, these findings clearly revealed the great potential of the in vitro biological activity of linseed extract as a safe source for combatting multidrug-resistant. In this work, the capture of carbon dioxide using a dense hollow fiber membrane was studied experimentally and theoretically. The factors affecting the flux and recovery of carbon dioxide were studied using a lab-scale system. Experiments were conducted using a mixture of methane and carbon dioxide to simulate natural gas. The effect of changing the CO. Persistent gender and racial disparities in high-impact medical and critical care journals underscore the need to revise policies and strategies to encourage greater diversity in critical care research.. Thirty evaluable patients were enrolled. Median age was 60.5 years. Median follow-up for all patients was 17 months. Ten patients (33%) experienced grade ≥ 3 treatment-related adverse events, the most common being neutropenia and diarrhea; 50% required ≥ 1 dose reduction. The disease control rate was 90% (progressive disease: 10%, partial response: 23%, stable disease: 67%). There was zero treatment-related mortality. Twenty-two patients (73%, 90% CI 57-86; p = 0.008) completed all chemotherapy and surgery. Two patients (9%) who successfully underwent resection had minor postoperative complications. Median length of hospital stay was 4 days. Median RFS was 7.1 months. Median OS for the entire cohort was 24 months and was not reached in patients who underwent surgical resection.. Neoadjuvant treatment with gemcitabine, cisplatin, and nab-paclitaxel is feasible and safe prior to resection of intrahepatic cholangiocarcinoma and does not adversely impact perioperative outcomes.

Topics: Acetogenins; Acute Disease; Acute Kidney Injury; Administration, Intravenous; Aged; Albumins; Alcoholism; Aldehyde Dehydrogenase; Aldehyde Dehydrogenase, Mitochondrial; alpha-Glucosidases; Anemia; Animals; Anthozoa; Anti-Bacterial Agents; Anti-Infective Agents; Antibodies, Bacterial; Antigens, Bacterial; Antihypertensive Agents; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Antioxidants; Apoptosis; Ascites; Asthma; Bacteria; beta-Lactamases; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Binding Sites; Biological Availability; Biomass; Borderline Personality Disorder; Brain; Brucella abortus; Brucella melitensis; Brucellosis; Calcium; Carbapenems; Case-Control Studies; Caseins; Cattle; CD8-Positive T-Lymphocytes; Ceftaroline; Cell Line; Cell Line, Tumor; Cell Physiological Phenomena; Cell Proliferation; Cephalosporins; Chemotherapy, Adjuvant; China; Chitin; Chlorella; Chlorophyll; Chlorophyll A; Chlorophyta; Cholangiocarcinoma; Cisplatin; Conotoxins; Contrast Media; Conus Snail; Cross-Sectional Studies; Cytokines; Decapodiformes; Deoxycytidine; Diagnostic and Statistical Manual of Mental Disorders; Dietary Fiber; Diterpenes; DNA Methylation; Dogs; Double-Blind Method; Drug Design; Drug Resistance, Bacterial; Drug Resistance, Multiple, Bacterial; Drug Screening Assays, Antitumor; Eicosapentaenoic Acid; Enzyme-Linked Immunosorbent Assay; Epidermis; Escherichia coli; Escherichia coli Infections; Extraintestinal Pathogenic Escherichia coli; Fatty Acids; Fatty Acids, Unsaturated; Fatty Acids, Volatile; Feasibility Studies; Feces; Female; Ferritins; Fluorodeoxyglucose F18; Gastrectomy; Gastrointestinal Microbiome; Gemcitabine; Glomerular Filtration Rate; Glucose; Glycerol; Granulocyte-Macrophage Colony-Stimulating Factor; HeLa Cells; Humans; Hypoxia-Inducible Factor 1, alpha Subunit; Hypoxia-Inducible Factor-Proline Dioxygenases; Immunoassay; Immunoglobulin G; India; Infant, Newborn; Infertility; Inflammation; Intensive Care Units; Iron; Iron Deficiencies; Kidney; Lacticaseibacillus rhamnosus; Laurencia; Leukocytes; Lipids; Liver Cirrhosis; Long Interspersed Nucleotide Elements; Longitudinal Studies; Male; Mesenchymal Stem Cells; Methicillin-Resistant Staphylococcus aureus; Mice; Microalgae; Microbial Sensitivity Tests; Microscopy; Middle Aged; Minerals; Molecular Conformation; Molecular Docking Simulation; Molecular Structure; Mycobacterium tuberculosis; Myeloid Cells; Myeloid-Derived Suppressor Cells; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Nephropidae; Nicotinic Antagonists; Nitrogen; Obesity; Oxaliplatin; Paclitaxel; Panax; Pancreatic Neoplasms; Pancreatitis; Personality; Personality Disorders; Personality Inventory; Photobioreactors; Plant Extracts; Plasmalogens; Plasmids; Polymorphism, Genetic; Polynesia; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prebiotics; Predictive Value of Tests; Prognosis; Prolyl-Hydroxylase Inhibitors; Rabbits; Radiopharmaceuticals; Rats; Rats, Wistar; Receptors, Nicotinic; Recombinant Proteins; Retrospective Studies; Rifampin; Risk Factors; RNA, Ribosomal, 16S; Salinity; Seaweed; Sensitivity and Specificity; Sepsis; Sesquiterpenes; Severity of Illness Index; Shock, Septic; Silicones; Single Photon Emission Computed Tomography Computed Tomography; Skin; Snails; Solubility; Solvents; Sputum; Staphylococcal Infections; Stomach Neoplasms; Stramenopiles; Structure-Activity Relationship; Technetium Tc 99m Exametazime; Technology; Terpenes; Tuberculosis; Tuberculosis, Multidrug-Resistant; Urinary Catheters; Urinary Tract Infections; Vascular Endothelial Growth Factor A; Virulence Factors; Water; Wound Healing

Previous studies have shown the effect of hydroxychloroquine in the treatment and prevention of recurrence of brucellosis. The aim of this study was to compare the effect of 4 and 6 week regimen containing hydroxychloroquine in the treatment of brucellosis.. In a single-blind randomized clinical trial, 92 patients with acute brucellosis were randomly divided in two treatment groups who received a triple drug regimen including doxycycline, streptomycin, and hydroxychloroquine (DSH] for 4 and 6 weeks. All patients were followed up for up to 6 months. Response to treatment, relapse rate, complications, and results of serological tests were compared in both groups. Data were analyzed by SPSS software version 16.. Of the 92 patients studied, 46 received a 4 week course and 46 received a 6 week course of therapy. There were no significant differences between the two groups in terms of age and sex distribution. The response rate, treatment failure, and relapse in the 4 week treatment group were 82.6%, 17.3%, and 7.89%, respectively, and in the 6 week treatment group were 91.3%, 8.7%, and 9.52%. The frequency of negative 2ME test at 24 weeks after treatment was 11.1% in the 4 week group and 8.7% in the 6 week group. No significant differences were found between the two groups in terms of response to treatment, treatment failure, relapse, and negative 2ME test.. The 4 week and 6 week courses of the combination of DSH are equally effective in treating brucellosis. We recommend further studies to support the use of the short-course 4 week regimen for the treatment of uncomplicated brucellosis.

Topics: Anti-Bacterial Agents; Brucellosis; Doxycycline; Drug Therapy, Combination; Humans; Hydroxychloroquine; Recurrence; Rifampin; Single-Blind Method; Streptomycin

Brucellosis remains the most common zoonotic disease throughout the world and especially in Iran. Several clinical trials have tested different therapeutic regimens for brucellosis, but few have assessed the optimal duration of treatment.. We performed a randomized controlled trial to compare a triple-drug regimen of doxycycline plus rifampicin for 6 weeks and streptomycin for the first 7 days with doxycycline plus rifampicin for 8 weeks and streptomycin for 7 days in patients with uncomplicated brucellosis in Arak, Iran. The primary outcome measure for the treatment groups was the relapse rate measured at 1, 3, 6, 12, and 24 months after cessation of therapy.. Eligible patients were randomized to one of the 2 groups with 72 per arm. We found no significant difference in the relapse rate for the 8-week treatment group compared to the 6-week group (9.7% vs 13.9%). There were no significant differences between the 6-week and 8-week groups regarding the relapse rate, period between clinical presentation and beginning of treatment, and time of relapse. Symptom resolution was achieved in all cases at a median 9.5 days and no cases experienced continuing symptoms after treatment.. Our trial found no significant difference between 6-week and 8-week regimens of doxycycline and rifampicin plus streptomycin for the first 7 days. Further comparative studies with a large sample size should be implemented to achieve a consistent therapeutic regimen for uncomplicated brucellosis, to help identify those who may benefit from longer treatment, and to minimize adverse effects and unnecessary continuation of treatment.

Topics: Adult; Anti-Bacterial Agents; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Humans; Iran; Male; Middle Aged; Rifampin; Streptomycin; Time Factors; Treatment Outcome; Young Adult

This prospective, non-randomized trial, compared the efficacy and tolerance of a doxycycline-rifampin regimen, administered for 45 days, versus doxycycline-rifampin given for 45 days plus gentamicin for the first 7-10 days, in the treatment of human brucellosis. Of 238 patients that were initially included in the study, 181 were finally evaluated. Ninety-four were treated with the doxycycline-rifampin and 87 with the doxycycline-rifampin-gentamicin regimens. In the doxycycline-rifampin group: relapses were noted in 13 (13.8%) patients; therapeutic failures in five (5.3%); and mild adverse effects in 28 (29.8%). In the doxycycline-rifampin-gentamicin group: four (4.6%) relapsed; and five (5.7%) therapeutic failures were registered. Mild adverse effects were registered in 29 (33.3%) patients. The doxycycline-rifampin-gentamicin regimen demonstrated a significantly lower relapse rate compared to the doxycycline-rifampin combination (P = 0.034). We conclude that adding gentamicin for the first 7-10 days to the standard oral doxycycline-rifampin regimen can decrease the rate of relapses.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Animals; Anti-Bacterial Agents; Brucellosis; Child; Doxycycline; Drug Therapy, Combination; Female; Gentamicins; Humans; Male; Middle Aged; Rifampin; Secondary Prevention; Treatment Outcome; Young Adult

Traditional regimens for the treatment of brucellosis are associated with significant relapse rates. The aim of this study was to compare the efficacy of ofloxacin plus rifampin (OFX-RIF) versus doxycycline plus streptomycin (DOX-STR) and doxycycline plus rifampin (DOX-RIF) regimens in the treatment of brucellosis.. Two hundred and nineteen patients with brucellosis were enrolled in a randomized clinical trial; 28 cases were withdrawn because they did not attend the follow-up. Out of 191 patients with brucellosis, 64 received OFX-RIF, 62 received DOX-RIF, and 65 patients received DOX-STR regimens. All patients were assessed during the period of therapy in the second, fourth, and sixth weeks by clinical course and were also followed up clinically and serologically for 6 months after the cessation of therapy.. The highest clinical response (95.4%) was observed in the DOX-STR group (p=0.009). The results of multivariate analysis indicate that treatment with DOX-STR had the least therapeutic failures among the three groups (p=0.033). Adverse reactions were seen in 16.8% of patients, but there was no significant difference among the three groups (p=0.613). The lowest relapse rate (4.6%) was observed in the DOX-STR group (p=0.109).. We conclude that the DOX-STR combination should remain the first-line regimen for the treatment of brucellosis in our region; we recommend DOX-RIF and OFX-RIF combinations as the second-line regimens.

Topics: Adult; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Multivariate Analysis; Ofloxacin; Rifampin; Streptomycin; Treatment Outcome; Young Adult

Serum lipid changes during infection may be associated with atherogenesis. No data are available on the effect of Brucellosis on lipids. Lipid parameters were determined in 28 patients with Brucellosis on admission and 4 months following treatment and were compared with 24 matched controls. Fasting levels of total cholesterol (TC), HDL-cholesterol (HDL-C), triglycerides, apolipoproteins (Apo) A, B, E CII, and CIII, and oxidized LDL (oxLDL) were measured. Activities of serum cholesterol ester transfer protein (CETP), paraoxonase 1 (PON1), and lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) and levels of cytokines [interleukins (IL)-1beta, IL-6, and tumor necrosis factor (TNFa)] were also determined. On admission, patients compared with controls had 1) lower levels of TC, HDL-C, LDL-cholesterol (LDL-C), ApoB, ApoAI, and ApoCIII and higher LDL-C/HDL-C and ApoB/ApoAI ratios; 2) higher levels of IL-1b, IL-6, and TNFa; 3) similar ApoCII and oxLDL levels and Lp-PLA(2) activity, lower PON1, and higher CETP activity; and 4) higher small dense LDL-C concentration. Four months later, increases in TC, HDL-C, LDL-C, ApoB, ApoAI, and ApoCIII levels, ApoB/ApoAI ratio, and PON1 activity were noticed compared with baseline, whereas CETP activity decreased. LDL-C/HDL-C ratio, ApoCII, and oxLDL levels, Lp-PLA(2) activity, and small dense LDL-C concentration were not altered. Brucella infection is associated with an atherogenic lipid profile that is not fully restored 4 months following treatment.

Topics: Acute Disease; Administration, Oral; Atherosclerosis; Brucella melitensis; Brucellosis; Case-Control Studies; Doxycycline; Female; Humans; Lipids; Male; Middle Aged; Rifampin

This study was designed to compare the efficacy of ciprofloxacin plus rifampin (CR) and ciprofloxacin plus doxycycline (CD) versus doxycycline plus rifampin (DR) in the treatment of brucellosis. A total of 178 patients with brucellosis who were referred to the Sina Hospital, Hamedan, Iran, were included. The responses to therapy were observed in 166 cases (93.7%) - 59 were in the DR group, 59 in the CR group and 48 in the CD group. No significant differences in the therapeutic responses were observed (P = 0.09). Relapse was observed in 11.7% (DR 7.7%, CR 8.3% and CD 17.5%) after a six-month follow-up. No significant differences were also observed in relapse rates among the three groups (P = 0.35). We concluded that DR is still the first choice regimen and CR or CD may be used as alternatives for treatment of brucellosis in adults.

Topics: Adult; Anti-Infective Agents; Brucellosis; Ciprofloxacin; Doxycycline; Drug Therapy, Combination; Female; Humans; Male; Prospective Studies; Recurrence; Rifampin

Combination drug therapy of brucellosis leads to recovery of symptoms, shortening of symptomatic interval, and decrease in morbidity rate, but single drug therapy is associated with more relapse episodes and a higher rate of drug resistance. Different drug combinations have been evaluated in the treatment of brucellosis. Considering the failure of treatment and relatively high rate of relapse of the disease with the World Health Organization's (WHO) recommended therapeutic regimen, we evaluated a new regimen that we assumed would increase the success of treatment and decrease the rate of relapse. In this study we compare the standard regimen of the WHO, doxycycline-rifampin (DR), to triple therapy with doxycycline-rifampin-amikacin (ADR).. Two hundred and twenty-eight consecutive patients with brucellosis, who attended Hamedan Sina Hospital between 1999 and 2001, whether seen as outpatients or as inpatients, were enrolled in the study. The participants were randomly allocated to the DR group (receiving doxycycline 100 mg twice a day and rifampin 10 mg/kg body weight/day every morning, both taken orally for eight weeks) or the ADR group (receiving doxycycline 100 mg twice a day and rifampin 10 mg/kg body weight/day every morning, both taken orally for eight weeks, plus 7.5 mg/kg amikacin intramuscularly twice a day for seven days). The patients were checked for the relief of symptoms, drug side-effects, and relapse of disease during the treatment and follow-up.. Of the 228 patients enrolled, eight were withdrawn - four patients from the DR group and four from the ADR group. Of the remaining 220 participants (110 in the ADR group and 110 in the DR group), 107 were male (48.6%) and 113 were female (51.4%). Mean age was 35.7+/-17 years in the ADR group and 37+/-18.4 years in the DR group (p=0.5). In the DR group, 97 (88.2%) and in the ADR group, 106 (96.4%) of the patients had relief of symptoms (a significant difference by Chi-square test (p=0.04)). After completion of treatment, and at the sixth month follow-up, nine (9.3%) patients in the DR group and six (5.7%) in the ADR group experienced a relapse of the disease, with no significant difference (p=0.4). Mild side-effects were found in only 10 patients, and none required discontinuation of the therapeutic regimen. Of these patients, four were from DR group and six from ADR group; no significant difference was observed (p=0.7).. Given the fact that the ADR regimen had a higher efficacy and more rapid action in terms of relief of symptoms compared to the DR regimen, and that no significant difference in drug side-effects and disease relapse existed in the patients of either group, adding amikacin to the DR standard treatment regimen seems beneficial.

Topics: Adolescent; Adult; Amikacin; Anti-Bacterial Agents; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Rifampin

The optimal treatment regimen and duration of the therapy is still controversial in spinal brucellosis. The aim of this study is to compare the efficacy, adverse drug reactions, complications and cost of ciprofloxacin plus rifampicin versus doxycycline plus streptomycin in the treatment of spinal brucellosis.. The patients diagnosed as spinal brucellosis between January 2002 to December 2004 were enrolled into the study. Patients were enrolled into the two antimicrobial therapy groups (doxycycline plus streptomycin vs. ciprofloxacin plus rifampicin) consecutively. For the cost analysis of the two regimens, only the cost of antibiotic therapy was analysed for each patient.. During the study period, 31 patients with spinal brucellosis were enrolled into the two antimicrobial therapy groups. Fifteen patients were included in doxycycline plus streptomycin group and 16 patients were included in ciprofloxacin plus rifampicin group. Forty-two levels of spinal column were involved in 31 patients. The most common affected site was lumbar spine (n = 32, 76%) and involvement level was not different in two groups. Despite the disadvantages (older age, more prevalent operation and abscess formation before the therapy) of the patients in the ciprofloxacin plus rifampicin group, the duration of the therapy (median 12 weeks in both groups) and clinical response were not different from the doxycycline plus streptomycin. The cost of ciprofloxacin plus rifampicin therapy was 1.2 fold higher than the cost of doxycycline plus streptomycin therapy.. Classical regimen (doxycycline plus streptomycin), with the appropriate duration (at least 12 weeks), is still the first line antibiotics and alternative therapies should be considered when adverse drug reactions were observed.

Topics: Anti-Bacterial Agents; Brucellosis; Ciprofloxacin; Doxycycline; Drug Therapy, Combination; Humans; Rifampin; Spine; Spondylitis; Streptomycin

Brucellosis is characterized by chronicity and relapses despite efficacious treatment. Cytokines and especially the Th1/Th2 balance may be involved in the susceptibility or resistance to the Brucella species. In order to identify predictors of treatment outcome, we measured the pre and posttreatment levels of serum interleukin-2 (IL-2) and soluble IL-2 receptor alpha (sIL-2Ralpha) in 20 children with brucellosis. All children were treated for 6 weeks and three of them (15%) presented with a relapse at 2, 3 and 8 months after treatment had ended.. Serum IL-2 levels, both pretreatment and posttreatment, did not significantly differ between patients and controls. By contrast, pretreatment sIL-2Ralpha levels were significantly higher in patients (P< or =0.0001) than in controls. sIL-2Ralpha levels significantly declined (P<0.001) after the 6-week antibiotic regimen in the 17 children who subsequently had a good outcome without relapses, but not in the three patients who relapsed.. A decline in serum sIL-2Ralpha levels might be used as a marker of treatment efficacy in brucellosis.

Topics: Anti-Infective Agents; Brucellosis; Child; Child, Preschool; Drug Therapy, Combination; Female; Humans; Infant; Interleukin-2; Interleukin-2 Receptor alpha Subunit; Male; Predictive Value of Tests; Receptors, Interleukin-2; Rifampin; Solubility; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

The efficacy and tolerability of three different combination treatment regimens in human brucellosis were compared in 118 uncomplicated patients enrolled in a prospective study between May 1997 and December 2002. Brucellosis was diagnosed using standard clinical and microbiological findings. Patients with central nervous system involvement, spondylitis, endocarditis or children under 16 years of age were excluded from the study. Patients were randomly assigned to receive 400 mg of ofloxacin plus 600 mg of rifampicin (OR, n = 41), 200 mg of doxycycline plus 600 mg of rifampicin (DR, n = 45) or 1g intramuscularly streptomycin (administered for three weeks) plus 200 mg doxycycline (DS, n = 32) daily for 6 weeks. All patients were followed up at least 6 months after cessation of therapy. There was no statistical difference between the groups on relapse rates and clinical response to the treatment (P>0.05). Five patients in OR (12.8%), six patients in DR (14.3%) and three patients in DS groups (9.7%) suffered relapse. The side-effects were seen in eight (19.5%), 21 (46.7%) and eight (25.0%) patients of OR, DR and DS groups, respectively. The use of combination therapy of ofloxacin plus rifampicin for 6 weeks was found to be as effective as DR and DS. The side-effects of therapy in OR and DS groups was less severe than in the DR group.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Brucella; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Ofloxacin; Rifampin; Streptomycin; Treatment Outcome

The combination therapies recommended by the World Health Organization for treatment of brucellosis are doxycycline plus rifampicin or doxycycline plus streptomycin. Although highly successful results have been obtained with these two regimens, relapse rates as high as 14.4%. The most effective and the least toxic chemotherapy for human brucellosis is still undetermined. The aim of the present study was to investigate the efficacy, adverse effects and cost of ofloxacin plus rifampicin therapy, and doxycycline plus rifampicin therapy and evaluate in the treatment of brucellosis.. The open trial has been carried out prospectively by the two medical centers from December 1999 to December 2001 in Duzce region Turkey. The diagnosis was based on the presence of signs and symptoms compatible with brucellosis including a positive agglutination titre (>/=1/160) and/or a positive culture. Doxycycline and rifampicin group consisted of 14 patients who were given doxycycline 200 mg/day plus rifampicin 600 mg/day during 45 days and this group Ofloxacin plus rifampicin group was consisted of 15 patients who were given ofloxacin 400 mg/day plus rifampicin 600 mg/day during 30 days.. Regarding clinical and/or demographic characteristics no significant difference was found between two groups of patients that underwent two different therapeutic regimens. At the end of the therapy, two relapses were seen in both groups (p = 0.695). Although duration of therapy was two weeks shorter in group treated with rifampicin plus ofloxacin, the cure rate was similar in both groups of examinees. Fever dropped more rapidly in the group that treated with rifampicin plus ofloxacin, 74 +/- 30 (ranges 48-216) vs. 106 +/- 26 (ranges 48-262) hours (p = 0.016).. Ofloxacin plus rifampicin therapy has advantages of shorter treatment duration and provided shorter course of fever with treatment than in doxycycline plus rifampicin therapy. However, cost of ofloxacin plus rifampicin treatment is higher than doxycycline plus rifampicin treatment. Because of the similar effects, adverse effects and relapses rates between two regimens, we still advice doxycycline plus rifampicin for the treatment of brucellosis for countries, which have limited resources.

Topics: Adolescent; Adult; Brucellosis; Diarrhea; Doxycycline; Drug Costs; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Nausea; Ofloxacin; Rifampin; Time Factors; Treatment Outcome

To compare the efficacy of two different regimens in treatment of brucellosis.. This randomised clinical trial study was conducted on 280 patients with brucellosis in Babol, Iran, from April 1999 to January 2002. One of the following two regimens was randomly prescribed for two months: co-trimoxazole plus doxycycline (CD group) and co-trimoxazole plus rifampin (CR group).. 140 patients with the mean age of 35.56 (16.2) years, and 140 patients with the mean age of 31.39 (18) years, were treated with co-trimoxazole plus doxycycline and co-trimoxazole plus rifampin, respectively. Clinical manifestations and laboratory test results were similar in both groups (p >0.05), except in sex and clinical types (p <0.05). Failure of treatment was seen in 10 (7.1%) and 23 (16.4%) cases treated in the CD group and CR group, respectively (95% CI, 0.174 to 0.862; OR = 0.387; p = 0.020). Relapse was seen in 12 cases (8.6%) treated in the CD group and in 14 cases (10%) treated in the CR group (95% CI, 0.365 to 1.87; OR = 0.826; p = 0.646). Failure of treatment plus relapse was seen in 22 (15.7%) and 37 (26.4%) cases treated in the CD group and CR group, respectively (95%CI, 0.278 to 0.929, OR = 0.508; p = 0.028). Risk for developing of failure of treatment and relapse in patients treated with co-trimoxazole plus rifampin was 1.96 times higher than those treated with co-trimoxazole plus doxycycline. Among the relapsed patients, 18 (69.2%) cases occurred within 6 months after completion of therapy, and most of them in uncomplicated patients.. Using two months of treatment, the efficacy of co-trimoxazole plus doxycycline is better than co-trimoxazole plus rifampin.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Brucellosis; Child; Doxycycline; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Recurrence; Rifampin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Brucellosis, a zoonosis with worldwide distribution, is a systemic infection and still an important public health problem in Turkey. The best antimicrobial combination and schedule for the treatment of brucellosis with spondylitis has not yet been clearly determined. In a prospective and randomized study, we compared the efficacy of five antimicrobial regimens for treatment of 102 patients with lumbar brucellar spondylitis. Patients were randomly assigned to receive antimicrobial combination therapy. Twenty patients received streptomycin 1 g/day intramuscularly for 15 days and tetracycline-HCl, 500 mg every 6 h orally for 45 days (ST), 21 patients received streptomycin 1 g/day i.m. for 15 days and doxycycline 100 mg every 12 h orally for 45 days (SD), 20 patients received doxycycline 100 mg every 12 h orally for 45 days and rifampicin 15 mg/kg per day in a single morning dose orally for 45 days (DR), 19 patients received ofloxacin, 200 mg every 12 h orally for 45 days and rifampicin 15 mg/kg per day in a single morning dose orally for 45 days (OR), and 22 patients received streptomycin 1 g/day i.m. for 15 days and doxycycline 100 mg every 12 h orally for 45 days plus rifampicin 15 mg/kg per day in a single morning dose orally for 45 days (SDR). Initial therapeutic failure occurred in 2 patients (10%) in the ST regimen group, 4 patients (19%) in the SD group, 3 patients (15%) in the DR group and 5 patients (26%) in the OR regimen. In addition, 2 patients (10%) in the DR group and 5 patients (26%) in the OR regimen relapsed during the follow-up period. There was no relapse in any patients in the ST, SD, and SDR groups. The response rates were 90% in the ST and 81% in the SD groups. In contrast, there was a maximum good response (100%) and no relapse in the SDR group. In conclusion, a combination of doxycycline, streptomycin, and rifampicin can be recommended as therapy for brucellar spondylitis and to reduce relapse rates.

Topics: Adult; Aged; Anti-Bacterial Agents; Brucella; Brucellosis; Doxycycline; Drug Resistance, Bacterial; Drug Therapy, Combination; Enzyme Inhibitors; Female; Humans; Male; Middle Aged; Prospective Studies; Recurrence; Rifampin; Spondylitis; Streptomycin; Treatment Outcome

Levamisole is an immunopotenciator drug which is used as an antihelmintic drug as well as very effective remedy on cellular immunity compared with humoral immunity. A total 71 patients (37 men, 34 women) who referred to our department between March 1997 and December 2001, with a history of the disease for about 1 year, were diagnosed as having chronic brucellosis through those tests brucella serum agglutination test (SAT), SAT with Coombs and SAT with 2-mercaptoethanol. The patients were randomly divided into levamisole group (36 patients) and control group (35 patients). All patients were given rifampicin 600 mg/day + doxycycline 200 mg/day for 6 weeks as a standard classical combined therapy for brucellosis. In the levamisole group, oral levamisole 80 mg every other day for 6 weeks was added to the treatment. There was a statistically significant difference between two groups, in complaints of arthralgia, fatigue and sweats before and 6 months after treatment, as well as in erythrocyte sedimentation rate and C-reactive protein elevations and lymphomonocytosis finding. While it was provided both clinical and serological improvement in all patients in the levamisole group; 11 patients in the control group did not improve both clinically and in view of specific and nonspecific laboratory findings and a recurrence occurred in one case, in this group. In conclusion, levamisole added to classical antibiotic therapy in treatment of chronic brucellosis was found quite efficient in all patients in providing adequate clinical and laboratory response in comparison to classical antibiotic therapy alone.

Topics: Adjuvants, Immunologic; Adolescent; Adult; Agglutination Tests; Anti-Bacterial Agents; Antibiotics, Antitubercular; Antibodies, Bacterial; Antinematodal Agents; Bone Marrow; Brucella melitensis; Brucellosis; Combined Modality Therapy; Doxycycline; Female; Humans; Levamisole; Male; Mercaptoethanol; Middle Aged; Rifampin

The present study was undertaken to evaluate the efficacy, safety, and patient tolerability of two antibiotic regimens for the treatment of brucellosis: rifampicin 600 mg/day and doxycycline 200 mg/day for 45 days (group 1), versus rifampicin 600 mg/day and ciprofloxacin 1 g/day for 30 days (group 2). Forty patients were diagnosed with brucellosis based on clinical and microbiological findings. The two groups were comparable regarding age and sex distribution. The average number of days without fever and symptoms was lower in group 2 patients than in group 1 patients (mean+/-SD: 3.85+/-1.98 for group 1 vs. 2.78+/-1.03 for group 2, P=0.044). During the 1-year follow-up period, three (15%) patients in group 2 and two (10%) patients in group 1 had clinical relapses; these rates were not significantly different. Ciprofloxacin and rifampicin treatment for brucellosis is as effective as the standard regimen of doxycycline and rifampicin and offers the advantage of a shorter duration of treatment.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents; Antibiotics, Antitubercular; Brucellosis; Chi-Square Distribution; Ciprofloxacin; Doxycycline; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Middle Aged; Rifampin; Treatment Outcome

Brucellosis is a common zoonosis in many parts of the world; the best regimen for the treatment of brucellosis has not been clearly determined. We have carried out a multicenter, open, controlled trial in five general hospitals in Spain to compare the efficacy and safety of doxycycline and rifampin (DR) versus doxycycline and streptomycin (DS) for the treatment of human brucellosis. The study included 194 ambulatory or hospitalized patients with acute brucellosis, without endocarditis or neurobrucellosis. The diagnostic criterion was isolation of Brucella species from blood or other tissues (n = 120) or a standard tube agglutination titer of 1/160 or more for anti-Brucella antibodies with compatible clinical findings (n = 74). Patients were randomly assigned to receive either 100 mg of doxycycline twice daily plus rifampin, 900 mg/day, in a single morning dose for 45 days (DR group) or the same dose of doxycycline for 45 days plus streptomycin, 1 g/day, intramuscularly for 14 days (DS group). A lack of therapeutic efficacy developed in 8 of the 100 patients in the DR group (8%) and in 2 of the 94 patients in the DS group (2%)(P = 0.10). Relapses occurred in 16 of the 100 patients in the DR group (16%) but in only 5 of the 94 patients in the DS group (5.3%) (P = 0.02). When relapse was considered in combination with initial lack of efficacy, 26 patients in the DR group (24%) and 7 patients in the DS group (7.45%) failed to respond to therapy (P = 0.0016). In general, therapy was well tolerated and only four patients (4%) in the DR group and two (2%) in the DS group had episodes of adverse effects necessitating discontinuation of treatment (P> 0.2). We conclude that a doxycycline-and-rifampin regimen is less effective than the doxycycline-and-streptomycin regimen in patients with acute brucellosis.

Topics: Adolescent; Adult; Aged; Brucella melitensis; Brucellosis; Child; Doxycycline; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Prospective Studies; Recurrence; Rifampin; Spain; Streptomycin

We studied the possible interaction between rifampin and doxycycline in 20 patients with brucellosis treated randomly with either doxycycline and streptomycin or doxycycline and rifampin. The doxycycline levels in the plasma of patients in the group treated with rifampin were significantly lower than those in the plasma of patients treated with doxycycline and streptomycin. Furthermore, clearance in patients treated with rifampin was significantly higher than that in patients treated with doxycycline and streptomycin, and consequently, the elimination half-life and the area under the concentration-time curve were significantly lower. There was no therapeutic failure or relapse in the group treated with doxycycline and streptomycin, whereas 2 of 10 patients in the group treated with doxycycline and rifampin had a therapeutic failure or relapse. The plasma doxycycline levels had an inverse correlation with plasma rifampin levels. In the group treated with rifampin, those who were rapid acetylators had lower levels of doxycycline. In conclusion, combined treatment with rifampin reduces the levels of doxycycline in plasma. These data suggest that therapeutic failures or relapses may result from this interaction.

Topics: Adult; Brucellosis; Doxycycline; Drug Interactions; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Rifampin

Quinolones have been reported to be active against Brucella species in vitro. In this prospective randomized study, the efficacy and safety of the combination of ofloxacin plus rifampin were compared with the efficacy and safety of doxycycline plus rifampin, both combinations administered for a 6-week period in treatment of brucellosis. Sixty-one patients were enrolled in the study, and 49 had blood or bone marrow cultures positive for Brucella melitensis. Thirty patients received 200 mg of doxycycline plus 600 mg of rifampin once daily, and 31 patients were treated with 400 mg of ofloxacin plus 600 mg of rifampin once daily for 6 weeks. Nine patients in each group had complications of the disease. There was one therapeutic failure in the ofloxacin-rifampin treatment group, and one patient from each group relapsed (3.3% of those in the doxycycline-rifampin treatment group versus 3.2% of those in the ofloxacin-rifampin treatment group). Gastric discomfort was the major side effect observed in 13 patients (43.3%) who received doxycycline plus rifampin, whereas only 2 patients (6.5%) treated with ofloxacin plus rifampin complained of gastric irritation. These results suggest that the combination of ofloxacin plus rifampin administered for 6 weeks is as effective as doxycycline plus rifampin given for the same period, regardless of the presence of complications of the disease.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents; Brucella melitensis; Brucellosis; Doxycycline; Female; Humans; Male; Middle Aged; Ofloxacin; Prospective Studies; Rifampin; Treatment Outcome

Treatment of childhood brucellosis is controversial and is currently dependent on inclusion of aminoglycoside antibiotics which are both costly and potentially toxic. Hence an alternate mode of therapy preferably dependent exclusively on oral agents is desirable because this decreases medical cost. In this study we prospectively treated 113 children with a combination of two oral agents, trimethoprim-sulfamethoxazole (10 to 12 mg/kg trimethoprim, 50 to 60 mg/kg sulfamethoxazole and rifampin 15 to 20 mg/kg in two divided doses for 6 weeks. The treatment was well-tolerated and all patients responded by defervescence of fever and resolution of all symptoms within 1 to 3 weeks. Relapse after 6 months occurred in four children all of whom responded to repeat therapy by the same agents. We conclude that the combination of trimethoprim-sulfamethoxazole and rifampin is both cost-effective and safe for the treatment of childhood brucellosis.

Topics: Administration, Oral; Adolescent; Agglutination Tests; Alanine Transaminase; Aspartate Aminotransferases; Blood Cell Count; Brucellosis; Child; Child, Preschool; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Prospective Studies; Recurrence; Rifampin; Seasons; Trimethoprim, Sulfamethoxazole Drug Combination

This report describes the results of six antimicrobial regimens used for the treatment of brucellosis in an open, randomized study performed over two periods (1980-1983 and 1984-1987). In the first period, rifampicin and doxycycline were used for 4 weeks, trimethoprim-sulfamethoxazole for 6 months, and doxycycline for 6 weeks. During the second period, we used streptomycin for 2 or 3 weeks together with doxycycline for 6 weeks and rifampicin with doxycycline for 6 weeks. Comparison of the results showed the following: (1) no statistically significant findings were revealed when the different regimens were compared and (2) the regimens containing streptomycin yielded statistically more favorable results than those consisting of rifampicin and monotherapy when the patients treated with rifampicin were compared with those taking streptomycin and those receiving single-agent therapy. No significant differences were observed between monotherapeutic regimens and those including rifampicin.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Brucellosis; Clinical Protocols; Doxycycline; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prospective Studies; Rifampin; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination

To compare the effectiveness of doxycycline-rifampin (DR) combination therapy with that of the classic doxycycline-streptomycin (DS) combination in patients with brucellosis.. A randomized, double-blind study, with a mean follow-up of 15.7 months.. A 1000-bed teaching hospital in Barcelona, Spain.. Ninety-five patients (68 men and 27 women; mean age, 39 years) diagnosed with brucellosis on the basis of both clinical and serologic findings; 81 of these patients had blood cultures positive for Brucella melitensis.. Forty-four patients received doxycycline, 100 mg every 12 hours, and rifampin, 15 mg/kg body weight per day in a single morning dose, for 45 days; 51 patients received the same dose of doxycycline for 45 days plus streptomycin, 1 g/d for 15 days.. Therapeutic failure and relapse during the follow-up period.. The mean time to defervescence was 4.2 days for the DR group and 3.2 days for the DS group (P greater than 0.2). The actuarial probability of therapeutic failure or relapse at 12 months of follow-up (Kaplan-Meier) was 14.4% in the DR group and 5.9% in the DS group (difference, 8.5%; 95% Cl, -4.8% to 21.6%; P greater than 0.2). All three patients with spondylitis in the DR group failed therapy compared with one of four patients in the DS group. Excluding patients with spondylitis, the actuarial failure rate was 4.9% and 4.3% in the DR and DS groups, respectively, at 12 months of follow-up (difference, 0.6%; Cl, -8.1% to 9.4%; P greater than 0.2).. Doxycycline-rifampin combination therapy for 45 days is as effective as the classic DS combination in most patients with brucellosis; however, DR therapy might be less effective in those patients with spondylitis.

Topics: Adolescent; Adult; Aged; Brucellosis; Child; Double-Blind Method; Doxycycline; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Middle Aged; Probability; Recurrence; Rifampin; Spondylitis; Streptomycin

Comparison and evaluation of the efficacy and safety of two treatment schedules in human brucellosis.. A comparative, randomized, multicentric, open study of 45 days doxycycline plus rifampin in the initial 21 days (group A) versus 45 doxycycline plus streptomycin in the initial 14 days (group B). 42 were included in each group. The diagnosis of brucellosis was based on blood culture or consistent clinical findings and a Wright's serum agglutination titer of 1/160 or greater. Clinical and laboratory monitoring was carried out, including blood cultures on the days 7 and 48 and after 3, 6, and 12 months.. 38 patients in each group were evaluable at the end of treatment. 3 group A patients and 1 group B patient had initial therapeutic failure. 31 group A patients and 35 group B patients could be followed up during 6 months or more (mean follow up of 10.5 and 11.5 months, respectively). 9 relapses (29%) developed in group A and 2 (6%) in group B (p less than 0.05). 22 patients of the 34 finally evaluated in group A (65%) were considered as cured, versus 33 of the 36 in group B (92%) (p less than 0.01). Side effects not requiring withdrawal of the treatment developed in 12 patients, without differences between the two groups.. In the therapy of human brucellosis, the association of doxycycline (45 days) and rifampin (21 days) is less effective than the classical association of doxycycline and streptomycin.

