trimethoprim--sulfamethoxazole-drug-combination and Brucellosis

Brucellosis is among the most prevalent zoonotic infections in Middle Eastern and North African (MENA) countries, critically impacting human and animal health. A comprehensive review of studies on antibiotic susceptibility and therapeutic regimes for brucellosis in ruminants and humans in the MENA region was conducted to evaluate the current therapeutic management in this region. Different scientific databases were searched for peer-reviewed original English articles published from January 1989 to February 2021. Reports from research organizations and health authorities have been taken into consideration. Brucella melitensis and Brucella abortus have been reported from the majority of MENA countries, suggesting a massive prevalence particularly of B. melitensis across these countries. Several sporadic cases of brucellosis relapse, therapeutic failure, and antibiotic resistance of animal and human isolates have been reported from the MENA region. However, several studies proved that brucellae are still in-vitro susceptible to the majority of antibiotic compounds and combinations in current recommended World Health Organization (WHO) treatment regimens, for example, levofloxacin, tetracyclines, doxycycline, streptomycin, ciprofloxacin, chloramphenicol, gentamicin, tigecycline, and trimethoprim/sulfamethoxazole. The current review presents an overview on resistance development of brucellae and highlights the current knowledge on effective antibiotics regimens for treating human brucellosis.

Topics: Animals; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Chloramphenicol; Ciprofloxacin; Doxycycline; Gentamicins; Humans; Levofloxacin; Microbial Sensitivity Tests; Middle East; Ruminants; Streptomycin; Tigecycline; Trimethoprim, Sulfamethoxazole Drug Combination

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

Brucellosis is one of the most widespread zoonoses worldwide. It can affect any organ system, particularly the gastrointestinal system, but there is no report of acute liver failure as a brucellosis complication.. We present a case of acute liver failure secondary to brucellosis infection. A 75-year-old Hispanic man presented to a University Hospital in Chía, Colombia, with a complaint of 15 days of fatigue, weakness, decreased appetite, epigastric abdominal pain, jaundice, and 10 kg weight loss. On examination in an emergency room, abdomen palpation was normal with hepatosplenomegaly and the results of a liver function test were elevated. The diagnosis of brucellosis was confirmed by epidemiological contact and positive Rose Bengal agglutination with negative enzyme-linked immunosorbent assay immunoglobulin M for Brucella. He was then treated with doxycycline plus trimethoprim/sulfamethoxazole, with a favorable clinical outcome.. The clinical presentation of brucellosis can be very imprecise because it can affect any organ system; however, there is no report of acute liver failure as a brucellosis complication. This is the first reported case in the Colombian literature of acute liver failure due to brucellosis. We found this case to be of interest because it could be taken into account for diagnosis in future appearances and we described adequate treatment and actions to be taken at presentation.

Topics: Aged; Animal Husbandry; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Colombia; Doxycycline; Enzyme-Linked Immunosorbent Assay; Humans; Liver Failure, Acute; Liver Function Tests; Male; Occupational Diseases; Rose Bengal; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

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 zoonotic disease that can be encountered during pregnancy especially in endemic areas such as Latin America, Africa, Asia, Mediterranean countries and eastern region of Turkey. We present a case of a 19-year-old pregnant woman of 19-20 weeks gestation diagnosed with brucellosis. Main presentation at admission were hematuria and nausea. Advanced investigations revealed blood culture positive for brucella. Abortion occurred in the course of medical therapy.

Topics: Abortion, Spontaneous; Adult; Anti-Infective Agents; Brucellosis; Female; Humans; Pregnancy; Pregnancy Complications, Infectious; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey; Young Adult

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

Human brucellosis remains endemic in the majority of Middle Eastern countries, accounting for tens of thousands of new annual cases, despite partly successful efforts at disease control. In the Middle East, more pronouncedly than elsewhere, brucellosis exhibits significant socioeconomic and political correlations, including population literacy and distribution, and development of health networks. Currently, Middle Eastern countries, having a vast pool of human cases, generate important information regarding the disease's clinical manifestations, diagnosis, and treatment. Given the socioeconomic framework of brucellosis endemicity, specific approaches allowing for rapid, cost-effective diagnosis, and efficient cost-effective therapy should be pursued. Overall, attempts at controlling disease without altering the socioeconomic and political correlations may prove futile, unfortunately projecting similar fates for attempts related to more important communicable diseases.