Topics: Adolescent; Adult; Aged; Brucella abortus; Brucellosis; Child; Doxycycline; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Prospective Studies; Recurrence; Remission Induction; Rifampin; Streptomycin; Time Factors

A randomized prospective, pilot study was performed to compare the efficacy of oral ciprofloxacin (750 mg or 1000 mg bd) with standard oral antimicrobial therapy (rifampicin plus doxycycline) in the treatment of acute infection with Brucella melitensis. All antimicrobial drugs were administered for 42 days. Although all patients responded rapidly, five of the six patients receiving ciprofloxacin relapsed following cessation of therapy. There were no relapses among the patients who received doxycycline/rifampicin. Despite its in-vitro activity against B. melitensis (MIC 0.5 mg/l), ciprofloxacin, administered twice daily, does not appear to constitute adequate therapy for acute brucellosis.

Topics: Acute Disease; Adolescent; Adult; Brucellosis; Ciprofloxacin; Doxycycline; Female; Humans; Male; Middle Aged; Pilot Projects; Prospective Studies; Random Allocation; Recurrence; Rifampin

A 6-year multicenter therapeutic study was performed on 1100 children with brucellosis in order to compare several antibiotic combinations and duration of treatment. The patients were randomized to receive oral therapy with oxytetracycline, doxycycline, rifampin and trimethoprim-sulfamethoxazole (TMP/SMX) either alone or in combination with each other or combined with streptomycin or gentamicin injections. The patients were also randomized into three groups based on the duration of oral therapy: 500 patients were treated for 3 weeks; 350 for 5 weeks; and 250 for 8 weeks. When intramuscular aminoglycosides were used, streptomycin was given for 2 weeks and gentamicin for 5 days. In oral monotherapy oxytetracycline, doxycycline and rifampin showed comparable results with low relapse rates (less than or equal to 9%) and no statistically significant differences were found among 3-, 5- or 8-week durations of therapy. TMP/SMX alone showed an unacceptably high relapse rate (30%) with all durations of therapy. In combined oral therapy rifampin plus oxytetracycline, rifampin plus TMP/SMX and oxytetracycline plus TMP/SMX showed comparable results with low relapse rates ranging from 4 to 8% in patients receiving therapy for 3 or 5 weeks, no relapses occurred in patients treated for 8 weeks. When oral monotherapy was combined with either streptomycin or gentamicin, very few relapses were seen, irrespective of the duration of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Oral; Adolescent; Brucellosis; Child; Child, Preschool; Doxycycline; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Infant; Infant, Newborn; Male; Multicenter Studies as Topic; Oxytetracycline; Random Allocation; Rifampin; Sulfamethoxazole; Time Factors; Trimethoprim

Effectiveness and therapeutic value of the doxycycline plus streptomycin and doxycycline plus rifampin schedules of treatment of human brucellosis have been assessed by carrying out a prospective study on 111 patients randomly distributed into two groups. Patients in group A were treated with doxycycline plus streptomycin sulphate and those in group B with doxycycline plus rifampin. The temperature of all patients reverted to normal, and 54 patients from group A (91.6%) and 45 from group B (86.5%) achieved total recovery with a single therapeutic cycle. Two therapeutic failures and 3 relapses in group A (8.4%) and 7 relapses in group B (13.46%) were observed. The tolerance to both regimens was good. Although the combination doxycycline plus rifampin offers a more convenient oral administration, in the light of these results, until more extensive research is carried out, it should be considered as an alternative rather than a first choice in the treatment of human brucellosis.

Topics: Adult; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Fluorescent Antibody Technique; Humans; Immunoglobulins; Male; Rifampin; Streptomycin

The present study was undertaken to evaluate efficacy, safety and patient acceptability of three antibiotic regimens for the treatment of acute brucellosis. Six different centres were involved: three in France, one in Greece and two in Spain. The regimens were: oral rifampicin 900 mg/day plus oral doxycycline 200 mg/day for 45 days (A), oral doxycycline 200 mg/day for 45 days plus im streptomycin 1 g/day for 21 days (regimen B) [corrected] and the WHO regimen (C) combining oral tetracycline 2 g/day for 21 days plus im streptomycin, 1 g/day, for 14 days. Regimens A and B were randomly allocated in all centres, while regimen C was allocated only in two centres. All patients were suffering from acute brucellosis clinically and biologically proven. 143 patients were allocated for treatment and analysed. Their mean age was 41 years (range 13-70), 49 were female and 94 male, and their mean weight was 64 kg (range 35-98). Among these patients, 14% had localized disease (nine orchitis, eight osteo-articular involvement and one pleural effusion), but there was no statistical difference between the three regimens in regard to this localized disease. Forty-five per cent of the patients had positive blood cultures. The cure rate with regimen A was 95%, 96% with regimen B and 59% with regimen C. Thus regimen A presented the same efficacy rate as regimen B, but regimen C cannot be regarded as the treatment of choice for acute brucellosis.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Body Temperature; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Humans; Male; Rifampin; Streptomycin; Tetracycline

Topics: Brucellosis; Clinical Trials as Topic; Doxycycline; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Prospective Studies; Random Allocation; Rifampin; Streptomycin

In an attempt to compare the efficacy of rifampin-doxycycline with tetracycline-streptomycin for the treatment of human brucellosis, we administered both combinations for a 30-day period, similar to the period recommended by the World Health Organization in a prospective, randomized trial. Forty-six patients were included in the final study (36 men and 10 women); 41 had blood cultures positive for Brucella melitensis. The 28 patients in group A received tetracycline hydrochloride at doses of 0.5 g every 6 h or doxycycline at 100 mg every 12 h for 30 days plus 1 g of streptomycin a day for 21 days. The 18 patients in group B received rifampin at 15 mg/kg per day in a single morning dose plus 100 mg of doxycycline every 12 h for 30 days. For patients with focal disease from both groups, therapy was prolonged to 45 days. All patients underwent rigorous clinical and bacteriological long-term follow-up. There were no therapeutic failures in either group, and the defervescence period was similar for both groups (3.1 days for group A, 2.6 days for group B). Two patients (7.1%) from group A had relapses, as did seven (38.8%) from group B (P = 0.024), and blood cultures again became positive for B. melitensis in all of them. In both groups treatment was generally well tolerated. The results strongly suggest that the rifampin-doxycycline combination is a less efficacious mode of therapy for brucellosis to prevent relapses than is the classical tetracycline-streptomycin combination when both are administered for 30 days. A more prolonged period of administration of the rifampin-doxycycline combination may be required to obtain the same low relapse rate as that achieved with the classical tetracycline-streptomycin treatment.

Topics: Adolescent; Adult; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Recurrence; Rifampin; Streptomycin; Tetracycline

Brucella suis is an emerging, zoonotic disease predominantly affecting dogs and humans that engage in feral pig hunting in Australia and other countries. Although B. suis infection in dogs shares some clinical similarities to the host-adapted species (B. canis), B. suis remains an incompletely understood pathogen in dogs with limited published data on its pathogenesis and clinical features. This case series describes the presentations, diagnosis, and clinical management of B. suis infection in three dogs: (1) a bitch with dystocia, abortion and mastitis; (2) an entire male dog with septic arthritis and presumptive osteomyelitis; and (3) a castrated male dog with lymphadenitis. Unique features of these cases are reported including the first documented detection of B. suis from milk and isolation from lymph nodes of canine patients, as well as the follow-up of pups born to a B. suis-infected bitch. Consistent with previous reports, all three dogs showed a favourable clinical response to combination antibiotic therapy with rifampicin and doxycycline. Individually tailored drug regimens were required based on the clinical presentation and other factors, including owner expectations and compliance with therapy as well as a zoonotic risk assessment (generally considered low, except around time of whelping). The authors include their recommendations for the clinical management of dogs that are at-risk or seropositive for B. suis with or without clinical signs or laboratory-confirmed infection.

Topics: Abortion, Veterinary; Animals; Animals, Wild; Brucella suis; Brucellosis; Dog Diseases; Dogs; Female; Humans; Male; Pregnancy; Rifampin; Sus scrofa; Swine; Swine Diseases

Topics: Adult; Anti-Bacterial Agents; Brucellosis; Doxycycline; Female; Humans; Myocarditis; Pneumonia; Rifampin

Brucellosis is a chronic disease caused by Brucella species with a wide range of hosts, from marine mammals to terrestrial species, but with strict host preferences. With the zoonotic character, the prevalence of human brucellosis cases is a reflection of animal infections. This study aimed to identify 192 Brucella isolates obtained from various sources by Bruce-ladder PCR and to determine their antibiotic susceptibilities by gradient diffusion method (E-test). As a result of the PCR, all human isolates (n = 57) were identified as B. melitensis. While 58 (82.9%) of the cattle isolates were identified as B. abortus, 59 (90.8%) of the sheep isolates were identified as B. melitensis. In addition, 12 (17.1%) of the cattle isolates and 6 (9.2%) of the sheep isolates were determined as B. melitensis and B. abortus, respectively. The primary host change behavior of B. melitensis was 1.9 times higher than that of B. abortus. While gentamicin and ciprofloxacin susceptibilities of Brucella isolates were 100%, tetracycline, doxycycline, streptomycin, trimethoprim/sulfamethoxazole and rifampicin susceptibilities were 99%, 99%, 97.4%, 91.7% and 83.9%, respectively. The lowest sensitivity of the isolates was determined against to cefoperazone as 26%. A triple-drug resistance was detected in 1 B. abortus isolate that included simultaneous resistance to cefoperazone, rifampicin, and trimethoprim/sulfamethoxazole. The high susceptibility profiles we found against to antibiotics such as tetracycline, doxycycline gentamicin and ciprofloxacin, used widely in treatment, are encouraging. However, the change in the canonical Brucella species-primary host preference suggests the need to reconsider eradication program, including updating vaccine formulations.

Topics: Animals; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Cattle; Cefoperazone; Ciprofloxacin; Doxycycline; Gentamicins; Humans; Mammals; Microbial Sensitivity Tests; Rifampin; Sheep; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

The clinical efficacy of perioperative chemotherapy regimen (rifampicin, doxycycline, levofloxacin, ceftriaxone) was evaluated for lumbar brucellosis spondylitis patients with neurological injury.. In Beijing Ditan Hospital affiliated with Capital Medical University, 32 patients with lumbar brucellosis spondylitis underwent surgery and triple perioperative chemotherapy (rifampicin, doxycycline, levofloxacin) between 2011 and 2021 due to neurological injury, and 34 patients matched up with the triple group underwent rifampicin, doxycycline, levofloxacin, and ceftriaxone. Both groups were compared in terms of changes in inflammation index, low back/leg pain, lumbar function, neurological function, and adverse drug reactions.. There was no significant difference in erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), low back pain visual analogue scale (VAS), leg pain VAS, lumbar Oswestry disability index (ODI) and nerve function injury rate between the two groups before chemotherapy (. For lumbar brucellosis spondylitis with neurological injury, quadruple perioperative chemotherapy of rifampicin, doxycycline, levofloxacin and ceftriaxone can significantly reduce perioperative inflammation, and improve low back/leg pain, as well as promoting neurological function recovery in the short term.

Topics: Brucellosis; Ceftriaxone; Doxycycline; Humans; Inflammation; Levofloxacin; Low Back Pain; Lumbar Vertebrae; Retrospective Studies; Rifampin; Spondylitis; Treatment Outcome

We report a case of congenital brucellosis subsequently associated with Klebsiella pneumoniae infection in a Saudi preterm neonate. A girl born with severe respiratory distress was admitted to a neonatal intensive care unit. Laboratory examinations revealed thrombocytopenia and slight leukocytosis. Her mother was a confirmed case of brucellosis. Initial blood culture confirmed the diagnosis of infection, and the baby was treated empirically with rifampicin, gentamicin, and ciprofloxacin. Follow-up revealed that her general condition was gradually improved. On day 27, the baby deteriorated, showing abdominal distension and signs of sepsis and requiring intubation. Rifampicin was replaced by amikacin. A septic workup showed a normal total leukocyte count, with 68.3% neutrophils, decreased platelet count, and increased C-reactive protein level. Blood culture and sensitivity testing reported multidrug-resistant K. pneumoniae susceptible to amikacin and resistance to gentamicin, ciprofloxacin, and beta-lactam antibiotics. The baby remains critically ill, showing a poor treatment response with rapid deterioration, and arrested on day 33. Concomitant bacterial infections might explain signs of sepsis and respiratory distress among neonates with congenital brucellosis. Accurate and early diagnosis, parental history, and adequate treatment are associated with the prognosis of congenital brucellosis and other related bacterial infections.

Topics: Amikacin; Anti-Bacterial Agents; Brucellosis; Ciprofloxacin; Coinfection; Female; Gentamicins; Humans; Infant, Newborn; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Respiratory Distress Syndrome; Rifampin; Sepsis

We report a case of brucellosis-induced severe neutropenia in a 2-year-old girl who presented with a 2-week history of fever. On clinical examination, the patient was febrile with mild aphthous stomatitis. However, her general condition was stable, and systemic examination did not show involvement of any other organ. Laboratory test results revealed severe neutropenia, mild anemia, and an elevated serum C-reactive protein level. Flow cytometry of peripheral blood leukocytes revealed no malignancy, and blood film morphology was unremarkable except for mild microcytosis and hypochromia. Antineutrophil antibody and Coombs test results were negative. We administered intravenous cefuroxime; however, therapy was switched to meropenem plus clarithromycin because fever persisted for 5 days, despite treatment. On the 10th day after admission, Brucella serology tests showed positive results, and trimethoprim-sulfamethoxazole plus rifampicin therapy was prescribed for 8 weeks. The fever defervesced, and the child was discharged in a good state of health. Neutropenia persisted for several months but gradually resolved. Neutropenia, defined as an absolute neutrophil count (ANC) < 1.5 cells × 10 9 /L beyond the first year of life, is a benign transient condition associated with an intercurrent infection (usually viral illnesses or infections) in immunocompetent children. However, severe neutropenia (ANC < 0.5 × 10 9 /L) associated with fever necessitates hospitalization and administration of broad-spectrum antibiotics to avoid the high risk of sepsis, particularly in children. Brucellosis is rarely associated with hematologic abnormalities such as neutropenia. Early diagnosis of hematologic complications of brucellosis is essential for prompt initiation of specific and aggressive treatment.

Topics: Anti-Bacterial Agents; Brucellosis; C-Reactive Protein; Cefuroxime; Child; Child, Preschool; Clarithromycin; Febrile Neutropenia; Female; Fever; Humans; Meropenem; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Brucellosis is an endemic disease in many developing countries and ranked by the World Health Organization among the top seven "neglected zoonoses". Although a Palestinian brucellosis control program was launched in 1998, the disease re-emerged after 2012. Interestingly, a similar re-emerging pattern was reported in the neighbouring Israeli regions. The aim of this work was to characterize the re-emerging strains and delineate their genetic relatedness. During 2015-2017, blood samples from 1324 suspected human cases were analyzed using two serological tests. Seropositive samples were cultured, and their DNAs were analyzed by different genetic markers to determine the involved Brucella species and rule out any possible involvement of the Rev.1 vaccine strain. The rpoB gene was sequenced from nine isolates to screen for rifampicin resistance mutations. Multi locus VNTR analysis (MLVA-16) was used for genotyping the isolates. The molecular analysis showed that all isolates were Brucella melitensis strains unrelated to the Rev.1 vaccine. The rpoB gene sequences showed four single nucleotide variations (SNVs) not associated with rifampicin resistance. MLVA-16 analysis clustered the isolates into 22 unique genotypes that belonged to the East Mediterranean lineage. Altogether, our findings show that the re-emergence of brucellosis was due to B. melitensis strains of local origin, the Palestinian and Israeli control programs' weaknesses could be a major factor behind the re-emergence of the disease. However, other socioeconomic and environmental factors must be investigated. Moreover, strengthening brucellosis control programs and enhancing cooperation between all stakeholders is essential to ensure long-term program outcomes to fight brucellosis.

Topics: Animals; Brucella melitensis; Brucellosis; Genotype; Humans; Israel; Middle East; Minisatellite Repeats; Multilocus Sequence Typing; Rifampin; Seroepidemiologic Studies

The purpose of this study was to determine the clinical value of triple antibiotic therapy consisting of doxycycline, compound sulfamethoxazole and rifampicin in the treatment of brucellosis spondylitis.. A retrospective analysis was performed on 100 patients with brucellosis spondylitis admitted to the First Affiliated Hospital of Hebei North University from March 2016 to June 2019. Patients were divided into the following two groups: the control group (n = 50) treated with dual antibiotic therapy (rifampicin + compound sulfamethoxazole), and the observation group (n = 50) treated with triple antibiotic therapy (rifampicin + doxycycline + compound sulfamethoxazole). The treatment effect, low back pain relief, levels of erythrocyte sedimentation rate (ESR), procalcitonin (PCT) and C-reactive protein (CRP), as well as the adverse reactions were compared between the two groups.. The response rate of the observation group was significantly higher than that of the control group (. The triple antibiotic therapy of doxycycline, compound sulfamethoxazole and rifampicin is effective in the treatment of brucellosis spondylitis. It can significantly alleviate patients' back pain and inflammation with a high safety profile, which is worthy of clinical application.

Topics: Adult; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Humans; Inflammation; Low Back Pain; Male; Retrospective Studies; Rifampin; Spondylitis; Sulfamethoxazole

Brucellosis is a common bacterial zoonotic infection, and greater than half a million new cases are diagnosed annually. This study investigates the expression of Th2 and Th17 immunity-related factors (Th2-LCR lncRNA, IL-25, TRAF3IP2, and IL-17RB) in different stages of. In total, 99 brucellosis patients were divided into three groups (. No significant differences in the expression of these genes were observed between the control group and patients after completion of antibiotic treatment. Compared to these two groups, only Th2-LCR lncRNA and TRAF3IP2 were significantly more highly expressed in the acute group. Th2-LCR lncRNA was also significantly elevated in the relapse group. TRAF3IP2 expression was additionally significantly increased in the acute group compared to the relapse group.. IL-25 and IL-17RB failed to differentiate between the infected and noninfected groups. TRAF3IP2 and Th2-LCR lncRNA might be good indicators of brucellosis during the acute phase, but the expression levels varied strongly among patients. To verify the suitability of these factors as an indicator for brucellosis, acute infection or relapse should be investigated in further studies on larger cohorts with well-defined inclusion criteria.

Topics: Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Doxycycline; Humans; Rifampin; RNA; RNA, Long Noncoding; Th17 Cells; Th2 Cells

Topics: Anti-Bacterial Agents; Bosnia and Herzegovina; Brucellosis; Cheese; Doxycycline; France; Gentamicins; Hepatitis; Humans; Raw Foods; Rifampin; Travel-Related Illness; Treatment Outcome

Brucellosis is a common Zoonosis affecting half a million people annually. The most common mode of infection is by consuming unpasteurized milk or milk products. The general manifestations are those of fever with generalized symptoms. The nervous system is affected in 4-7% of cases. The manifestations are protean and include meningo-encephalitis as well as peripheral nervous system involvement. The diagnosis relies on culture, which is cumbersome and can be falsely negative. Agglutination tests for the various species of the organism are the mainstay for diagnosis. Treatment is for 3-6 months with combination therapy including Doxycycline, Rifampicin and ceftriaxone. The main issue is prevention and better animal husbandry.

Topics: Agglutination Tests; Animals; Brucellosis; Doxycycline; Fever; Rifampin

Brucellosis is a common zoonotic disease worldwide. It has protean clinical manifestation and sometimes may has a life-threatening complication. A 4-year-old boy presented with a history of fever, myalgia and appetite loss for 3 weeks. On examination, he had hepatosplenomegaly. The initial working diagnosis was an infection, autoimmune disease and malignancy. Investigations showed positive

Topics: Animals; Brucellosis; Child; Child, Preschool; Doxycycline; Humans; Lymphohistiocytosis, Hemophagocytic; Male; Rifampin; Zoonoses

Topics: Animals; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Child; China; Female; Goats; Humans; Milk; Raw Foods; Rifampin; Salmonella typhi; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

We present the case of an 18-year-old female with a 1-month history of fever, headache, and double vision, whose examination revealed papilledema and cranial nerve VI palsy. Blood cultures grew Brucella abortus cattle vaccine strain RB51, which is inherently resistant to rifampin. We discuss the management of the first known case of neurobrucellosis by this strain.

Topics: Adolescent; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Brain; Brucella abortus; Brucella Vaccine; Brucellosis; Cattle; Central Nervous System Infections; Female; Humans; Magnetic Resonance Imaging; Neuroimaging; Rifampin

Topics: Adolescent; Anti-Bacterial Agents; Antibiotics, Antitubercular; Back Pain; Brucellosis; Diagnosis, Differential; Doxycycline; Encephalitis, Herpes Simplex; Fever; Humans; Magnetic Resonance Imaging; Male; Rifampin

Brucellosis is a zoonotic infection transmitted from infected animals to humans, osteonecrosis of the femoral head (ONFH) is a devastating disease that affects patients' life with pain, dysfunction of walking and always lead to total hip arthroplasty (THA). We presented a case of ONFH which was very likely due to the infection of Brucella spp.. The patient was a 49 years-old male who was a herder living in Inner Mongolia, the northern part of China. He first showed recurrent fever then presented bilateral hip pain, which was confirmed to be brucellosis and ONFH on the right side of the hip. He was admitted to our center showed bilateral ONFH with the restrictive movement of both hips. We performed THA after it was confirmed that the infection has been cured. The patient can walk with the help of the walker the second day after surgery.. Brucellosis is still a common epidemic disease worldwide, which can lead to many complications, brucellosis arthritis is the most common complication of Brucellosis. Osteonecrosis of the femoral head can also present in the patients with brucellosis. All the patients presented with recurrent fever and hip pain, who is from the epidemic region, should be taken both septic arthritis and ONFH into consideration.

Topics: Anti-Bacterial Agents; Arthroplasty, Replacement, Hip; Brucellosis; China; Doxycycline; Femur Head; Femur Head Necrosis; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Rifampin

Brucellosis is one of the most frequent zoonotic infections. Cardiac involvement is rare and when involved, affects aortic valve the most. The appearance of a new murmur on clinical examination during sepsis should suspect seeding on valves. Our patient had pulmonary valve endocarditis secondary to brucellosis which was managed with pharmacotherapy as there was no valvular pathology. Triple therapy is standard of care and usually given for months, non-response to pharmacological treatment warrants surgical intervention. Our patient completed the triple-drug regimen at 3 months and is asymptomatic at present.

Topics: Adolescent; Anti-Bacterial Agents; Brucella; Brucellosis; Doxycycline; Echocardiography, Transesophageal; Endocarditis, Bacterial; Humans; Male; Pulmonary Valve; Rifampin; Streptomycin

Tuberculosis (TB) can manifest prolonged fever or fever of unknown origin, especially when it is located extrapulmonary. We report a case of disseminated TB complicated by iliac bone osteolysis and a gluteal abscess in a 75-year-old female patient with fever and bone marrow dysplasia. Diagnosis of TB was made despite transient false-positive high-titer agglutination tests and ELISA antibodies to Brucella. The case presented shows that in a highly suggestive case of TB, positive agglutination tests or ELISA antibodies to Brucella should be interpreted with caution, and repeated testing should be performed to assess their persistence and fluctuation over time.

Topics: Aged; Anti-Bacterial Agents; Brucella; Brucellosis; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Female; Fever; Humans; Rifampin; Tuberculosis, Pulmonary

Brucellosis is a zoonotic disease caused by brucella. It has been an increasing trend in recent years (Wang H, Xu WM, Zhu KJ, Zhu SJ, Zhang HF, Wang J, Yang Y, Shao FY, Jiang NM, Tao ZY, Jin HY, Tang Y, Huo LL, Dong F, Li ZJ, Ding H, Liu ZG, Emerg Microbes Infect 9:889-99, 2020). Brucellosis is capable to invade multiple systems throughout the body, lacking in typical clinical manifestations, and easily misdiagnosed and mistreated.. We report a case of a male, 5-year-and-11-month old child without relevant medical history, who was admitted to hospital for 20 days of fever. When admitted to the hospital, we found that he was enervated, irritable and sleepy, accompanied with red eyes phenomenon. After anti-infection treatment with meropenem, no improvement observed. Lumbar puncture revealed normal CSF protein, normal cells, and negative culture. Later, doppler echocardiography suggested coronary aneurysms, and incomplete Kawasaki Disease with coronary aneurysms was proposed. The next day, brucellosis agglutination test was positive. Metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid suggested B.melitensis, which was confirmed again by blood culture. The child was finally diagnosed as brucellosis with meningocephalitis, coronary aneurysm and keratitis. According to our preliminary research and review, such case has never been reported in detail before. After diagnosis confirmation, the child was treated with rifampicin, compound sulfamethoxazole, and ceftriaxone for cocktail anti-infection therapy. Aspirin and dipyridamole were also applied for anticoagulant therapy. After medical treatment, body temperature of the child has reached normal level, eye symptoms alleviated, and mental condition gradually turned normal. Re-examination of the doppler echocardiographic indicated that the coronary aneurysm was aggravated, so warfarin was added for amplification of anticoagulation treatment. At present, 3 months of follow-up, the coronary artery dilatation gradually assuaged, and the condition is continued to alleviate.. Brucellosis can invade nervous system, coronary artery, and cornea. Brucellosis lacks specific signs for clinical diagnosis. The traditional agglutination test and the new mNGS are convenient and effective, which can provide the reference for clinical diagnosis.

Topics: Agglutination Tests; Animals; Anti-Infective Agents; Anticoagulants; Brucella melitensis; Brucellosis; Ceftriaxone; Child, Preschool; Coronary Aneurysm; Diagnostic Errors; Fever; Humans; Keratitis; Male; Meningoencephalitis; Rifampin; Sulfamethoxazole; Treatment Outcome; Zoonoses

Topics: Anti-Bacterial Agents; Antibodies, Bacterial; Brucellosis; Child; Female; Humans; Infant, Newborn; Rifampin; Saudi Arabia

Brucellosis is a zoonotic disease caused by Brucella spp. affecting multiple body systems and may lead to complications. Saudi Arabia is a country where brucellosis is endemic. This study aimed to describe the epidemiological characteristics of uncomplicated brucellosis and to assess outcomes of different antibiotic regimens.. A retrospective cohort study in a Saudi tertiary academic medical center. Adults with confirmed uncomplicated brucellosis between January 2008 and December 2018 who received antibiotics were included. The primary endpoint was clinical cure. Secondary endpoints included all-cause mortality and length of stay.. Fifty-four patients met the inclusion criteria and were included in the study. Twenty five patients received a combination of doxycycline, rifampin, and aminoglycoside (group 1), whereas 29 patients received doxycycline and rifampin (group 2). There was no significant difference between the two groups in clinical cure, all-cause mortality, length of stay, and end of therapy parameters, including temperature, white blood cells count, C-reactive protein levels, and erythrocyte sedimentation rates.. Due to lack of differences in clinical outcomes, mortality, length of stay, and end of therapy parameters between the two groups, a regimen comprising two, rather than three, agents can be sufficient for uncomplicated brucellosis. This finding conforms to previous studies. Therefore, replacing rifampin with an aminoglycoside for its presumed superior efficacy as per the World Health Organization's guidelines is not substantiated by our study. Further studies with a larger sample size are required to confirm these findings.

Topics: Adult; Aged; Aged, 80 and over; Aminoglycosides; Anti-Bacterial Agents; Brucella; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Retrospective Studies; Rifampin; Saudi Arabia; Streptomycin; Tertiary Care Centers; Young Adult

Brucellosis is a rare zoonotic infection caused by small, fastidious Gram-negative coccobacilli of the genus Brucella that may be associated with haemolytic complications including thrombotic microangiopathy and haemolytic anaemia. We describe a patient with culture confirmed brucellosis who presented with malaise, high grade fever, hepatosplenomegaly and Coombs-positive autoimmune haemolytic anaemia. The patient was successfully treated with combination of doxycycline and rifampicin with no further episodes of relapses or haemolysis. Although rare, the possibility of brucellosis should always be kept in mind in patients with risk factors who present with haemolysis and endemic area.

Topics: Adult; Anemia, Hemolytic, Autoimmune; Anti-Bacterial Agents; Brucellosis; Doxycycline; Female; Humans; Rifampin; Ultrasonography

To determine the frequency of therapeutic failure among patients with acute and subacute brucellosis and to explore the predictors of failure.. The study included 213 consecutive, naïve patients with acute and subacute brucellosis. All participants underwent clinical evaluation, chest radiography, stool microscopic examination and interferon-gamma release assay. Patients received the WHO-recommended therapy of doxycycline 200 mg/day and rifampin 900 mg/day, for 6 weeks.. Mean age of the study population was 39.8 ± 12.2 years; 64.8% of them were males. The therapeutic failure rate was 16.4%. Adverse effects were reported by 13.1%. Multivariate analysis of factors associated with therapeutic failure revealed latent tuberculosis infection (LTBI) (OR 3.1, 95% CI, 1.9-24.6, P: 0.009), ascariasis (OR 2.6, 95% CI 1.5-17.9, P: 0.012), and the use of acid suppressive therapy (OR 2.1, 95% CI 1.2-19.5, P: 0.037) as the predictors of therapeutic failure.. The prevalence of therapeutic failure among the Egyptian patients with acute/subacute brucellosis is increasing. Predictors of therapeutic failure are LTBI, ascariasis, and the use of acid suppressive therapy.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Ascariasis; Brucellosis; Doxycycline; Drug Therapy, Combination; Egypt; Female; Humans; Latent Tuberculosis; Male; Middle Aged; Multivariate Analysis; Prognosis; Prospective Studies; Rifampin; Treatment Failure; Young Adult

New therapies are needed to treat chronic bacterial diseases and intracellular pathogens, in particular, are very difficult to manage. The use of nanotherapeutics represents an approach to exploit size and charge of biological membranes to overcome barriers for treatment of intracellular pathogens including Brucella melitensis. In this work, polyanhydride nanoparticles comprised of copolymers of sebacic acid, 1,6-bis(p-carboxyphenoxy)hexane, and 1,8-bis(p-carboxyphenoxy)-3,6-dioxaoctane were synthesized to encapsulate antimicrobial compounds doxycycline and rifampicin. The nanoparticles demonstrated sustained release of rifampicin for a week with the antimicrobial activity peaking at 72 h and lasting up to a week. Treatment of B. melitensis infected macrophages with rifampicin-containing nanoparticles rapidly eliminated viable intracellular bacteria following 48 h of treatment and pretreatment with the nano-formulations prevented intracellular infection in contrast to soluble drug controls. Treatment of infected BALB/c mice with a nanoparticle cocktail containing doxycycline and rifampicin for five days decreased bacterial burden by three log

Topics: Animals; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Delayed-Action Preparations; Doxycycline; Drug Delivery Systems; Drug Liberation; Female; Mice; Mice, Inbred BALB C; Nanomedicine; Nanoparticles; RAW 264.7 Cells; Rifampin

Brucellosis is a systemic infectious disease frequently associated with osteoarticular involvement. While sacroiliitis is a common manifestation of brucellosis, septic osteoarthritis is less frequent. Here, we report two cases of septic osteoarthritis caused by Brucella melitensis.. Both patients had a history of contact with goats before admission. Upon clinical examination, they showed marked pain and limited movement in the hip. Imaging findings revealed obvious osteonecrosis of the right femoral head. Inflammatory markers, including erythrocyte sedimentation rate and C-reactive protein level, were elevated. The tube agglutination test results of both patients were positive (1:160 and 1:200). Real-time polymerase chain reaction analysis of synovial fluid revealed the presence of B. melitensis. We deduced that septic osteoarthritis could explain these clinical and radiological findings. Both patients were followed-up for 12 months. They returned to their normal routine after completing a standard antibiotic regimen, including doxycycline (100 mg, daily) and rifampicin (600 mg), for 6 weeks.. Brucellar hip arthritis is a serious clinical manifestation of brucellosis, presenting mainly as marked joint pain and limited mobility. It is characterized by joint effusion, synovitis, and soft-tissue swelling on magnetic resonance images. Physicians should consider brucellosis as one of the differential diagnoses of arthritis.

Topics: Adult; Animals; Anti-Bacterial Agents; Blood Sedimentation; Brucella melitensis; Brucellosis; Diagnosis, Differential; DNA, Bacterial; Doxycycline; Goats; Hip; Humans; Magnetic Resonance Imaging; Male; Osteoarthritis, Hip; Polymerase Chain Reaction; Rifampin; Synovitis

Because of its infrequent and the lack of clinical data and image finding, the management of acute infections with the hepatosplenic brucella abscesses is challenging.. There were 10 serologically diagnosed cases with this brucella infection. All patients had fever, 50% patients had upper abdominal pain. Ninety percent patients lived in an urban environment. The localization of lesions included: 30% hepatosplenic, 30% liver, and 40% spleen.. Abdominal computed tomography (CT) scans and magnetic resonance imaging (MRI) demonstrated hepatosplenomegaly, with multiple small abscess lesions of various sizes in the acute stage of brucellosis, with the largest diameter of 1.5 cm in the liver. After contrast-enhanced CT and MRI findings, the arterial phase in which the enhancing area of lesions was thick, revealed multifocal hypodense or hypointense lesions of various sizes. These lesions manifested distinct boundary, which was intensified obviously in portal venous phase.. Our results indicate that early CT or MRI dynamic contrast enhancement of suspected cases could improve rapid diagnosis. However, diagnostic criteria remain problematic and diagnosis is mostly based on a combination of clinical suspicion, serologic markers, and radiologic findings.

Topics: Adolescent; Aged; Brucellosis; China; Doxycycline; Female; Humans; Liver Abscess; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Retrospective Studies; Rifampin; Splenomegaly; Tomography, X-Ray Computed; Treatment Outcome

To explore how to diagnose and treat brucellosis accurately and timely in patients with fever of unkown origin in non-pastoral areas. The epidemiological history, clinical symptoms, complete blood counts, procalcitonin and treatment efficacy of 7 patients with brucellosis were analyzed retrospectively. Some characteristic manifestations should be differentiated from tuberculosis. The clinical symptoms were relieved after combination of doxycycline, rifampicin, levofloxacin and amikacin for 6 weeks, only one patient with bone destruction needed orthopedic surgery. The overall response rate was 6/7. No relapse occurred during half year follow-up.. 探讨非牧区"发热待查"患者中如何准确和迅速诊治布鲁菌病。对7例布鲁菌病患者的流行病学史、临床表现、血常规及降钙素原进行回顾性分析,发现有一定特征性改变，但需要与结核感染相鉴别。7例布鲁菌病患者经多西环素、利福平、左氧氟沙星、阿米卡星2~4种药物联合治疗6周，临床症状缓解，有1例患者有骨质破坏未愈，需要外科手术治疗，总有效率为6/7，所有患者治疗后半年随访均无复发。.

Topics: Acute Disease; Amikacin; Anti-Bacterial Agents; Brucellosis; Doxycycline; Drug Therapy, Combination; Humans; Levofloxacin; Procalcitonin; Retrospective Studies; Rifampin; Treatment Outcome

The purpose of this study is to summarize the manifestations, diagnosis, differential diagnosis, and treatment of childhood brucellosis in non-epidemic areas of China. A retrospective review of 16 admitted children patients with brucella's disease who were diagnosed of brucellosis during the period from 2011 to 2016 was performed. Diagnostic criteria, clinical presentations, and outcomes were recorded. The most common symptom was fever. Osteoarticular involvement was found in 50% of the patients. They were infected by contacting with infected animals or consuming of unpasteurized milk or meat of sheep or goats, also. Standard agglutination test was positive in all patients and blood culture in 10 (62.5%) patients as well as medulloculture in 3 (18.8%) patients were positive. A combination of antibiotic treatment with rifampin plus cotrimoxazole showed good response and all clinical manifestations improved. Brucellosis is misdiagnosed frequently and should be considered in the differential diagnosis when patients do not respond to standard treatment. Blood culture, together with brucella serology test, is important and helpful in the diagnosis. MRI is a good method in differentiating those with symptoms of arthritis.

Topics: Adolescent; Agglutination Tests; Anti-Bacterial Agents; Brucellosis; Child; Child, Preschool; China; Diagnosis, Differential; Female; Fever; Humans; Infant; Male; Retrospective Studies; Rifampin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Brucellosis is an endemic disease in the Inner Mongolia Autonomous Region of China and Ulanqab exhibits the highest prevalence of brucellosis in this region. Due to the complex nature of Brucellosis, a cure for this disease has proven to be elusive. Furthermore, the reduced susceptibility of Brucella spp. to antimicrobial agents has been reported as a potential cause of therapeutic failure. However, detailed in vitro antimicrobial susceptibility patterns pertaining to Brucella isolates from this region have not yet been published. The aim of this study was to evaluate the antibiotic susceptibility profile of Brucella melitensis clinical isolates from Ulanqab, Inner Mongolia, China.. A total of 85 B. melitesis isolates were obtained from humans in Ulanqab of Inner Mongolia, China; the antimicrobial susceptibility of 85 clinical isolates to nine antibiotics was assessed using the E-test method according to the CLSI (Clinical and Laboratory Standards Institute) guidelines.. All of the tested isolates were susceptible to minocycline, sparfloxacin, doxycycline, tetracycline, ciprofloxacin, gentamicin and levofloxacin. Resistance to rifampin and cotrimoxazole was observed in 1.0% (1/85) and 7.0% (6/85) of the isolates, respectively. However, rpoB gene mutations were not observed in single isolates exhibiting resistance to rifampin.. We observed that B. melitensis isolates are susceptible to the majority of the tested antibiotics. Furthermore, minocycline and sparfloxacin exhibited extremely high bactericidal effects in relation to the B. melitensis isolates. The sensitivity of commonly used drugs for the treatment of brucellosis should be regularly monitored. To the best of our knowledge, this is the first report of rifampin and cotrimoxazole resistant isolates of B. melitensis in China. In summary, based on the findings from this study, we suggest that antibiotic administration and use should be rationalized to prevent future drug resistance.

Topics: Anti-Bacterial Agents; Brucella melitensis; Brucellosis; China; Drug Resistance, Bacterial; Humans; Microbial Sensitivity Tests; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Brucellosis is a worldwide zoonotic disease caused by Brucella spp. Brucella invades the body through the skin mucosa, digestive tract, and respiratory tract. However, only a few studies on human spontaneous abortion attributable to Brucella have been reported. In this work, the patient living in Shanxi Province in China who had suffered a spontaneous abortion was underwent pathogen detection and Brucella melitensis biovar 3 was identified.. The patient in this study was 22 years old. On July 16, 2015, she was admitted to Shanxi Grand Hospital, Shanxi Province, China because of one day of vaginal bleeding and three days of abdominal distension accompanied by fever after five months of amenorrhea. A serum tube agglutination test for brucellosis and blood culture were positive. At the time of discharge, she was prescribed oral doxycycline (100 mg/dose, twice a day) and rifampicin (600 mg/dose, once daily) for 6 weeks as recommended by the World Health Organization (WHO). No recurrence was observed during the six months of follow-up after the cessation of antibiotic treatment.. This is the first reported case of miscarriage resulting from Brucella melitensis biovar 3 isolated from a pregnant woman who was infected through unpasteurized milk in China. Brucellosis infection was overlooked in the Maternity Hospital because of physician unawareness. Early recognition and prompt treatment of brucellosis infection are crucial for a successful outcome in pregnancy.

Topics: Abortion, Spontaneous; Animals; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; China; Doxycycline; Female; Humans; Pregnancy; Rifampin; Treatment Outcome; Young Adult

Brucellosis can lead to haematological abnormalities including cytopenia confusing with haematological malignancies. The aim of this study was to compare the main characteristics of brucellosis patients without cytopenia (Group 1) and with cytopenia (Group 2).. This five-year period study which was performed in two referral hospitals in Turkey, included all adult brucellosis patients. Abnormally, low counts of leucocyte or haemoglobin or platelets in a patient were considered as cytopenia. The demographics, clinical, laboratory, treatment and outcome data were analyzed.. A total of 484 brucellosis patients were enrolled. Among the cases, 162 (33.5%) of them had cytopenia. One hundred and four (21.5%) had anaemia, 88 (18.8%) had thrombocytopenia, 71 (14.6%) had leucopenia and 28 (5.8%) had pancytopenia. The mean age of group 2 was 35.01±16.05 yr and it was 33.31±14.39 yr in group 1. While there was no difference between the groups in terms of duration of treatment, the median length of hospital stay (LOS) was significantly longer in group 2 (9 vs 10 days; P<0.001). The most frequently applied combination therapy consisted of doxycycline plus rifampicin and doxycycline plus streptomycin regimens. No significant difference was observed in terms of duration of treatment, LOS and restoration time of cytopenia between the patients who received either of these combinations.. Our findings suggested that the patients with cytopenia should be investigated for brucellosis, especially if living in, or with a history of travel to, endemic areas, in view of the increase in world travel.

Topics: Adult; Anemia; Brucellosis; Doxycycline; Female; Hematologic Neoplasms; Humans; Male; Middle Aged; Pancytopenia; Rifampin; Streptomycin; Thrombocytopenia; Turkey

Brucellosis is a rarely encountered infection in Norway. The aim of this study was to explore all Brucella melitensis isolates collected in Norway from 1999 to 2016 in relation to origin of infection and antimicrobial resistance patterns. A total of 23 isolates were analysed by whole-genome sequencing and compared with selected sequences of B. melitensis available from NCBI. Additionally, SNP analysis in antibiotic resistance determining genes was performed. The majority belonged to the East Mediterranean clade (genotype II), while the remaining isolates belonged to the African clade (genotype III). These results indicate that human brucellosis in Norway is related to travels or migration from the Middle East, Asia or Africa, in accordance with results from Germany, Denmark and Sweden. Antibiotic susceptibility patterns were determined by broth microdilution method and/or gradient strip method. All isolates were susceptible for all tested antibiotics, except for rifampicin where phenotypical results indicated resistance or intermediate resistance in all isolates based on broth microdilution method, and in four isolates based on gradient strip testing. In contrast, screening of the rpoB gene did not reveal any mutations in the previously described rpoB "hot spot" regions related to rifampicin resistance, indicating overestimation of resistance based on phenotypical results.

Topics: Brucella melitensis; Brucellosis; Drug Resistance, Bacterial; Female; Humans; Male; Microbial Sensitivity Tests; Norway; Polymorphism, Single Nucleotide; Rifampin; Whole Genome Sequencing

Hemophagocyticlymphohistocytosis (HLH) is a proliferation of histiocytes with importanthemophagocytosisoccurring in different organs such as the spleen and the bone marrow. HLH is now increasingly diagnosed in the context of infections, malignancies and connective tissue diseases. Although brucellosis is an endemic infection in Tunisia, its association with HLH is a very rare condition which should be considered in patients with splenomegaly and cytopenia. Here, we describe brucellosis associated HLH in a 31 year-old man. The patient was admitted to our hospital with fever, sweating, and fatigue. Physical and laboratory findings revealed splenomegaly, pancytopenia, elevated serum transaminases, triglycerides, lactate dehydrogenase, and ferritin, and bone marrow hemophagocytosis. The Brucella agglutination test was positive. The patient improved after treatment with Rifampin and doxycyclin.

Topics: Adult; Anti-Bacterial Agents; Brucellosis; Doxycycline; Humans; Lymphohistiocytosis, Hemophagocytic; Male; Remission Induction; Rifampin; Treatment Outcome

Rifampicin has been widely used due to its broad antibacterial spectrum. Acute haemolysis is a rarely encountered complication of rifampicin. A 58-year-old woman was admitted to our department because of high-grade fever with rigors, accompanied by abdominal and lumbar pain and laboratory evidence of acute haemolysis. She had been treated for brucellosis initially with doxycycline and streptomycin. Due to subsequent appearance of myositis, ciprofloxacin and rifampicin were added for treatment of localised brucellosis. After intravenous administration of rifampicin, the patient deteriorated significantly. After exclusion of other causes of haemolysis, autoimmune haemolytic anaemia related to rifampicin was established by strongly positive direct Coombs test. Drug withdrawal in conjunction with intravenous immune globulin and prednisolone resulted in resolution of haemolysis and no relapse in the ensuing 1-year period. Our case highlights the importance of recognising commonly administrative drugs as cause of haemolytic anaemia, that can often be life threatening.

Topics: Abdominal Pain; Anemia, Hemolytic, Autoimmune; Anti-Bacterial Agents; Brucellosis; Chills; Female; Fever; Humans; Immunoglobulins, Intravenous; Middle Aged; Prednisolone; Rifampin; Treatment Outcome

An infant aged 6 weeks presented with failure to thrive since birth, fever and lethargy for 4 days. The child was fed on unpasteurised diluted goat's milk after birth. She was diagnosed to have brucellosis both by blood culture and serology. Her mother's Brucella serology was negative. She was successfully treated with injection amikacin and tablet rifampicin and had satisfactory weight gain thereafter. Acquired brucellosis should be considered in the differential diagnosis of failure to thrive in young infants.

Topics: Amikacin; Animals; Anti-Bacterial Agents; Bacteremia; Brucellosis; Female; Goats; Humans; Infant; Milk; Rifampin; Treatment Outcome

This study aims to analyze the clinical characteristics and treatment outcomes of 590 patients with brucellosis in Xinjiang, China.. The clinical characteristics, laboratory findings, complications and prognosis of 590 patients infected with brucellosis were retrospectively analyzed. These patients had a mean age of 44.24 ± 15.83 years with 60.5% having a history of close contacting with cattle and sheep. Of them, 53.6% (316 /590) were in acute phase and 21.5% were in chronic phase. Agglutination test showed 98.5% positive with 34% blood culture positive of Brucella. The major symptoms were fatigue (91%), hyperhidrosis(88.1%), fever(86.9%), and joint pain(81%) with 29.8% having enlarged liver, 26.1% having enlarged spleen and 23.2% having osteoarticular complications. Combination of doxycycline plus rifampicin for 12 weeks was an effective regimen for patients without complications. The 3-drug regimen (doxycycline+rifampicin+levofloxacin) for 12 weeks was recommended for these with complications. There were 6 patients died (1.02%) with overall relapse rate of 5.98%.. Brucellosis is mostly associated with contacting with domestic animal production in Xinjiang, China. Clinical symptoms include fever, fatigue, hyperhidrosis, and joint pain with common complication of osteoarticular involvement. Three-drug-regimen of doxycycline+rifampicin+levofloxacin for 12 weeks was effective for these patients with complications.

Topics: Adolescent; Adult; Aged; Animals; Animals, Domestic; Anti-Bacterial Agents; Arthralgia; Brucella; Brucellosis; Child; Child, Preschool; China; Doxycycline; Drug Therapy, Combination; Female; Fever; Hepatomegaly; Humans; Levofloxacin; Male; Middle Aged; Retrospective Studies; Rifampin; Splenomegaly; Treatment Outcome; Young Adult

The spleen is known as an important filter for blood-borne pathogens that are trapped by specialized macrophages in the marginal zone (MZ): the CD209

Topics: Animals; Anti-Bacterial Agents; B-Lymphocytes; Brucella abortus; Brucella melitensis; Brucella suis; Brucellosis; Chemokine CCL19; Chemokine CCL21; Chemokine CXCL13; Chronic Disease; Gene Expression Regulation; Host-Pathogen Interactions; Interferon gamma Receptor; Interferon-gamma; Macrophages; Mice; Mice, Inbred C57BL; Mice, Knockout; Receptors, Interferon; Receptors, Tumor Necrosis Factor, Type I; Rifampin; RNA, Messenger; Signal Transduction; Spleen; Streptomycin; T-Lymphocytes

Brucellosis is a zoonosis caused by Brucella spp. It may be acquired by consuming unpasteurized dairy products. Brucellosis has a low incidence in Chile, thus, we have a scarce data.. To report and to characterize the first series of clinical cases of adult patients diagnosed with brucellosis in Chile.. We describe a series of 13 clinical cases in patients diagnosed between 2000 and 2016 in three different centers in the Metropolitan Region, Chile. A retrospective analysis was performed on clinical presentation, laboratory, antibiotic treatment, morbidity and mortality.. The mean age was 50 years old. Eight cases had a record of consumption of unpasteurized dairy products. The most frequently reported complaints were fever. The most frequent focal point involved was the spine. Only one patient had a positive blood culture, while the diagnosis was made using serological techniques in the other part of the group. The most indicated antibiotic regimens were doxycycline-rifampicin and doxycycline-gentamicin. The hospital stay was 20 days approximately as an average. Clinical cure was achieved in all cases.. Brucellosis is an infrequent zoonosis in Chile, and it produces a nonspecific clinical picture, so it is necessary to have high suspicion to make the diagnosis based in the antecedent of consumption of unpasteurized dairy or raw meat.

Topics: Adult; Aged; Brucellosis; Chile; Dairy Products; Doxycycline; Drug Therapy, Combination; Female; Gentamicins; Humans; Length of Stay; Male; Middle Aged; Retrospective Studies; Rifampin; Urban Population; Young Adult

Kazakhstan belongs to countries with a high level of brucellosis among humans and farm animals. Although antibiotic therapy is the main way to treat acute brucellosis in humans there is still little information on a circulation of the antibiotic-resistant. Susceptibilities to tetracyclin, gentamycin, doxycyclin, streptomycin and rifampicin were investigated in 329 clinical isolates of. All isolates were susceptible to streptomycin, tetracycline and doxycycline. 97.3% of the Brucella isolates were susceptible to gentamycin, although only 37.4% of isolates were susceptible to rifampicin. 21.9% of isolates had intermediate resistance, and 26.4% of isolates were resistant to this antibacterial drug.. Isolates of

Topics: Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Doxycycline; Drug Resistance, Multiple, Bacterial; Gentamicins; Humans; Kazakhstan; Microbial Sensitivity Tests; Rifampin; Streptomycin; Tetracycline

Brucellosis is highly endemic in Turkey and doxycycline is commonly used for its treatment. The present study aimed at documenting the cutaneous side effects of doxycycline in pediatric brucellosis patients in Turkey.. Pediatric patients with brucellosis that were treated between February 2014 and January 2016 were analyzed retrospectively, and those that developed doxycycline-related cutaneous side effects were identified. Demographic data, epidemiological history, physical examination findings, laboratory test results, anti-brucellosis treatment regimen, duration of follow up and outcome were recorded.. Among the 189 brucellosis patients, 141 treated with doxycycline plus rifampicin. Seven patients (5%) (two female and five male) developed doxycycline-related cutaneous side effects. Mean duration of treatment before the onset of cutaneous side effects was 9.5 weeks. Doxycycline therapy was continued in five of these patients and was changed in two patients. In the patients that continued to receive doxycycline the cutaneous side effects gradually improved.. Cutaneous side effects of doxycycline should always be a consideration, especially in regions in which brucellosis is endemic and doxycycline is commonly used to treat it.

Topics: Adolescent; Anti-Bacterial Agents; Brucellosis; Child; Child, Preschool; Doxycycline; Drug Therapy, Combination; Endemic Diseases; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Male; Retrospective Studies; Rifampin; Skin; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey

Brucellosis caused by Brucella suis is a notifiable disease that has recently emerged in dogs in New South Wales (NSW). Given the potential for zoonotic transmission, euthanasia of affected dogs is recommended, but this action is not mandatory. We report the clinical management of three dogs that underwent treatment at their owners' request.. A 14-month-old spayed female crossbreed originally obtained from an urban animal shelter underwent extensive investigations in 2011-12 for lameness and back pain, culminating in decompressive laminectomy. Diagnosis of multifocal discospondylitis and spinal empyema was made, with B. suis cultured from surgical biopsy specimens. The dog responded to long-term treatment using rifampicin and doxycycline. A second case of B. suis infection was diagnosed in January 2016 in a 3-year-old crossbreed pig-hunting dog with unilateral testicular enlargement. Following serological diagnosis the dog was given preliminary therapy using rifampicin and doxycycline, the affected testis was resected and the patient given a further month of combination therapy. In March 2016 a 7-year-old crossbreed pig-hunting dog with brucellosis was handled similarly, although both testes were removed.. Brucellosis should be considered in the differential diagnosis of back pain, discospondylitis, lameness, abortion, prostatic abscessation and testicular/epididymal enlargement in dogs, especially if there is exposure to feral pigs or consumption of uncooked feral pig meat. Euthanasia is the only guarantee of reducing the public health risk to zero. However, where treatment is desired by the owner, combination therapy using rifampicin and doxycycline appears to be effective, when combined with surgical resection of infected tissues. Further monitoring of dogs during and after treatment is required to document cure.

Topics: Animals; Anti-Bacterial Agents; Antibiotics, Antitubercular; Brucella suis; Brucellosis; Diagnosis, Differential; Dog Diseases; Dogs; Doxycycline; Female; Lameness, Animal; Male; New South Wales; Public Health; Rifampin; Swine; Testis

This study aimed to identify a follow-up modality that can be used to evaluate therapeutic responses in patients receiving treatment for brucellar sacroillitis and to determine whether antibiotherapy can be stopped.. A total of 32 patients with sacroiliac joint involvement demonstrated via magnetic resonance imaging or bone scintigraphy were followed up and treated. Patients received 200 mg/day of doxycycline and 600-900 mg/day of rifampicin for 3-21 months, and 1 g/day of streptomycin for 21 days.. The mean age of the 32 patients involved was 21.81±4.09. In total, 10/32 patients did not complete therapy, and the remaining 22 patients received combination antibiotic treatment for a mean of 8.95±4.34 months. Of the 22 patients, 15 underwent MRI, and 7 of them did not consent to MRI. Similarly, 17 patients were followed up by bone scintigraphy, and 5 patients did not have scintigraphy results. In 9/17 patients followed up with bone scintigraphy, sacroiliitis findings were found to reduce after a mean of 7.44±3.71 months, whereas in 12/15 patients on whom MRI was performed,  there were no active sacroiliitis findings for a mean of 6.95±2.83 months.. While active involvement findings in bone scintigraphy were observed for a longer period in scintigraphy images, active sacroiliitis findings disappeared in a relatively shorter period of time with MRI. Therefore, we have demonstrated that high-resolution MRI is a very sensitive technique compared to scintigraphy.

Topics: Adult; Anti-Bacterial Agents; Brucellosis; Doxycycline; Drug Monitoring; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Radionuclide Imaging; Retrospective Studies; Rifampin; Sacroiliitis; Streptomycin; Young Adult

We present a 51-year-old male patient with Brucella abortus septic arthritis in the right knee following arthroscopic meniscus surgery. He had eaten a traditional dish of raw minced cattle conceptus (bovine fetus) that was prepared after the cow was slaughtered. Despite treatment with empirical antibiotics and debridement of the postoperative surgical wound, the infection persisted without improvement. Polymerase chain reaction sequencing identified Brucella abortus from tissue samples obtained from the patient. After confirmation of the diagnosis of brucellar infection, antibiotics were replaced with doxycycline and rifampin, which were used for 4 months. In patients with a non-specific arthralgia who eat raw meat or live close to animals, it is important to consider the possibility of septic arthritis due to infection with Brucella spp.

Topics: Arthritis, Infectious; Arthroscopy; Brucella abortus; Brucellosis; Doxycycline; Humans; Knee; Magnetic Resonance Imaging; Male; Meniscus; Middle Aged; Rifampin

Topics: Adult; Anti-Bacterial Agents; Bacterial Proteins; Brucella melitensis; Brucellosis; Doxycycline; Humans; Magnetic Resonance Imaging; Male; Phylogeny; Polymerase Chain Reaction; Republic of Korea; Rifampin; Sequence Analysis, DNA; Spondylitis

Topics: Administration, Oral; Arteries; Arthralgia; Bacteremia; Brucella melitensis; Brucellosis; Child; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Femoral Fractures; Fractures, Open; Gentamicins; Germany; Hip; Humans; Infusions, Intravenous; Knee; Male; Postoperative Complications; Refugees; Rifampin; Syria; Thigh; Ultrasonography; Veins

A teenage woman migrating from Syria arrived in May 2015 in Germany. She gave birth to a healthy child in early 2016, but became febrile shortly after delivery. Blood cultures revealed Brucella melitensis. In retrospect, she reported contact with sheep in Syria and recurrent pain in the hip joints over about five months before diagnosis of brucellosis. We discuss consequences for adequate treatment of mother and child as well as for clinical and laboratory management.

Topics: Administration, Oral; Adolescent; Animals; Anti-Bacterial Agents; Antibiotics, Antitubercular; Brucella melitensis; Brucellosis; Doxycycline; Drug Combinations; Emigration and Immigration; Germany; Humans; Refugees; Rifampin; Sheep; Sheep Diseases; Syria; Treatment Outcome; Zoonoses

Brucellosis is a common zoonotic disease with worldwide distribution and protean clinical manifestations. Therefore, its prompt and timely diagnosis is still challenging. Among several complications of brucellosis, spontaneous bacterial peritonitis (SBP) in previously healthy participants is rarely recognised, although this condition can be fatal if misdiagnosed and untreated. We present a case of a 69-year-old previously healthy stockbreeder who suffered from back pain along with abdominal pain and distension because of ascites of 6-8 weeks duration. Cultures of ascitic fluid and peripheral blood specimens revealed Brucella spp as the causative agent of ascites and spondylodiscitis, which was then confirmed by MRI findings. After appropriate treatment for 4.5 months (streptomycin 1 g/day for 3 weeks intramuscularly, doxycycline 100 mg twice a day orally and rifampicin 900 mg/day orally), the patient fully recovered. Conclusively, in the appropriate epidemiological and clinical setting, the consideration of brucellosis in the differential diagnosis of SBP could be rational as well as life-saving.

Topics: Abdominal Pain; Aged; Animal Husbandry; Anti-Bacterial Agents; Ascites; Back Pain; Brucella; Brucellosis; Doxycycline; Humans; Male; Peritonitis; Rifampin; Streptomycin; Treatment Outcome

Brucellosis is one of the most common zoonotic disease affecting humans and animals and is endemic in many parts of the world including the Gulf Cooperation Council region (GCC). The aim of this study was to identify the species and determine the antimicrobial susceptibility pattern of Brucella strains isolated from clinical specimens, from Qatar.. We evaluated 231 Brucella isolates. All isolates were identified as B. melitensis. All the isolates were susceptible to doxycycline, tetracycline, streptomycin, gentamicin, trimethoprim / sulfamethoxazole and ciprofloxacin except rifampicin, where 48 % of the strains showed elevated MICs (>1 mg/L). The rifampicin-resistance related hotspots within the rpoB gene were amplified and sequenced using PCR and no rpoB mutations were found in strains with rifampicin MICs of >2 mg/L.. This study identified B. melitensis as the etiological agent of brucellosis in Qatar. No resistant isolates were detected among conventionally used antimicrobial agents.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Brucella melitensis; Brucellosis; Doxycycline; Drug Resistance, Bacterial; Gentamicins; Humans; In Vitro Techniques; Microbial Sensitivity Tests; Qatar; Rifampin; Tetracycline

Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome of excessive inflammation and tissue destruction due to abnormal immune activation and inflammation. HLH can occur primarily due to genetic etiology, or secondarily associated with malignancies, autoimmmune diseases or infections. There are a number of reports that revealed the relationship of hemophagocytosis with brucellosis. In this report, we described a brucellosis-related HLH case. A 73-year-old male who work as farmer was admitted to our hospital with the complaints of fever continuing for 10 days, loss of appetite and back pain. Physical examination revealed right upper quadrant tenderness and hepatomegaly. Since the patient exhibited five of the diagnostic criteria for HLH (fever, hepatosplenomegaly, bicytopenia, hypertriglyceridemia and high ferritin level), he was diagnosed as secondary HLH. PCR, microscopic agglutination and indirect fluorescent antibody tests gave negative results for the diagnosis of Crimean-Congo hemorrhagic fever, leptospirosis and Q fever, respectively. On the other hand, Rose Bengal test for brucellosis was positive, while standard tube agglutination test (STA) was negative. The patient's serum yielded a very high positive (1/1280) result when Coombs' test was performed in terms of the possibility of blocking antibodies or prozone phenomenon. Additionally, B.melitensis was isolated from his blood culture on the sixth day. The patient was treated with doxycycline and rifampicin, and on the 10th day of antibiotic therapy the patient was discharged and recommended to complete his treatment up to 6 weeks. In conclusion, in patients with secondary HLH symptoms especially in the endemic areas, brucellosis should be considered as a predisposing infection.

Topics: Aged; Agricultural Workers' Diseases; Anti-Bacterial Agents; Bacteremia; Brucella melitensis; Brucellosis; Causality; Coombs Test; Doxycycline; Humans; Lymphohistiocytosis, Hemophagocytic; Male; Rifampin

This study aimed to determine the susceptibility profile of Brazilian Brucella abortus isolates from cattle to eight antimicrobial agents that are recommended for the treatment of human brucellosis and to correlate the susceptibility patterns with origin, biotype and MLVA16-genotype of the strains. Screening of 147 B. abortus strains showed 100% sensitivity to doxycycline and ofloxacin, one (0.68%) strain resistant to ciprofloxacin, two strains (1.36%) resistant to streptomycin, two strains (1.36%) resistant to trimethoprim-sulfamethoxazole and five strains (3.40%) resistant to gentamicin. For rifampicin, three strains (2.04%) were resistant and 54 strains (36.73%) showed reduced sensitivity. Two strains were considered multidrug resistant. In conclusion, the majority of B. abortus strains isolated from cattle in Brazil were sensitive to the antimicrobials commonly used for the treatment of human brucellosis; however, a considerable proportion of strains showed reduced susceptibility to rifampicin and two strains were considered multidrug resistant. Moreover, there was no correlation among the drug susceptibility pattern, origin, biotype and MLVA16-genotypes of these strains.

Topics: Animals; Anti-Bacterial Agents; Bacterial Typing Techniques; Brazil; Brucella abortus; Brucellosis; Cattle; Ciprofloxacin; DNA, Bacterial; Doxycycline; Drug Resistance, Multiple, Bacterial; Genotype; Gentamicins; Rifampin; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination

Brucella is among the most common zoonotic diseases affecting humans. Although musculoskeletal involvement is seen in a large proportion of patients, the disease is often diagnosed late or misdiagnosed due to its subtle nature and rarity, and lack of awareness among clinicians. In this report, a 12-year-old girl was diagnosed with acute septic arthritis of the hip based on clinico-radiological features, and managed with standard treatment, including arthrotomy. However, the child did not respond to the treatment. Based on the histopathology and local endemicity, Brucella was suspected, and confirmed after serological testing. The child subsequently responded to treatment and, at latest follow-up at 1 year, had a full painless range of motion, with no relapse.

Topics: Acute Disease; Anti-Bacterial Agents; Arthritis, Infectious; Brucella melitensis; Brucellosis; Child; Doxycycline; Female; Femur; Gentamicins; Hip Joint; Humans; Osteomyelitis; Radiography; Rifampin

Osteoarticular involvement is the most frequently observed complication of brucellosis. Brucellosis tenosynovitis of the extensor tendon sheath is an extremely rare manifestation of musculoskeletal brucellosis. A 36-year-old male patient presented with described pain in his right wrist that had started six days earlier. There was also a diffuse swelling in the first finger of his right hand. The patient described fever, night sweats, widespread muscle pain and fatigue that had been going on for the last six days. Standard tube agglutination for Brucella was positive at a titre of 1/320. At diagnosis, the patient showed radiographic abnormalities. Doxycycline 200 mg/d and rifampicin 600 mg/d were given for six weeks. Complete resolution was achieved with medical treatment.

Topics: Adult; Anti-Bacterial Agents; Arm; Brucella; Brucellosis; Doxycycline; Drug Therapy, Combination; Humans; Male; Rifampin; Tenosynovitis; Treatment Outcome

Although Brucella spondylitis and Brucella discitis have been frequently reported, Brucella infection of the vertebral arch is rare and has not been previously described. We present the first case of Brucella infection of the thoracic vertebral arch with epidural abscess formation and discuss the clinical key points.. A 57-year-old man of Han nationality with a history of contact with an isolated sheep stomach 2 months previously was admitted with an undulant fever, night sweats, back pain, and weakness. Thoracic magnetic resonance imaging showed laminar destruction of T9 and an epidural abscess at the T9 to 10 level with significant cord compression. Diagnosis of Brucella infection of his vertebral arch was confirmed by a positive blood culture with growth of Brucella melitensis. Total laminectomy, abscess cleansing, and percutaneous pedicular screw fixation was performed initially, followed by antibiotic treatment with a combination of doxycycline and rifampin for 4 months. Recovery was confirmed by clinical, magnetic resonance imaging, and blood culture findings.. This is an unusual case of Brucella infection of the vertebral arch with epidural abscess formation. Effective antibiotic therapy of a sufficient duration and timely performance of surgical treatment are the key points in management of such cases.

Topics: Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Discitis; Doxycycline; Epidural Abscess; Humans; Laminectomy; Magnetic Resonance Imaging; Male; Middle Aged; Rifampin; Thoracic Vertebrae; Tomography, X-Ray Computed

Pulmonary involvement is a rare complication of brucellosis. We describe the largest series to date, to our knowledge, of patients with pulmonary brucellosis.. This 10-year, retrospective, descriptive study involved 27 centers in Turkey, including all patients with brucellosis with confirmed respiratory system involvement.. Of 133 patients (67 men), 123 (92.5%) had acute infection (defined as < 2 months), with an overall mean ± SD duration of symptoms of 33.9 ± 8.5 days. The radiologic pattern of pulmonary disease was consolidation/lobar pneumonia in 91 patients (68.4%) and pleural effusion in 41 patients (30.8%), including 30 (22.5%) with both. Moreover, 23 patients (17.3%) had bronchitis (one with coexistent pneumonia), and 10 (7.5%) had nodular lung lesions (one with coexistent pneumonia and effusion). Blood culture results were positive in 56 of 119 patients, and all other cases were serologically confirmed. None of 60 sputum specimens and two of 19 pleural fluid samples (10.5%) yielded positive culture results for brucellosis. Other features of brucellosis, such as osteoarticular complications, were detected in 61 patients (45.9%); 59 (44.4%) had raised liver transaminase levels, and 59 (44.4%) had thrombocytopenia. Fifteen patients (11.3%) required management in an ICU for an average of 3.8 ± 2.2 days. All patients responded to standard combination antimicrobial therapy for brucellosis with no deaths, although treatment regimens required modification in seven patients.. Brucellosis with pulmonary involvement is rare but has a good prognosis following treatment with appropriate antibiotics. Many clues in the exposure history, presenting clinical features, and baseline blood tests should alert the clinician to consider brucellosis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bronchitis; Brucellosis; Ceftriaxone; Doxycycline; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Pleural Effusion; Pneumonia; Prognosis; Retrospective Studies; Rifampin; Streptomycin; Turkey; Young Adult

We evaluated the efficacy and tolerability of antibiotic regimens and optimal duration of therapy in complicated and uncomplicated forms of spinal brucellosis. This is a multicentre, retrospective and comparative study involving a total of 293 patients with spinal brucellosis from 19 health institutions. Comparison of complicated and uncomplicated spinal brucellosis was statistically analysed. Complicated spinal brucellosis was diagnosed in 78 (26.6%) of our patients. Clinical presentation was found to be significantly more acute, with fever and weight loss, in patients in the complicated group. They had significantly higher leukocyte and platelet counts, erythrocyte sedimentation rates and C-reactive protein levels, and lower haemoglobulin levels. The involvement of the thoracic spine was significantly more frequent in complicated cases. Spondylodiscitis was complicated, with paravertebral abscess in 38 (13.0%), prevertebral abscess in 13 (4.4%), epidural abscess in 30 (10.2%), psoas abscess in 10 (3.4%) and radiculitis in 8 (2.7%) patients. The five major combination regimens were: doxycycline 200 mg/day, rifampicin 600 mg/day and streptomycin 1 g/day; doxycycline 200 mg/day, rifampicin 600 mg/day and gentamicin 5 mg/kg; doxycycline 200 mg/day and rifampicin 600 mg/day; doxycycline 200 mg/day and streptomycin 1 g/day; and doxycycline 200 mg/day, rifampicin 600 mg/day and ciprofloxacin 1 g/day. There were no significant therapeutic differences between these antibiotic groups; the results were similar regarding the complicated and uncomplicated groups. Patients were mostly treated with doxycycline and rifampicin with or without an aminoglycoside. In the former subgroup, complicated cases received antibiotics for a longer duration than uncomplicated cases. Early recognition of complicated cases is critical in preventing devastating complications. Antimicrobial treatment should be prolonged in complicated spinal brucellosis in particular.

Topics: Abscess; Adolescent; Adult; Aged; Aged, 80 and over; Aminoglycosides; Anti-Bacterial Agents; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Retrospective Studies; Rifampin; Spondylitis; Treatment Outcome; Young Adult

Brucellosis is the most common bacterial zoonosis, and causes a considerable burden of disease in endemic countries. Cardiovascular involvement is the main cause of mortality due to infection with Brucella spp, and most commonly manifests as endocarditis, peripheral and cerebrovascular aneurysms, or arterial and venous thromboses. We report a case of brucellosis presenting as bacteraemia and aortic endarteritis 18 years after the last known exposure to risk factors for brucella infection. The patient was treated with doxycycline, rifampicin, and gentamicin, and underwent surgical repair of a penetrating aortic ulcer, with a good clinical recovery. We review the signs and symptoms, diagnostic approach, prognosis, and treatment of brucella arteritis. We draw attention to the absence of consensus about the optimum therapy for vascular brucellosis, and the urgent need for additional studies and renewed scientific interest in this major pathogen.

Topics: Abattoirs; Aged; Animals; Anti-Bacterial Agents; Aortic Diseases; Bacteremia; Blood Vessel Prosthesis; Brucella abortus; Brucellosis; Doxycycline; Ecuador; Endarteritis; Endocarditis, Bacterial; Gentamicins; Humans; Male; Occupational Exposure; Prognosis; Rifampin; Ulcer

Topics: Adult; Anti-Bacterial Agents; Brucellosis; Humans; Immunosuppressive Agents; Liver Transplantation; Male; Rifampin; Tacrolimus; Trimethoprim, Sulfamethoxazole Drug Combination

Involvement of the renal parenchyma in the acute phase of brucellosis is very rare. Only two cases of renal brucelloma have been reported in the English language literature to date. We report a case of renal abscess caused by Brucella in the acute phase. A 45-year-old Chinese man presented with a high fever, urine occult blood, and a low density lesion in the right kidney. Ultrasound-guided aspiration was done. Brucella melitensis was isolated from both blood and puncture fluid culture. Minocycline combined with moxifloxacin was prescribed for 4 months. The infection relapsed at 6 months after discontinuation. Minocycline combined with rifampin was administered for another 2 months. The brucellosis had not relapsed at more than 20 months later. It is possible to cure renal brucelloma with antibiotics and ultrasound-guided aspiration. Treatment should not be discontinued until the abscess has disappeared and two consecutive blood cultures taken 1 month apart are negative.

Topics: Abscess; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Drug Therapy, Combination; Fluoroquinolones; Humans; Kidney Diseases; Male; Middle Aged; Minocycline; Moxifloxacin; Rifampin

The effects of doxycycline-streptomycin-rifampin versus a standard doxycycline-streptomycin regimen on residual Brucella DNA were compared in 36 acute brucellosis patients. At admission, all patients given triple (n = 22) and double (n = 14) regimens had detectable Brucella DNA with similar mean loads (P = 0.982). At follow-up, 14 to 20 months postpresentation, significantly more patients receiving triple than double regimens had undetectable Brucella DNA (P = 0.026). The doxycycline-streptomycin-rifampin regimen eliminates Brucella DNA more efficiently than doxycycline-streptomycin, which may result in superior long-term clearance of Brucella.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Load; Brucella melitensis; Brucellosis; DNA, Bacterial; Doxycycline; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Prospective Studies; Rifampin; Streptomycin

Topics: Anti-Bacterial Agents; Brucellosis; Diagnosis, Differential; Doxycycline; Endosonography; Humans; Lower Urinary Tract Symptoms; Male; Middle Aged; Organ Size; Prostate; Prostatic Neoplasms; Prostatitis; Rifampin; Treatment Outcome

The aim of this study was to assess in vitro antimicrobial susceptibility of Brucella melitensis isolates isolated from naturally infected sheep cases in an area where human brucellosis is endemic, focusing on rifampin (RIF), streptomycin (SM), ciprofloxacin (CPFX), trimethoprim/sulfamethoxazole (TMP/SMZ), gentamicin (GM) and tetracycline (TC) and on 11 other antimicrobials. The identification and typing of Brucella isolates were carried out using standard classification tests and polymerase chain reaction (PCR) methods. Antimicrobial susceptibility testing was carried out on Mueller-Hilton agar. The resistance to SM, CPFX and GM was determined at the rate of 7.3% and to RIF at the rate of 9.7%. The highest (46.3%) resistance was determined against TMP/SMZ. All strains were found to be sensitive to TC at the rate of 100.0%. In conclusion, ovine origin B. melitensis strains evaluated in this study were resistant to at least one antimicrobial (51.2%) that is commonly used in human clinical medicine against brucellosis.

Topics: Animals; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Ciprofloxacin; DNA Primers; Gentamicins; Humans; Microbial Sensitivity Tests; Polymerase Chain Reaction; Rifampin; Sheep; Sheep Diseases; Streptomycin; Sulfamethoxazole; Tetracycline; Trimethoprim; Turkey

We present a 23-year-old woman who was admitted due to fever, palpitation, musculoskeletal pain and a transient bout of sudden-onset left-sided hemiparesis. She had also myopericarditis according to echocardiography findings. After comprehensive diagnostic work-up for infectious and immunologic disorders, brucellosis was confirmed by bone marrow aspiration culture. She received doxycycline, rifampin and trimethoprim-sulfamethoxazole for 3 months. The treatment was continued with doxycycline and rifampin for another 6 months. By the end of treatment, she recovered completely with no evidence of persistent neurological or cardiac complications.

Topics: Adult; Anti-Bacterial Agents; Brucellosis; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Female; Humans; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Infective Agents; Antitubercular Agents; Brucellosis; Child; Female; Humans; Immunocompromised Host; Liver Transplantation; Opportunistic Infections; Postoperative Complications; Recurrence; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

To determine brucellosis's epidemiologic, laboratory, diagnostic and public health features considering brucellosis is endemic in Azna County, western Iran.. This descriptive cross-sectional study was investigated on 43 patients with brucellosis in Azna County. The subjects were the patients with symptoms correspondent with brucellosis and positive Wright and 2ME tests. A questionnaire about demographic, epidemiological and laboratory findings was filled in. Afterwards, patients were treated using usual antimicrobial drugs regimen. The collected data were analyzed by SPSS software version 16.. Forty-three subjects were found to be positive in laboratory tests. Incidence of Brucellosis was 59.31 per hundred thousand population. About 34.9% of patients were female and 65.1% male. Nearly 95.2 % of human cases were living in rural and 4.8 % in urban areas. Around 20.9% of patients had history of animal contact. The commonest transmission was unpasteurized dairy products (79.1%). The most contagious seasons were summer and spring (60.3%). The most common age group was 15-24 (27.9%), and about 60.5% of the patients were between 15-44 years old. Disease was more common among housewives (30.2%) and farmers (20.9%). The majority of the patients had Wright test titre=1:320 (54.1%) and 2ME test titre=1:160 (56.1%) in serological titration. Doxycycline with Rifampin was used for treatment of the greatest of patients (60.4%).. In order to control this zoonotic disease, close cooperation of health and veterinary organizations is necessary.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Brucellosis; Child; Child, Preschool; Cross-Sectional Studies; Dairy Products; Female; Humans; Incidence; Infant; Iran; Male; Middle Aged; Rifampin; Rural Population; Seasons; Sex Factors; Socioeconomic Factors; Young Adult

Brucellosis is considered a known widespread zoonotic disease and is endemic in Mediterranean region, like Iran. This study reviewed the clinical manifestations, laboratory findings, and therapeutic regimen in childhood brucellosis in Iran. In this retrospective study, we reviewed hospital-records of 34 consecutive children with a confirmed diagnosis of brucellosis among a total number of 10,864 patients admitted to Children's Medical Center, Tehran, Iran, between 2002 and 2010. Among the patients diagnosed with brucellosis, 22 (65%) were admitted during spring and summer. Clinical findings of these patients at admission were arthritis, splenomegaly, hepatomegaly, lymphadenopathy, maculopapular skin rashes, and fever. Anaemia (53%) and leukopenia (33%) were the most common findings in the children. Only one patient had presented with leukocytosis. Four children (12%) were thrombocytopenic, and none of patients had pancytopenia. Blood cultures were positive in 5 patients (23%). Only one patient underwent bone-marrow aspiration and had positive culture for Brucella spp. Positive titres were found in 33 cases (97%) in Wright test, 23 cases (96%) in Coombs test, and 16 patients (72.7%) in 2ME (2-Mercaptoethanol) test. In one case, Wright and Coombs test titres were below 1:80 while Brucella spp. were isolated from blood at the same time. It is concluded, prolonged fever with joint involvement and organomegaly may increase possibility of infection with Brucella spp. Appropriate treatment regimen by more tolerable oral drugs, with a duration of at least 8 weeks, is recommended.

Topics: Adolescent; Anti-Infective Agents; Arthritis; Brucellosis; Child; Child, Hospitalized; Child, Preschool; Doxycycline; Drug Therapy, Combination; Exanthema; Female; Fever; Hepatomegaly; Humans; Iran; Laboratories; Lymphatic Diseases; Male; Referral and Consultation; Retrospective Studies; Rifampin; Splenomegaly; Sulfamethoxazole; Trimethoprim

A 15-year-old girl, who was evaluated for arthralgia of knees, was diagnosed as having brucellosis by serum agglutination and enzyme linked immunosorbent assay tests. Physical examination of the patient revealed massive hepatomegaly. Abdominal ultrasonography and computerised tomography showed a single large cystic lesion of the liver. The echinococcus indirect haemagglutination was positive at a titre of 1/1280. A giant hydatid cyst was removed with surgical intervention; in addition, she was treated with albendazole and antibrucellosis drug combination with success. Here, an immunocompetent adolescent case with brucellosis and concomitant hydatid cyst disease was reported to emphasise that the coexistence of both entities are infrequent but may occur due to increased prevalence of the diseases.