Topics: Anti-Bacterial Agents; Brucellosis; Endemic Diseases; Humans; Middle East; Politics; Socioeconomic Factors; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination

The global burden of human brucellosis remains enormous, yet its optimal treatment remains based on traditional combinations of doxycycline with either rifampicin or streptomycin. Of the currently existing alternative regimens, only the combination of doxycycline with gentamicin can be considered therapeutically adequate and cost effective, the latter factor being a major obstacle in the utilisation of quinolones for brucellosis. Newer antibiotics, most notably tigecycline, may help in achieving monotherapy or shorter treatment duration. Alternatively, modification of the acidic intracellular environment where Brucellae reside may allow for enhanced effectiveness of existing antibiotics.

Topics: Anti-Bacterial Agents; Brucellosis; Drug Therapy, Combination; Humans; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Child, Preschool; Gentamicins; Humans; Male; Pneumonia, Bacterial; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

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

Forty years after active drug therapy was defined, the treatment of brucellosis still raises the problem of selecting the correct antibiotic and the duration of treatment. Indeed, requirements may be complex since one must select antibiotics which are active in vitro and which diffuse readily into the tissues and into the cells without developing bacterial resistance. Prescriptions must also be long enough, not only to achieve cure, but also to eliminate the Brucella strain. Antibiotics must be found which meet this last criteria yet do not lead to toxic effects or impair the patient's own immune response. Acute septicemic brucellosis in adult men and non-pregnant women has been effectively treated with the following three regimens: 1) doxycycline 200 mg/d and rifampin 900 mg/d orally for 45 days; 2) doxycycline 200 mg/d orally for 45 days and streptomycin 1 g/d IM for three weeks; 3) TMP-SMZ 320-1600 mg/d and rifampin 900 mg/d orally for 45 days. All regimens require a combination of two antibiotics and a prolonged course for total recovery, although casual relapses may occur. The doxycycline-rifampin combination shows the most favorable efficacy/safety ratio, and either antibiotic alone was used successfully in pregnant women by some investigators. The TMP-SMZ-rifampin combination is recommended in children below 8 years of age. Osteoarticular infections can be treated with doxycycline plus rifampin for 3 to 6 months, and streptomycin during the first 2 or 3 weeks. In nervous system complications, the preferred treatment is TMP-SMZ plus rifampin for 3 to 6 months. Brucellar endocarditis should be treated parenterally with streptomycin or gentamycin combined with TMP-SMZ, rifampin and doxycycline, and often requires valvular replacement. Many other antibiotics have been used with good clinical responses in the treatment of brucellosis, e.g., chloramphenicol, erythromycin, ampicillin, and more recently cephalosporins, thienamycin and fluoroquinolones; however, more cases have to be studied before any of these agents is definitely chosen for the treatment of brucellosis.

Topics: Adult; Anti-Bacterial Agents; Brucellosis; Child; Drug Therapy, Combination; Female; Humans; Male; Pregnancy; Trimethoprim, Sulfamethoxazole Drug Combination

The clinical pattern of 400 cases of brucellosis in Kuwait is presented. The disease was acute in 77 per cent, sub-acute in 12.5 per cent and chronic in 10.5 per cent of cases. Raw milk was the major source of infection. The major features on presentation, irrespective of the course of the disease, were fever, sweating, headache, rigors, arthralgia, myalgia, and low back pain. Hepatosplenomegaly was present in 41 per cent of cases and in 32 per cent neither liver nor spleen were palpable. The haematologic findings were not specific and hepatic dysfunction (shown by liver enzyme abnormalities) was common. Skeletal (26 per cent) and genital (8.5 per cent) changes and neurobrucellosis (7 per cent) were the major complications. The ELISA was the most sensitive and reliable diagnostic test especially in relation to chronic brucellosis and neurobrucellosis. ELISA allowed the determination of brucella-specific immunoglobulins (Ig)G, IgM and IgA in the CSF, and provided profiles of Ig, in sera, which were different in patients with chronic (elevated IgG and IgA) from those with acute (elevated IgM alone or IgG, IgM and IgA) brucellosis. Treatment with tetracycline, doxycycline or rifampicin gave a cure rate of over 91 per cent in acute and subacute brucellosis. Co-trimoxazole was associated with a relapse rate of 50 per cent. Two drug combinations of streptomycin and tetracycline, streptomycin and rifampicin or streptomycin and doxycycline were effective, but one of five patients with chronic brucellosis relapsed. A combination of streptomycin, tetracycline and rifampicin with or without steroids was used successfully in neurobrucellosis, septicaemic shock and subacute bacterial endocarditis.

Topics: Acute Disease; Adolescent; Adult; Anti-Bacterial Agents; Anti-Infective Agents; Brucellosis; Child; Chronic Disease; Drug Combinations; Drug Therapy, Combination; Female; Humans; Kuwait; Male; Middle Aged; Prospective Studies; Sulfamethoxazole; Tetracyclines; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The reasons for combining trimethoprim (TMP) with sulfonamides (SUL) are still mainly theoretical but are supported by results from experimental infections and treatment of specific pathogens in humans, such as Branhamella catarrhalis, Neisseria gonorrhoeae, Brucella, Nocardia asteroides and perhaps Bordetella pertussis and Chlamydia trachomatis. Addition of SUL to TMP confers a therapeutic advantage also in patients with complicated urinary tract infection but probably not in young women with acute cystitis. Conditions that may enable TMP-SUL synergy in vivo can be expected to occur only in occasional cases of infection due to staphylococci, streptococci, Haemophilus or enteric bacteria. This fact together with ethical problems and availability of alternative therapies make further evaluations of the clinical significance of the SUL component of TMP-SUL very difficult. Although the use of TMP alone has shown promise in exacerbations of chronic bronchitis the role of the SUL component in TMP-SUL treatment of infections outside the urinary tract remains to be defined in comparative clinical trials.

Topics: Aged; Anti-Bacterial Agents; Brucellosis; Clinical Trials as Topic; Drug Combinations; Drug Synergism; Female; Gonorrhea; Humans; Kinetics; Lymphogranuloma Venereum; Male; Microbial Sensitivity Tests; Nocardia Infections; Sulfamethoxazole; Tissue Distribution; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

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

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

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

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

The reasons for combining trimethoprim (TMP) with sulfonamides (SUL) are still mainly theoretical but are supported by results from experimental infections and treatment of specific pathogens in humans, such as Branhamella catarrhalis, Neisseria gonorrhoeae, Brucella, Nocardia asteroides and perhaps Bordetella pertussis and Chlamydia trachomatis. Addition of SUL to TMP confers a therapeutic advantage also in patients with complicated urinary tract infection but probably not in young women with acute cystitis. Conditions that may enable TMP-SUL synergy in vivo can be expected to occur only in occasional cases of infection due to staphylococci, streptococci, Haemophilus or enteric bacteria. This fact together with ethical problems and availability of alternative therapies make further evaluations of the clinical significance of the SUL component of TMP-SUL very difficult. Although the use of TMP alone has shown promise in exacerbations of chronic bronchitis the role of the SUL component in TMP-SUL treatment of infections outside the urinary tract remains to be defined in comparative clinical trials.

Topics: Aged; Anti-Bacterial Agents; Brucellosis; Clinical Trials as Topic; Drug Combinations; Drug Synergism; Female; Gonorrhea; Humans; Kinetics; Lymphogranuloma Venereum; Male; Microbial Sensitivity Tests; Nocardia Infections; Sulfamethoxazole; Tissue Distribution; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Brucellosis; Clinical Trials as Topic; Drug Combinations; Humans; Streptomycin; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Human brucellosis can be managed with different therapeutic measures. The present study compares the therapeutic efficacy of the classical treatment with streptomycin, doxicyclin and cotrimoxazole, every one of the treatment regimes being applied to 19 patients with acute brucellosis. The results do not demonstrate an advantage of the new association over the classical treatment. Relapses, time elapsed until the patient was afebrile and drug tolerance were similar for both treatments. The classical treatment has a lower cost but the new association implies more patient comfort because the number of pills to be ingested daily is reduced to less than half, a fact that could make it the treatment of choice.

Topics: Acute Disease; Adolescent; Adult; Brucellosis; Child; Clinical Trials as Topic; Doxycycline; Drug Combinations; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Streptomycin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Brucellosis is a zoonotic disease caused by Gram-negative bacteria. It has variable manifestations (gastrointestinal, hepatobiliary, skeletal). Neurobrucellosis may develop at any stage of the disease (acute, subacute, and chronic phases) and affects the central and peripheral nervous systems. Acute peripheral neuropathy mimicking Guillain-Barré syndrome caused by brucellosis is rarely reported: only four cases in children were found in the literature review.. We report a case of a 4-year-old Syrian boy who presented with fever, weakness of lower limbs, backache, and fatigue. The patient lived in a brucellosis endemic area. A physical examination including a neurological examination showed mild paresthesia and muscle weakness. He had a stiff neck with Kernig's sign with an absence of deep tendon reflexes in the lower extremities. Proprioception in the lower extremities was impaired, but he did not have any sensory problems. Abdominal cutaneous reflexes were absent. Brucellosis and Guillain-Barré syndrome were found in laboratory investigations and on electroneurogram (ENG). The patient was treated with sulfamethoxazole + trimethoprim, rifampicin, gentamicin, and dexamethasone, with an improvement.. This case demonstrates a rare case of brucellosis neurologic manifestation. Brucellosis should be kept in mind in all patients with acute paralysis, especially in those who live in endemic areas.