Topics: Adolescent; Albendazole; Anti-Bacterial Agents; Anticestodal Agents; Brucellosis; Doxycycline; Drug Therapy, Combination; Echinococcosis, Hepatic; Female; Humans; Rifampin; Tomography, X-Ray Computed

We report the first known Australian case of probable neurobrucellosis, in a young feral-pig shooter who presented with episodic left-sided visual loss and left-sided numbness and headache. Treatment with intravenous ceftriaxone and oral rifampicin, doxycycline and trimethoprim–sulfamethoxazole resulted in a good clinical response.

Topics: Adult; Agglutination Tests; Agricultural Workers' Diseases; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Australia; Brucella; Brucellosis; Ceftriaxone; Central Nervous System Bacterial Infections; Doxycycline; Drug Therapy, Combination; Headache; Humans; Hypesthesia; Male; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination; Vision Disorders

Brucellosis is an important cause of spondylodiscitis in endemic areas. Brucellar spondylodiscitis is a serious complication because of its association with abscess formation. Prospective studies comparing patients with and without abscesses are lacking. The objective of this study was to determine the frequency and demographic, clinical, laboratory, and radiological features of brucellar spondylodiscitis and to compare patients with and without abscesses regarding treatment and outcome. Out of 135 consecutive patients with brucellosis, 31 patients with spondylodiscitis were recruited for the study. Patients were grouped according to magnetic resonance imaging findings. The frequency of spondylodiscitis was 23.0 %. Sites of involvement were lumbar (58.1 %), lumbosacral (22.6 %), cervical (9.7 %), thoracolumbar (6.5 %), and thoracic (3.2 %). Abscesses occurred in 19 (61.3 %) patients and were associated with low hemoglobin levels. Medical treatment included a combination of streptomycin (for the first 3 weeks), doxycycline, and rifampin. The total duration of treatment was 12-39 (mean 17.0 ± 8.5 SD) weeks. By 12 weeks of treatment, evidence of clinical improvement (67 vs. 28 %) and radiological regression (92 vs. 50 %) was significantly greater in patients without abscesses. The duration of treatment was longer if an abscess was present. Two female patients with abscesses required surgical intervention. Both patients presented with high fever, neurologic deficit, and high Brucella standard tube agglutination test titers. Each patient should be evaluated individually, based on clinical findings, laboratory data, and radiological results, when undergoing treatment for brucellar spondylodiscitis. If abscesses are found, a longer course of treatment and even surgical intervention may be needed.

Topics: Abscess; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Brucellosis; Discitis; Doxycycline; Drug Therapy, Combination; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Rifampin; Streptomycin; Treatment Outcome

Topics: Animals; Anti-Bacterial Agents; Brucellosis; Doxycycline; Drug Therapy, Combination; Endemic Diseases; Eye Infections, Bacterial; Humans; Retinal Hemorrhage; Rifampin; Streptomycin; Uveitis; Zoonoses

The demographical, clinical, and therapeutical features of patients with brucellar spondylodiscitis (BS) were evaluated in this study. Of the 96 patients with brucellosis, 20 (20.8%) were diagnosed with spondylodiscitis. Patients who had BS were more likely to be older (p = 0.001), have higher erythrocyte sedimentation rates (p = 0.01), and more likely to be anemic (p = 0.017). Lumbar segment (18/20) was frequently involved region. BS was complicated with paravertebral or epidural abscess in seven, radiculitis in six, and psoas abscess in five of cases. Antibiotic regimens including two or three antibiotics with combination of doxycycline, rifampin, and streptomycin were used. In this series, the mean duration of antimicrobial therapy was 18 weeks (range 12-56 weeks). Attention is drawn to this disease given the need for prolonged duration of treatment especially in complicated cases in order to avoid possible sequelae.

Topics: Adult; Age Factors; Aged; Anti-Bacterial Agents; Brucellosis; Discitis; Doxycycline; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Rifampin; Streptomycin; Treatment Outcome

A 49-year-old man with a medical history of polycystic kidney disease was presented to the emergency department with fever and left flank pain. Abdominal examination revealed an enlarged and painful left kidney. The C-reactive protein level was significantly high and the magnetic resonance imaging revealed areas of abnormal intensity and fluid-fluid levels in renal cysts. Brucella abortus was yielded from both blood and cyst fluid culture. Standard therapy (rifampicin plus doxycycline) of brucellosis was started, but the clinical and laboratory signs subsided after the addition of ciprofloxacin. There was no need for aspiration of infected cyst fluid. Hereby, according to the medical database search, we report that the first renal cyst infection caused by B. abortus was successfully treated with triple antibiotic therapy.

Topics: Brucella abortus; Brucellosis; Ciprofloxacin; Doxycycline; Drug Therapy, Combination; Emergency Service, Hospital; Flank Pain; Follow-Up Studies; Humans; Infusions, Intravenous; Magnetic Resonance Imaging; Middle Aged; Polycystic Kidney Diseases; Rifampin; Treatment Outcome

A 27-year-old man, recent visitor to the Middle East, presented with 6-week history of fever (up to 102°F) followed by altered behavior and left hemiparesis. CSF was acellular with raised protein (138 mg/dL). CSF bacterial culture was sterile; adenosine deaminase normal (3 U/L); cryptococcal antigen, Venereal Disease Research Laboratory test, and Japanese B serology were negative. HIV serology and vasculitic workup were unremarkable. Serum Brucella agglutination titer was 320 IU (immunoglobulin M fraction 280 IU). Cranial MRI showed nonenhancing bilateral white matter and basal ganglia hyperintensities on T2-weighted images (figure, A-C). The patient was treated with IV ceftriaxone (1 month) along with oral doxycycline and rifampicin (4 months). At 3 months, Brucella agglutination titer was <20 IU and the patient became independent. Follow-up imaging showed a reduction in lesions (figure, D). Brucellosis frequently presents as chronic meningitis along with cranial neuropathies and spinal arachnoiditis.(1) Demyelinating lesions are described in neurobrucellosis,(1,2) involvement of the deep gray matter being unusual.

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Basal Ganglia; Brain; Brucellosis; Ceftriaxone; Doxycycline; Humans; Magnetic Resonance Imaging; Male; Rifampin

The aim of the present study was to assess the antimicrobial susceptibility of Brucella melitensis isolates to rifampicin (RIF) depending on time and regional differences. A total of 94 human Brucella isolates collected in an 8-year period from the beginning of 2002 to the end of 2009 throughout Turkey were investigated. The isolates were identified at species and biovar levels by conventional methods, and minimum inhibitory concentrations (MIC) of RIF was determined by using the E test method. All isolates were identified as B. melitensis (93 isolates, biovar 3; 1, biovar 1), and MIC(50) and MIC(90) values of RIF were 1 and 1.5 μg/ml, respectively (MIC range, 0.25-1.5 μg/ml). All isolates were sensitive to RIF except 2 isolates, which had intermediate susceptibility to RIF. These findings indicated that B. melitensis biovar 3 may be the most frequently agent responsible for human brucellosis in Turkey. None of the isolates in our region was resistant to RIF.

Topics: Antibiotics, Antitubercular; Bacterial Typing Techniques; Brucella melitensis; Brucellosis; Drug Resistance, Bacterial; Geography; Humans; Microbial Sensitivity Tests; Rifampin; Turkey

To describe the clinical presentations, laboratory findings, prevalence and pattern of complications and the response to treatment of brucellosis in a 12-year period in a Turkish research hospital.. Between 1996 and 2008, 231 patients were diagnosed with brucellosis and treated in our clinic. Medical records of 189 of the 231 patients with at least one demonstrable complication of the disease were reviewed for anamnesis, diagnosis, complications, treatment and clinical outcomes.. The decreasing order of the complications was: hematological, 104 (55%); osteoarticular, 70 (37%); hepatobiliary, 59 (31%), and gastrointestinal, 23 (12%). The most common laboratory findings were anemia, lymphomonocytosis, elevated sedimentation rate and C-reactive protein, and elevated aminotransaminases.. The hematological, osteoarticular and hepatobiliary manifestations were predominant. Bursitis, synovitis, glomerulonephritis, cutaneous lesion and deep vein thrombosis were the rare complications observed in our study. In clinical practice, brucellosis should be considered in the differential diagnosis in the presence of infrequent complications.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Blood Sedimentation; Brucellosis; C-Reactive Protein; Diagnosis, Differential; Doxycycline; Female; Gastrointestinal Diseases; Hematologic Diseases; Humans; Joint Diseases; Male; Middle Aged; Prevalence; Retrospective Studies; Rifampin; Streptomycin; Time Factors; Turkey; Young Adult

No data on whether brucellar meningitis or meningoencephalitis can be treated with oral antibiotics or whether an intravenous extended-spectrum cephalosporin, namely, ceftriaxone, which does not accumulate in phagocytes, should be added to the regimen exist in the literature. The aim of a study conducted in Istanbul, Turkey, was to compare the efficacy and tolerability of ceftriaxone-based antibiotic treatment regimens with those of an oral treatment protocol in patients with these conditions. This retrospective study enrolled 215 adult patients in 28 health care institutions from four different countries. The first protocol (P1) comprised ceftriaxone, rifampin, and doxycycline. The second protocol (P2) consisted of trimethoprim-sulfamethoxazole, rifampin, and doxycycline. In the third protocol (P3), the patients started with P1 and transferred to P2 when ceftriaxone was stopped. The treatment period was shorter with the regimens which included ceftriaxone (4.40 ± 2.47 months in P1, 6.52 ± 4.15 months in P2, and 5.18 ± 2.27 months in P3) (P = 0.002). In seven patients, therapy was modified due to antibiotic side effects. When these cases were excluded, therapeutic failure did not differ significantly between ceftriaxone-based regimens (n = 5/166, 3.0%) and the oral therapy (n = 4/42, 9.5%) (P = 0.084). The efficacy of the ceftriaxone-based regimens was found to be better (n = 6/166 [3.6%] versus n = 6/42 [14.3%]; P = 0.017) when a composite negative outcome (CNO; relapse plus therapeutic failure) was considered. Accordingly, CNO was greatest in P2 (14.3%, n = 6/42) compared to P1 (2.6%, n = 3/117) and P3 (6.1%, n = 3/49) (P = 0.020). Seemingly, ceftriaxone-based regimens are more successful and require shorter therapy than the oral treatment protocol.

Topics: Administration, Oral; Adolescent; Adult; Aged; Anti-Bacterial Agents; Brucella; Brucellosis; Ceftriaxone; Doxycycline; Drug Therapy, Combination; Female; Humans; Injections, Intravenous; Male; Meningitis; Meningoencephalitis; Middle Aged; Recurrence; Retrospective Studies; Rifampin; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey

Brucellosis is an endemic disease in Turkey, and testicular abscess is a rare and frequently misdiagnosed complication of brucellosis. In the literature there are only seven reported cases, and all were treated with both medical and surgical therapy. We report a case of brucellar testicular abscess treated with medical therapy only. Although the patient recovered clinically at the end of 6 weeks, the regression of the testicular lesion could not be observed until after 5 months.

Topics: Abscess; Adult; Anti-Bacterial Agents; Brucellosis; Doxycycline; Epididymitis; Humans; Male; Orchitis; Rifampin; Testicular Diseases; Turkey

Brucellosis is a zoonotic infectious disease that is common around the world. Its clinical course demonstrates great diversity as it can affect all organs and systems. However, the central nervous system is rarely affected in the pediatric population. Neurobrucellosis is most frequently observed with meningitis and has numerous complications, including meningocephalitis, myelitis, cranial nerve paralyses, radiculopathy, and neuropathy. Neurobrucellosis affects the second, third, sixth, seventh, and eighth cranial nerves. Involvement of the oculomotor nerves is a very rare complication in neurobrucellosis although several adult cases have been reported. In this article, we present the case of a 9-year-old girl who developed unilateral nerve paralysis as a secondary complication of neurobrucellosis and recovered without sequel after treatment. This case is notable because it is a very rare, the first within the pediatric population. Our article emphasizes that neurobrucellosis should be considered among the distinguishing diagnoses in every case that is admitted for nerve paralysis in regions where Brucella infection is endemic.

Topics: Anti-Bacterial Agents; Brucella; Brucellosis; Ceftriaxone; Central Nervous System Bacterial Infections; Child; Drug Therapy, Combination; Female; Humans; Oculomotor Nerve Diseases; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Brucellosis is considered the most widespread zoonosis in the world. It has been reported that the prevalence of seropositivity among the Turkish population varies from 3% to 14%. We present a case of brucellosis after pediatric liver transplantation. A 15-year-old boy with the diagnosis of neuro Wilson's disease underwent deceased-donor liver transplantation. The postoperative immunosuppressive protocol consisted of steroids and tacrolimus. Two months after the operation the patient experienced fever to 40°C. The patient complained of poor appetite, headache, and diarrhea. He had had pancytopenia. Despite administration of appropriate antibiotics, antiviral and antifungal agents, fever persisted for > 1 month. Multiple blood, urine, stool, and sputum cultures were negative. Bone marrow aspirate revealed hypocellularity. Liver biopsy was performed, but rejection was not observed on biopsy specimen. Brucella serology was positive and Brucella agglutination titer was 1:320. Bone marrow culture was positive for Brucella but blood culture was negative. The patient was then treated with oral doxycycline and rifampin for 8 weeks. No previous case report about Brucella infection after liver transplantation has appeared in the literature, to our knowledge; our case is presented as the first. Bone marrow hypoplasia is a rare feature of Brucella infection. Our patient with brucellosis and pancytopenia had had hypocellular bone marrow. The clinical and hematologic findings resolved with treatment of the infection. Brucella infection should be suspected in liver transplanted recipients with fever of unknown origin, especially in a recipient who has lived in an endemic area. Brucella also should be considered as a possible diagnosis in patients with pancytopenia.

Topics: Adolescent; Anti-Bacterial Agents; Antibiotics, Antitubercular; Brucella; Brucellosis; Doxycycline; Humans; Liver Transplantation; Male; Pancytopenia; Rifampin; Tissue Donors

Neurobrucellosis is an uncommon complication of pediatric brucellosis. Acute meningitis and encephalitis are the most common clinical manifestations, however symptoms may be protean and diagnosis requires a high index of suspicion in patients from endemic areas. Diagnosis is often based on neurological symptoms, serology, and suggestive brain imaging because cerebrospinal fluid culture yields are low. Two cases of pediatric neurobrucellosis with unusual clinical and radiologic findings are presented.

Topics: Adolescent; Anti-Bacterial Agents; Brucellosis; Child; Doxycycline; Drug Therapy, Combination; Encephalitis; Female; Gentamicins; Humans; Incidence; Israel; Meningitis; Neuroimaging; Rifampin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Positive cultures from hepatic abscess drainage are extremely rare, and in this case the infection would have remained undiagnosed if Brucella suis had not been isolated. Failure to correctly diagnose this zoonosis delays patient treatment and is dangerous, as in this case that could have been a laboratory-acquired disease. This type of infection is preventable if proper safety protocols are established and followed.

Topics: Aged; Brucella suis; Brucellosis; Doxycycline; Drainage; Humans; Liver Abscess; Male; Rifampin; Tomography, X-Ray Computed; Treatment Outcome

We aimed to examine cases of brucellosis that presented with severe thrombocytopenia and hemorrhagic diathesis.. A total of 10 brucellosis cases with severe thrombocytopenia were included in this case-series study. Patients' files were reviewed for their clinical and laboratory findings, as well as clinical outcomes and complications. Platelet counts of < 20,000/mm³ were diagnosed as severe thrombocytopenia.. The lowest thrombocyte count was 3000/mm³ while the highest was 19,000/mm³ (mean: 12,000/mm³). Patients had the following symptoms: epistaxis (7 cases), petechia with epistaxis (4 cases), bleeding gums (3 cases), ecchymosis with epistaxis (2 cases), melena and renal failure (2 cases), and hematuria (1 case). Patients were given rifampicin and doxycycline along with supportive hematological therapy. All were treated successfully with no evidence of recurrence at follow-up visits.. Since brucellosis is endemic in developing countries, it must be considered in the differential diagnosis of cases that present with severe thrombocytopenia and hemorrhagic diathesis.

Topics: Brucellosis; Hemorrhagic Disorders; Humans; Platelet Count; Rifampin; Thrombocytopenia

Topics: Agglutination Tests; Animal Husbandry; Animals; Brucella; Brucellosis; Dairy Products; Doxycycline; Food Contamination; Humans; Male; Milk; Occupational Diseases; Pleural Effusion; Pneumonia, Bacterial; Rifampin; Sheep; Spain; Tomography, X-Ray Computed; Young Adult

Topics: Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Diagnostic Errors; Doxycycline; Gentamicins; Humans; Male; Middle Aged; Psoas Abscess; Rifampin; Tomography, X-Ray Computed

On February 10, 2012, the Maine Center for Disease Control and Prevention (Maine CDC) was notified of a positive Brucella culture from a harbor porpoise (Phocoena phocoena) found on the coast of southern Maine. Maine CDC, in consultation with CDC, initiated an investigation of potential occupational exposures of staff members at university A and at diagnostic laboratories known to have handled samples from the porpoise. This report describes the results of that investigation. In humans, brucellosis can cause fever, sweats, headaches, back pains, physical weakness, and sometimes severe infections of the brain, bone, heart, liver, or spleen. Because staff members at university A did not use respiratory protection while handling the porpoise or its specimens, the four exposed staff members were advised to begin immediately a 3-week regimen of rifampicin and doxycycline for antimicrobial prophylaxis, conduct daily fever checks, be monitored for symptoms of acute febrile illness weekly, and have their serum tested for Brucella antibodies immediately and at regular intervals for 24 weeks after the last known exposure. As of June 26, none of the four persons had seroconverted or become ill. The potential for human infection and illness as well as the intensity, duration, and expense of the follow-up recommended for Brucella exposure highlights the need for facilities to develop standard protocols for preventing exposures during the handling of marine mammals, particularly during aerosol-generating procedures.

Topics: Aerosols; Animals; Anti-Bacterial Agents; Autopsy; Brucella; Brucellosis; Doxycycline; Humans; Maine; Occupational Exposure; Phocoena; Post-Exposure Prophylaxis; Rifampin; Specimen Handling

Brucellosis poses a significant public health problem in Mediterranean countries, including Egypt. Treatment of this disease is often empirical due to limited information on the antibiotic susceptibility profiles of Brucella spp. in this region of the world. The aim of this study was to determine the antibiotic susceptibility profiles of Brucella blood isolates in Egypt, a country endemic for brucellosis.. Brucella spp. isolates were identified from the blood cultures of acute febrile illness (AFI) patients presenting to a network of infectious disease hospitals from 1999-2007. Minimum inhibitory concentrations were determined for tetracycline, gentamicin, doxycycline, trimethoprim-sulfamethoxazole, streptomycin, ceftriaxone, ciprofloxacin and rifampin using the E-test. Interpretations were made according to Clinical and Laboratory Standards Institute (CLSI) guidelines.. A total of 355 Brucella spp. isolates were analyzed. All were susceptible to tetracycline, doxycycline, trimethoprim-sulfamethoxazole, streptomycin and ciprofloxacin; probable resistance to rifampin and ceftriaxone was observed among 277 (64%) and 7 (2%) of the isolates, respectively. Percentages of isolates showing probable resistance to rifampin were significantly lower before 2001 than in the following years (7% vs. >81%, p < 0.01).. Despite the high burden of brucellosis in Egypt and frequent empirical treatment, isolates have remained susceptible to the majority of tested antibiotics. However, this is the first report of high rates of probable resistance to rifampin among Brucella isolates from Egypt. Patients should be closely monitored while following standard treatment regimens. Continued surveillance, drug susceptibility studies and updated CLSI interpretive criteria are needed to monitor and update antibiotic prescribing policies for brucellosis.

Topics: Anti-Bacterial Agents; Brucella; Brucellosis; Drug Resistance, Bacterial; Egypt; Genotype; Humans; Microbial Sensitivity Tests; Rifampin

Although the presence of brucella endocarditis is encountered rarely, it is the most fetal complication of brucellosis, which is shown to affect the aortic valve primarily and the mitral valve secondarily. Involvement of the tricuspid valve is extremely rare. A 62-year-old female was admitted with complaints of fever, fatigue, difficulty in breathing, and swellings in her legs. A transthoracic echocardiogram was performed since acute right heart failure was considered due to her symptoms. The echocardiogram showed enlarged right heart chambers, serious tricuspid valve insufficiency, and a mass on the tricuspid valve compatible with a vegetation moving in and out of the right ventricle. Although no growths were observed in the blood culture, antibody titration for brucellosis was found to be 1/640 (+) in the serological examination. The patient was diagnosed with brucella endocarditis and placed on doxycycline, rifampicin, and ceftriaxone treatment for eight weeks. At the end of the eight-week treatment, the symptoms of right heart failure receded and the patient recovered from the endocarditis. Tricuspid valve brucella endocarditis should be considered in patients suffering from acute right heart failure accompanied by systemic infection findings since brucellosis is presently endemic in Turkey.

Topics: Acute Disease; Anti-Bacterial Agents; Brucellosis; Ceftriaxone; Diagnosis, Differential; Doxycycline; Echocardiography; Electrocardiography; Endocarditis, Bacterial; Female; Heart Failure; Humans; Middle Aged; Rifampin; Treatment Outcome; Tricuspid Valve

We investigated the seroprevalence of human brucellosis and risk factors in a village in Eastern Anatolia, Turkey, where a brucellosis outbreak among cattle had recently occurred.. All 501 inhabitants enrolled were screened with the Rose Bengal Test and were asked to fill out a questionnaire to determine the signs and symptoms of brucellosis and the risk factors. Patients' laboratory findings and clinical responses were also evaluated.. The Rose Bengal Test was positive in 44 persons. In comparison of age groups, fever (20.2%), arthralgia (19.2%) and weight loss (8.4%) were frequently seen in children (p<0.05). Hepatomegaly (17.9%) was also prevalent in the age group of 0 to 14 years (p<0.05). The consumption of dairy products, a family history of brucellosis, and raising livestock were significantly related to seropositivity (p<0.05). Rifampicin plus doxycyline was the most common regimen administered in these cases (54.5%) and also had the highest relapse rate (p<0.05).. Brucellosis remains an important public-health problem in the rural areas of Turkey. Appropriate public health measures and education must be pursued to eradicate human brucellosis.

Topics: Adolescent; Adult; Aged; Animals; Brucellosis; Brucellosis, Bovine; Cattle; Child; Child, Preschool; Cholestyramine Resin; Doxycycline; Drug Therapy, Combination; Female; Health Education; Humans; Male; Middle Aged; Prevalence; Rifampin; Risk Factors; Rose Bengal; Seroepidemiologic Studies; Treatment Outcome; Turkey; Young Adult

Topics: Adult; Brucellosis; Citalopram; Doxycycline; Drug Interactions; Female; Humans; Panic Disorder; Recurrence; Rifampin; Treatment Outcome

Topics: Agglutination Tests; Anti-Bacterial Agents; Brucellosis; Doxycycline; Gentamicins; Humans; Male; Middle Aged; Radionuclide Imaging; Rifampin; Sternoclavicular Joint; Treatment Outcome; Turkey

A 49-year-old man was admitted to the hospital with complaints of fatigue, epistaxis and a skin rash. The whole blood count revealed isolated thrombocytopenia (4,000/mL), and the patient was admitted to the hematology department with a diagnosis of immune thrombocytopenia. He did not respond to steroid treatment for 15 days, and a subfebrile fever developed during this period. A diagnosis of acute brucellosis was considered due to positive serological tests and a blood culture positive for Brucella spp. After starting doxycycline and rifampicin therapy, the patient's thrombocyte count increased to 15,000/mL on the third day, to 41,000/mL on the sixth day and was normal on the 21st day of treatment. A diagnosis of brucellosis must be considered in patients presenting with severe and isolated thrombocytopenia in countries where brucellosis is endemic.

Topics: Animals; Anti-Bacterial Agents; Brucellosis; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Humans; Male; Middle Aged; Platelet Count; Purpura, Thrombocytopenic, Idiopathic; Rifampin; Thrombocytopenia; Turkey; Zoonoses

Brucellosis, a serious zoonosis, is a widespread disease in many countries, especially the developing ones, with an annual report of 500,000 new cases to the World Health Organization (WHO). Although successful results have been achieved by the combination therapies recommended by the WHO, their relapse rates have been high, and therefore, the most effective agents with least side-effects are still undetermined.. An observational study has been prospectively carried out from 2007 to 2010 in the Infectious Clinics of Hashemi-nejad and Imam Reza Hospitals, Mashhad, Iran. In this study, among the patients of brucellosis, whose diseases were recently diagnosed, 50 patients, receiving one of the two common authentic regimens of doxycycline plus rifampin for eight weeks or ciprofloxacin plus rifampin for six weeks, were selected. The diagnosis was based on the presence of signs and symptoms compatible with brucellosis, including a positive Wright and 2ME tests, with titers equal to or more than 1/160 and 1/40 respectively.. The cure rate was the same for the groups (P=0.55). However, the relapse rate was much more for the latter (P= 0.02).. Doxycycline plus rifampin was considered better than ciprofloxacin plus rifampin for the treatment of acute brucellosis.

Topics: Acute Disease; Anti-Bacterial Agents; Brucellosis; Ciprofloxacin; Doxycycline; Drug Therapy, Combination; Follow-Up Studies; Humans; Incidence; Iran; Prospective Studies; Rifampin; Treatment Outcome

Brucellosis is an important public health problem in Peru. We evaluated 48 human Brucella melitensis biotype 1 strains from Peru between 2000 and 2006. MICs of isolates to doxycycline, azithromycin, gentamicin, rifampin, ciprofloxacin, and trimethoprim-sulfamethoxazole were determined by the Etest method. All isolates were sensitive to tested drugs during the periods of testing. Relapses did not appear to be related to drug resistance.

Topics: Anti-Infective Agents; Azithromycin; Brucella melitensis; Brucellosis; Ciprofloxacin; Doxycycline; Gentamicins; Humans; Microbial Sensitivity Tests; Peru; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Brucellar cervical spondylodiscitis and epidural abscess are serious medical conditions that can cause permanent neurological deficits. Fortunately, they are rare. We report a 34-year-old male patient, complaining of fever and neck pain and stiffness, with increased deep tendon reflexes. A lumbar puncture was normal. Brucella species organisms were isolated from blood cultures, and the Rose-Bengal test and the standard tube agglutination (STA) test were positive. The diagnosis was made on MRI. The patient was treated with doxycycline and rifampin daily for 16 weeks. On day 51 of treatment, the patient had no symptoms and his physical and neurological examinations were normal. His repeat cervical MRI was almost normal. The STA test was negative at week 20. It is important to consider brucellar cervical spondylodiscitis with epidural abscess in endemic regions.

Topics: Adult; Anti-Bacterial Agents; Brucellosis; Cervical Vertebrae; Discitis; Doxycycline; Epidural Abscess; Humans; Magnetic Resonance Imaging; Male; Rifampin

Topics: Adult; Animals; Anti-Bacterial Agents; Brucellosis; Cheese; Delayed Diagnosis; Doxycycline; Drug Therapy, Combination; Female; Food Microbiology; Gentamicins; Humans; Rifampin; Streptomycin; Travel; Turkey; Zoonoses

This study was undertaken in order to evaluate the effect of brucellosis in pregnancy. The serum agglutination test, Coombs and/or blood culture systems were used in the diagnosis of brucellosis. From July 2003 to September 2010, the clinical and delivery patterns of 40 healthy pregnant women were compared with 39 pregnant women who had brucellosis. There were no birth defects, anomalies or mortalities. We observed that brucellosis in pregnancy increases the incidence of preterm delivery (P = 0.01) and low birth weight (P = 0.001) from that seen in general deliveries. A cephtriaxone/rifampicin combination was found to be the most effective treatment in pregnant women infected with brucellosis (P = 0.004). Brucellosis in pregnancy has no effect on the incidence of congenital malformations or stillbirths. Preterm delivery and low birth weight can be seen as pregnancy outcomes in brucellosis. Appropriate antimicrobial therapy of brucellosis in pregnancy will reduce morbidity and prevent complications.

Topics: Adult; Agglutination Tests; Anti-Infective Agents; Antibodies, Bacterial; Brucella melitensis; Brucellosis; Case-Control Studies; Coombs Test; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Incidence; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Premature Birth; Rifampin; Turkey; Young Adult

Brucellosis is a worldwide zoonotic disease and still constitutes a major public health problem. In the study we claimed to identify Brucella species from clinical samples of patients with active brucellosis from Van region of Eastern Anatolia and to determine in vitro antimicrobial susceptibilities of these strains to commonly used anti-Brucella agents and a possible new alternative tigecycline.. A total of 56 Brucella isolates were enrolled the study and the identification of the isolates were based on conventional methods. In vitro activities of antimicrobials were evaluated by the E test method.. All isolates were identified as B. melitensis. MIC(90) values of doxycycline, streptomycin, rifampin, trimethoprim-sulfamethoxazole and tigecycline were 0.064 mg/L, 1 mg/L, 2 mg/L, 0.125 mg/L and 0.094 mg/L, respectively. Tigecycline had low MIC(50) and MIC(90) values against all B. melitensis strains; the highest MIC observed was 0.25 μg/mL.. Our data suggest that tigecycline can be a therapeutic alternative option for the treatment of brucellosis.

Topics: Anti-Bacterial Agents; Brucella; Brucella melitensis; Brucellosis; Doxycycline; Humans; Microbial Sensitivity Tests; Minocycline; Rifampin; Streptomycin; Tigecycline; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey

Drug-associated hypocalcemia is rare, but may occur during routinely administered drugs. We reported a case of vertebral brucellosis, which developed two hypocalcemic episodes associated with hypokalemic alkalosis with two drug combinations including rifampicin. Possible underlying mechanisms of hypocalcemia were discussed. The patient had carpopedal spasm at both hypocalcemic presentations. Laboratory analysis revealed hypocalcemia, hypokalemia, alkalosis with hypercalciuria, and low-normal parathormone (PTH) at first and elevated PTH at the second admission. The patient improved with cessation of drugs and appropriate management of hypocalcemia and hypokalemia with calcium, vitamin D, magnesium, and potassium replacement. The underlying mechanism of hypocalcemia in this patient seemed to be due to tubular damage resulting with Bartter-like syndrome, which is well defined with aminogylcosides. But the recurrence of hypocalcemia with an aminoglycoside-free antibiotic combination including rifampicin suggests a possible role of rifampicin on hypocalcemia associated Bartter-like syndrome that has never been reported before.

Topics: Adult; Antibiotics, Antitubercular; Brucellosis; Calcitriol; Calcium; Drug Therapy, Combination; Female; Humans; Hypocalcemia; Recurrence; Rifampin; Spasm; Spinal Diseases; Streptomycin; Vitamin D Deficiency

From April 2000 to March 2010, 19 pregnant women with brucellosis were evaluated, treated and followed up. Ten (53%) pregnant women had spontaneous abortions. Six of eleven (55%) women infected in the first trimester had a spontaneous abortion. After treatment, all subsequently became pregnant and gave birth to normal babies. Among 13 patients who received cotrimoxazole plus rifampin, only four (31%) aborted and nine mothers had normal term deliveries. Two patients with recurrent abortions had brucellosis and became pregnant and gave birth after treatment. The brucellosis screening program for pregnant women and those with spontaneous abortion is necessary in brucellosis endemic regions.

Topics: Abortion, Spontaneous; Adolescent; Adult; Anti-Infective Agents; Brucellosis; Drug Therapy, Combination; Female; Humans; Iran; Mass Screening; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Rifampin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Brucellosis is a worldwide zoonotic gram-negative bacterium of worldwide distribution. Its role in causing miscarriage in animals is well documented. Data on its role in human abortion are very few. This paper was carried out on selected women with abortion or history of abortion to clarify the role of brucellosis in human abortion. A total of 129 women were selected from Al-Zahraa University Hospital and other obstetric and gynecological hospitals in the vicinity of Greater Cairo. The patients were subjected to clinical, gynecological, and serodiagnosis (STAT and ELISA) of brucellosis. Also, routine urine (Nuclepore technique) and stool (Kato thick smear) was done as well as skin tests and ELISA for common hepatic parasites. The results showed that 59 had brucellosis, 27 had toxoplasmosis, 15 had fascioliasis and 29 had other cause(s) of abortion. Meanwhile, none had visceral leishmaniasis or schistosomiasis mansoni. the signs and symptoms of all patients were hepatosplenomegaly (31.1%), lower back abdominal pain (23.13%), lassitude, headache (each, 21.7%), lymphadenopathy (20.1%), vomiting (17.1%), loss of appetite, myalgia or diarrhea or constipation (each, 15.42 %), weight loss (14.6%), chest pain (13.9%), night sweating or dizziness (11.65%), fever or right sided abdominal pain (each, 10.7%), chills (7.71%), urticaria or monoarthralgia (each, 3.85%). These signs and symptoms were confusing for specific clinical picture of brucellosis. Brucellosis patients were successfully treated with a combination of Rifampicin 600 mg. once daily and Septrin 800 mg twice daily for 6 weeks. Cure was achieved clinically and serologically. Patients with toxoplasmosis or fascioliasis were also treated with Fasinex and Mirazid respectively. Other parasites were also treated.

Topics: Abortion, Spontaneous; Adolescent; Adult; Anti-Bacterial Agents; Brucellosis; Female; Humans; Infectious Disease Transmission, Vertical; Middle Aged; Pregnancy; Pregnancy Complications, Infectious; Rifampin; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

We present the case of a 42-year-old male patient who applied to the emergency department of our hospital with clinical nephritis, orchitis, acute renal failure without endocarditis, and a low-grade fever. Brucella agglutinin titers were 1:160, Rose Bengal test was positive and Brucella melitensis was isolated from urine and blood cultures.. A combination of oral rifampin (600 mg/day) and doxycycline (200 mg/day) was administered along with supportive treatment leading to resolution of his clinical status by eight weeks. This was a rare complication of severe renal involvement due to brucellosis which resolved with antibiotic treatment.

Topics: Acute Kidney Injury; Adult; Anti-Bacterial Agents; Blood; Brucella melitensis; Brucellosis; Doxycycline; Humans; Male; Rifampin; Urine

We describe the case of a 29-year-old woman who presented with pancytopenia and myelofibrosis. Brucella melitensis was identified in her blood. The patient recovered completely with doxycycline and rifampin. A repeat bone marrow biopsy showed hypercellularity without myelofibrosis. Bone marrow findings in cases of pancytopenia due to brucellosis reveal normocellularity, hypercellularity, hemophagocytosis, or granuloma. To our knowledge this is the first report of brucellosis causing myelofibrosis. Brucellosis should be considered as a possible cause of myelofibrosis in endemic areas.

Topics: Adult; Biopsy; Bone Marrow; Brucella melitensis; Brucellosis; Doxycycline; Female; Humans; Pancytopenia; Primary Myelofibrosis; Rifampin

After primary infection, some bacteria can remain in a latent state for several years before a new bacteremia, often due to a weakened immune status. This is common for Mycobacterium tuberculosis, less for other pathogens more difficult to have in mind when facing patients with fever. We report the case of an 84-year-old female patient presenting with fever in the months following antilymphoma chemotherapy, due to bacteremic brucellosis (with a hemophagocytic syndrome) probably latent after primary infection as a child.

Topics: Aged, 80 and over; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Combined Chemotherapy Protocols; Bacteremia; Brucella melitensis; Brucellosis; Combined Modality Therapy; Cyclophosphamide; Doxycycline; Drug Therapy, Combination; Female; France; Humans; Immunocompromised Host; Immunoglobulins, Intravenous; Lymphoma, Non-Hodgkin; Recurrence; Rifampin; Rituximab; Spain; Time Factors; Vidarabine

The aim of this study was to determine, using molecular methods, whether rifampicin and fluoroquinolone resistance was present in a clinical Brucella melitensis population.. Sixty-two B. melitensis strains, isolated from humans-most experiencing their first brucellosis episode-over an 11 year period in Spain, were genotyped by multiple locus variable analysis (MLVA-16) for future studies. In the present work, molecular screening was undertaken to detect the presence of rpoB and gyrA/gyrB/parC/parE mutations (previously described in in vitro Brucella spp. mutants) related to resistance to rifampicin and fluoroquinolones, respectively.. Sixty-two MLVA-16 genotypes were identified among the B. melitensis population, with genetic similarity values ranging from 32% to 94%. rpoB mutations related to rifampicin resistance (positions 154, 526, 536, 539, 541, 574) were not detected. Neither were changes in GyrA described in in vitro mutants (67, 71, 87, 91 and an insertion at 340) detected in these strains. All showed identical GyrA, GyrB, ParC and ParE sequences with respect to B. melitensis 16M, except for one strain (ciprofloxacin and moxifloxacin MICs 0.25-0.50 mg/L) that harboured the Val264Ala replacement outside the GyrA quinolone resistance-determining region (QRDR); no differences were seen, however, in the NorMI/II efflux pump genes.. The absence of rpoB mutations clearly related to rifampicin resistance in clinical B. melitensis strains reinforces the first-choice status of this antibiotic in the treatment of first brucellosis episodes, and demonstrates the usefulness of molecular screening for resistant genotypes. The absence of topoisomerase II-IV mutations, however, cannot rule out fluoroquinolone resistance due to the interplay of different mechanisms.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Brucella melitensis; Brucellosis; DNA, Bacterial; Drug Resistance, Bacterial; Fluoroquinolones; Humans; Mass Screening; Molecular Sequence Data; Mutation, Missense; Point Mutation; Rifampin; Sequence Analysis, DNA; Spain

We report a case of a 63-year-old female patient who underwent a total knee arthroplasty in which the knee later became infected with Brucella melitensis. Diagnosis was made by positive culture of a sinus tract discharge. Radiological views of the knee did not show signs of implant loosening. The patient was successfully treated with rifampicin and doxycycline without surgery.

Topics: Anti-Bacterial Agents; Arthroplasty, Replacement, Knee; Brucella melitensis; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Humans; Middle Aged; Prosthesis-Related Infections; Rifampin

Brucellosis is a zoonotic disease transmittable to humans. It is diagnosed either by isolation of Brucella organism in culture of blood or other sample types (e.g., bone marrow or liver biopsy specimens), or by a combination of serological tests and clinical findings. Dialysis patients constitute a special population group with an impaired autoimmune system and a propensity to develop infections, such as brucellosis. This paper presents the high incidence of brucellosis in our dialysis patients during last year, while there was not any zoonotic infection recorded in the previous at least 5 year period.. This is a retrospective study including 8 dialysis patients, undergoing renal replacement therapies (5 patients were on hemodialysis (HD) and 3 on peritoneal dialysis (PD)), who out of a total of 124 patients developed brucellosis, during the last year. Four patients were male and four female and their mean age was 67 +/- 9 years. Clinical presentation of Brucellosis infection was mild with low-grade fever and symptoms of influenza. All patients were living in places where animal brucellosis was prevalent. Infection was diagnosed on the basis of clinical symptoms and signs and with polymerase chain reaction (PCR) analysis of peripheral blood. The affected patients had consumed fresh unpasteurized milk and cheese and were treated with oral doxycycline and oral rifampicin for 6 weeks. All patients are in follow up for at least 1 year, during which there were no relapses.. Brucellosis is a zoonotic disease that can occur in dialysis patients who are susceptible to infection under certain conditions. Our brucellosis patients lived in agricultural and veterinary areas and had consumed unpasteurized milk and cheese and insufficiently cooked meat derived from infected animals.