Topics: Brucellosis; Child; Child, Preschool; Guillain-Barre Syndrome; Humans; Male; Muscle Weakness; Paralysis; Trimethoprim, Sulfamethoxazole Drug Combination

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

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 transmitted from infected animals to humans mainly by unpasteurised dairy products. Typical symptoms include undulant fever and arthralgia, but the disease can affect all organ systems and cause chronic debilitating and disabling illness. The condition is likely severely underdiagnosed, especially in impoverished populations.. A young girl presented with a one-day history of ankle pain and low-grade fever. She was born in a refugee camp in the Middle East, but lived with a Norwegian foster family and was considered to be healthy before the symptoms emerged. Blood culture surprisingly revealed growth of Brucella melitensis. She was successfully treated with a combination of trimethoprim-sulfamethoxazole and rifampicin.. This girl was likely infected with Brucella through ingestion of goat's milk, which she was given in the refugee camp. The disease presented with arthritis nearly two years after exposure.

Topics: Animals; Arthralgia; Arthritis; Blood Culture; Brucella melitensis; Brucellosis; Female; Humans; Trimethoprim, Sulfamethoxazole Drug Combination

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

Brucellosis is being increasingly recognized after solid organ transplantation but has not been reported after orthotopic heart transplantation. We present the case of a 51-year-old farmer who underwent orthotopic heart transplantation and was readmitted after 3 months in a severely immunosuppressed state with significant nonspecific complaints. He posed a diagnostic and management dilemma to all disciplines, but finally turned out to be harboring Brucella infection. He responded well to medical management and was discharged in a stable clinical status. Although rare, brucellosis should be included in the investigative workup for nonspecific symptoms after cardiac transplantation.

Topics: Agricultural Workers' Diseases; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Brucella; Brucellosis; C-Reactive Protein; Cattle; Dairy Products; Delayed Diagnosis; Doxycycline; Drug Therapy, Combination; Heart Transplantation; Humans; Immunocompromised Host; Immunoglobulin M; Immunosuppressive Agents; Leukocytosis; Male; Middle Aged; Postoperative Complications; Trimethoprim, Sulfamethoxazole Drug Combination

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 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

Topics: Anti-Bacterial Agents; Brucella; Brucellosis; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Pituitary Diseases; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Human Brucella canis infection incidence is unknown. Most identified cases are associated with pet dogs. Laboratory-acquired infections can occur following contact with Brucella spp. We identified a paediatric B. canis case, the source and other exposed persons. A 3-year-old New York City child with fever and dyspnoea was hospitalized for 48 h for bronchiolitis. After her admission, blood culture grew B. canis, she was prescribed anti-microbials and recovered. B. canis was also isolated from blood of the child's pet dog; these isolates were genetically similar. The dog originated from an Iowa breeding facility which was quarantined after identification of the dog's infection. Additionally, 31 laboratory workers were exposed and subsequently monitored for symptoms; 15 completed post-exposure prophylaxis. To our knowledge, this is the first report strongly suggesting B. canis zoonotic transmission to a child in the United States, and highlights the need for coordinated control policies to minimize human illness.

Topics: Animals; Anti-Bacterial Agents; Brucella canis; Brucellosis; Child, Preschool; Commerce; Dog Diseases; Dogs; Female; Humans; Iowa; New York City; Pennsylvania; Trimethoprim, Sulfamethoxazole Drug Combination; Zoonoses

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

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

Some infectious organisms may give rise to acute pancreatitis; brucellosis, however, extremely rarely leads to acute pancreatitis. A 40-year-old man was diagnosed with acute pancreatitis, the etiology of which was determined to be acute brucellosis. The patient was discharged without complications approximately 15 days after the initiation of trimethoprim-sulfamethoxazole and doxycycline treatment. Brucella infections may rarely be complicated by acute pancreatitis. Thus, brucellosis should be remembered in the etiology of acute pancreatitis in regions such as Turkey, where Brucella infections are endemic.

Topics: Acute Disease; Adult; Agriculture; Brucellosis; Diagnosis, Differential; Doxycycline; Humans; Male; Pancreatitis; Trimethoprim, Sulfamethoxazole Drug Combination; 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

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 one of the most common systemic zoonotic diseases transmitted by consumption of unpasteurized dairy products or by occupational contact with infected animals. Brucellosis is rare in renal transplant recipients. Only 3 cases have been reported in the literature. We report a case of brucellosis with hematologic and hepatobiliary complications in a patient 3 years after renal transplantation. The mean time from transplantation to the diagnosis of brucellosis in these 4 reported patients was 5.1 years (range 17 months to 13 years). All patients had fever and constitutional symptoms, and all attained clinical cure after combination antibiotic therapy. Given the small number of patients, further study is needed to identify the characteristics of brucellosis in renal transplant recipients. Drug interactions and acute renal failure developed in our patient during antibiotic treatment. Therefore, we should monitor the levels of immunosuppressive agents frequently. Several studies have shown in vitro susceptibilities of Brucella melitensis to tigecycline. In our patient, fever finally subsided after tigecycline administration. The minimum inhibitory concentration of tigecycline using Etest was 0.094 μg/mL. Tigecycline may be a potential option for treatment of brucellosis in the setting of transplantation.

Topics: Animals; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Drug Therapy, Combination; Humans; Immunosuppressive Agents; Kidney; Kidney Transplantation; Male; Middle Aged; Minocycline; Tigecycline; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Zoonoses

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 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

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

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

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

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

Antibiotic treatment, surgical intervention and postoperative antibiotic regimens are recommended for the treatment of brucella endocarditis (BE). Our clinical antibiotic regimens involve a triple antibiotic regimen for treating BE before the operation. The combination of three antibiotics is continued for at least six months and until the titres of the Wright serologic test are diminished to 1:160 levels. In this study, our aim was to evaluate the effects of combined medical and surgical treatments on survival and relapse rates in the periods of mid to late terms. We investigated 13 patients who were treated between January 1993 and June 2009. Our clinical observations led us to use a combination of rifampicin (900 mg twice a day), streptomycin (12 to 16 mg/kg/24 h intramuscularly) and doxycycline (200 mg/kg twice a day); rifampicin, tetracycline (8 mg/kg three times a day) and cotrimoxazole (15 mg/kg twice a day) or rifampicin, doxycycline and cotrimoxazole regimen for treating BE before the operation. This treatment should be continued for at least six months after surgery in order to prevent relapses.

Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Aortic Valve; Brucellosis; Combined Modality Therapy; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Recurrence; Survival Analysis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

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

The zoonotic risk of Brucella canis has been considered fairly high for persons who handle breeding dogs in kennels or are exposed to infected animals. Transmission to humans in other circumstances has been thought to be rare. We describe an uncommon outbreak of brucellosis caused by B. canis which, to the best of our knowledge, is the first reported in the literature. This outbreak involved six persons (three children and three adults), a bitch and three puppies which had close daily contact with the family. The clinical symptoms of the index case led to an erroneous diagnosis and the infection would have gone undiagnosed if culture had not been positive. This report aims to increase awareness of medical personnel of the need to order screening tests for children, immunodeficient persons or pregnant women presenting with fever of unknown origin, unexplained spleen or liver enlargement or other systemic signs. The emerging zoonotic potential of this disease in urban areas and the need to coordinate canine brucellosis surveillance systems should be evaluated.

Topics: Adult; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Brucella canis; Brucellosis; Child, Preschool; Dog Diseases; Dogs; Family; Female; Humans; Infant; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Zoonoses

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

Brucellosis is one of the most common zoonotic diseases that can be encountered during pregnancy. We present two pregnant women with brucellosis. One of them delivered normally and the other patient had an abortion. We reviewed the literature regarding the clinical course of brucellosis in pregnant women. Brucellosis during pregnancy can be associated with abortion, congenital and neonatal infections and infection of the delivery team. Therefore treatment with a combination of rifampicin and trimethoprim-sulfamethoxazole should be started as soon as it is diagnosed to prevent possible complications.

Topics: Abortion, Spontaneous; Adult; Brucellosis; Female; Humans; Pregnancy; Pregnancy Complications, Infectious; Trimethoprim, Sulfamethoxazole Drug Combination