Topics: Aged; Anti-Bacterial Agents; Brucella; Brucellosis; Doxycycline; Female; Humans; Incidence; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis; Retrospective Studies; Rifampin; Treatment Outcome

Topics: Abdominal Pain; Adult; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Diagnosis, Differential; Doxycycline; Female; Fever; Humans; Nausea; Rifampin; Vomiting

A 37-year-old patient with cephalgia and fever after his return from Mexico is reported. Due to persistently elevated transaminases, a liver biopsy was performed. Histological examination revealed hepatic involvement of a granulomatous disease. Serologic analyses detected anti-Brucella IgM. The suspected diagnosis was thus brucellosis taking the typical anamnesis into account. Treatment with rifampicin and doxycycline led to a complete convalescence of the patient.. Brucellosis is an anthropozoonosis that exists worldwide. Potential sources of infection are uncooked or unpasteurized milk and milk products of infected animals. Complete cure of most brucellosis-infected patients can be achieved by an early and adequate antibiotic treatment.

Topics: Adult; Alanine Transaminase; Anti-Bacterial Agents; Antibodies, Bacterial; Aspartate Aminotransferases; Biopsy; Brucella; Brucellosis; Combined Modality Therapy; Doxycycline; Drug Therapy, Combination; Dyspnea; Fever of Unknown Origin; Hepatitis; Humans; Immunoglobulin M; Liver; Liver Function Tests; Male; Mexico; Rifampin; Travel; Ultrasonography, Interventional

Hemophagocytic syndrome (HS) may be primary, or secondary, to malignancy, or to metabolic, collagen vascular, and infectious diseases such as brucellosis, miliary tuberculosis and some viral and fungal infections. The diagnostic findings of HS are high fever, hepatosplenomegaly, cytopenia, high serum ferritin and triglycerides, and low serum fibrinogen levels. Brucellosis is a zoonotic disease, with fever, fatigue, sweating, arthritis, hepatosplenomegaly, lymphadenopathy, and cytopenia being the most common symptoms and findings. Hematological manifestations of the disease may include anemia, leucopenia, leukocytosis, thrombocytopenia, and thrombocytosis. Brucellosis may occur in association with HS. Here, we describe brucellosis associated HS in an 8 year-old male patient. The patient was admitted to our clinic with weight loss, arthralgia, prolonged fever, sweating, and fatigue. Physical and laboratory findings revealed hepatosplenomegaly, pancytopenia, elevated serum transaminases, triglycerides, lactate dehydrogenase, and ferritin, and with erythrocytes, leukocytes, and thrombocytes phagocytosed by macrophages indicating hemophagocytosis. The Brucella agglutination test was positive. The patient improved after treatment with Rifampin (15 mg/kg/day) and trimethoprim-sulfamethoxazole (10 mg/kg/day).

Topics: Agglutination Tests; Anti-Bacterial Agents; Bacteriological Techniques; Bone Marrow; Brucella; Brucellosis; Child; Humans; Lymphohistiocytosis, Hemophagocytic; Male; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Due to its high morbidity rates brucellosis, a systemic inflammatory disease, is still an important health problem, particularly in Mediterranean regions. One-third of the patients are characterized with musculoskeletal involvement. Principally in chronic cases, there are difficulties in the follow-up of therapy success. Radiological imaging methods are used in musculoskeletal brucellosis in addition to standard serological tests. Two macrophage products, namely neopterin (NPT) and chitotriosidase (ChT), are used as novel markers in order to reflect the status of inflammatory diseases. In this study, we aimed to test the validity of these markers in follow-up of patients with brucellosis.. A total of 40 brucellosis cases were included in the study and 27 healthy individuals were used as controls. Twenty of the brucellosis patients were presented with sacroiliac joint involvement. A 6-week treatment of doxycycline combined with rifampicin or streptomycin was used to treat brucellosis. Clinical observations and serological outcome were used to determine whether treatment was successful or not.. All of the 20 brucellosis patients without musculoskeletal involvement healed with the first cure of treatment, but all of the brucella-sacroiliitis patients had to be retreated. In addition to routine testing, serum NPT and ChT levels were evaluated after each treatment. The results presented a clear fall in both NPT and ChT levels in parallel with the serological data of the patients.. In conclusion, NPT as well as ChT seems to be a useful marker in the follow-up of brucellosis patients and for evaluating the success of therapy.

Topics: Adult; Biomarkers; Brucellosis; Doxycycline; Drug Therapy, Combination; Follow-Up Studies; Hexosaminidases; Humans; Macrophages; Male; Neopterin; Reproducibility of Results; Rifampin; Streptomycin; Young Adult

Topics: Abscess; Adult; Albania; Anti-Bacterial Agents; Biopsy, Needle; Brucellosis; Cervical Vertebrae; Discitis; Doxycycline; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Female; Greece; Humans; Magnetic Resonance Imaging; Nerve Compression Syndromes; Rifampin; Spinal Nerve Roots; Streptomycin; Tomography, X-Ray Computed

Topics: Aged; Animals; Anti-Bacterial Agents; Arthroplasty, Replacement, Knee; Brucella melitensis; Brucellosis; Cheese; Doxycycline; Female; Food Contamination; Goats; Humans; Knee Joint; Knee Prosthesis; Prosthesis-Related Infections; Reoperation; Rifampin; Treatment Outcome

Topics: Adolescent; Anti-Bacterial Agents; Antibodies, Bacterial; Brucella melitensis; Brucellosis; Doxycycline; Humans; Male; Orchitis; Rifampin; Testis; Ultrasonography

Brucella spp. replicate and survive in lympho-proliferative tissues and cells, thus effective treatment of brucellosis requires the combined and long term use of intracellularly active antibiotics. Elimination of the microorganism largely depends on the reactive oxygen and nitrogen intermediates released by activated macrophages. In this study we aimed to determine the in vitro activity of hydrogen peroxide (H2O2; reactive oxygen intermediate) and acidified sodium nitrite (ASN; reactive nitrogen intermediate) alone and in combination with rifampicin (RIF) and tetracycline (TET) against four clinical isolates of Brucella melitensis. Initially minimal inhibitory concentrations of RIF and TET were determined by microbroth dilution susceptibility test. The activity of 2 and 5 mM H2O2 and 3 and 6 mM ASN was tested against each isolate by direct colony count from the agar plates inoculated with bacterial suspensions treated with H2O2 or ASN. The last step in the assay was to determine the combined effectiveness of RIF and TET plus H2O2 and ASN. From each three rolls of assay apparatus samples were taken at 0., 1., 6. and 24. hours and inoculated on Brucella agar. The plates were incubated at 37 degrees C for 48 hours and colonies were counted. While RIF alone or in combination with H2O2 supressed the growth of bacteria even in the first hour, TET alone did not show any effect in 24 hours. However, in combination with reactive oxygen and nitrogen intermediates TET affected bacterial growth starting from six hours. In conclusion, further explanation of the interactions between antibiotics and the substances produced by the immune system of the host during the infections caused by intracellular pathogens, might have an important impact on the determination of the treatment protocols and the measures to prevent relapses.

Topics: Animals; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Drug Interactions; Humans; Hydrogen Peroxide; Oxidants; Reactive Nitrogen Species; Reactive Oxygen Species; Rifampin; Sodium Nitrite; Tetracycline

Brucellosis is a significant health problem especially in developing countries as Turkey. Skeletal system involvement is relatively a common complication of human brucellosis, however genitourinary, cardiovascular, neurovascular and skin involvements are less frequent. In this case report, a 36-years-old female patient with fever, arthralgia, disseminated macular rash at the extremities and body and peripheral polineuropathy has been presented. The patient, living at a rural area, had a history of consumption of raw milk products. Polyneuropathy of the patient presenting as glove-sock type paresthesia was evaluated with electromyography and reported as mild demyelinated sensorial polyneuropathy and radiculopathy compatible with right L(4-5) involvement. Brucella agglutination test was found to be positive at a titer of 1/1280 in the serum sample. Other bacterial and viral agents presenting with maculopapular rash were ruled out by serological tests. Bacterial growth was detected in the blood culture by automated BacT/ALERT 3D system (bioMerieux, USA) and the bacteria was identified as Brucella melitensis by automated VITEK-2 system (bioMerieux, France). Microbiologic diagnosis was confirmed by detection of agglutination with polyvalent and monovalent anti-M Brucella sera. The patient was successfully treated with rifampicin and doxycycline combination for six weeks. The macular rash was recruited leaving a brown pigmentation in the first week of treatment, whereas the neurologic signs and symptoms disappeared at the end of the first month. Brucella infection should be considered in the differential diagnosis of skin rash and neurologic disorders especially in endemic areas such as Turkey.

Topics: Adult; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Diagnosis, Differential; Doxycycline; Exanthema; Female; Humans; Peripheral Nervous System Diseases; Rifampin

To present a case of acute brucellosis triggering acute hemolytic anemia in a subject with glucose-6-phosphate dehydrogenase (G6PD) deficiency.. A 17-year-old male patient presented with fever, malaise and jaundice. His blood and bone marrow cultures yielded Brucella species. In addition, he was found to have acute hemolytic anemia due to previously undiagnosed G6PD deficiency. He was started on folic acid supplementation and given a combination of doxycycline and rifampicin for 6 weeks. His response to antibiotic therapy was optimal; the hemolytic anemia resolved. There were no further episodes of hemolysis.. This case showed that the differential diagnosis of acute hemolytic anemia in subjects with G6PD deficiency should include brucellosis, especially in regions where the infection is endemic.

Topics: Adolescent; Anemia, Hemolytic; Anti-Bacterial Agents; Brucellosis; Doxycycline; Folic Acid; Glucosephosphate Dehydrogenase Deficiency; Hematinics; Humans; Male; Rifampin

Peritonitis due to brucellosis is extremely rare and the reported cases are mostly chronic hepatic failure patients with ascites or chronic renal failure patients on continuous ambulatory peritoneal dialysis. We report a 20-year-old male patient, with no underlying disease, who was diagnosed as peritonitis due to brucellosis mimicking tuberculosis, with ascites with pleocytosis, lymphocytic predominance and high levels of adenosine deaminase.

Topics: Anti-Bacterial Agents; Ascites; Brucellosis; Diagnosis, Differential; Doxycycline; Humans; Male; Paracentesis; Peritonitis; Peritonitis, Tuberculous; Rifampin; Young Adult

Brucellosis which is a systemic infection, is seen endemically in Turkey. Although there a lot of complications related to brucellosis, soft tissue involvement is rare. In this case report a patient with mature cystic teratoma and a Brucella related obturatory abscess, was presented. A 21-year-old female patient with bilateral pelvic pain was admitted to the hospital with complaints of weakness, backache and ab- dominal swelling. Pelvic examination revealed bilateral adnexial sensitive masses. There were no history of systemic complaints or other organ involvement. The patient had no history of contact with infected animals, intramuscular injections or consumption of non-pasteurized foods. A mass of 56 x 63 mm with regular margins and hyperechogenic segments at the left side was detected at ultrasonographic examination. Left ovarian cystectomy and mass excision at the left side were performed during laparotomy. Histopathological examination of the mass revealed chronic granulomatous inflammation characterized by central necrosis, histiocyte and lymphocyte infiltration and formation of giant cells, compatible with brucellosis. Brucella melitensis was isolated from the capsule of pelvic mass on the fifth day of culture in BacT/ALERT Selectlink (Organon Teknika, U.S.A.) system. Brucella Wright agglutination titer which was 1:80 at the admittance, rose to 1:2560 at the sixth week of the follow-up. The patient was treated successfully with the excision of the abscess and 6 weeks course of oral doxycycline and rifampicin. Brucellosis should be considered in the differential diagnosis of pelvic pain and obturatory abscess, especially in endemic areas for brucellosis.

Topics: Abdominal Abscess; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Female; Humans; Pelvic Pain; Rifampin; Young Adult

Human brucellosis is a multisystemic infectious disease with a broad spectrum of clinical manifestations. Severe complications involving musculoskeletal, nervous, genitourinary, and cardiovascular systems may be encountered during the course of the disease; however, cutaneous complications have been reported rarely. We report a patient with brucellosis in whom the main presenting clinical feature was a maculopapular rash and fever. He was initially diagnosed as brucellosis based on the standard tube agglutination test and blood culture positivity. Histopathologic examination of these maculopapular lesions showed perivascular and periadnexal inflammation with loose granuloma formation including giant cells. We emphasize that brucellosis is an infectious disease that should always be kept in mind in the differential diagnosis of a patient with rash and fever, especially in endemic areas.

Topics: Agglutination Tests; Anti-Bacterial Agents; Antihypertensive Agents; Brucellosis; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Duodenal Ulcer; Exanthema; Humans; Hypertension; Lymphoma, T-Cell, Cutaneous; Male; Middle Aged; Rifampin; Skin Neoplasms

Topics: Abscess; Adolescent; Anti-Bacterial Agents; Brucellosis; Cefuroxime; Child; Doxycycline; Female; Gentamicins; Humans; Immunoglobulin G; Joint Diseases; Kidney Diseases; Lyme Disease; Male; Methicillin-Resistant Staphylococcus aureus; Pain; Rifampin

Brucellosis is a major public health problem in Turkey and all over the world. Joint pain, night sweats, anorexia, weakness, loss of weight and headache are the basic symptoms of brucellosis and the illness can affect many organs. Genitourinary involvement is reported in 2-20% of cases, epididimoorchitis being the most frequent complication, however, prostatic involvement is far more uncommon. In this paper, a case of Brucella prostatitis misdiagnosed as prostate carcinoma has been presented. A 50-years-old man who was a microbiology laboratory staff has been admitted to our outpatient clinic with the complaints of joint pain, weakness, fever, urgency, difficulty and pain during urination. Since prostate specific antigen (PSA) was 23.6 ng/ml (normal value < 4 ng/ml) and free PSA (fPSA) was 3.89 ng/ml (normal value < 1 ng/ml), needle biopsy from the prostate was performed. Blood cultures performed by BACTEC 9200 (Becton Dickinson, Sparks, Md.) system yielded Brucella melitensis, and the pathological examination of the prostate biopsy revealed prostatic hyperplasia and prostatitis. Brucella standard tube agglutination titer was 1/320. Upon the diagnosis of Brucella prostatitis the patient was treated with a combination of 200 mg doxycycline and 600 mg rifampicin daily for 6 months. During the follow-up period no complication was detected in the patient and the PSA level decreased to 1.57 ng/ml and fPSA to 0.43 ng/ml. This case was reported to withdraw attention to prostatic involvement during brucellosis. Elevated PSA values with the signs and symptoms of brucellosis in endemic areas should be evaluated accordingly and appropriate therapy should be initiated without any delay.

Topics: Anti-Bacterial Agents; Bacteremia; Biopsy, Needle; Brucella melitensis; Brucellosis; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Humans; Male; Middle Aged; Prostate; Prostate-Specific Antigen; Prostatic Hyperplasia; Prostatic Neoplasms; Prostatitis; Rifampin

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Biomarkers; Biopsy; Brucellosis; Creatinine; Humans; Male; Nephritis, Interstitial; Rifampin

We have presented a patient of 71-year-age with brucellar spondylodiscitis, involving the cervical spine, especially the C3-C4 segment. The patient had painful percussion of the cervical spine and passive mobilization of the neck, decreased range of motion, and cervical paravertebral tenderness; but no abnormalities observed on neurological examination. Wright agglutination test for brucella was positive at 1/320. Cervical localization for brucellar spondylodiscitis is an unusual case and should be detected and treated as early as possible. In endemic regions, spinal involvement of brucellosis should be considered in cases with fever, neck and low back pain.

Topics: Aged; Anti-Bacterial Agents; Brucellosis; Cervical Vertebrae; Discitis; Doxycycline; Drug Combinations; Drug Therapy, Combination; Exercise Therapy; Humans; Magnetic Resonance Imaging; Male; Rifampin; Spironolactone; Sulfonamides

The central nervous system involvement of Brucellosis causes a hard to treat infection with multiple sequelae. The aim of this paper is to discuss the course of neurobrucellosis in response to therapy.. Patients with neurobrucellosis were evaluated. The diagnosis was established by the isolation of bacteria, abnormal CSF findings and positive serology. Ceftriaxone, rifampicin, doxycycline and trimethoprim sulfamethoxazole were the antibiotic choices for these cases.. We present 11 cases with neurobrucellosis. None of our patients died, albeit one case has a critical situation due to subarachnoid hemorrhage and its' concordant sequelae. Only one of four patients with walking difficulty and two with hearing loss were normalized with therapy. Imaging techniques did not provide any specific contribution regarding the Brucella infection.. Parenteral ceftriaxone should be used as an initial alternative in the management of neurobrucellosis. Although the therapy should be individualized, the duration of therapy should be a minimum of six months with suitable antibiotics.

Topics: Adult; Anti-Bacterial Agents; Brucellosis; Ceftriaxone; Central Nervous System Bacterial Infections; Doxycycline; Female; Humans; Male; Middle Aged; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey

A 30-year-old-lady, (Case 1) was found to have brucella uveitis in her left eye. Serum agglutination (SAT) and SAT/Coombs titers were positive at 1:320 and 1:160, respectively. In Case 2, a 12-year-old-girl diagnosis of left brucellosis uveitis was made. Both SAT and SAT/Coombs titers were positive at 1:1280. This report confirms that Brucellae organisms as a cause of uveitis.

Topics: Adult; Agglutination Tests; Brucellosis; Child; Coombs Test; Doxycycline; Drug Therapy, Combination; Eye Infections, Bacterial; Female; Humans; Panuveitis; Prednisolone; Rifampin; Tetracycline; Uveitis, Posterior

Topics: Adult; Anti-Bacterial Agents; Brucellosis; Disease Outbreaks; Family; Female; Greece; Humans; Infant; Male; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Brucellosis is a rare disease in which neurological complications, and more particularly, intracranial aneurysmal hemorrhages were rarely reported.. A brucellar meningitis was diagnosed in a 29-year-old man, who had been suffering from an unusual headache for about two months. Three days after beginning treatment, the patient developed an intracranial right frontal hemorrhage that led to the discovery of a ruptured anterior communicating artery aneurysm. The aneurysm was clipped surgically and doxycycline and rifampin were given for three months. The outcome was excellent.. Clinical manifestations of brucellosis are variable. Neurovascular complications are rare and probably linked to delay in diagnosis of CNS invasion or inadequate initial treatment. Appropriate and prompt medical, and if necessary, surgical management can lead to excellent outcome.

Topics: Adult; Anti-Bacterial Agents; Brucellosis; Cerebral Ventriculography; Doxycycline; Humans; Male; Meningitis, Bacterial; Rifampin; Subarachnoid Hemorrhage; Tomography, X-Ray Computed

Topics: Adult; Animals; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Doxycycline; Humans; Male; Rifampin; Skin Diseases

Brucellosis, a common disease in some areas of the world, beside its typical signs and symptoms, as fever, arthropathy, hepatomegaly and splenomegaly, sometimes can complicate into thrombocytopenia, even in severe forms. The pathogenesis of thrombocytopenia in course of brucellosis is variable, and a main role is played by immunological reactions. Authors describe a case report of an eight years child who presented a severe thrombocytopenia in course of acute brucellosis. The patient responded efficaciously to the antibiotic therapy combined with immunoglobulin intravenous therapy.

Topics: Acute Disease; Anti-Bacterial Agents; Brucellosis; Cheese; Child; Combined Modality Therapy; Doxycycline; Food Contamination; Food Microbiology; Humans; Immunoglobulins, Intravenous; Male; Purpura, Thrombocytopenic, Idiopathic; Rifampin

Over six months, 129 consecutive brucellosis cases were diagnosed in females attending the outpatients' clinics the females in Al-Azhar and Ain Shams Universities Hospitals. Their ages ranged between 12-65 years old. 113 (87.6%) gave history of raw milk consumption, 13 (10%) gave history of home slaughtering of sheep, 2 (1.5%) gave history of animal contact, and one patient gave history of abortion, that partner had brucellosis. A total of 61.2% of patients gave serum agglutination test of 1: 640, who suffered acute or subacute infection. Titers of 1:320 (38.8%) were found in the majority of chronic cases. Causes of endemic parasitosis were excluded. Symptoms were fever (79.5%), headache (72.4%), generalized arthralgia (65.3%), sweating (65.3%), chills (63.8%), backache (34.6%), abdominal pain (27.5%), loss of appetite (25.5%), lassitude (17.2%), myalgia (14.2%), monoarthralgia (7.9%). Spinal involvement was in 15% patients, who had chronic brucellosis. 32/35 were successfully treated with a combination of streptomycin and tetracycline, 17/21 with streptomycin and septrin, 38/43 with tetracycline and septrin, and 26/26 (100%) with rifampicin and tetracycline or septrin, which treated all resistant patients.

Topics: Acute Disease; Adolescent; Adult; Age Factors; Aged; Anti-Bacterial Agents; Brucellosis; Child; Chronic Disease; Drug Therapy, Combination; Egypt; Female; Fever; Humans; Middle Aged; Rifampin; Risk Factors; Streptomycin; Tetracycline; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Brucellosis is prevalent in North and East Africa, the Middle East, South and Central Asia, South and Central America and the Mediterranean countries of Europe. In 5% of cases it may lead to central nervous system manifestation presenting most often as a meningitis or meningoencephalitis. Here we report and discuss a case of neurobrucellosis with meningitis with cranial nerves neuritis. A 56-year-old German male was admitted with bilateral abducens nerve palsy, amblyacousia and intractable headaches. An enzyme-linked immunosorbent assay (ELISA) revealed antibodies against Brucella in serum and cerebrospinal fluid (CSF). Additionally, our patient suffered from an infarction of the left thalamus. In conclusion, in cases of unresponsive meningitis or meningoencephalitis and history of travel in endemic regions, neurobrucellosis should be considered. If initial microbiological tests fail, complementary investigations such as ELISA are indicated to detect Brucella species in serum and/or CSF.

Topics: Abducens Nerve Diseases; Anti-Bacterial Agents; Anti-Inflammatory Agents; Brain Infarction; Brucella; Brucellosis; Cranial Nerve Diseases; Doxycycline; Headache; Humans; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Methylprednisolone; Middle Aged; Rifampin; Thalamic Diseases; Treatment Outcome

Gastroenterological manifestations of human brucellosis are relatively uncommon. A case of Brucella melitensis infection in a 39-year-old man accompanied by lesions of the colon, observed by colonoscopic and histopathologic examinations, and a brief review of the relevant literature are reported.

Topics: Acute Disease; Adult; Antibiotics, Antitubercular; Brucella melitensis; Brucellosis; Colitis; Humans; Male; Rifampin

We describe a case of a 10 year old patient who presented with intermittent fever and pain in the pelvis and elbow region. From the history, imaging and laboratory tests, a diagnosis of Brucella sacroiliitis and elbow osteoarthritis was made. The patient was given an antibiotic treatment for 3 months with a progressive improvement of symptoms to complete recovery, and normalization of imaging and laboratory findings.

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Arthritis, Infectious; Brucella melitensis; Brucellosis; Child; Doxycycline; Drug Therapy, Combination; Female; Gentamicins; Humans; Humerus; Osteomyelitis; Rifampin; Sacroiliac Joint; Treatment Outcome

Splenic abscess due to Brucella spp. is extremely rare. We report a case of a splenic abscess due to Brucella spp. in a 61-year-old male patient. Brucella slide and tube agglutination tests (Wright) were positive while blood culture and culture from splenic tissue yielded negative results. The abdominal ultrasonography revealed a hypoechoic intrasplenic mass 15x12 mm in diameter at the middle portion of the spleen. The splenic lesions disappeared after prolonged treatment for 7 months with a combination of doxycycline, and rifampicin, followed by TMP-SXT. Brucella spp. should be considered in the differential diagnosis of splenic abscess in countries where brucellosis is endemic. The results of this case and literature review shows that a conservative approach using optimum antibiotics alone without surgical intervention can be successful in the treatment of patients with splenic brucellosis.

Topics: Abdominal Abscess; Agglutination Tests; Anti-Infective Agents; Brucellosis; Doxycycline; Drug Therapy, Combination; Enzyme Inhibitors; Humans; Male; Middle Aged; Rifampin; Spleen; Splenic Diseases; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography

Hepatic abscess caused by brucellosis is extremely rare in children. We report the case of a 5-year-old girl in whom an abscess of the liver developed during an episode of acute brucellosis. To our knowledge, this is the second reported case of hepatic abscess caused by brucellosis in a child.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Brucella melitensis; Brucellosis; Child, Preschool; Female; Gentamicins; Humans; Liver Abscess; Magnetic Resonance Imaging; Rifampin; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography

Topics: Animals; Anti-Bacterial Agents; Antibiotics, Antitubercular; Aortic Valve; Brucellosis; Ceftriaxone; Doxycycline; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Rifampin; Zoonoses

Topics: Adult; Anti-Bacterial Agents; Brucellosis; Doxycycline; Drug Therapy, Combination; Epididymitis; Humans; Male; Orchitis; Recurrence; Rifampin; Scrotum; Treatment Outcome; Ultrasonography

Human brucellosis is a worldwide re-emerging zoonosis. However, its histological appearance has only been occasionally described. We report the case of a young girl who had been suffering from a spontaneous fracture of the eighth thoracic vertebra at the age of 7. At the age of 15, X-ray showed a translucence of the seventh and ninth thoracic vertebra, and additionally, a bi-lateral episcleritis was detected. Three months later, she was admitted to the hospital because of perspiration at night and moderate fever. Computer tomography revealed coarsely spotted infiltrates in the lower fields of both lungs. Serology for rheumatic diseases was negative. Thoracoscopical wedge resection was done for histological clarification of pulmonary changes. Microscopically, a granulomatous inflammation with central necrosis was seen. A Ziehl-Neelsen stain did not demonstrate acid-fast bacteria. In spite of negative serology, real-time polymerase chain reaction detected Brucella melitensis deoxyribonucleic acid in the formalin-fixed tissue samples of the lung. Interrogation of the patient revealed visits in different Arabian countries during childhood as a presumable source of infection. In conclusion, granulomatous inflammation negative for Ziehl-Neelsen and Grocott stains presenting together with other localized lesions should lead to specific investigations on brucellosis.

Topics: Adolescent; Animals; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Cattle; Diagnosis, Differential; DNA, Bacterial; Doxycycline; Drug Therapy, Combination; Female; Humans; Lung Diseases; Magnetic Resonance Imaging; Prednisone; Radiography, Thoracic; Rifampin; Treatment Outcome

Soft tissue involvement is an uncommon complication of brucellosis. We report a rare case of gluteal abscesses caused by brucellosis. The patient was a housewife living in a city. There was no history of systemic complaints or other organ involvement. Diagnosis was made by positive pus culture and serological tests. Histopathological examination of the abscess wall revealed granulomatous inflammatory reaction. The patient was treated successfully with abscess drainage and a 6-week course of oral doxycycline and rifampicin. Brucellosis should be kept in mind in the diagnosis of gluteal abscess, especially in endemic areas.

Topics: Abscess; Adult; Anti-Bacterial Agents; Brucella; Brucellosis; Buttocks; Doxycycline; Female; Humans; Rifampin; Treatment Outcome

Brucellosis is primarily a zoonotic disease that continues to be an important public health problem. It is a rare, multisystem infection of childhood and it may present with a wide spectrum of clinical presentations and complications. However, lung involvement is extremely rare in the course of childhood brucellosis. This case report describes a 6-year-old child who was referred to our hospital as meningococcemia but diagnosed as lobar pneumonia in follow-up. Brucella agglutination test and bone marrow culture were diagnostic of brucellosis. The patient responded to the combination therapy of rifampicin and trimethoprim-sulfamethoxazole.

Topics: Anti-Bacterial Agents; Brucella; Brucellosis; Child; Female; Humans; Pneumonia, Bacterial; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Brucellosis is an important health issue in many parts of the world and clinicians are still seeking for better treatment choices. The aim of this study was to investigate the efficacy of moxifloxacin in an experimental brucellosis model and to compare its activity with rifampicin. Wistar albino rats infected with Brucella abortus were then randomized into 3 groups, which received rifampicin, moxifloxacin, and tap water, respectively. After 21 days, they were sacrificed and spleen, liver and blood cultures were performed. Spleen and liver cultures of all the animals yielded B. abortus in the control group, while these rates were 20% and 20% in the rifampicin group and 50% and 40% in the moxifloxacin group, respectively. The blood culture positivity was 66% in the control group and 10% in the moxifloxacin group. Blood cultures were all negative in the rifampicin group. As a conclusion, moxifloxacin might be an alternative choice in the treatment of brucellosis.

Topics: Animals; Anti-Bacterial Agents; Aza Compounds; Brucellosis; Disease Models, Animal; Fluoroquinolones; Moxifloxacin; Quinolines; Rats; Rats, Wistar; Rifampin

Brucellosis is a multisystem disease that may present with a large spectrum of clinical manifestations. Only five cases of intracranial aneurysm formation and/or subarachnoidal hemorrhage associated with brucellosis have been reported. In this paper, we take the opportunity to review these reports and present a new case of basilar artery aneurysm and subarachnoidal hemorrhage due to brucellosis.

Topics: Adult; Anti-Bacterial Agents; Antitubercular Agents; Brucellosis; Cerebral Angiography; Doxycycline; Humans; Intracranial Aneurysm; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Rifampin; Subarachnoid Hemorrhage

Acute oliguric renal failure (ARF) developed in a patient 2 days after she was started on intermittent anti-Brucella therapy including rifampicin. The clinical picture was compatible with acute allergic interstitial nephritis. Renal histology revealed mainly acute tubular necrosis with mild tubulo-interstitial mononuclear cellular infiltrate. Intermittent therapy, as in our patient, has been the major factor in the development of rifampicin induced ARF in cases reviewed in literature.

Topics: Acute Disease; Brucellosis; Female; Humans; Middle Aged; Nephritis, Interstitial; Rifampin

Hematological complications have been frequently associated with acute brucellosis, but pancytopenia is less frequently seen. Also, capillary leak syndrome has been rarely reported in the literature. In this report, we present a case of brucellosis with pancytopenia leading to capillary leak syndrome. A 21-year-old man was admitted to hospital with complaints of a one-month history of weakness, sweats, and fever and he had hepatosplenomegaly and edema over the pretibial areas. Hemogram revealed pancytopenia and biochemical tests revealed moderate hypoalbuminemia, elevations of lactate dehydrogenase and aspartate aminotransferase. He was diagnosed as brucellosis and capillary leak syndrome. He was given doxycycline and rifampicin. The patient's symptoms were resolved after treatment.

Topics: Adult; Anti-Bacterial Agents; Brucellosis; Capillary Leak Syndrome; Doxycycline; Humans; Male; Pancytopenia; Rifampin

Topics: Agricultural Workers' Diseases; Animals; Brucellosis; Cysts; Doxycycline; Humans; Male; Middle Aged; Rifampin; Skin Diseases, Bacterial; Zoonoses

Brucellosis treatment is based on sub-optimal, not universally implemented regimens (doxycycline-rifampicin and doxycycline-streptomycin). The authors sought to evaluate specialists' and physicians' attitude towards regimens used, non-medical aspects, and future trends in human brucellosis treatment.. A questionnaire-based survey of multi-national specialists, physicians, and trainees, was conducted, questionnaire answered following lectures outlining major scientific facts about existing regimens. Responders indicated preference between the two regimens, their opinion on protracted monotherapy or triple regimens of shorter duration, awareness of disease notification and hospitalization practices. Results were evaluated in relation with professional status and experience with the disease.. Although scientifically inferior to doxycycline-streptomycin, doxycycline-rifampicin is the choice regimen for 64.6% of the participants. A shorter triple regimen, but not protracted monotherapy, would be desirable (60.2% and 10.4%, respectively). Low awareness of disease-notifying status and related procedures were recorded in 53.9%.. When choosing between currently acceptable brucellosis regimens, medical personnel prefer convenience, even at the cost of a slightly higher relapse percentage. Future trials should evaluate shorter triple regimens. Enhancement of awareness on the disease and its principles may increase therapeutic cost effectiveness.

Topics: Anti-Bacterial Agents; Attitude of Health Personnel; Brucellosis; Doxycycline; Drug Therapy, Combination; Global Health; Health Knowledge, Attitudes, Practice; Humans; Practice Patterns, Physicians'; Rifampin; Surveys and Questionnaires; Treatment Outcome

A 35-year-old man presented with a meningeal syndrome and acute onset of visual blurring. Clinical investigations revealed bacterial meningitis with bilateral papillitis and ophthalmoparesis. Serum and cerebrospinal fluid serology confirmed the diagnosis of chronic active neurobrucellosis. Following therapy there was no improvement and he developed optic atrophy. Extensive literature review revealed, one case of bilateral irreversible papillitis resulting from neurobrucellosis. However no cases of neurobrucellosis have been reported with meningitis, irreversible papillitis and ophthalmoparesis. This case demonstrates that in endemic areas, acute meningitis is a potential manifestation of neurobrucellosis and that bilateral irreversible papillitis with ophthalmoparesis can be a potential serious complication.

Topics: Acute Disease; Adrenal Cortex Hormones; Adult; Brucella abortus; Brucella melitensis; Brucellosis; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Follow-Up Studies; Humans; Male; Meningitis, Bacterial; Ophthalmoplegia; Optic Atrophy; Papilledema; Rifampin; Streptomycin

Polymerase chain reaction (PCR) was applied to confirm the diagnosis of brucellosis and to study its clearance in response to the standard treatment regimen with doxycycline and rifampin at hospitals in Callao and Lima, Peru. The PCR confirmed the diagnosis in 23 (91.7%) patients with brucellosis including 12 culture-confirmed cases. For patients treated at the hospital in Callao, PCR was positive for all samples collected during and at the conclusion of treatment and for 76.9% of follow-up samples collected on average 15.9 weeks after completion of treatment. For patients treated at the hospital in Lima, PCR tests were positive for 81.8% of samples collected during treatment, for 33.3% of samples collected at the conclusion of treatment, and for > or = 50% of samples collected at first, second, and third post-treatment follow-up. Thus, Brucella DNA may persist in the serum weeks to months after completion of the standard treatment regimen.

Topics: Anti-Bacterial Agents; Brucella; Brucellosis; DNA, Bacterial; Doxycycline; Follow-Up Studies; Humans; Polymerase Chain Reaction; Retrospective Studies; Rifampin

Since prozone is a well known phenomenon in the serologic diagnosis of Brucella infections, it is necessary to prepare higher serum dilutions in the standard tube agglutination (STA) test for the brucellosis suspected patients. However, due to limited economical support, the serum dilutions generally last at 1/320-1/640 titers in some laboratories in Turkey. In this report, a brucellosis case whose STA test was found negative until the titer of 1/1280, has been presented. A 36-year-old female was admitted to our hospital with the complaints of fever, sweating, fatigue, generalized arthralgia and weight loss, lasting for 45 days. Hepatosplenomegaly was detected in the physical examination, and laboratory tests yielded anemia, leucopenia, elevated erythrocyte sedimentation rate and high C-reactive protein levels. Although brucellosis was suspected, Brucella STA test was found negative at 1/640 titer. On the sixth day of admission, Brucella melitensis was isolated from her blood culture. Since a positive result at 1/40 titer was detected in Brucella STA test with the use of Coombs antiserum, the patient's serum was retested at higher dilutions than 1/640, and positive result was obtained starting from 1/1280 dilution and extended to 1/5120 titer. The patient was treated with rifampin and doxycyline and discharged with complete cure. In conclusion, in countries endemic for brucellosis, STA test should be performed at 1/1280 or higher titrations in suspected patients especially in the presence of negative culture results, for the prevention of false negative results due to prozone phenomenon.

Topics: Adult; Agglutination Tests; Anti-Bacterial Agents; Bacteremia; Brucella melitensis; Brucellosis; Doxycycline; False Negative Reactions; Female; Humans; Rifampin; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Brucella; Brucellosis; Ciprofloxacin; Doxycycline; Humans; Microbial Sensitivity Tests; Minocycline; Rifampin; Tigecycline

The in vitro efficacy and synergistic activity of tigecycline in comparison with other antimicrobials used in brucellosis, were tested for 16 Brucella melitensis strains by the E-test method. Tigecycline had the lowest minimal inhibitory concentration levels, and rifampin the highest, in the study. Tigecycline also provided the better synergistic activity compared to doxycycline according to the fractional inhibitory concentration index. The results of this in vitro study suggest tigecycline as a therapeutic alternative for brucellosis. These observations need to be supported with clinical studies.

Topics: Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Doxycycline; Drug Synergism; Drug Therapy, Combination; Humans; Microbial Sensitivity Tests; Minocycline; Rifampin; Streptomycin; Tigecycline

Overseas deployments place military personnel at risk for tropical diseases not typically observed on the U.S. mainland. This case describes the first reported case of brucellosis returning from Operation Enduring Freedom and Operation Iraqi Freedom. A 31-year-old infantry soldier complained of a 6-week history of headaches, relapsing fever, and constitutional symptoms since returning from Iraq. This soldier was determined to have the only reported case of brucellosis, but was one of many soldiers at risk from eating unpasteurized cheese on the local economy. Although malaria and leishmaniasis continue to be the most common deployment-related illnesses, brucellosis must also be considered in the differential of any redeployed soldier with headache, fever, and body aches. Public health as well as command elements must reinforce their role in preventing exposure to this pathogen.

Topics: Adult; Anti-Bacterial Agents; Brucellosis; Doxycycline; Humans; Iraq; Male; Military Medicine; Military Personnel; Rifampin; United States; Warfare

Brucellosis, an "anthropophitic" disease of worldwide distribution can involve several organs and tissues but the osteoarticular disease is the most common complication. It can occur as sacroiliitis, bursitis, tenosynovitis or osteomyelitis. Prosthetic joint infection is a serious complication of total joint arthroplasty, with coagulase negative staphylococci and Staphylococcus aureus accounting for 50% of cases. Treatment of prosthetic infections remains complex. Prosthetic infections caused by Brucella spp are rarely described in the literature. We report a patient with a prosthetic joint infection due to Brucella spp, documented by a polymerase chain reaction. The patient has been cured after two-stage exchange of the prosthesis and long-term antimicrobial therapy.

Topics: Aged; Anti-Bacterial Agents; Arthroplasty, Replacement, Knee; Brucella; Brucellosis; Doxycycline; Drug Administration Schedule; Drug Therapy, Combination; Humans; Male; Prosthesis-Related Infections; Reoperation; Rifampin; Treatment Outcome

Brucellosis represents a rare cause of neonatal infection. In this article we report a very unusual case of congenital infection due to BRUCELLA MELITENSIS in a term neonate presenting after birth with severe respiratory distress and radiological manifestations (lobar consolidation and diffuse interstitial infiltrations) compatible with pulmonary involvement. The neonate was successfully treated with trimethoprim-sulfamethoxazole, rifampicin, and gentamicin.