To present our 10-year clinical experience with brucellosis patients at the University Clinic for Infectious Diseases and Febrile Conditions in Skopje, Republic of Macedonia.. A total of 550 patients with brucellosis treated between 1998 and 2007 were retrospectively assessed for their demographic, epidemiological, and clinical characteristics and outcomes.. Of the 550 patients, 395 (72%) were male. The median age was 34.5 years (range, 1-82). Direct contact with infected animals was recorded in 333 (61%) patients and positive family history in 310 (56%). The most frequently seen symptoms were arthralgia (438, 80%), fever (419, 76%), and sweating (394, 72%). The most common signs were fever and hepatomegaly, which were verified in 357 (65%) and 273 (50%) patients, respectively. Focal brucellosis was found in 362 patients (66%) and osteoarticular in 299 (54%). Therapeutic failures were registered in 37 (6.7%) patients. Of the 453 (82%) patients who completed a follow-up period of at least 6 months, relapses occurred in 60 (13%).. Due to non-specific clinical manifestation and laboratory parameters, brucellosis should be considered one of the differential diagnoses of any patient suffering from obscure involvement of various organs in a brucellosis-endemic region. High percentage of relapses and therapeutic failures in spite of the use of currently recommended therapeutic regimens indicates the seriousness of this zoonosis and the need to control it.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Animals; Anti-Bacterial Agents; Arthralgia; Brucellosis; Child; Child, Preschool; Disease Outbreaks; Endemic Diseases; Female; Fever; Humans; Infant; Male; Middle Aged; Republic of North Macedonia; Retrospective Studies; Sweating; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult; Zoonoses

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

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

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

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

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

Topics: Anti-Infective Agents; Brucellosis; Child; Erythema Nodosum; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination

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

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

We report a series of four cases presented with transient ischemic attacks (TIA) or ischemic stroke as the predominant manifestation of neurobrucellosis (NB). Three of the patients were 20-28 years of age, and one patient was 53 years old. They all used to consume unpasteurized milk or its products. Two patients had systemic brucellosis in the past and received antibiotic treatment. Other causes of TIA including cardiac embolism, hypercoagulability, vascular malformations, systemic vasculitis, and infective endocarditis were excluded. NB was diagnosed with serological tests or cultures for Brucella in the cerebrospinal fluid. None of the patients had any further TIA after the initiation of specific treatment. NB should always be sought in young patients with TIA or ischemic stroke, especially if they have no risk factors for stroke and live in an endemic area for brucellosis, even if they do not have other systemic signs of brucellosis.

Topics: Adult; Anti-Bacterial Agents; Brain Diseases; Brucellosis; Humans; Immunoglobulins; Ischemic Attack, Transient; Male; Middle Aged; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

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

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

Pancytopenia, although mainly reported in adults, has also been described in children with brucellosis. However, bone marrow hypoplasia is a rare feature of the infection. An 11-year-old boy was admitted with fever, vomiting, and abdominal pain of 10 days' duration. On physical examination, pallor and high fever were detected in the absence of lymphadenopathy and hepatosplenomegaly. His hemoglobin was 8.6 g/dL, white blood cell count 1,100/mm(3), neutrophil count 500/mm(3), platelets 56,000/mm(3), and reticulocytes 0.1%. Hypocellular bone marrow was found by aspiration, and bone marrow biopsy revealed hypocellularity. The agglutination titer was greater than 1/640. Trimethoprim/sulfamethoxazole was prescribed. His fever subsided and pancytopenia subsequently improved. Pancytopenia associated with brucellosis is attributed to hypersplenism, hemophagocytosis, and granulomatous lesions of the bone marrow, which is usually hypercellular. Bone marrow hypoplasia is rarely reported and should be kept in mind in the etiology of aplastic anemia in a country where brucellosis is frequently encountered.

Topics: Agglutination Tests; Anti-Bacterial Agents; Blood Cell Count; Bone Marrow; Bone Marrow Diseases; Brucella; Brucellosis; Child; Humans; Male; Pancytopenia; Trimethoprim, Sulfamethoxazole Drug Combination

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

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

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

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

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

Topics: Adolescent; Anti-Infective Agents; Brucellosis; Child; Child, Preschool; Drug Resistance, Microbial; Endemic Diseases; Humans; Infant; Infant, Newborn; Saudi Arabia; Trimethoprim, Sulfamethoxazole Drug Combination

Brucella endocarditis is an underdiagnosed complication of human brucellosis, associated with high morbidity and mortality. We report the successful management of a number of cases of Brucella mellitensis endocarditis.. Seven consecutive cases of Brucella mellitensis endocarditis were treated over the last 20 years, based on high suspicion of the disease at first place. The early suspicion of Brucella endocarditis relied on medical history and a standard tube agglutination titer > or =20. Blood and/or cardiac tissue cultures were positive in all patients, but available late following surgery. All patients were successfully treated with a combination of aggressive medical and early surgical therapy. All affected valves were replaced within 1 week from admission (five aortic and three mitrals). Medical treatment included co-trimoxazole, tetracyclines and streptomycin, before surgery, followed by co-trimoxazole and tetracyclines for a median of 12 months (range: 3-15 months) after surgery until the titers returned to a level < or =1:160.. There were neither operative deaths nor recurrence of infection. One patient died two years after the operation due to massive cerebrovascular accident. Ten-year survival was 85.7+/-13.2%.. Although Brucella mellitensis endocarditis is a rare entity, its optimum management should be a combination of aggressive medical treatment and early surgical intervention, based on high degree of suspicion in areas with high incidence of the disease.