Topics: Agriculture; Anti-Infective Agents; Brucellosis; Drug Therapy, Combination; Female; Gentamicins; Humans; Infant, Newborn; Lung; Radiography; Respiratory Distress Syndrome, Newborn; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Infective sacro-ileitis is due to common bacteria, 25% being tuberculosis and 10% brucellosis. Slow progression characterizes joint tuberculosis, an uncommon variant of this disease. The onset is usually insidious, and early diagnosis requires a high index of clinical suspicion. We report two cases with tuberculous sacro-ileitis which initially mimicked brucellosis infiltration. Diagnosis of tuberculosis of the sacroiliac joint was established by fine-needle aspiration of joint and radiological imaging methods such as computerized tomography, magnetic resonance and three-phase bone scan. The current diagnosis and treatment of this condition is discussed based on these cases and a literature review.

Topics: Abscess; Adult; Antitubercular Agents; Arthritis, Infectious; Brucellosis; Diagnosis, Differential; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Male; Pyrazinamide; Radiography; Rifampin; Sacroiliac Joint; Tuberculosis, Osteoarticular; Tuberculosis, Pulmonary; Ultrasonography

Breast involvement of brucella can be frequently detected in animals, however, it is extremely rare in humans. Clinical findings and complications may cause difficulties in diagnosis. We report the case of a 52-year old woman with bilateral brucella mastitis, which is difficult to differentiate from inflammatory breast carcinoma.

Topics: Brucellosis; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Female; Humans; Mammography; Mastitis; Middle Aged; Rifampin

To study the clinical spectrum of brucellosis in Bikaner (Northwest India).. A total of 175 cases were diagnosed as brucellosis during the period of six year (June 1997 to May 2003). They were studied for clinical profile and treated by rifampicin and doxycyclin and additionally streptomycin for initial 14 days in patients of neurobrucellosis. These patients were followed up to 3 months.. Patients of brucellosis presented with a wide spectrum of clinical manifestations. Out of 175 cases 155 were from rural area. Age ranged between 12-60 years (124 males, 51 females). Analysis of risk factors revealed history of raw milk ingestion (86.86%), occupational contact with animals (81.14%), handling of infected material (62.28%), household contact (16%) and 2 patients were veterinarian. Joint pain (83.43%) and fever (77.71%) were the commonest presenting feature. Sacroiliac joint was most commonly involved (46.86%). 31 cases had involvement of multiple joints. Other mode of presentation were neurobrucellosis (18.86%), manifested as polyradiculoneuropathy, myeloradiculopathy, meningoencephalopathy and polyradiculomyeloencephalopathy; predominant pulmonary involvement (4.0%) presented as bronchitis, pneumonia and pleural effusion; epididymoorchitis, infective endocarditis, nephrotic syndrome and recurrent abortion. All patients responded well to the treatment.. Brucellosis is an important emerging zoonotic disease but it is often under-diagnosed due to lack of suspicion and diagnostic facilities despite the fact that cattle farming (an important high risk group) is one of the main occupation in rural area. This report should infuse the awareness about this reemerging disease specifically in high-risk group.

Topics: Adolescent; Adult; Animals; Anti-Bacterial Agents; Arthritis, Infectious; Brucellosis; Child; Doxycycline; Female; Follow-Up Studies; Food Microbiology; Humans; India; Male; Meningoencephalitis; Middle Aged; Milk; Occupational Diseases; Orchitis; Pleural Effusion; Prospective Studies; Rifampin; Risk Factors; Rural Health; Streptomycin

Topics: Abdominal Pain; Adult; Animals; Brucella; Brucellosis; Calcinosis; Combined Modality Therapy; Doxycycline; Drug Therapy, Combination; Fever; Food Contamination; Food Microbiology; Hepatectomy; Humans; Liver Abscess; Male; Milk; Recurrence; Rifampin

Brucellosis is a significant public health problem particularly in developing countries. People are frequently infected through milk, milk products, urine and pregnancy material of animals with brucellosis. Epididymoorchitis is the most frequent genitourinary complication of brucellosis and is often unilateral. In this report, a 35 years old male patient who was diagnosed as epididymoorchitis based on clinical presentation, laboratory findings and imaging techniques, has been presented. Brucella melitensis was isolated from blood, bone marrow and ejaculate cultures of the patient. The patient was treated with rifampicine and doxycycline combination therapy for six weeks and no complication has developed in the one year follow-up period. In areas where brucellosis is endemic, such as our country, Brucella infection should be considered in the differential diagnosis of epididymoorchitis and in addition to blood and bone marrow cultures, ejaculate cultures should also be evaluated.

Topics: Adult; Anti-Bacterial Agents; Bacteremia; Bone Marrow; Brucella melitensis; Brucellosis; Diagnosis, Differential; Doxycycline; Epididymitis; Humans; Male; Orchitis; Rifampin; Semen

In the Netherlands, brucellosis is uncommon. Diagnosis is difficult and frequently delayed. We present three patients with back pain and/or arthralgia caused by brucellosis. We emphasise the importance of considering brucellosis in patients returning from a stay in a rural area of an endemic country, who present with osteoarticular symptoms and signs of chronic inflammation. Clues to the diagnosis come from a thorough medical history.

Topics: Adult; Aged; Arthralgia; Back Pain; Brucellosis; Ciprofloxacin; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Dyspnea; Female; Humans; India; Male; Middle Aged; Netherlands; Rifampin; Turkey

We report here a 70-year-old female patient who was diagnosed with brucellosis and presented with mass formation resembling a tumor. The mass was protuberant, 10 cm from the skin surface with a diameter of 15 cm, located at the inferior-lateral region of the left scapula. Brucella melitensis was yielded from culture of mass fluid. The patient responded to ceftriaxone, rifampin and doxycycline therapy and recovered without any sequela at the end of surgery and 3 months of medical treatment.

Topics: Aged; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Ceftriaxone; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Female; Humans; Rifampin; Scapula; Soft Tissue Neoplasms

Brucellosis continues to be an important cause of fever in underdeveloped countries and in rural areas of developed world. It is a multisystemic disease, associated with wide variety of symptoms. A wide variety of symptoms, including haematological abnormalities, such as anaemia, thrombocytopenia, pancytopenia, dissemine intravascular coagulation and leucopoenia could be seen, all of which are more common than usually thought. In this short study, we present a relatively uncommon haematological manifestation that of isolated thrombocytopenia mimicking idiopathic thrombocytopenic purpura, which we observed in seven of 114 patients who were diagnosed with brucellosis in our hospital over a 2-year period. Having given brucellosis treatment with rifampicin and doxycycline, complete remission was achieved and thrombocyte count returned to normal in all cases.

Topics: Adult; Aged; Antibiotics, Antitubercular; Brucellosis; Diagnosis, Differential; Doxycycline; Female; Humans; Male; Middle Aged; Purpura, Thrombocytopenic, Idiopathic; Rifampin; Thrombocytopenia

Topics: Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Ciprofloxacin; Drug Therapy, Combination; Humans; Microbial Sensitivity Tests; Mutation; Rifampin; Tetracycline

Topics: Animals; Anti-Bacterial Agents; Biomedical Research; Brucellosis; Developing Countries; Doxycycline; Drug Combinations; Drug Resistance, Microbial; Drug Therapy, Combination; Fluoroquinolones; Gentamicins; Global Health; Guideline Adherence; History, 21st Century; Humans; Recurrence; Rifampin; Streptomycin; Terminology as Topic; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; World Health Organization

A 39-year-old man with a 4-month history of transient pins and needles sensations occurring below the waist while walking and difficulty walking presented to our outpatient clinic. He had an approximate 1-year history of bilateral hearing loss, the etiology of which was unknown. His symptoms had been progressive, and there was no significant family history. He demonstrated a spastic gait and required assistance for walking. Deep tendon reflexes were hypertonic; a sensation deficit was defined as originating from the 12th thoracic vertebra. Babinski's sign was positive bilaterally. Sphincter abnormalities were seen in the patient's bladder and bowel functions. Cerebral and spinal magnetic resonance images with contrast media were unremarkable. An analysis of the patient's cerebrospinal fluid was consistent with neurobrucellosis. Owing to spastic paraparesis and hearing loss, the diagnosis of neurobrucellosis was made. Combined antimicrobial therapy was started and continued 6 months. His neurologic condition improved, and he was able to walk without help after 3 months' treatment. Our case illustrates that acquired progressive spastic paraparesis may occur during the course of neurobrucellosis. Neurobrucellosis should be borne in mind when patients present with spastic paraparesis.

Topics: Adult; Anti-Bacterial Agents; Brucellosis; Ceftriaxone; Doxycycline; Hearing Loss; Humans; Male; Paraparesis, Spastic; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Agglutination Tests; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Brucella melitensis; Brucellosis; DNA, Bacterial; Doxycycline; Drug Therapy, Combination; Hearing Loss, Sensorineural; Humans; Male; Rifampin; RNA, Ribosomal, 16S; Vestibulocochlear Nerve Diseases; Zoonoses

We reviewed a case of Brucella spondylodiscitis admitted to a referral, university hospital, in Ankara, Turkey. A 75-year-old female was referred to our hospital with low back pain. Previous magnetic resonance imaging yielded cortical destruction of T9-10 and T12-L2 vertebral bodies, focal infectious foci at discs within this range, significant microabscesses at paravertebral areas, which lead to the diagnosis of spondylodiscitis. History of consumption of unpasteurized dairy products led us to first suspect brucellosis yet, the serum agglutination test and blood culture were negative and did mislead us to several other, sometimes invasive, diagnostic tests. The final diagnosis was reached by culturing the specimen obtained through fine-needle aspiration from the paravertebral microabscesses. The exhausting diagnostic journey that started with the suspicion of tuberculosis or malignancy ended with a diagnosis of brucellosis. Brucellosis should be considered in all patients with osteoarthritic complaints in endemic regions, and the "prozone phenomenon" should be kept in mind, before proceeding to high-tech lab tests, imaging, or invasive procedures.

Topics: Aged; Anti-Bacterial Agents; Brucella; Brucellosis; Discitis; Doxycycline; Drug Therapy, Combination; False Negative Reactions; Female; Follow-Up Studies; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Radiography; Rifampin; Serologic Tests; Thoracic Vertebrae; Time Factors; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Child; Doxycycline; Drug Therapy, Combination; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Psoas Abscess; Rifampin; Time Factors; Treatment Outcome

Topics: Acute Disease; Adult; Antibiotics, Antitubercular; Brucellosis; Humans; Male; Nephritis, Interstitial; Rifampin

Brucellosis is a common zoonosis which still remains as a major health problem in certain parts of the world. Osteoarticular involvement is the most frequent complication of brucellosis, in which the diagnosis of brucellar spondylodiscitis is often difficult since the clinical presentation may be obscured by many other conditions. Herein, we reported an uncommon case of spondylodiscitis due to brucella in an elderly male who had diabetes mellitus and degenerative spinal disease as underlying conditions. The diagnosis was established by using magnetic resonance imaging after the brucella-agglutination test was found to be positive. The diagnosis was also confirmed by positive blood culture. A high degree of suspicion in the diagnosis of brucellar spondylitis is essential to reduce the delay for the treatment. Thus, it should be essentially included in the differential diagnosis of longstanding back pain particularly in regions where brucellosis is endemic. Screening serologic tests for brucella should be used more widely in cases with low index of suspicion, especially in endemic areas.

Topics: Aged; Anti-Bacterial Agents; Brucella; Brucellosis; Diagnosis, Differential; Discitis; Doxycycline; Drug Therapy, Combination; Humans; Magnetic Resonance Imaging; Male; Rifampin; Treatment Outcome

From March 1998 to September 2001, 64 children and from October 2001 to December 2004, 66 children < or = 15 years with brucellosis in Babol, Iran, were treated with cotrimoxazole and rifampin for 6 or 8 weeks, respectively. Cure rate for 6 weeks was 89.1% and for 8 weeks it was 95.5%. Six weeks of therapy with cotrimoxazole plus rifampin is sufficient for treatment of childhood brucellosis.

Topics: Adolescent; Brucellosis; Child; Child, Preschool; Cohort Studies; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Iran; Male; Retrospective Studies; Rifampin; Risk Assessment; Severity of Illness Index; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

We diagnosed active brucellosis infection at the tenth week of gestation in a woman with a twin pregnancy. Antimicrobial therapy with rifampicin was started at 900 mg/day and continued for six weeks. Healthy twins were delivered at the 38th week of gestation. Early and adequate treatment of maternal brucella infection might have prevented the early detrimental consequences of the disease.

Topics: Adult; Anti-Bacterial Agents; Brucella abortus; Brucellosis; Female; Humans; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Pregnancy, Multiple; Rifampin; Twins

Brucella infective endocarditis is an uncommon, but serious complication of brucellosis. The aortic valve is the most commonly affected cardiac valve. Due to characteristics of the infection, medical therapy alone is not sufficient in treating the disease and best results are obtained with surgery combination. We describe a case of Brucella endocarditis involving the aortic valve suspected in front of the clinical data and the results of serology, confirmed by the culture of the native valves. In association with the medical treatment, management valve replacement lead to a favorable medium-term evolution.

Topics: Anti-Bacterial Agents; Aortic Valve; Aortic Valve Insufficiency; Brucellosis; Doxycycline; Endocarditis, Bacterial; Follow-Up Studies; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Rifampin

In this report an acute brucellosis case presenting with the symptoms of urinary tract infection (UTI) has been discussed. A 29 years old male patient was admitted to the emergency service of our hospital with the complaints of acute UTI. His complaints were persisting for five days before admission. His physical examination was normal but there were fever (39 degrees C) and costovertebral angle tenderness. His medical history revealed that multiple stones in the lower pole of the right kidney and paranchyme loss were detected by IVP two years ago. The bacteria that were isolated from blood and urine cultures were identified as Brucella melitensis by conventional methods. Rose Bengal test was found positive, and standard tube agglutination test was positive at a titer of 1/640. The patient was treated with oral ciprofloxacin (1000 mg/day) and rifampicin (600 mg/day) combination for six weeks. The aim of this presentation was to draw attention to this uncommon condition, as UTI symptoms are not the first symptoms of acute brucellosis. UTI symptoms should be carefully considered as a presentation of brucellosis especially in regions where brucellosis is endemic.

Topics: Acute Disease; Adult; Anti-Infective Agents; Brucella melitensis; Brucellosis; Ciprofloxacin; Humans; Male; Rifampin; Urinary Tract Infections

Brucellosis remains a major zoonotic disease worldwide. It has never been reported at King Chulalongkorn Memorial Hospital (KCMH). The authors describe the first case of brucellosis in KCMH, and also review all previous reports in Thailand. The presented case was a 52-year-old Thai man, living in Phetchabun Province, who was diagnosed with idiopathic pulmonary fibrosis two years prior to admission. He presented with prolonged fever, dry cough, weight loss of eight kg over three months, hepatosplenomegaly, and pancytopenia. Blood and bone marrow cultures grew Brucella melitensis at 72 hours of incubation. A slide agglutination (Rose Bengal) test was also positive for Brucella antibody. He had been exposed to contaminated placenta of his goats that had spontaneous abortion in the past few months before his illness. The patient was successfully treated with gentamicin, doxycycline, and rifampicin. Clinicians should have a high index of suspicion when evaluating patients presenting with prolonged fever and having an exposure risk of brucellosis.

Topics: Animals; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Doxycycline; Drug Therapy, Combination; Enzyme Inhibitors; Fever; Fluorescent Dyes; Gentamicins; Goats; Hospitals; Humans; Literature; Male; Middle Aged; Rifampin; Rose Bengal; Thailand

We describe the case of a student with a history of two and a half months of fever, hepatosplenomegaly, cutaneous, hematological and bone manifestations, within an epidemiological background compatible with the diagnosis of Brucellosis. Diagnosis of Brucella abortus was confirmed by serology and positive blood cultures. Clinical manifestations of brucellosis and diagnostic and treatment strategies are reviewed.

Topics: Anti-Bacterial Agents; Brucella abortus; Brucellosis; Child; Doxycycline; Follow-Up Studies; Humans; Male; Rifampin

Brucellosis is a systemic infectious disease with a broad spectrum of clinical manifestations. Arthritis is frequently observed in its course and may be one of the main presenting clinical features of the disease. We report a case of brucellar monoarthritis of the knee with a prolonged clinical course despite efficient antibiotic treatment.

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Infectious; Brucella melitensis; Brucellosis; Doxycycline; Drug Therapy, Combination; Humans; Indomethacin; Male; Middle Aged; Rifampin; Streptomycin; Sulfamethoxazole; Treatment Outcome; Trimethoprim

Brucellosis is one of the important health problems for both humans and animals in Turkey since agriculture and stock raising appears to be the most important means of subsistence. Investigations on the pathogenesis of brucellosis reveal that the etiologic agent can survive in phagocytic cells, and cell-mediated immunity plays an important role in immunity against bacteria.. In this study, we investigated whether supplementation of levamisole, a well-known antihelminthic agent with immune-stimulating activity to conventional antibiotic therapy, would improve the anergy against Brucella.. The results of our study reveal that a 6-week course of levamisole as a supplement to conventional antibiotic therapy in chronic brucellosis is not superior to conventional antibiotic treatment alone with respect to lymphocyte subgroup ratios and phagocytic function.. In chronic brucellosis, levamisole administered as a supplement concomitantly with conventional antibiotic therapy has no immunostimulating effect on the basis of the lymphocyte subgroups ratios measured and the ability of phagocytosis in the present study. Further large clinical and laboratory trials are necessary to investigate the immunological and physiological effects of levamisole on T(H1) subtypes and cytokine secretion.

Topics: Brucella melitensis; Brucellosis; Chronic Disease; Combined Modality Therapy; Doxycycline; Drug Therapy, Combination; Female; Humans; Immunity, Cellular; Levamisole; Lymphocytes; Male; Phagocytosis; Rifampin; Turkey

Brucellosis is a zoonosis that affects several organs and has a protean presentation. The authors report the case of a 61-year-old male patient with brucellar spondylodiscitis involving several vertebrae and a paravertebral abscess localized in the erector spinae muscle. Diagnosis was made by positive blood culture and MRI. No relapse was seen with a combined treatment (doxycycline/rifampin) for 3 months, followed by doxycycline alone for 6 months. Almost all radiologic findings disappeared at the end of a 1-year follow-up without any further treatment.

Topics: Abscess; Anti-Bacterial Agents; Brucella; Brucellosis; Discitis; Doxycycline; Drug Therapy, Combination; Fever; Humans; Low Back Pain; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Rifampin; Thoracic Vertebrae; Treatment Outcome

The mechanisms by which brucellae evade intracellular killing by polymorphonuclear leukocytes are incompletely understood. In this study, we evaluated changes of leukocyte superoxide dismutase (SOD) activity and plasma total nitrite as an indicator of nitric oxide (NO) levels during brucellosis therapy.. Thirty-two patients with acute brucellosis, 27 patients with chronic brucellosis and 30 healthy controls were included in the study. Patients with acute brucellosis were tested for leukocyte SOD activity and plasma total nitrite levels before, during (21st day), and at the end (45th day) of the combined therapy of rifampicin and doxycycline. The same parameters were also investigated in chronic cases and controls.. The SOD activities were lower in patients with acute brucellosis before therapy compared with those 21 and 45 days after starting therapy (P < 0.001). In contrast, total nitrite levels did not change significantly (P > 0.05).. In the present study, leukocyte SOD activity was found to be decreased in patients with acute brucellosis. Enzyme activity was increased by treatment, finally reaching the activity of healthy controls. Using an antioxidant agent in addition to classical antimicrobial therapy for acute brucellosis might be a therapeutic approach.

Topics: Acute Disease; Antioxidants; Brucellosis; Chronic Disease; Doxycycline; Female; Humans; Leukocytes; Male; Nitric Oxide; Nitrites; Rifampin; Superoxide Dismutase

Cryoglobulinemia has been described in infectious diseases, but in only three patients with brucellosis. We report a 59-year-old male with Brucella peritonitis with cutaneous vasculitis and renal failure that could be related to mixed cryoglobulinemia. As in cryoglobulinemia associated with other infections, resolution of the disease was obtained with specific antimicrobial therapy.

Topics: Anti-Bacterial Agents; Ascitic Fluid; Brucella melitensis; Brucellosis; Cryoglobulinemia; Doxycycline; Humans; Male; Middle Aged; Ofloxacin; Peritonitis; Renal Insufficiency; Rifampin; Vasculitis, Leukocytoclastic, Cutaneous

Endocarditis is a rare but life-threatening complication of brucellosis. Its mortality rate has recently been reduced with the use of combined medical and surgical treatment.. Between March 2002 and April 2004, 6 patients with Brucella endocarditis underwent surgery at the Siyami Ersek Cardiovascular Center in Istanbul, Turkey. The diagnosis of Brucellosis was based on the presence of clinical signs and symptoms compatible with brucellosis, serology and/or a positive blood culture. All patients with suspected Brucella endocarditis were studied by echocardiography. The diagnosis of Brucella endocarditis was made in accordance with Duke's criteria.. The most commonly affected valve was the aortic valve (4 patients). Four patients had prosthetic valves because of a previous history of rheumatic fever. In 5 patients, elective surgery was performed. Five patients underwent valve replacement with prosthetic valves, but 1 patient underwent excision of the abscess cavity without valve replacement. There was no operative mortality. All patients continued antibiotic treatment for at least 3 months postoperatively. The median duration of follow-up after surgery was 12 months. During the follow-up period, 1 patient died, while the others remained alive with no recurrences.. Prosthetic valve replacement is a safe procedure in patients with Brucella endocarditis. Surgical interventions combined with triple antibiotic therapy yield good results with no recurrence in the long-term follow-up.

Topics: Adult; Aged; Brucellosis; Combined Modality Therapy; Doxycycline; Endocarditis, Bacterial; Female; Humans; Male; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Pulmonary involvement is a rare manifestation of brucellosis. The aim of this study was to determine the incidence and forms of pulmonary involvement in the course of brucellosis.. A prospective study was carried out in 110 patients with brucellosis. All the patients were evaluated with their pulmonary symptoms, physical examination and chest radiography. If pulmonary pathologic findings were present, patients underwent additional diagnostic evaluations including computerized tomography of the thorax and pulmonary function tests.. From 110 patients, 11 (six females and five males) were diagnosed as pulmonary brucellosis. Eight of 11 patients had pulmonary symptoms including cough, sputum and dyspnoea. Radiologic findings were parenchymal nodules, lobar pneumonia, paratracheal lymphadenopathy and pleural effusion. At the end of the treatment of brucellosis, clinical findings of pulmonary involvement were recovered in all patients except four dyspnoeic patients who had coexisting COPD. Radiological findings were normal in three and improved in four patients after 6 months of the treatment.. Pulmonary involvement is a rare event in the course of brucellosis. But especially in endemic regions, brucellosis should never be forgotten as a causative agent in patients with pulmonary symptoms.

Topics: Adult; Aged; Anti-Bacterial Agents; Brucella; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Humans; Incidence; Lung Diseases; Male; Middle Aged; Prospective Studies; Radiography; Rifampin; Streptomycin

Topics: Anti-Bacterial Agents; Arthritis; Brucella melitensis; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Humans; Middle Aged; Rifampin; Temporomandibular Joint; Temporomandibular Joint Disorders

Brucellosis is an infectious disease of humans and animals caused by Brucella species. We report on a 34-year-old housewife who presented with recurrent headache, fever, and malaise. Blood cultures yielded slow-growing gram-negative coccobacilli that were later identified as Brucella melitensis. The patient recalled handling goat placenta in China. She was prescribed a 6-week course of doxycycline and rifampicin. Laboratory staff who had been exposed to the isolate remained asymptomatic. The epidemiology, diagnosis, and treatment of brucellosis are discussed.

Topics: Adult; Anti-Bacterial Agents; Brucellosis; Diagnosis, Differential; Doxycycline; Enzyme Inhibitors; Female; Hong Kong; Humans; Rifampin

The purpose of this study was to investigate levels of lipid peroxidation, indicated by plasma malondialdehyde (MDA), with consideration of clinical status and treatment outcomes in patients with acute brucellosis. Plasma MDA levels were measured in patients with acute brucellosis and healthy subjects. Significantly higher MDA levels were detected in plasma of patients with acute brucellosis compared to controls (P<0.01). Plasma levels of MDA were significantly decreased after the brucellosis treatment (P<0.01). The results of the present study indicate for the first time that a considerable level of lipid peroxidation is involved in acute brucellosis cases and this may be of importance with respect to the understanding of disease pathogenesis and may serve as a target for treatment regime.

Topics: Acute Disease; Adolescent; Adult; Blood Sedimentation; Brucellosis; C-Reactive Protein; Doxycycline; Female; Humans; Lipid Peroxidation; Male; Malondialdehyde; Middle Aged; Prospective Studies; Rifampin; Streptomycin

A model of Brucella melitensis infection was used in the setting of long-term ethanol administration to study the effects of ethanol on antibiotic therapy of B. melitensis infection. Wistar rats received a liquid diet containing maximally 42.2% of total calories as ethanol. Controls were pair-fed a liquid diet without ethanol. Diets began 15 days pre- and continued post-infection. Rats were infected intraperitoneally with B. melitensis. Doxycycline (10 mg/kg/day) plus rifampicin (6 mg/kg/day) were administered intragastrically starting days 7 to 14 following B. melitensis inoculation. The cure rate was 64.71% in ethanol-fed and 100% in control groups. Although the number of B. melitensis in spleens and livers was reduced, cure was unsuccessful in 6 ethanol-fed rats and this was not explained by the appearance of resistance, since none of the strains isolated following a 7-day course of therapy showed an increase in the minimum inhibitory concentration (MIC) of antibiotics. This study suggests that long-term ethanol ingestion diminishes the efficacy of doxycycline plus rifampicin combination therapy of rat brucellosis in an experimental design.

Topics: Animals; Anti-Bacterial Agents; Antibiotics, Antitubercular; Brucella melitensis; Brucellosis; Central Nervous System Depressants; Diet; Disease Models, Animal; Doxycycline; Drug Interactions; Ethanol; Microbial Sensitivity Tests; Rats; Rats, Wistar; Rifampin

Eleven cases of human brucellosis occurred among livestock workers and a veterinarian who lived and worked in a rural area around Jeongeup City, Jeollabuk-Do, Korea from February 2003 to August 2003. Eight of the patients had taken care of Korean native cattle that were infected with bovine brucellosis and had already been slaughtered. Two of the patients had taken care of dairy cattle, and one case was a veterinarian who acquired the disease through an accidental contact with infected cattle while assisting in calf delivery. Eleven cases were identified by serologic work ups and four cases were identified via positive blood cultures. This study shows that the Republic of Korea is no longer free of human brucellosis, Brucella abortus biotype 1. We reviewed the patients' characteristics and serologic data during the one-year follow up period, and we also discuss on the efficacy and side effects of the rifampin and doxycyline regimen used for the treatment of human brucellosis.

Topics: Adult; Animal Husbandry; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Base Sequence; Brucella abortus; Brucellosis; Brucellosis, Bovine; Cattle; Disease Outbreaks; DNA, Bacterial; Doxycycline; Female; Humans; Korea; Male; Middle Aged; Occupational Diseases; Rifampin; Veterinarians

Brucellar spinal epidural abscesses (BSEA) are rare and very few series of them have been reported. In order to evaluate the clinical characteristics, management and outcome of this entity, the clinical records and current status of a series of 11 patients have been retrospectively reviewed. A series of 11 patients treated for BSEA in our Service during a period of 12 years (1989-2000) have been retrospectively studied. Spinal epidural abscesses (SEA) were diagnosed by MRI, CT or at surgery. Brucellar aetiology of SEA was considered when seroagglutination tests were positive at a titre of 1/160 or higher, and/or Brucella spp. were isolated in the blood or sample cultures. Ten of the 11 cases were treated with rifampicin plus doxycycline and in the remaining patient streptomycin was added because of a poor initial response. Six patients underwent surgical decompression and debridement of the SEA. Outcome was excellent in nine cases and good in two. There was no mortality and only one patient recovered incompletely from preadmission neurological deficits. Although BSEA is considered to be an unusual complication of spondylitis, our findings show that in some cases it can follow direct haematogenous spread to the extradural space. Surgical treatment must be undertaken when major neurological deficits are present. If antibiotic treatment is chosen as the initial therapy, the possibility of sudden neurological deterioration must be taken into account. Contrary to the high morbi-mortality rates reported in pyogenic or tuberculous SEA, BSEA has a good prognosis with early diagnosis and appropriate management.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotics, Antitubercular; Brucella melitensis; Brucellosis; Doxycycline; Drug Therapy, Combination; Epidural Abscess; Humans; Magnetic Resonance Imaging; Middle Aged; Retrospective Studies; Rifampin; Spine; Treatment Outcome

Doxycycline is the most effective antibiotic for managing brucellosis. Although it is relatively free from side effects, complications involving the skin, nails and teeth may rarely be encountered.. Four patients with brucellosis developed yellow-brown discolouration of teeth following a 30-45 day course of doxycycline therapy during summer at a dose of 200mg/day.. All four patients were diagnosed as having doxycycline-induced staining of the permanent dentition. In all cases, the staining completely resolved and the teeth recovered their original colour following abrasive dental cleaning.. These observations indicate that the incidence of staining of the permanent dentition, as a complication of doxycycline, may be much higher than the literature indicates, especially if treatment is administered during summer months. Fortunately, this complication is reversible and does not require termination of doxycycline therapy. Complete resolution following abrasive cleaning may suggest that an extrinsic mechanism within the dental milieu may be involved in its pathogenesis. Strict avoidance of sunlight exposure during high-dose, long-term doxycycline therapy might prevent the development of this complication.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Brucellosis; Child; Doxycycline; Female; Follow-Up Studies; Humans; Male; Rifampin; Streptomycin; Sunlight; Tooth Discoloration; Toothbrushing

The efficacy of levofloxacin and dirithromycin, alone and in combination with rifampicin in the treatment of experimental brucellosis was investigated. Seventy adult white male mice were infected intraperitoneally with Brucella abortus S544 standard strain. Four of the animals were sacrificed on the 21st day of inoculation for infection control. The remaining 66 mice were randomised into treatment and control groups. Following 14 days of treatment the animals were sacrificed and spleen cultures were made. The cure rates were 36.4% for levofloxacin, 27.3% for dirithromycin, 72.7% for rifampicin, 72.7% for levofloxacin + rifampicin and 81.8% for dirithromycin + rifampicin. The results of this study indicate that levofloxacin and dirithromycin are ineffective in the treatment of experimental murine brucellosis as monotherapy or in combination with rifampicin.

Topics: Animals; Anti-Bacterial Agents; Brucella abortus; Brucellosis; Drug Therapy, Combination; Erythromycin; Levofloxacin; Male; Mice; Ofloxacin; Rifampin; Treatment Outcome

Brucellosis is a multisystemic disease. The most common cause of death from the disease is endocarditis. The aortic valve is most commonly affected. The disease rarely involves the mitral valve. A 30 year-old woman presented with complaints of chills and fever up to 38 degrees C at night, fatigue, palpitations, and dyspnea for the previous 3 weeks. Cardiac auscultation revealed a diastolic murmur in the mitral area. Her temperature was 38.3 degrees C. On echocardiographic examination, the mitral valve area was 0.62 cm (2) and an isoechoic mass thought to be a vegetation was detected on the anterior mitral leaflet. A diagnosis of infective endocarditis was made and vancomycin administration was commenced. Brucella melitensis was isolated in all three blood samples, however, the patient remained seronegative with Brucella agglutination titers of up to 1/160. The antibiotic therapy was then shifted to doxycycline (200 mg/day), rifampicin (600 mg/day), and ciprofloxacin (1000 mg/day). After 30 days of treatment, surgery was performed for the severely stenotic mitral valve and to remove the vegetation. The operation was successful. The postoperative period was uneventful. On the follow-up she had no complaints. In cases with Brucella endocarditis, after diagnosis, antibiotic therapy must be started immediately and when the clinical condition improves, surgical intervention should be performed when indicated.

Topics: Adult; Brucella melitensis; Brucellosis; Ciprofloxacin; Combined Modality Therapy; Doxycycline; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Humans; Mitral Valve Stenosis; Rifampin

We report two cases of brucellosis in members of a hunt club, both of whom had killed and dressed wild boars. Serologic studies usually suffice for screening patients with suspected or possible brucellosis; however, and as illustrated by our index case, one should ask the laboratory to dilute serum out beyond the customary 1:160 titer if results are negative yet the clinical suspicion high. Hunters should be advised to wear gloves prior to dressing wild mammals.

Topics: Adult; Animals; Anti-Bacterial Agents; Bronchitis; Brucella abortus; Brucellosis; Diagnosis, Differential; Doxycycline; Enzyme Inhibitors; Firearms; Humans; Male; Rifampin; South Carolina; Sus scrofa; Titrimetry

Forty-one children <8 years of age treated for brucellosis with oral minocycline (2.5 mg/kg) twice daily for 3 weeks were recalled and examined to check for dental staining and defects. Dental staining and defects were found in 14 of 41 exposed children (34.1%) and in 30 of 82 matched controls (36.6%), respectively (P > 0.2).

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Brucellosis; Child; Child, Preschool; Dental Enamel; Humans; Minocycline; Retrospective Studies; Rifampin; Tooth Diseases

To report a case of brucellosis with bilateral permanent loss of vision.. Case report.. Bilateral loss of vision developed within two weeks in a young adult with positive Brucella antibodies. There was optic disc swelling with optic neuropathy and serous retinal detachment in both eyes. The patient had chronic active brucellosis confirmed by serum antibody titers (1/640).. This case shows that optic neuropathy may result in severe visual loss in patients with brucellosis.

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Brucella; Brucellosis; Doxycycline; Drug Therapy, Combination; Eye Infections, Bacterial; Glucocorticoids; Humans; Male; Optic Nerve Diseases; Papilledema; Prednisolone; Retinal Detachment; Rifampin; Vision, Low

This study was undertaken to investigate the usefulness of spiramycin in treatment for brucellosis in an animal model.. Eighty-four Sprague-Dawley rats were infected by intraperitoneal injection of Brucella melitensis suspension. Seven days after inoculation, four rats were selected randomly, killed and spleen cultures and Brucella standard tube agglutination test were carried out. All four rats were found to be infected. Eighty adult rats were randomly divided into four groups of 20 rats each. Tap water was given to the first group. Rifampicin 50 mg/kg per day and doxycycline 40 mg/kg per day were given to the second group, spiramycin 50 mg/kg per day orally was given to the third group, and a combination of spiramycin and rifampicin at the same dose and period was given to the fourth group. Duration of therapy regimens in all groups was 21 days. The spleens of all 80 rats were removed aseptically, homogenized, and placed onto Brucella agar plates to determine if viable bacteria were present.. Bacterial growth occurred in all of the rats' spleens in the first group and in two rats' spleens in the spiramycin group. Mean colony forming unit (c.f.u.) values were at the highest in the first group. The effectivities of spiramycin and rifampicin-spiramycin were similar to rifampicin-doxycycline. There were no differences in the treatment results between the three groups that received combined rifampicin-doxycycline, rifampicin-spiramycin and only spiramycin (P>0.05).. The results show that spiramycin cures experimental rat brucellosis and may be an effective alternative in the therapy of human brucellosis.

Topics: Animals; Anti-Bacterial Agents; Brucellosis; Cell Count; Disease Models, Animal; Enzyme Inhibitors; Male; Random Allocation; Rats; Rifampin; Spiramycin; Stem Cells

Brucella bacteremia is not uncommon in children living in endemic areas. Reports on brucella bacteremia, however, are scarce. Its clinical features and complications are unknown. This retrospective review describes the clinical and laboratory characteristics, the relapse rate, and response to different regimens of antimicrobials in children with brucella bacteremia over a 5-year period. Antimicrobial susceptibility testing was performed on all isolates. Data on 62 children with brucella bacteremia were collected between 1996 and 2000. All isolates were of Brucella melitensis species. Most children were between five and 10 years of age; males were twice as affected as females (66% vs 34%). Fever and arthralgia were the most common presenting symptoms, 81% and 48% respectively. Fever and arthritis were the most common physical findings, 81% and 19% respectively. Forty-five (73%) patients presented within 10 days of illness onset. Brucella titers were measured in all patients; 95% had a positive titer of 1:320 or more. Resistance to co-trimoxazole (sulfamethoxazole + trimethoprim) increased from 22% in 1996 to 66% in year 2000. Rifampicin and co-trimoxazole were the most commonly used combination in 50%, rifampicin, co-trimoxazole, supplemented with gentamicin or streptomycin in 27%. The median duration of therapy was 6 weeks. The overall relapse rate was 13% (95% CI, 4.6%-21.2%) but was higher among those with symptoms lasting >10 days (P<0.001). There was a high relapse rate among patients infected with co-trimoxazole-resistant species and treated with co-trimoxazole compared to patients infected with sensitive species who also received co-trimoxazole (22% vs. 8%), but this was not statistically significant (P = 0.16). Patients with brucella bacteremia present early in their course of illness. Their clinical features, however, did not differ from brucellosis patients who did not have bacteremia. Despite the high rate of in-vitro resistance to co-trimoxazole, this did not correlate with a significant relapse rate.

Topics: Adolescent; Anti-Bacterial Agents; Bacteremia; Brucella melitensis; Brucellosis; Child; Child, Preschool; Drug Resistance, Microbial; Drug Therapy, Combination; Enzyme Inhibitors; Female; Humans; Infant; Infant, Newborn; Male; Recurrence; Retrospective Studies; Rifampin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Infective Agents; Brucellosis; Doxycycline; Endocarditis, Bacterial; Humans; Male; Middle Aged; Rifampin; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination

Pulmonary manifestations of Brucellosis are rare. We came across seven patients with predominant symptomatology of pulmonary involvement amongst 98 patients of active brucellosis seen in last four years.. The study is related to patients of brucellosis whose principal presenting features were related to respiratory symptom (cough, expectoration, pain in chest and breathlessness) along with fever and other constitutional symptoms. It included seven patients amongst 98 patients of active brucellosis seen during June 1996 to Feb. 2000 at PBM Hospital Bikaner. Diagnosis was confirmed by demonstration of the raised brucella agglutination titre of 1:320 or more in the serum. All patients were treated with rifampicin 900 mg daily and doxycyclin 100 mg twice daily for six week. The treatment was extended for another four weeks in two patients because of persistence of skiagram abnormalities.. Three patients had abnormality in skiagram chest in the form of pleural effusion, multiple paranchymal opacities and pneumonia. The skiagram chest was normal in remaining four patients. The response of treatment started with 10-15 days and all the patients became symptom-free at the end of six weeks except one patient. Skiagram chest at this time was normal in patients of pleural effusion but there was persistence of haziness and few opacities in other two patients. Follow up skiagram chest at the end of six months and twelve months was normal in all patients except calcified opacity in one patient. There was no evidence of relapse in any patient at the end of one year follow up. Liver function tests remained within normal range and no drug toxicity was observed.. Pulmonary manifestations of brucellosis are rare. Treatment with rifampicin and doxycylin showed marked clinical and radiological improvement. All patients were completely disease-free at the end of one year follow up.