Topics: Adult; Aged; Brucella melitensis; Brucellosis; Combined Modality Therapy; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Humans; Male; Middle Aged; Streptomycin; Survival Rate; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

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

Topics: Acute Disease; Agglutination Tests; Anti-Bacterial Agents; Anti-Infective Agents; Brucellosis; Child; Enzyme-Linked Immunosorbent Assay; Gentamicins; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination

It is occasionally difficult to distinguish the features of spinal brucellosis from those of ankylosing spondylitis (AS), and the resultant delayed diagnosis may allow insidious progression of the complications of the brucella infection. The case of a 33-year-old male HLA-B27-positive patient with known diagnosis of AS for 7 years, who developed a paravertebral abscess in the left erector spinae muscle due to brucellosis, is presented in this paper. This case report illustrates two important points; first, co-occurrence of AS and brucellosis in the same patient, and second, posterior element involvement with abscess formation in erector spinae muscle, which has not been previously reported. Magnetic resonance imaging is a sensitive method for detecting spinal brucellosis and extent of infection throughout paravertebral structures. Clinicians serving patients from areas with endemic brucellosis should not overlook the possibility of this infection in the presence of axial musculoskeletal symptoms, even among patients with AS.

Topics: Abscess; Adult; Anti-Bacterial Agents; Brucella; Brucellosis; Diclofenac; Doxycycline; Drug Therapy, Combination; Humans; Lumbosacral Region; Magnetic Resonance Imaging; Male; Muscle, Skeletal; Myositis; Osteomyelitis; Spondylitis, Ankylosing; Streptomycin; Sulfasalazine; Trimethoprim, Sulfamethoxazole Drug Combination

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

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

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

Topics: Brucellosis; Child; Child, Preschool; Doxycycline; Drug Administration Schedule; Drug Therapy, Combination; Female; Gentamicins; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination

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; 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

Cutaneous and soft tissue lesions are uncommon manifestations of brucellosis. Though breast involvement in animal brucellosis is not uncommon, involvement of the breast in human brucellosis is extremely rare. We report a case of breast abscess in a 39-year-old female caused by Brucella melitensis. Treatment with combination of trimethoprim/sulphamethoxazole (TMP/ SMX; cotrimoxazole) and doxycycline for 3 months resulted in clinical cure.

Topics: Abscess; Adult; Anti-Bacterial Agents; Breast Diseases; Brucella melitensis; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Humans; Saudi Arabia; Trimethoprim, Sulfamethoxazole Drug Combination

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

We report a case of Brucellosis in a seven year old child satisfactorily cleared up after therapy with ceftriaxone. We analyze the advantages of the drug in pediatric practice compared with usual therapy. The review of some clinical trials about use of the drug in treatment of Brucellosis is not conclusive. The use of the drug with higher dosages than the ones used by mentioned Authors is suggested.

Topics: Brucellosis; Ceftriaxone; Child; Follow-Up Studies; Humans; Male; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

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

Between 1974 and 1989 we prospectively observed 530 patients with brucellosis. The findings for 62 patients (42 males and 20 females; mean age, 34.7 years) with 63 episodes in which the sacroiliac joint was involved (the most frequent osteoarticular location [11.7%]) were analyzed. Ten of the older patients (mean age, 55.3 years) had concomitant spondylitis. Systemic symptoms were usually important, and characteristic pain and findings of sacroiliitis were observed in approximately 75% of cases. Blood cultures were positive for Brucella melitensis for 44 patients. The most frequent radiographic findings were blurring of articular margins (42 cases) and widening of the sacroiliac space (20 cases). No radiographic anomalies were detected in 13 cases. Results of 99mTc and gallium-67 bone scans were abnormal in approximately 90% of cases (abnormalities were often mild). Overall, clinical, radiographic, and isotopic bone scan findings were sensitive and useful, although they were occasionally minimal or difficult to evaluate, making diagnostic findings confusing or misleading. Brucellar sacroiliitis is a mild disease associated with a good outcome similar to that observed for patients with uncomplicated brucellosis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Arthritis, Infectious; Brucella melitensis; Brucellosis; Chi-Square Distribution; Child; Female; Follow-Up Studies; Humans; Macrolides; Male; Middle Aged; Prospective Studies; Radiography; Radionuclide Imaging; Sacroiliac Joint; Spondylitis, Ankylosing; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Bacteremia; Brucella melitensis; Brucellosis; Drug Therapy, Combination; Gentamicins; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Trimethoprim, Sulfamethoxazole Drug Combination