Topics: Adolescent; Adult; Brucellosis; Doxycycline; Humans; India; Lung Diseases; Male; Occupational Exposure; Rifampin; Treatment Outcome

A 59-year-old male farmer presented with a rare case of spondylodiscitis as a manifestation of systemic brucellosis. The patient presented with radicular pain and restricted mobility of the spine due to localized muscle spasm in addition to systemic complaints. Magnetic resonance imaging demonstrated discovertebral involvement at the L4-5 intervertebral space, indicating infectious spondylodiscitis. The Rose-Bengal test was positive and the serum antibody titer was 1/1280. The patient was treated with streptomycin combined with tetracycline plus rifampicin, with complete recovery. Early diagnosis is important and prompt antibrucellar chemotherapy is effective in most cases. Therefore, spondylodiscitis due to brucellosis should be considered in the differential diagnosis of spinal infections.

Topics: Anti-Bacterial Agents; Brucellosis; Discitis; Drug Therapy, Combination; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Rifampin; Streptomycin; Tetracycline

An 11-year-old boy presented with chronic meningitis followed by acute flaccid paralysis. The aetiology remained uncertain until the brucellar serology test became positive and there was a good response to specific antimicrobial therapy. Nerve conduction studies confirmed a proximal radiculopathy. Awareness of the condition and performance of the appropriate tests will differentiate neurobrucellosis from other chronic central nervous system infections.

Topics: Anti-Bacterial Agents; Brucellosis; Central Nervous System Bacterial Infections; Child; Chronic Disease; Doxycycline; Humans; Male; Meningitis, Bacterial; Neural Conduction; Paralysis; Radiculopathy; Rifampin

The hematological manifestations of brucellosis include anemia, leucopenia, thrombocytopenia and clotting disorders. In this case report, two patients, with clinically and serologically proven brucellosis, manifesting with thrombocytopenia were presented. The first patient who was a 32 years old man, was admitted to the hospital with the complaints of fever, malaise and night sweats. His Brucella agglutination titer was 1/1280 and thrombocyte count was 41.000/mm3. The second case was a 46 years old man with the complaints of fever and rash. His Brucella agglutination titer was 1/640, thrombocyte count was 38.000/mm3. Following treatment with doxycycline and rifampisin the thrombocyte counts of the patients returned to normal (respectively, 176.000/mm3 and 162.000/mm3. The blood cultures of both of these patients did not yield Brucella. The antibiotic therapy of patients discontinued after 6 weeks, with full recovery.

Topics: Adult; Agglutination Tests; Anti-Bacterial Agents; Antibodies, Bacterial; Brucella; Brucellosis; Doxycycline; Drug Therapy, Combination; Humans; Male; Middle Aged; Platelet Count; Rifampin; Thrombocytopenia

Brucellosis is an infectious disease with multisystem involvement caused by the genus Brucella. Neurological complications including meningitis, meningoencephalitis, myelitis-radiculoneuritis, brain abscess, epidural abscess, and meningovascular syndromes are rarely encountered. We present here a patient with sixth cranial nerve palsy that occurred during treatment for brucellosis, a form of presentation rarely been reported in English-language literature. We conclude that neurobrucellosis, pseudotumor cerebri, and side effects of tetracyclines which are frequently used in brucellosis should be kept in mind when considering intractable headaches and cranial nerve palsies in patients with brucellosis.

Topics: Abducens Nerve Diseases; Acute Disease; Adult; Anti-Bacterial Agents; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Methylprednisolone; Pseudotumor Cerebri; Rifampin; Streptomycin; Treatment Outcome

In order to evaluate the efficacy and tolerability of a high intravenous dose of rifampin plus oral minocycline (administered daily for 3 weeks) for the treatment of acute brucellosis, we retrospectively reviewed the outcome of 239 consecutive patients (135 adults and 104 children) diagnosed and treated over a 17-year period in Italy. The combination used resulted in 100% response and a relapse rate lower than 2%. Fifty-two (30 adults and 22 children) (29.8%) complained of mild adverse effects including an increase in aspartate aminotransferase (>250 IU) observed in 12 cases and considered related to rifampin and in 11 cases a reversible hyperpigmentation of the tongue attributed to minocycline. A randomized prospective comparative study should be performed to confirm our encouraging results.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Brucella; Brucellosis; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Infusions, Intravenous; Italy; Male; Middle Aged; Minocycline; Recurrence; Retrospective Studies; Rifampin; Risk Assessment; Treatment Outcome

One hundred and sixty-six presumed brucellosis patients were included in the study. These patients were classified as primary (91), relapse (18) and suspected (57) cases according to their clinical presentations, and serologic and microbiologic test results. Primary and relapse cases were evaluated retrospectively according to age, sex, residence, routes of transmission, clinical and laboratory findings, treatment regimens, duration of treatment, and relapse rates. Of the 109 primary and relapse patients, 57 were male and 52 female. The ages of the patients ranged between 16-75 (mean age 40.2). The percentages of the urban and rural residence of the patients were 41.3% and 58.7%, respectively. The most common mode of transmission was consumption of unpasteurized milk and milk products (67.9%). Malaise, fever and sweating were the most frequently observed symptoms (96.3%, 95.4%, 91.7%, respectively). The most common signs were fever (97.2%), splenomegaly (59.6%), and hepatomegaly (37.6%). The liver was the most frequently involved organ (21.1%). Almost all (99.1%) patients were serologically positive. However, the positivity rate of culture was low (15.6%). The most frequently preferred antimicrobial regimen was rifampin and doxycycline combination. The relapse rate was 8.3%. Brucellosis is still prevalent in Turkey as in many other countries in the Mediterranean basin. The clinical presentation of the disease may show regional variations. Patients with a history of occupational or nutritional contact with the bacterium and with a compatible clinical picture should be examined using appropriate diagnostic techniques before any attempt to prescribe an antimicrobial.

Topics: Adolescent; Adult; Brucellosis; Dairy Products; Doxycycline; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Recurrence; Retrospective Studies; Rifampin

41 Brucella strains isolated from blood and cerebrospinal fluid cultures were identified to species level and biotypes detected. All of the isolates were Brucella melitensis: 2 strains of B. melitensis biotype-1 and 39 strains of B. melitensis biotype-3. In vitro activities of these strains were detected by the E test method. According to the 90% minimal inhibitory concentration (MIC90) values, the most active agent was doxycycline (MIC90 0.064 microg/ml), followed by ciprofloxacin (MIC90 0.25 microg/ml), trimethoprim-sulfamethoxazole and ceftriaxone (MIC90 0.38 microg/ml). Rifampin exhibited the highest MIC90 value (0.75 microg/ml).

Topics: Anti-Bacterial Agents; Bacterial Typing Techniques; Brucella melitensis; Brucellosis; Ceftriaxone; Ciprofloxacin; Doxycycline; Drug Resistance, Bacterial; Humans; Microbial Sensitivity Tests; Rifampin; Sensitivity and Specificity; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey

Gaucher disease type I and brucellosis are chronic diseases with similar symptoms and physical signs though the former is the most common lysosomal storage disease and the latter is an infectious disease. The similarities between these diseases make differential diagnosis difficult. Immunodeficiency is a feature of Gaucher disease type I and increases the susceptibility towards infections. A Gaucher disease type I patient with brucellosis is presented with improvement after treatment of brucellosis.

Topics: Adult; Anti-Bacterial Agents; Antibiotics, Antitubercular; Brucellosis; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Gaucher Disease; Humans; Magnetic Resonance Imaging; Male; Rifampin; Spleen

Topics: Brucellosis; Ciprofloxacin; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Liver Abscess; Middle Aged; Rifampin; Severity of Illness Index; Tetracycline; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography, Doppler

The case of a 25-y-old woman with brucellar ovarian abscess is reported. Cultures of blood, ascites and a pus specimen yielded Brucella melitensis. The possibility of ovarian abscess being caused by Brucella melitensis should be considered in countries where the infection is endemic.

Topics: Abscess; Adult; Anti-Bacterial Agents; Ascites; Brucella melitensis; Brucellosis; Doxycycline; Female; Humans; Laparoscopy; Ovarian Diseases; Rifampin

1) To identify patients of brucella spondylitis and sacroiliitis amongst patients of 'infective spondylitis' and 'sacroiliitis', 2) To study clinical and radiographic features and outcome of brucella spondylitis.. We reviewed 21 patients of infective spondylitis and 12 of sacroiliitis attending our hospital between March and September 2000 and followed them to identify patients of brucella spondylitis and brucella sacroiliitis, using serological tests.. 1) Twenty six patients (17 spondylitis and nine sacroiliitis) were detected to have brucella infection to be the cause of their illness. 2) Brucella spondylitis is commonly mistaken for tuberculous spondylitis in our country. Thus leading to a delay in the diagnosis as well as occurrence of angular deformity and neurological deficit, which are reportedly uncommon in this condition. 3) Consumption (or handling) of unpasteurized milk (tabela milk) and occasional animal contact were found to be the source of infection in the general population. 4) Predominantly lumbar spine involvement, end-plate erosion of L4, L3, L5, decreased intervertebral disc space, repair with'formation of an osteophyte, simultaneous involvement of several sites and association of spondylitis with sacroiliitis were important radiographic features.. Brucellosis exists in the general population, high clinical suspicion especially when there is history of animal contact or consumption of unpasteurized milk, familiarity with clinical and radiological features of brucella spondylitis and detection of antibodies to brucella by ELISA will help us detect and treat these patients in time.

Topics: Adolescent; Adult; Aged; Antibodies, Bacterial; Brucella abortus; Brucella melitensis; Brucellosis; Doxycycline; Enzyme-Linked Immunosorbent Assay; Female; Humans; India; Magnetic Resonance Imaging; Male; Middle Aged; Rifampin; Sacroiliac Joint; Spondylitis; Trimethoprim, Sulfamethoxazole Drug Combination

A 40 year patient presented with pyrexia of one month duration. Routine work up for fever of unknown origin (FUO) was negative. Bone marrow aspiration and culture done yielded Brucella. Bone marrow cultures are recommended for patients for FUO for whom the routine workup turns out to be negative. Serological tests for brucellosis can be false-negative in some cases of brucellosis due to prozone phenomena.

Topics: Adult; Anti-Bacterial Agents; Bone Marrow; Brucella; Brucellosis; Doxycycline; Drug Therapy, Combination; Enzyme Inhibitors; Humans; India; Male; Netilmicin; Rifampin

Topics: Anti-Bacterial Agents; Brucella abortus; Brucellosis; Doxycycline; Drug Therapy, Combination; Epididymitis; Humans; Male; Middle Aged; Oligospermia; Orchitis; Recurrence; Rifampin

We report the case of a 14-year-old girl with Guillain-Barré syndrome associated with brucellosis due to Brucella melitensis. The diagnosis was established by the isolation of B. melitensis from her blood and by the determination of high levels of Brucella aglutinins in her sera and cerebrospinal fluid. A combination of rifampin, co-trimoxazole and physical therapy resulted in complete healing within 30 days. Antibrucellar treatment continued for 12 weeks. This case report suggests that brucellosis should be kept in mind in the aetiology of Guillain-Barré syndrome in the endemic areas for brucellosis, and bacteriological and serological tests for brucellosis should be performed.

Topics: Adolescent; Anti-Infective Agents; Antibiotics, Antitubercular; Brucella melitensis; Brucellosis; Drug Combinations; Female; Guillain-Barre Syndrome; Humans; Physical Therapy Modalities; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Anti-Bacterial Agents; Antibiotics, Antitubercular; Antibodies, Bacterial; Brucella melitensis; Brucellosis; Child; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Female; Fever of Unknown Origin; Humans; Male; Practice Guidelines as Topic; Rifampin

This report describes the case of a 45-year-old woman with a 5-month history of fever, generalized malaise, myalgia, lower back pain and difficulty in walking. Serodiagnosis for brucella, carried out at the onset of symptoms 5 months previously, was negative. When the patient was admitted to our hospital there was contracture of the paraspinal muscles but no peripheral nerve damage. Laboratory tests showed positive agglutination for Brucella and an increase in the rate of dilution from 1/160 to 1/640 over 2 weeks. Radiographs and a computed tomography scan of the spine revealed bone erosion in the posterior borders of the L4-L5 vertebral end plates and a soft tissue mass surrounding the interposed disc and protruding into the spinal canal. Magnetic resonance imaging confirmed the presence of a paraspinal abscess around the affected disc and tissue edema. Culture tests of the blood and abscess tissue, taken by biopsy, were negative. Rifampicin treatment (600 mg daily), combined with a bust cast to immobilize the spine, led to clinical healing without the need for surgery. Because onset symptoms are nonspecific and insidious, in nonrisk subjects a diagnosis of brucellosis may sometimes be suspected only if there are local symptoms. The phenomenon of the absence of positivity in patients with a high antibody titer should also be considered Cases such as that described herein demonstrate the need for culture tests and serodiagnosis, even in nonrisk patients with persistent fever and arthralgia, to prevent the later complications of brucellosis.

Topics: Abscess; Antibiotics, Antitubercular; Brucella melitensis; Brucellosis; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Reverse Transcriptase Polymerase Chain Reaction; Rifampin; RNA, Ribosomal, 16S; Spinal Diseases; Spine; Spondylitis

The aim of this study was to compare the efficacy, tolerability and side effects of 2 treatment regimens for brucellosis.. Fifty-seven patients with brucellosis were followed up in our clinic. The patients were given rifampicin plus doxycycline or rifampicin plus quinolone. Thirty patients (group one) received rifampicin 600mg/daily plus doxycycline 100mg twice daily and 27 patients (group 2) received quinolones (ofloxacin 200mg twice daily peroral) plus rifampicin 600mg/daily. Both regimens were administered for 45-days. During the course of treatment, patients were followed for the disappearance of physical signs and symptoms. All patients were followed up at least 6-months after cessation of therapy. Diagnosis of brucellosis was established by utilizing the following criteria; Isolation of brucella species in blood, body fluids (Sceptor, Becton-Dickinson, United States of America), compatible clinical picture supported by the detection of specific antibodies at significant titers or demonstration, or both, of an at least 4 fold rise in antibody titer in serum specimens taken after 2-weeks. Significant titer was determined to be >one/160 in the standart tube agglutination test (Brucella abortus Cromatest, Linear Chemicals, Spain).. Of patients 14 (24.5%) were male and 43 (75.5%) were female. Mean age was 36.8 11.3 years (range 15-65). Sacroiliitis was the most common involvement in both groups 9 (30%) versus 6 (22%), followed by peripheral arthritis 6 (20%) versus 6 (22%). In this study, relapse rate was found 7.2% and 6.7% for ofloxacin plus rifampicin and doxycycline plus rifampicin for a 6-week therapy (p>0.05). No significant adverse effects were associated with either combination.. These results indicated that a 45-day course of doxycycline plus ofloxacin combination was as effective as the doxycycline plus rifampicin combination in patients with brucellosis.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Quinolones; Rifampin

Human brucellosis is a multisystem disease that may present with a broad spectrum of clinical manifestations, and its complications can affect almost all organs and systems with varying incidence. Soft-tissue infection due to Brucella species is a rare complication of brucellosis. This report presents a case of a 30-y-old previously healthy woman whose right buttock abscess culture grew Brucella spp. The patient was treated successfully with abscess drainage and antibiotic therapy.

Topics: Abscess; Adult; Brucellosis; Buttocks; Doxycycline; Female; Humans; Rifampin; Treatment Outcome

With the aim to estimate the clinical and immunological efficiency of the ciprofloxacin (cifloxinal) 105 patients with acute (51), subacute (19) and chronic (35) brucellosis were studied. Control group (17 patients with acute and 30 patients with chronic brucellosis) have been treated with combination of two antibiotics: doxycycline and rifampicin. Ciprofloxacin in a dose 500 mg bid within 14 days in acute stage and 20 days in chronic stage of disease essentially reduced duration of local inflammatory processes of brucellosis with simultaneous treatment of the chronic infection focus, provides good proximate and distant outcomes of treatment. Ciprofloxacin can be considered as an alternative drug for the treatment of brucellosis, more effective (clinically and immunologically) than a combination of two antibiotics: doxycycline and rifampicin.

Topics: Acute Disease; Adult; Antibody Formation; Brucella melitensis; Brucellosis; Chronic Disease; Ciprofloxacin; Doxycycline; Drug Therapy, Combination; Humans; Middle Aged; Rifampin; Severity of Illness Index; Treatment Outcome

To present epidemiologic, clinical and laboratory features, treatment and outcome of patients suffering from Brucella melitensis-induced epididymo-orchitis, in comparison with cases of nonspecific epididymo-orchitis. Distinction between these two entities is essential, as treatment and outcome are entirely different.. In this retrospective study, records of 17 patients serologically diagnosed as suffering from B. melitensis epididymo-orchitis were reviewed in comparison with 141 cases of non-Brucella epididymo-orchitis. All patients presented consecutively at a tertiary hospital in southwestern Greece, from 1991 to 2000. Statistical analysis was performed using the chi-square test.. B. melitensis epididymo-orchitis differed from nonspecific epididymo-orchitis, due to its high occupational risk, seasonal pattern, gradual onset (P<0.01), longer duration, typical undulatory fever (P<0.05), absence of serious leukocytosis (P<0.05) and lower urinary tract symptoms, and relatively minimal local signs of florid inflammation (P<0.01). Oral medication with doxycycline and rifampicin for 6 weeks was effective, and no relapses or serious side effects were recorded during the follow-up period.. B. melitensis-induced epididymo-orchitis is a recognized clinical problem in endemic regions, requiring early detection and appropriate medication. Clinicians encountering epididymo-orchitis should consider the likelihood of brucellosis and initiate anti-Brucella medication upon clinical diagnosis and not only after serologic confirmation.

Topics: Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Doxycycline; Endemic Diseases; Epididymitis; Greece; Humans; Male; Orchitis; Retrospective Studies; Rifampin; Treatment Outcome

Brucellosis may lead to complications that affect different organ systems, including the liver and spleen. In acute disease, hepatosplenic abscess is a rare complication. We report herein a woman with splenic abscess due to acute Brucella melitensis infection who was successfully treated with antibiotics alone.

Topics: Abdominal Abscess; Aged; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Doxycycline; Female; Humans; Rifampin; Splenic Diseases; Streptomycin

Peritonitis is an uncommon complication of brucellosis. Brucella peritonitis in chronic ambulatory peritoneal dialysis (CAPD) patients has not been reported before. A male patient is presented with peritonitis caused by Brucella melitensis who was on CAPD. The source of infection was thought to be unpasteurized, unsalted cheese eaten a month before the onset of symptoms. At the beginning, antibiotic therapy with doxycyline and rifampicin led to a rapid clinical improvement, with disappearance of the organism in the peritoneal fluid. However, peritonitis relapsed after discontinuation of antimicrobial therapy. Successful management required a combination of medical therapy and removal of the Tenckhoff catheter.

Topics: Acute Disease; Anti-Bacterial Agents; Brucellosis; Doxycycline; Humans; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Rifampin

Topics: Adult; Blood Cell Count; Brucella melitensis; Brucellosis; Doxycycline; Drug Therapy, Combination; Exanthema; Fever; Humans; Male; Rifampin; Turkey

Central nervous system involvement by brucellosis is infrequent and usually presents as acute meningoencephalitis. Neurobrucellosis presenting as a focal brain mass has rarely been demonstrated on imaging studies. We describe the imaging and pathologic findings in a child affected by neurobrucellosis with focal cortico-subcortical involvement.

Topics: Adolescent; Anti-Bacterial Agents; Brain; Brain Diseases; Brucellosis; Drug Therapy, Combination; Humans; Magnetic Resonance Imaging; Male; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Infective Agents; Aortic Valve; Brucellosis; Doxycycline; Drug Therapy, Combination; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Prosthesis-Related Infections; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

To document the clinical course and the treatment of episcleritis associated with brucellosis.. Three consecutive cases of patients with recurrent episcleritis associated with brucellosis were evaluated through clinical and laboratory data including serology (tube agglutination), blood culture, and synovial fluid culture.. All the patients had ingested contaminated milk and/or fresh cheese. The diagnosis of brucellosis was confirmed by high antibody titer, positive blood culture, negative synovial fluid culture and unresponsive condition to the previous nonspecific therapy for episcleritis and reactive arthritis. The patients responded well to the therapy with doxycycline and rifampicin.. We proposed that recurrent episcleritis had a co-occurence with reactive arthritis in the course of the brucellosis, and that it responded well to the antibrucellar antibiotics rather than to steroids. This also implies that brucellosis as a rule is an underlying triggering infection associated with reactive arthritis.

Topics: Aged; Antibodies, Bacterial; Arthritis, Reactive; Brucella; Brucellosis; Doxycycline; Drug Therapy, Combination; Eye Infections, Bacterial; Female; Humans; Middle Aged; Recurrence; Rifampin; Scleritis; Synovial Fluid

Topics: Adult; Animals; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Doxycycline; Endocarditis, Bacterial; Humans; Male; Rifampin; Streptomycin

To study the epidemiological and clinical pattern of brucellosis in children of Dhofar and to ascertain the efficacy of a pre-determined antibiotic regimen to treat the disease.. The study was hospital based and was carried out prospectively for 3 years. All cases diagnosed to have brucellosis on clinical and serological basis were entered into the study. The epidemiological background and clinical presentations were analyzed and the clinical response to a combination of oral rifampicin and co-trimoxazole was evaluated.. Three hundred and seventy five cases of brucellosis were eligible for the study. Ingestion of raw milk and its products were responsible for causation of the disease in 63% of cases. Eighty three per cent had direct contact with animals mainly cattle. A minority of 4.5% denied ingestion of raw milk or coming into direct contact with animals. Fever was the most common presenting feature at 91%. We identified 2 distinct groups of presentation: Seventy per cent of those who presented with arthritis belonged to the older age group (7.34 years, standard deviation 2.64). They did not have a systemic illness. The younger age group presented with severe systemic illness associated with severe leucopenia and thrombocytopenia. The clinical response to the combination of rifampicin and co-trimoxazole was satisfactory in 90% of patients and 98% of brucella species isolated from the blood of patients were sensitive to both antibiotics used.. Ingestion of infected milk and contact with infected animals are the main causes of human brucellosis, although aerial transmission from contaminated environmental soil could not be excluded. The main clinical presentation of brucellosis in children is fever but the skeletal manifestations of the disease are significant. The hematological manifestations of the disease in endemic areas deserve special attention. The combination of oral rifampicin and co-trimoxazole for 6 weeks is adequate to treat most cases of brucellosis in children.

Topics: Anti-Infective Agents; Brucellosis; Child; Child, Preschool; Doxycycline; Drug Therapy, Combination; Female; Humans; Infant; Male; Oman; Prospective Studies; Rifampin; Risk Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Brucellosis is hyperendemic in Saudi Arabia where, despite rapid urbanisation, a large segment of the population has a nomadic background and clings to cultural traditions such as the drinking of raw milk. We report here an unusual complication of brucellosis in a microbiology technologist. A 41-year-old male presented with an 8-day history of right ankle pain which, over a 3-day period, extended up to his calf where swelling and tightness developed. The leg symptomatology occurred on a background of fever, seats and rigors. X-ray of the limb was normal but a venogram revealed thrombosis of the deep veins of the right calf. Although his blood culture was negative, he developed high brucella antibody titres. Treatment with anticoagulants combined with a course of doxycycline and rifampin produced a full recovery.

Topics: Adult; Anti-Bacterial Agents; Antibodies, Bacterial; Anticoagulants; Brucella abortus; Brucella melitensis; Brucellosis; Diagnosis, Differential; Doxycycline; Enzyme Inhibitors; Humans; Male; Occupational Exposure; Phlebitis; Rifampin

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Brucellosis; Doxycycline; Humans; Male; Middle Aged; Mycobacterium Infections; Rifampin; Spleen

Topics: Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Doxycycline; Female; Humans; Low Back Pain; Middle Aged; Rifampin; Spondylitis

Topics: Animals; Brucella melitensis; Brucellosis; Disease Models, Animal; Erythromycin; Male; Mice; Mice, Inbred BALB C; Microbial Sensitivity Tests; Rifampin; Treatment Outcome

A 22-year-old man with leukocytoclastic vasculitis as a cutaneous manifestation of brucellosis is presented. Skin lesions resolved 48 hours after starting treatment with tetracycline and rifampicin. Although skin manifestations are rarely associated with infection due to Brucella and do not seem to worsen the prognosis, they may cause the patient to seek medical attention as well as contribute to the diagnosis.

Topics: Adult; Anti-Bacterial Agents; Antibiotics, Antitubercular; Biopsy; Brucella melitensis; Brucellosis; Humans; Male; Rifampin; Skin; Tetracycline; Vasculitis, Leukocytoclastic, Cutaneous

Topics: Adolescent; Anti-Bacterial Agents; Brucella; Brucellosis; Doxycycline; Humans; Low Back Pain; Male; Radionuclide Imaging; Rifampin; Sacroiliac Joint; Tomography, X-Ray Computed

Eight patients presented neurological signs secondary to Brucella infection. The clinical presentation was a meningoencephalitis in three cases, a meningoencephalomyelitis in one case, an epiduritis with spinal cord compression in one case, an acute polyradiculoneuritis in two cases and a chronic polyradiculoneuritis in one case. Acoustic nerve was impaired in seven cases. Cerebrospinal fluid (CSF) analysis revealed a lymphocytic meningitis and a high protein concentration in all cases. The agglutination test titers were elevated in the serum and in the CSF of seven patients (> or = 1/80) and two patients respectively. Brucella melitensis culture was disclosed in the blood of one patient and in the CSF of two patients. Three patients were treated by the association cycline and rifampicin whereas a tritherapy including cycline, rifampicin and TMP-SMZ was used in the other cases. Outcome was favorable in seven cases. This study outlines the polymorphism of neurological manifestations due to brucellosis, even in familial cases and this diagnostic must be especially done in Middle East and South Mediterranean countries.

Topics: Acute Disease; Adolescent; Adult; Aged; Agglutination Tests; Brucellosis; Chronic Disease; Enzyme Inhibitors; Female; Humans; Male; Mediterranean Region; Meningoencephalitis; Middle Aged; Middle East; Polyradiculoneuropathy; Retrospective Studies; Rifampin; Spinal Cord Compression; Tetracyclines

Topics: Abscess; Adult; Anti-Infective Agents; Brain Diseases; Brucellosis; Drug Therapy, Combination; Endoscopy; Female; Humans; Pituitary Diseases; Rifampin; Sulfamethoxazole; Trimethoprim

Topics: Animals; Anti-Bacterial Agents; Antibiotics, Antitubercular; Antibodies, Bacterial; Brucella; Brucellosis; DNA, Bacterial; Doxycycline; Humans; Mammals; Polymerase Chain Reaction; Rifampin; Zoonoses

A 22 year old female presented with sudden onset of uncrossed diplopia at distance, intracranial hypertension, esotropia and was evaluated. Microbiological tests of CSF and sera showed for brucellosis and the patient received therapy for this and her intracranial hypertension. The papilledema, headache, esotropia and diplopia all disappeared after therapy.. Diagnostic tests for brucella must be considered for patients who have divergence palsy and papilledema, especially those living in endemic areas.

Topics: Acetazolamide; Adult; Antibiotics, Antitubercular; Brucella melitensis; Brucellosis; Ceftriaxone; Central Nervous System Bacterial Infections; Cephalosporins; Cerebrospinal Fluid; Diplopia; Diuretics; Drug Therapy, Combination; Esotropia; Female; Humans; Intracranial Hypertension; Papilledema; Rifampin

This paper describes a case of systemic brucellosis accompanied by brucellar orchitis that resolved favourably. There was however a relapse at the testicular level inappropriately treated that triggered a new episode of systemic brucellosis.

Topics: Adult; Anti-Infective Agents; Brucellosis; Doxycycline; Epididymitis; Humans; Male; Orchitis; Recurrence; Rifampin; Streptomycin

Topics: Brucella; Brucellosis; Doxycycline; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Humans; Male; Middle Aged; Ofloxacin; Rifampin

Although there have been reports of Brucella granuloma or abscess in the literature, they were all localized extradurally except one, and most patients underwent surgery.. A 40-year-old female presented with urinary and fecal incontinence and a two-month history of progressive weakness of the right leg and numbness of the left leg. Four months previously, she had been diagnosed with systemic brucellosis with a period of radiculomeningoencephalitis; she was treated successfully with rifampicin, doxycycline, trimethoprim/sulfamethoxazole (TMP/SMZ), and streptomycin, and was discharged symptom-free on rifampicin and doxycycline. Neurological examination revealed spastic paraparesis, globally hyperactive deep tendon reflexes (DTRs) and sensory level at T6. Magnetic resonance imaging (MRI) of the spinal cord revealed a 10 x 30 mm intradural-intramedullary mass lesion at the T5 level with surrounding edema that enhanced with contrast. The cerebrospinal fluid (CSF) was xanthochromic with lymphocytic pleocytosis and elevated levels of albumin, immunoglobulins, and antibody titers for Brucella. The medications were modified to rifampicin 1200 mg, doxycycline 400 mg, and TMP/SMZ 480/2400 mg daily, and methylprednisolone 100 mg in decremental doses (for 6 weeks). After 2 months, the patient was almost symptom-free and her medication doses were decreased. After 5 months, the mass lesion resolved almost completely. The treatment was discontinued after 2 years.. The case is presented because of its uniqueness. In cases of Brucella granuloma, the authors recommend a trial of medical treatment with adequate dosages for a reasonable length of time before considering surgical intervention.

Topics: Adult; Brucellosis; Dose-Response Relationship, Drug; Doxycycline; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Granuloma; Humans; Magnetic Resonance Imaging; Methylprednisolone; Neurologic Examination; Rifampin; Spinal Cord; Spinal Cord Diseases; Thoracic Vertebrae; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

This study was undertaken to see if brucella spondylitis existed as a cause of backache in Mumbai and to identify the clinical setting in patients of backache where brucella serology is indicated.. In 18 months (June 1996-Dec. 1997) we performed tube agglutination test (TAT) for Brucella melitensis and abortus on 72 patients of low backache from Orthopaedics Department of a teritary health centre. All 72 patients satisfied the inclusion and exclusion criteria designed to exclude radiologically detectable congenital or degenerative cause of backache.. Six out of 72 patients were seropositive for brucellosis. All six patients had either history of animal contact or ingestion of raw milk or milk product (cheese or paneer). The lumbosacral backache was severe, radiating to the legs and straight leg raising test was significantly positive, they had marked tenderness on spinous process of lower lumbar vertebrae. Changes of brucella spondylitis were present on plain radiogram of lumbosacral spine in three patients. Four patients had abnormalities on bone scintigraphy.. Low backache of brucella spondylitis closely simulates pain of prolapsed intervertebral disc. Serologic testing for brucellosis is an important step in management of such patients, especially when history of animal contact or raw milk or milk product ingestion is present, as the disease can be eminantly treated with antibiotics.

Topics: Adolescent; Adult; Agglutination Tests; Anti-Bacterial Agents; Brucella abortus; Brucella melitensis; Brucellosis; Doxycycline; Female; Humans; Low Back Pain; Lumbar Vertebrae; Male; Rifampin; Spondylitis

Seventy-three cases of acute brucellosis were studied in relation to fever duration and hospital stay following different drug combinations, including gentamicin plus cotrimoxazole, rifampicin plus doxycycline, rifampicin plus cotrimoxazole, rifampicin plus tetracycline, streptomycin plus doxycycline, doxycycline plus cotrimoxazole, tetracycline plus cotrimoxazole, and tetracycline plus streptomycin. No statistical significant difference was found between these combinations regarding early clinical response in human brucellosis.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Analysis of Variance; Anti-Bacterial Agents; Antibiotics, Antitubercular; Brucella melitensis; Brucellosis; Child; Child, Preschool; Doxycycline; Female; Gentamicins; Humans; Infant; Male; Middle Aged; Retrospective Studies; Rifampin; Streptomycin; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Agglutination Tests; Anti-Bacterial Agents; Brucellosis; Cerebrospinal Fluid; Diplopia; Headache; Humans; Male; Paraplegia; Polyradiculoneuropathy; Prednisone; Rifampin; Rose Bengal

Topics: Adolescent; Anti-Bacterial Agents; Antibiotics, Antitubercular; Arthritis, Infectious; Brucellosis; Disease-Free Survival; Doxycycline; Enzyme-Linked Immunosorbent Assay; Humans; Immunoglobulins; Male; Rifampin; Sacroiliac Joint

Brucellosis is rare in pregnancy. Recently, an increase in the incidence of this disease has been observed in our area. We present 7 cases of brucellosis in pregnancy and review the literature on the effects of brucellosis on the outcome of pregnancy. Brucellosis is rare in the Middle East and Africa and the most common source of infection is unpasteurized milk products. Brucella is a coccobacillus, gram-negative bacterium, whose hosts are mostly animals. There is controversy about the relationship between brucellosis and the outcome of pregnancy. There is some evidence that there is a higher rate of complications such as abortion, premature rupture of membranes and preterm delivery in infected animals. Reasons for this difference in the impact of brucella in animals and man include the absence of the carbohydrate erythritol in the human placenta, which appears to be a preferential medium and growth factor for brucella in the placentas of animals. There is uncertainty regarding effects of brucella in early pregnancy and no evidence of its transplacental passage in later pregnancy, causing adverse obstetrical outcome, although recently there has been a single report of Brucella abortus (biotype 2). We present 7 cases of brucellosis in pregnant women found between 1977-1988. Its incidence among the women who delivered here is 0.007% (7/92, 768 deliveries). Our first case was complicated by preterm premature rupture of membranes and preterm delivery in the 20th week of gestation. In 2 other cases there was preterm delivery with 1 developing clinical chorioamnionitis. The 4 remaining women delivered at term, although 1 had preterm premature rupture of membranes and intra-uterine growth retardation, and 2 had postpartum endometritis.

Topics: Adult; Brucellosis; Drug Therapy, Combination; Female; Humans; Incidence; Infant, Newborn; Infant, Premature; Israel; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Rifampin; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Brucellosis is a classical zoonosis caused by a Gram-negative bacillus of the genus Brucella. Human brucellosis can either be acute or chronic and present with a variety of manifestations, mostly with fever and signs of musculo-skeletal involvement. It may be complicated by involvement of the cardiovascular, central nervous or genito-urinary systems. However, pulmonary brucellosis is a rare complication. We report a case of miliary and reticulo-nodular brucellar pneumonia with positive blood and sputum cultures and positive serological tests. To the best of our knowledge this is the first case to be reported from Israel of miliary pneumonia with sputum positive for brucellosis.

Topics: Adult; Brucellosis; Drug Therapy, Combination; Humans; Lung Diseases; Male; Radiography; Rifampin; Tetracycline

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Humans; Intervertebral Disc; Middle Aged; Osteoarthritis; Rifampin; Shoulder Joint; Spinal Cord Compression

Topics: Adult; Brucellosis; Doxycycline; Drug Therapy, Combination; Humans; Ilium; Male; Osteomyelitis; Psoas Abscess; Rifampin; Sacroiliac Joint; Streptomycin

Brucellosis may show itself only through its bone and muscle complications, especially in the lumbar region, such as vertebral colliquation or psoas abscess. The authors describe a case of brucellosis (56 year old male, butcher) with lumbar bone and muscle involvement. The first symptom was a persistent pain of the right lumbar region, with irradiation to the homolateral leg. At admission the patient showed a lumbar cutaneous fistula with pus-like secretion. Quick diagnosis and therapy can prevent irreparable damage, even when the symptoms are silent.

Topics: Animals; Anti-Bacterial Agents; Bone Diseases; Brucellosis; Cattle; Diagnosis, Differential; Doxycycline; Humans; Ilium; Lumbar Vertebrae; Male; Middle Aged; Muscular Diseases; Psoas Muscles; Rifampin; Therapeutic Irrigation

A 33-year-old Portugese worker presented with a one-week history of nonproductive cough and fever. A presumptive diagnosis "viral infection of the respiratory tract" was made. However, because of persisting cough and fever further investigations were necessary, and finally Brucella melitensis was isolated in blood cultures. Three months before admission to the hospital the man was dressing the carcasses of a goat in Portugal and consumpted fresh goats milk cheese. Antibiotic therapy with Rifampicin and Trimethoprim/Sulfamethoxazol over 6 weeks improved the signs and symptoms of the infection.

Topics: Adult; Animals; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Cough; Drug Therapy, Combination; Fever of Unknown Origin; Germany; Goats; Humans; Male; Portugal; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination; Zoonoses

Topics: Adult; Anti-Bacterial Agents; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Humans; Incidence; Male; Rifampin; Spain; Streptomycin

Brucella infective endocarditis is an uncommon, but serious complication of brucellosis. The aortic valve is the most commonly affected cardiac valve, and a fearful complication is the formation of aortic root abscess. Due to the characteristics of the infection, medical therapy alone is not sufficient in treating the disease and best results are achieved in combination with surgery. We describe 2 cases of brucella endocarditis involving the aortic valve. Aggressive treatment, with surgery performed during a period of active infection, produced good results in eradication of infection and in preventing fatal complications such as rupture of aortic root abscesses.

Topics: Anti-Bacterial Agents; Aortic Valve; Brucellosis; Doxycycline; Drug Therapy, Combination; Echocardiography, Transesophageal; Endocarditis, Bacterial; Follow-Up Studies; Humans; Male; Middle Aged; Rifampin; Time Factors

Reports on simultaneous central and peripheral nervous system involvement in a patient with brucellosis are very rare. We report of one young female patient with a long history of consumption of non-pasteurized dairy products in which clinical and laboratory findings confirmed the existence of an active brucellosis with nervous system impairment. Cerebrospinal fluid (CSF) analyses were negative. Electrophysiology and positive findings on sural nerve biopsy complemented the diagnosis of polyneuroradiculomyeloencephalitis. Treatment with a combination of doxycycline and rifampin for 2 months was successfully applied. No relapse or sequelae occurred in the patient after 12 months of follow up.

Topics: Adult; Antibodies, Bacterial; Brucella; Brucellosis; Dairy Products; Doxycycline; Drug Therapy, Combination; Encephalomyelitis; Female; Food Contamination; Humans; Mexico; Polyradiculoneuropathy; Rifampin

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Antibiotics, Antitubercular; Bacteriological Techniques; Brain; Brucellosis; Cerebrospinal Fluid; Diagnosis, Differential; Doxycycline; Humans; Magnetic Resonance Imaging; Male; Neural Conduction; Polyradiculopathy; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Neurobrucellosis is an uncommon disease in children. The authors present two cases of brucellar meningo-encephalitis. Headache and vomiting were the main complaints and one child had also some behavioural disturbance as well as papilloedema and sixth cranial nerve palsy. The clinical diagnosis was suggested by epidemiological data in both cases. Blood and CSF cultures confirmed brucellar aetiology in one of the cases and positive serum and CSF specific antibodies in both. Clinical course was favourable after treatment with doxycycline, rifampicin and streptomycin. No relapse occurred and there were no sequelae.. Neurobrucellosis should be considered in the differential diagnosis of neurobehavioural disturbance of children living in areas where brucellosis is endemic.

Topics: Brucellosis; Child; Doxycycline; Humans; Male; Meningoencephalitis; Rifampin; Streptomycin

Brucellosis is a zoonosis that affect cows, goats and pigs, but in endemic zones human beings are frequently infected. Brucella infection in animals is associated with a high incidence of abortion, in humans a cause-effect relationship has not been proven. We present four cases of pregnant women with Brucella infection, all were treated only with rifampin, the patients had adequate obstetric evolution, the deliveries were at term and there were not birth defects or intrauterine growth retardation. One woman had a relapse during her puerperium. In the medical literature review there were not enough support to attribute to brucellosis as causal factor of abortion in humans. The treatment during pregnancy must include the combination of rifampin with another antibiotic with intracellular action.

Topics: Adult; Apgar Score; Brucellosis; Female; Humans; Infant, Newborn; Male; Pregnancy; Pregnancy Complications, Infectious; Puerperal Disorders; Recurrence; Rifampin; Time Factors

Topics: Adolescent; Anti-Bacterial Agents; Antibiotics, Antitubercular; Biopsy; Bone Marrow; Brucella melitensis; Brucellosis; Cough; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Gentamicins; Humans; Male; Rifampin

Two children who presented with fever, thrombocytopenic purpura and mucosal haemorrhages proved to have brucellosis. Large platelets in the peripheral smear and megakaryocytic hyperplasia in the bone marrow suggested increased peripheral destruction as the primary mechanism of the thrombocytopenia. There was a prompt clinical and haematological response to specific anti-brucella chemotherapy. The nature of this association and its implications for brucella-endemic areas are discussed.

Topics: Acute Disease; Blood Platelets; Bone Marrow; Brucellosis; Child; Child, Preschool; Diagnosis, Differential; Drug Therapy, Combination; Female; Gentamicins; Humans; Male; Megakaryocytes; Platelet Count; Purpura, Thrombocytopenic; Rifampin; Saudi Arabia; Trimethoprim, Sulfamethoxazole Drug Combination

The clinical efficacy of pefloxacin in the treatment of 51 and 19 patients with acute and subacute brucellosis respectively was studied. It was shown that in a dose of 400 mg twice a day for 15 days pefloxacin provided a rapid regression of the brucellosis clinical signs. By the efficacy it was not inferior to the combination of doxycycline and rifampicin used in the routine doses. Pefloxacin had no toxic action on the function of the liver, kidneys and hematopoietic system. The side effects were minimal. Pefloxacin did not suppress the immunity. By decreasing the activity of the brucellosis process it promoted normalization of the immunological indices.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Anti-Infective Agents; Brucellosis; Doxycycline; Female; Humans; Immunity; Male; Pefloxacin; Remission Induction; Rifampin; Treatment Outcome

Topics: Brucellosis; Child; Drug Administration Schedule; Drug Therapy, Combination; Humans; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Mice infected with Brucella melitensis were treated with doxycycline and rifampicin in daily dosages of: 1.5, 3 and 6 mg/kg separately and in combination, for a period of 14 days. Doxycycline alone in all dosages did not result in a cure rate superior to controls. A significant reduction in the viable count of B. melitensis recovered from the spleens of mice (which was the criterion for cure) was achieved with 6 and 3 mg/kg/day of doxycycline. Rifampicin at a dose of 6 mg/kg/day gave significantly better cure rates and reduction of mean viable counts of B. melitensis than untreated controls or doxycycline in similar doses. Low dose therapy with rifampicin (1.5 and 3 mg/kg) resulted in a further reduction in viable counts from spleens but with a cure rate no better than untreated animals. Rifampicin was more potent than doxycycline in all low dose regimens. When rifampicin was given in combination with doxycycline, the effect observed was similar to that of rifampicin alone. No synergy between rifampicin and doxycycline was demonstrable in the mouse model of brucellosis.

Topics: Animals; Brucellosis; Doxycycline; Drug Therapy, Combination; Male; Mice; Mice, Inbred ICR; Rifampin

The spinal form of brucellosis is still a disabling disease in many countries outside North America and northern and central Europe. Fifteen consecutive cases of spinal brucellosis diagnosed and treated over a 20-year period were reviewed retrospectively. Six patients were farmers, while 10 patients had a history of ingestion of unpasteurized milk or other dairy products. A high index of suspicion is necessary for the diagnosis, since there are no pathognomonic signs or symptoms. Radiological assessment of the disease was reviewed and highlights in the differential diagnoses were stressed. The diagnosis was based on actual culture of Brucella bacilli in seven patients. The principal treatment of brucellosis of the spine is conservative, namely, immobilization and antimicrobial therapy. We have found both a combination of ofloxacin and rifampin and ofloxacin monotherapy efficient as the early regimens used in this series. Three patients had to undergo surgery, since a diagnosis could not be made in any other way.

Topics: Adolescent; Adult; Aged; Brucella melitensis; Brucellosis; Combined Modality Therapy; Diagnosis, Differential; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Immobilization; Male; Middle Aged; Neurologic Examination; Ofloxacin; Osteomyelitis; Rifampin; Spine; Spondylitis; Tomography, X-Ray Computed

A 33-year-old patient from former Yugoslavia presented with low back pain and fever. Plain X-rays and myelography were normal, but a technetium-99m scan was suspect for vertebral osteomyelitis. Serology and blood cultures were positive for Brucella (melitensis). Antibiotic therapy with tetracycline and rifampicine rapidly improved the signs and symptoms of the infection. A retrospective analysis of 11 cases of Brucellosis treated in the Kantonsspital, Chur, over the years 1973 to 1992 revealed that 9 patients were foreign workers from rural areas in the Mediterranean region (Spain, Portugal, Italy, Yugoslavia, Greece). The majority had a history of consuming milk and dairy products from their own farm animals up to a few months before the onset of symptoms. Blood cultures were positive in 5 cases (B. melitensis) while the remaining 6 had high titers of agglutinating antibodies. A diagnostic delay of several weeks to months was typical. Because Brucellosis usually presents with unspecific often flu-like symptoms, with unspecific laboratory findings, and with a varying array of organ manifestations a high index of suspicion is essential for a timely diagnosis.

Topics: Adolescent; Adult; Brucella melitensis; Brucellosis; Diagnostic Imaging; Emigration and Immigration; Female; Humans; Male; Retrospective Studies; Rifampin; Rural Population; Spondylitis; Switzerland; Tetracycline

The in vivo efficacy of streptomycin (STR), doxycycline (DOX), rifampin (RIF), ciprofloxacin (CIP), and their combinations was evaluated for a Brucella melitensis experimental infection in a mouse model. Animals were infected with 2 x 10(4) to 4 x 10(4) CFU of B. melitensis intraperitoneally on day 0 and were randomized to receive, starting on day 7, STR alone at 75, 150, or 300 mg/kg of body weight per day intraperitoneally or DOX at 6 mg/kg/day orally, RIF at 3 mg/kg/day orally, or CIP at 200 mg/kg/day orally, each of the last three drugs alone or in combination with STR at 75, 150, or 300 mg/kg/day, for 14 days. Therapy failure (defined as nonsterile spleens) was observed in all animals treated with STR at all doses and with CIP given as monotherapy. Mean log CFU isolated from the spleens remaining infected following monotherapy with STR or CIP were not different from those in control mice. RIF at a low dose did not have an effect on cure rates; however, a reduction in CFU relative to the CFU in untreated animals was obtained. DOX at low levels achieved a 35% cure rate and a reduction in CFU in animals not cured. All animals treated with DOX or RIF combined with any STR dose were cured, but none of the animals receiving the STR-CIP combinations was cured, and the splenic CFU remained similar to those in the controls. These results demonstrate that the combinations DOX-STR and RIF-STR are synergistic against B. melitensis, while the combination STR-CIP is indifferent and ineffective in the management of acute murine brucellosis. The results also appear to support the clinical superiority of combination drug therapy over monotherapy.

Topics: Animals; Body Weight; Brucella; Brucellosis; Ciprofloxacin; Colony Count, Microbial; Doxycycline; Drug Synergism; Drug Therapy, Combination; Male; Mice; Mice, Inbred ICR; Microbial Sensitivity Tests; Organ Size; Rifampin; Spleen; Streptomycin

Eighteen patients with epididymo-orchitis were reviewed clinically, microbiologically and serologically. While there were positive urine culture in 5 patients before treatment, only one of them had positive culture in the epididymal aspirate. The epididymo-orchitis in two patients was the complications of the brucellosis. Ofloxacin or doxycycline was used in the treatment of 16 patients for 2-3 weeks and all, except one patient were recovered completely. The cases secondary to the brucellosis were treated with rifampicin plus doxycycline combination for 6 weeks. After treatment, no positive urine cultures were noted in all patients. As a result the epididymal aspiration to clarify etiological agent is not necessarily needed and empirical treatment may be generally curative.

Topics: Adolescent; Adult; Bacteriuria; Brucellosis; Doxycycline; Drug Therapy, Combination; Epididymitis; Escherichia coli; Escherichia coli Infections; Humans; Male; Middle Aged; Ofloxacin; Orchitis; Prospective Studies; Rifampin

Topics: Adolescent; Adult; Arthritis, Infectious; Brucella melitensis; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Humans; Radiography; Rifampin; Sacroiliac Joint

A patient with systemic brucellosis due to Brucella melitensis had severe renal involvement. Clinical features included hypertension, macroscopic haematuria, massive proteinuria of 10 g per 24 hours and azotaemia. Following treatment with antibiotics, the azotaemia resolved and proteinuria decreased to less than 0.5 g per 24 hours, but microscopic haematuria and hypertension persisted. Renal biopsy during recovery revealed IgA nephropathy with minimal mesangial changes, suggesting a causal relation between brucellosis and IgA nephropathy with a reversible nephrotic syndrome.

Topics: Adult; Brucellosis; Doxycycline; Female; Glomerulonephritis, IGA; Humans; Nephrotic Syndrome; Rifampin

Topics: Adult; Animals; Ascitic Fluid; Brucella melitensis; Brucellosis; Denmark; Female; Goats; Humans; Hydrocephalus; Milk; Peritonitis; Rifampin; Tetracycline; Turkey; Ventriculoperitoneal Shunt; Yogurt

Mice infected with Brucella melitensis were treated with streptomycin, co-trimoxazole, ciprofloxacin, doxycycline, and rifampin intraperitoneally and with ciprofloxacin, ofloxacin, pefloxacin, doxycycline, and rifampin orally for 14 to 21 days. Doxycycline- and rifampin-treated animals (either route) demonstrated a cure rate significantly better than that of controls. Longer therapy periods were associated with a significantly better outcome. Therapy failure was observed in all mice treated with ciprofloxacin, ofloxacin, and pefloxacin administered orally as well as in mice treated intraperitoneally with ciprofloxacin. Our findings demonstrate that treatment of experimental brucellosis in mice with doxycycline and rifampin yields therapeutic results that are superior to those yielded by treatment with quinolones.

Topics: Administration, Oral; Animals; Brucellosis; Ciprofloxacin; Doxycycline; Injections, Intraperitoneal; Male; Mice; Mice, Inbred ICR; Microbial Sensitivity Tests; Ofloxacin; Pefloxacin; Rifampin; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Antibodies, Bacterial; Antibody Specificity; Brucella abortus; Brucella Vaccine; Brucellosis; Doxycycline; Drug Evaluation; Drug Therapy, Combination; Humans; Immunization; Injections, Jet; Rifampin; Syringes; Time Factors; Vaccines, Synthetic

Topics: Brucellosis; Doxycycline; Drug Therapy, Combination; Humans; Rifampin

A rifampin-resistant mutant of Brucella abortus, designated RB51, was derived by repeated passage of strain 2308 on Trypticase soy supplemented with 1.5% agar and varying concentrations rifampin or penicillin. The RB51 colonies absorbed crystal violet and RB51 cell suspensions autoagglutinated, indicating a rough type colonial morphology for this strain. No O-chain component was detected in lipopolysaccharide (LPS) extracted from RB51 on SDS-PAGE gels stained with silver. Western blot analysis with the monoclonal antibody BRU 38, which is specific for the perosamine homopolymer O-chain of smooth Brucella LPS, indicated that the LPS of RB51 is highly deficient in O-chain when compared with the parenteral smooth strain 2308 or rough strain 45/20. Biochemically, RB51 resembles parental strain 2308 in its ability to utilize erythritol. Intraperitoneal inoculation of RB51 into mice results in a splenic colonization which is cleared within four weeks post infection. RB51 does not revert to smooth colony morphology upon passage in vivo (mice) or in vitro. Mice infected with RB51 produce antibodies against B. abortus antigens including class 2 and 3 outer membrane proteins but not against the O-chain. Furthermore, rabbits, goats and cattle hyperimmunized with sonicates of RB51 develop antibodies to B. abortus cellular antigens but do not develop antibodies specific for the O-chain. Immunization of mice with 1 x 10(8) viable RB51 organisms confers significant protection against challenge with virulent B. abortus strain 2308.

Topics: Animals; Antigens, Bacterial; Blotting, Western; Brucella abortus; Brucellosis; Brucellosis, Bovine; Cattle; Drug Resistance, Microbial; Goats; Mice; Mice, Inbred BALB C; Rabbits; Rifampin

Two hundred and sixty three patients with a diagnosis of brucellosis between January 1984 and December 1987 were studied prospectively. Sixty five patients (25%) developed osteoarticular complications. These patients had a more prolonged course than those with no complications. Spondylitis in 38 (58%) and sacroiliitis in 29 (45%) were the most prevalent. There were no significant laboratory, serological, or bacteriological differences between patients with and without osteoarticular complications. At diagnosis 47 patients (72%) showed radiographic abnormalities, commonly in axial sites but rarely in peripheral sites. Radionuclide bone scan was positive with no radiographic abnormalities in 17 (26%) of cases. Fifty seven patients received medical treatment alone, 51 (89%) being cured with a single course of treatment. Treatment failed or there was a relapse in six patients (11%), of whom five had spondylitis. Eight of the 65 patients (12%), all of whom had spondylitis and paravertebral or epidural abscesses, also required surgical treatment.

Topics: Adolescent; Adult; Aged; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Humans; Joints; Male; Middle Aged; Osteoarthritis; Prospective Studies; Rifampin; Sacroiliac Joint; Spine; Streptomycin

Infection after arthroplasty is a serious complication associated with a high incidence of morbidity. A 24-year-old woman developed brucella septic arthritis in both knees following bilateral total knee arthroplasty. This complication appears not to have been previously reported in the literature.

Topics: Adult; Brucellosis; Female; Humans; Knee Prosthesis; Rifampin

Brucella meningoencephalitis is rare in young children. We describe a patient who developed Brucella meningoencephalitis at the age of 20 months while he had a ventriculoperitoneal shunt in situ for treatment of hydrocephalus. This patient was treated with streptomycin and rifampicin. The shunt was left in situ, and all the clinical and laboratory test abnormalities subsided with this management. We propose that in a patient with Brucella meningoencephalitis, the cerebrospinal fluid shunt system can be left in situ and treatment with appropriate combination of antibiotics should prove to be successful.

Topics: Brucellosis; Cerebrospinal Fluid Shunts; Drug Therapy, Combination; Humans; Infant; Male; Meningoencephalitis; Rifampin; Streptomycin

A prospective study of 33 patients with skeletal complications of brucellosis is reported. The diagnosis depends on the brucellar agglutination titre because the clinical, radiological and histological features are not specific, and blood culture and culture of synovial fluid are often negative. The commonest site is the sacroiliac joint, and brucellosis must be differentiated from tuberculosis as an important cause of backache. Treatment is with chemotherapy, the preferred combination being rifampicin and co-trimoxazole. Relapse can occur, but the chances can be reduced by careful clinical monitoring, and by repeated serological tests and gallium scanning; it is treated by further chemotherapy. Operation is indicated to relieve spinal cord compression or to drain a large paravertebral abscess.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Arthritis, Infectious; Brucellosis; Child; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Prospective Studies; Radiography; Rifampin; Sacroiliac Joint; Trimethoprim, Sulfamethoxazole Drug Combination

A young infant with acute brucellosis is reported. He presented with a septicaemia-like picture. Diagnosis was based on a fourfold rise of Brucella agglutination titres and a positive blood culture. He had been exclusively breast-fed when his mother developed brucellosis 4 weeks after delivery. It is strongly suspected that the transmission of Brucella melitensis to this infant was through the maternal breast-milk.. Physicians admitted a 45-day old boy to King Khalid University Hospital in Riyadh, Saudi Arabia who had had a fever (39.8 degrees Celsius) for 2 days. He was irritable and did not feed very well at the breast. He was a healthy full term infant. The physicians could not identify an infection in the infant. 2 weeks before the infant became ill, the mother had a fever, progressive malaise, and right hip pain for 5 days. Based on a positive Brucella serology, her physician treated her with tetracycline and streptomycin. She exclusively breastfed the infant during the illness. Neither the mother nor the infant had any contact with farm animals, but a friend did give the mother raw goat milk 2 weeks postpartum. 79% of the white blood cell count contained lymphocytes. They believed he had bacterial sepsis so they treated him with intravenous ampicillin and cloxacillin. His temperature peaked daily between 38-39 degrees Celsius for the 1st 3 days. After hearing of the mother's illness with brucellosis and since the blood, urine, and cerebrospinal fluid cultures were negative for common bacterial pathogens, the physicians then administered oral trimethoprim-sulphamethoxazole and rifampicin for 6 weeks. His condition improved quickly and by day 7 the fever had subsided. 2 weeks after admission, his Brucella agglutination titer was 1:160 and his blood culture grew Brucella melitensis. At the same time, they measured the mother's blood and breast milk titers which were both positive (1:320 and 1:640 respectively). They could not isolate B. melitensis in either her blood or breast milk, however. Perhaps the antibiotics wiped out the organisms. 1 year after admission, the boy was fine. Seroconversion occurred within 2 weeks which may mean that he acquired brucellosis recently and postnatally. The physicians believed that the only route of transmission was breast milk.

Topics: Breast Feeding; Brucellosis; Humans; Infant; Male; Milk, Human; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

During the course of a bronchiolitis in a 3 month-old child, one blood culture yielded Brucella melitensis. The diagnosis of brucellosis is difficult in infancy because the symptoms are nonspecific and the disease may be mild and self-limited. The child received only breast milk and dietetic preparations. So, the detection in the maternal serum of a significant titer of Brucella agglutinin enabled us to consider the very rare human-to-human transmission from mother to child. Because the efficacy of ceftriaxone assessed by a favorable initial response, and in order to avoid complications due to the use of tetracyclines and cotrimoxazole in infant, our patient was successfully treated with ceftriaxone plus rifampin.

Topics: Breast Feeding; Brucellosis; Ceftriaxone; France; Humans; Infant; Male; Rifampin; Turkey

Of 400 patients with brucellosis, 104 (26%) had arthritis, of whom 96 could be followed up. The systemic disease in the 96 patients was acute in 54 (56%), subacute in 24 (25%), and chronic in 18 (19%). The main presenting symptoms were joint pain, fever, sweating, and easy fatigability. The joints most commonly affected were the sacroiliac joint (26%) and knee (25%) followed by hip (18%) and spine (8%). There was no particular pattern of joint affection in relation to age. Joint effusion occurred in 32/104 (30%) of cases, predominantly (94%) in the acute group. Culture of synovial fluid was negative in all, and analysis of synovial fluid for cellular profile, glucose, and protein content was not particularly helpful in diagnosis. Plain radiographs did not show major pathological changes. Among the laboratory tests, including haematological and liver function tests, the brucella enzyme linked immunosorbent assay (ELISA) was the most reliable in the diagnosis of disease, using serum and synovial fluid specimens. Treatment with a combination of streptomycin plus tetracyclines or rifampicin resulted in an excellent cure rate and resolution of arthritis without sequelae or mortality. Thus brucellosis should be considered in the differential diagnosis of arthritis, especially in areas in which the disease is endemic.

Topics: Arthritis, Infectious; Brucellosis; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Hip Joint; Humans; Knee Joint; Kuwait; Prospective Studies; Rifampin; Sacroiliac Joint; Spine; Streptomycin; Tetracyclines

Antibiotic binding by leukocytes from patients with chronic brucellosis was studied in vitro. The pathogens were located intracellularly. The specimens were collected during the disease aggravation prior to the treatment and at the beginning of the remission after the routine therapy. It was found that during the disease aggravation at the intoxication peak and accumulation of a large number of Brucella in the cells binding of methacycline, rifampicin and gentamicin somewhat increased. After completion of the treatment course when the number of Brucella in the leukocytes markedly lowered, up to disappearance, the antibiotic binding decreased and reached the control figures. Penetration of erythromycin into the cells infected with Brucella lowered at the disease peak and remained at that level with an insignificant tendency to normalization at the beginning of the clinical remission after the treatment. The facts suggested that intracellular localization of the bacteria would change the quantitative characteristics of interaction of the cells, i.e. human leukocytes with antibacterial chemotherapeutic agents. The direction of the shifts must depend on the particular proportion of various types of mechanisms for penetration of drugs into the intracellular medium.

Topics: Adult; Anti-Bacterial Agents; Brucellosis; Erythromycin; Female; Gentamicins; Humans; Leukocytes; Male; Methacycline; Middle Aged; Rifampin

During the year 1987, 106 cases of human brucellosis were studied prospectively at the Jordan University Hospital. The disease was more often diagnosed among adults (73.6%) than children (26.4%). Serious clinical complications were observed in 5.7% patients. An initial Brucella antibody titre greater than or equal to 160 proved to be reliable in confirming suspected cases of acute and subacute brucellosis. Culture of blood was found to be more sensitive (44.4%) and significant (P less than 0.02) than bone marrow culture (27.7%) for detecting Brucella melitensis. All patients treated with rifampicin plus tetracycline or co-trimoxazole were considered to be clinically cured by disappearance of all major clinical features of brucellosis. By contrast, 2/10 patients treated with rifampicin alone, as well as 1/56 patients treated with tetracycline and streptomycin, clinically relapsed. It is evident from this study that the treatment with rifampicin alone is not as effective in brucellosis as it is when given with another appropriate drug.

Topics: Adult; Brucellosis; Child; Child, Preschool; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Prospective Studies; Remission Induction; Rifampin; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Brucellosis; Endocarditis, Bacterial; Humans; Rifampin

A 20-year-old male Turkish immigrant to Norway suffering from severe chronic neurobrucellosis with spastic paraplegia and deafness is presented. The diagnosis was established by isolation of Brucella melitensis from cerebrospinal fluid (CSF) culture. Brucella antibody agglutination titers were high in serum and CSF. In spite of intensive, prolonged treatment with a combination of trimethoprim-sulfamethoxazole (TPM-SMZ), rifampicin and doxycycline, the course of the illness was characterized by relapses and severe neurological defects.

Topics: Adult; Agglutination; Brucellosis; Deafness; Humans; Male; Paraplegia; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey

Topics: Brucellosis; Doxycycline; Drug Therapy, Combination; Humans; Hypertension, Portal; Male; Middle Aged; Rifampin

Topics: Brucellosis; Doxycycline; Drug Therapy, Combination; France; Humans; Rifampin

Six cases of well-documented Brucella endocarditis are reported. All the patients gave a history of ingestion of raw milk and/or being in contact with sheep and/or camels during herding. The diagnosis was based in each case on a history of ingestion of raw milk, high titres of Brucella antibodies, a positive blood culture and echocardiography. A combination of tetracycline, rifampicin and streptomycin was found to be effective in eradicating the Brucella organism. Two cases required aortic valve replacement, and another two required replacement of both aortic and mitral valves. One case died before any surgical intervention could be performed and one patient did not require surgery. Although it was noted that the Brucella organism attacks mainly valves which are already damaged, it may also attack and infect normal valves.

Topics: Adolescent; Adult; Aortic Valve; Brucellosis; Endocarditis, Bacterial; Female; Humans; Male; Prognosis; Rifampin; Saudi Arabia; Tetracycline

Topics: Brucellosis; Doxycycline; Endocarditis, Bacterial; Humans; Male; Middle Aged; Rifampin

Technetium scintigraphy established sacroiliitis in a 21-year-old man who had complained of hip pain for two weeks. Brucella melitensis was cultured from hip-joint fluid. He was treated with 160 mg trimethoprim and 800 mg sulphamethoxazole, three times daily for six weeks. He also had prophylactically 600 mg rifampicin daily by mouth for the last three weeks. He was symptom-free four weeks after onset of treatment. At follow-up one year later there was no sign of recurrence. Brucella titres and blood sedimentation rate were within normal limits.

Topics: Adult; Arthritis, Infectious; Brucella; Brucellosis; Humans; Male; Radiography; Radionuclide Imaging; Rifampin; Sacroiliac Joint; Sulfamethoxazole; Trimethoprim

When a 35-year-old man with essential hypertension was treated with antibiotics for brucellosis his blood pressure rose significantly. While all other treatment was kept constant rifampicin was discontinued. On rechallenge rifampicin did not alter serum concentrations of enalapril or the area under the curve (AUC) between 0 and 7 h, but it did reduce the AUC of the active metabolite enalaprilat by 31%. These observations suggest that there may be an interaction between rifampicin and enalapril, causing reduced hypotensive efficacy of enalapril. The mechanism of such an interaction merits further study, but it could be due to enhanced renal clearance of enalaprilat.

Topics: Adult; Blood Pressure; Brucellosis; Drug Interactions; Enalapril; Enalaprilat; Humans; Hypertension; Male; Rifampin; Time Factors

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Brucellosis; Drug Therapy, Combination; Humans; Male; Rifampin; Tetracyclines; Thrombocytopenia

After a brief review of the literature on the treatment of brucellosis the results obtained with a new protocol (Rifampicin + Minocycline for 20 days) are reported. The combination was well-tolerated and undeniably effective producing a 94% cure rate.

Topics: Adolescent; Adult; Aged; Brucellosis; Child; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Middle Aged; Minocycline; Rifampin; Tetracyclines; Time Factors

Infection with Brucella melitensis is endemic in Saudi Arabia but involvement of the central nervous system (CNS) is rare. We report on three patients with acute brucella meningitis, all of whom had a history of exposure to a possible source of infection. Diagnosis was confirmed by isolation of Brucella species from blood cultures. Examination of cerebrospinal fluid revealed lymphocytic pleocytosis with a high concentration of protein and low concentration of glucose. The patients were treated by combinations of co-trimoxazole, doxycycline or rifampicin. All responded well without recurrences. A combination of two of the three drugs was effective in treating brucellosis of the CNS when given for a period of 6-8 weeks.

Topics: Adult; Brucellosis; Doxycycline; Drug Combinations; Female; Humans; Male; Meningitis; Middle Aged; Rifampin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Administration, Oral; Adolescent; Adult; Aged; Brucellosis; Doxycycline; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Prospective Studies; Rifampin

Topics: Brucellosis; Doxycycline; Humans; Nervous System Diseases; Rifampin

Topics: Aged; Brucella; Brucellosis; Doxycycline; Drug Resistance, Microbial; Drug Therapy, Combination; Humans; Male; Recurrence; Rifampin

The in vitro susceptibility of Brucella melitensis was examined vis-a-vis the clinical outcome in 75 patients with brucellosis. The initial MICs for Brucella isolates from patients who relapsed and from those who did not were similar. Furthermore, the MICs for isolates from patients whose infections relapsed were no different from those for original isolates. Our results clearly showed that neither initial nor subsequent antibiotic susceptibility plays a role in the likelihood of relapse of patients with brucellosis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Brucella; Brucellosis; Child; Doxycycline; Drug Resistance, Microbial; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Prospective Studies; Recurrence; Rifampin; Streptomycin; Tetracycline

We treated six patients with nervous system brucellosis causing polyradiculitis (2 patients), myelopathy (2), encephalitis (1), or meningitis (1). Diagnosis was based on Brucella species cultured from one patient, and a twofold or greater rise in antibody titer after therapy was started in the others. Treatment with trimethoprim-sulfamethoxazole with rifampin (5 patients) or tetracycline (1 patient) produced excellent clinical and laboratory response.

Topics: Adult; Aged; Animals; Brucellosis; Drug Combinations; Female; Humans; Male; Middle Aged; Nervous System Diseases; Rifampin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

After an examination of the data on brucellosis treatment in the literature, it is concluded that short-term courses of cotrimoxazole and tetracyclines give largely unsatisfactory results. In view of the synergism noted between rifampicin and doxycycline against in vitro and animal brucella, the association was given to 19 clinical cases and was found to be effective and easily handled. It is therefore concluded that this treatment is currently the best alternative to the classic streptomycin-doxycycline association.

Topics: Adolescent; Adult; Brucellosis; Child; Doxycycline; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Rifampin; Streptomycin

Rifampin, which exhibits good intracellular diffusion and in vitro bactericidal activity on brucella, is effective in experimental brucellosis in mice, without selection of resistant strains. It was therefore legitimate to use rifampin in man since conventional treatment of acute brucellosis is followed by recurrence in 15% (tetracycline alone) or 3.7% (streptomycin-tetracycline combination) of cases. Rifampin was given to 13 patients with brucellosis (acute brucellosis in 8, osteoarticular brucellosis in 3 and chronic brucellosis in 2). Rifampin was given as sole therapy in a daily dosage of 600 to 1 200 mg. A tetracycline was subsequently needed in three cases, in combination with rifampin in two, and as replacement therapy in one. Treatment lasted 20 to 60 days in acute brucellosis and 2 to 15 months in other forms. Only one failure was recorded among the 11 cases of acute or localized brucellosis. Conversely, effectiveness of rifampin proved incomplete (1 case) or null (1 case) in chronic forms. The satisfactory effectiveness of rifampin is confirmed by a review of the literature which found 17 reports addressing the subject. These include 324 cases of brucellosis treated by rifampin, as sole therapy in 255 patients, with only 24 failures ascribable to faulty dosage. Indeed, rifampin must be given for at least 30 days, in a minimal daily dosage of 600 mg or 10 mg per kg, in a single dose. Cotrimoxazole is an antagonist and should not be associated with rifampin. Conversely, tetracyclines are synergistic and their association, which is useless in acute brucellosis, is helpful in localized and chronic forms.

Topics: Acute Disease; Adult; Aged; Bone Diseases; Brucellosis; Chronic Disease; Doxycycline; Drug Therapy, Combination; Female; Humans; Joint Diseases; Male; Middle Aged; Rifampin; Sepsis

Topics: Adult; Brucellosis; Doxycycline; Drug Therapy, Combination; Glomerular Mesangium; Glomerulonephritis; Humans; Immunoglobulin A; Male; Rifampin

Topics: Adolescent; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Humans; Osteoarthritis; Rifampin; Streptomycin

Primary plaque forming cells (PFC) are present in spleens of mice 150 days or more following an infection with Brucella abortus. The development of primary plaques in mice long after antigenic challenge is an uncommon phenomenon, unlike the plaque formation (PF) induced by a non-living antigen. The mechanism of this persistent PF has been now investigated in light of a prolonged persistence of the corresponding antigen in tissues. Living E. coli, inoculated in massive dose into mice, survived in their organs for a brief time, while concomitantly PFC disappeared by day sixteen. Infection with B. abortus, in contrast, induced persistent presence of bacteria in the organs of inoculated mice and stimulated long lasting plaque formation. Only direct plaques were found during all stages of infection. Repeated inoculations of dead B. abortus also induced continuous production of primary plaques, whereas an interval in supply of the antigen resulted in disappearance of PFC. Rifampin (40 mg/kg) eliminated bacteria from the treated mice, which resulted in the disappearance of primary PFC. It seems likely that long lasting PF in B. abortus infected mice is connected with a constant antigenic stimulus operating in the carrier state.

Topics: Animals; Antibodies, Bacterial; Antibody-Producing Cells; Brucella abortus; Brucellosis; Female; Hemolytic Plaque Technique; Male; Mice; Oxytetracycline; Rifampin; Spleen; Time Factors

The authors report a case presenting with a very rare localization of brucellosis: the isolated involvement of a single bone of the metatarsus, in a child in otherwise excellent general condition. The lesions of the diaphysis and epiphyses induced a fragility of the epiphyseal cartilage and a minimal traumatism resulted in a detachment of the epiphysis which was the first clinical sign. The bacteriological examination of a sample of pus led to the early diagnosis of brucellosis, therefore allowing efficient treatment.

Topics: Brucella; Brucellosis; Child; Humans; Male; Metatarsus; Minocycline; Osteitis; Rifampin

Tetracyclines are remarkably effective in brucellosis and give consistently good results. However, recurrences have been reported even after correct management. Combination therapy with tetracycline and streptomycin, advocated by the FAO/WHO, has improved results without giving complete satisfaction. Association of tetracycline with rifampicin suggested on sound theoretical grounds, has given promising results.

Topics: Acute Disease; Anti-Bacterial Agents; Brucellosis; Drug Therapy, Combination; Humans; Middle Aged; Osteoarthritis; Rifampin; Streptomycin; Tetracyclines; Time Factors

IN vitro susceptibilities of 98 isolates of Brucella melitensis to N-formimidoyl thienamycin, tetracycline, co-trimoxazole, rifampin, and cefoxitin were determined. N-Formimidoyl thienamycin showed good activity which was similar to those of tetracycline and rifampin and different from that of the other beta-lactam antibiotic tested (cefoxitin), which showed poor activity. Co-trimoxazole showed good activity.

Topics: Anti-Bacterial Agents; Brucella; Brucellosis; Cefoxitin; Drug Combinations; Humans; Imipenem; Lactams; Microbial Sensitivity Tests; Rifampin; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Brucellosis; Humans; Minocycline; Rifampin; Streptomycin; Sulfamethoxazole; Trimethoprim

Topics: Adult; Blood Protein Electrophoresis; Blood Proteins; Brucellosis; Humans; Rifampin; Time Factors

Topics: Acute Disease; Brucellosis; Doxycycline; Drug Administration Schedule; Drug Therapy, Combination; Humans; Rifampin; Sepsis

14 children, aged between 15 months and 14 years, with brucellosis were treated with oral rifampicin only (20 mg/kg per day) for 3 weeks. Laboratory diagnosis depended on blood culture (positive for Brucella melitensis in 11 of the cases), serum agglutination, complement-fixation test, and Coomb's test. Response was good in each child, with fever clearing between the 2nd and 8th day. 2 children relapsed, but one relapse was probably a reinfection from contaminated cheese. Both children were given a further course of treatment (rifampicin and co-trimoxazole) which was successful. Despite the reasonably good results with rifampicin alone, it is advisable to combine the drug with co-trimoxazole when treating brucellosis.

Topics: Adolescent; Brucellosis; Child; Child, Preschool; Female; Humans; Infant; Male; Rifampin

Topics: Brucellosis; Drug Therapy, Combination; Humans; Minocycline; Rifampin; Tetracyclines

The authors discuss the present value of rifampicin in the treatment of human brucellosis on the basis of: 1) a bacteriological study of 42 strains of Brucella spp. (MIC's of rifampicin, tetracyclin, doxycyclin, minocyclin and streptomycin; results of doxycyclin-rifampicin and doxycyclin-streptomycin combinations), and 2) a clinical study of 38 cases of brucellosis treated with rifampicin, including 25 acute septicemias and 13 osteo-arthritis. Satisfactory results were observed in 92% of the cases with rifampicin alone, but one cannot state that the benefits are significant.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Brucella; Brucellosis; Drug Therapy, Combination; Female; Humans; Infant; Male; Microbial Sensitivity Tests; Middle Aged; Osteoarthritis; Pregnancy; Rifampin; Sepsis

Brucella endocarditis is a rare, but often fatal, complication of brucellosis. A 32 year old man acquired brucellosis while on a visit to his former home in Greece and presented six months later with malaise, fever and aortic regurgitation. Blood cultures grew Brucella melitensis biotype 1. Combined chemotherapy with streptomycin, tetracycline and rifampin sterilized his blood; however, his aortic valve was replaced owing to recurrent emboli and cardiac failure. Over the next 18 months the patient's antibody titer to Brucella fell and his blood reamined sterile. Cure was achieved by resection of the infected aortic valve and 10 weeks of bactericidal therapy for B. melitensis.

Topics: Adult; Aortic Valve Insufficiency; Brucellosis; Drug Therapy, Combination; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Rifampin; Streptomycin; Tetracycline

Rifampin, a broad-spectrum antibiotic able to penetrate intracellularly, was used for treatment of infections with Brucella melitensis in mice and Brucella abortus in guinea pigs. Treatments were administered for seven, 14, or 21 days; mice were given 25 mg of rifampin/kg per day, and guinea pigs 100 mg/kg per day. Efficacy of the drug was determined by comparison of rifampin-treated animals with saline-treated controls and with tetracycline-treated mice (200 mg/kg per day) according to the following criteria: (1) primary infections of the spleen and (in guinea pigs) of the lymph nodes; (2) residual infections of the spleen, i.e., infections shown after complementary treatment with suspensions of killed Corynebacterium parvum or with cortisone; (3) splenomegaly; and (4) serological response (in guinea pigs). Treatment with rifampin, even for one or two weeks, drastically reduced the number of infections by all of these criteris, and treatment for three weeks cured nearly all mice; the incidences of primary and residual infections in rifampin-treated mice after three weeks were 0 and 8.5%, respectively, as compared with 70.3% and 73.5%, respectively, in tetracycline-treated mice. Of 25 guinea pigs treated with rifampin for three weeks, spleen infection was shown in one, and lymph node infections in 10.

Topics: Animals; Antibodies; Body Weight; Brucella abortus; Brucellosis; Female; Guinea Pigs; Mice; Organ Size; Rifampin; Spleen

The intracellular and bactericidal activity of rifampicine was observed in the treatment of experimental brucellosis in the mouse and guinea pig. Batches of mice infected by intraperitoneal route with B. melitensis, strain 53 H 38, were treated with rifampicine (20 mg/kg/day) or with tetracycline-base (200 mg/kg/day). When the treatment begins 14 days after inoculation and lasts a week, the rifampicine produces a more significant decrease of the weight of the spleen than does tetracycline. After 14 days' treatment, apart from this effect, the degree of infection of the spleen decreases at least 10(5) times with rifampicine and 10(2) times with tetracycline. After 21 days, bacteriological sterilization is obtained with rifampicine whereas 66% of the tetracycline-treated mice are still infected. However, a residual infection of weak intensity persists in 6.6% of the rifampicine-treated mice against 75% of the tetracycline-treated mice, as shown by an injection of Corynebacterium parvum and a cortisone treatment at the end of the antibiotherapy. If the antibiotic treatment begins on the day of inoculation, the greatly superior efficacity of rifampicine is in that case more rapid. Rifampicine (100 mg/kg/day) offers comparable efficacity in the guinea pig infected by intraperitoneal route with B. abortus strain 544; these efficacity is shown by the decrease in the weight of the spleen and the intensity of splenic and ganglionic infection. The rapid decrease of agglutinins and amboceptors after 7 days of treatment suggests the possible role of a suppressor of this antibiotic. Finally, the effect of rifampicine on the growth of the guinea pig was noted.

Topics: Animals; Brucella abortus; Brucellosis; Female; Guinea Pigs; Mice; Rifampin; Spleen; Tetracycline

Topics: Brucella; Brucellosis; Chlortetracycline; Humans; Immunotherapy; Rifampin; Streptomycin; Sulfamethoxazole; Sulfonamides; Trimethoprim

Topics: Animals; Bacteriological Techniques; Brucellosis; Culture Techniques; Female; Injections, Intraperitoneal; Mice; Organ Size; Rifampin; Spleen; Tetracycline; Time Factors