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

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 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

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

The clinical features of 21 episodes of skeletal brucellosis in 17 Iraqi patients are reported. Six had monarthritis of a large joint, six had spondylitis, and five had spondarthritis. Brucellosis remains a major health problem in Iraq. The disease is transmitted to man through the ingestion of unpasteurised milk or milk products but can also be acquired through physical contact.

Topics: Adult; Aged; Anti-Bacterial Agents; Arthritis, Infectious; Brucella abortus; Brucellosis; Drug Combinations; Drug Therapy, Combination; Female; Humans; Iraq; Male; Middle Aged; Spinal Diseases; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Five cases of Brucella infective endocarditis are described involving a native aortic valve, two native mitral valves, a mitral valve bioprosthesis, and a ventricular septal defect patch. The diagnosis of Brucella infective endocarditis was established from the clinical features, with a high Brucella serologic titer in each case. Blood and tissue cultures were positive in four of five patients. Two-dimensional echocardiograms demonstrated moderately large vegetations on the three affected native valves and the patch and also revealed the development of vegetation on the mitral bioprosthesis as the disease progressed. All the patients were successfully treated by combined surgical and medical therapy, the latter consisting of co-trimoxazole, tetracycline, and streptomycin/gentamicin for 6 weeks; the affected valves and the ventricular septal defect patch were all replaced. There were no operative deaths and there has been no recurrence of infection to date. One patient died suddenly of an unknown cause 1 year after the operation.

Topics: Adult; Aortic Valve; Brucellosis; Combined Modality Therapy; Drug Combinations; Echocardiography; Endocarditis, Bacterial; Female; Gentamicins; Heart Valve Prosthesis; Humans; Male; Mitral Valve; Streptomycin; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The clinical and pathological findings in a patient who had acute hepatitis caused by Brucella melitensis are described. Antibiotic therapy induced a good clinical and biochemical response, although a relapse occurred. Brucellosis must be considered in the differential diagnosis of pyrexia of unknown origin, particularly if associated hepatic involvement is present. A careful occupational and travel history is essential.

Topics: Brucella; Brucellosis; Cheese; Cholecystitis; Diagnostic Errors; Drug Combinations; Female; Hepatitis; Humans; Middle Aged; Recurrence; Sulfamethoxazole; Travel; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

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

We studied 50 children with brucellosis. Diagnoses were made from clinical pictures and agglutination titres. Fevers, sweating and chills were common complaints. Hepatosplenomegaly and arthritis were usual findings. Tetracycline is an effective drug for management of childhood brucellosis. Seven patients with relapse were treated successfully with combination of tetracycline and co-trimoxazole.

Topics: Adolescent; Age Factors; Agglutination Tests; Brucellosis; Child; Child, Preschool; Drug Combinations; Female; Humans; Iraq; Male; Pregnancy; Prospective Studies; Seasons; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

We studied the in-vitro activity of seven antibiotics against 95 strains of Brucella melitensis isolated in blood cultures of 95 patients with brucellosis. The minimum inhibitory concentration (MIC) was measured by the agar dilution method. All strains of B. melitensis were inhibited by doxycycline at 0.25 mg/l, tetracycline at 0.5 mg/l, ciprofloxacin at 0.5 mg/l, streptomycin at 1 mg/l, ceftriaxone at 1 mg/l, rifampicin at 4 mg/l and by co-trimoxazole at 0.5/9.5 mg/l. We did not find strains resistant to any of the antibiotics studied. All antibiotics, including ciprofloxacin and ceftriaxone, showed a good in-vitro activity against B. melitensis.

Topics: Anti-Bacterial Agents; Brucella; Brucellosis; Ceftriaxone; Ciprofloxacin; Drug Combinations; Humans; Microbial Sensitivity Tests; Quinolines; Sulfamethoxazole; Tetracyclines; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The clinical characteristics and the response to treatment with high doses of co-trimoxazole in 12 children with brucellar arthritis were analysed retrospectively. The children lived in an urban area and all but two had a history of unprocessed milk or cheese ingestion. Fever and oligoarthritis of the lower extremities were the most common clinical findings. Control of the disease was achieved by three months of treatment. Compliance with the medication was excellent, and no significant side effects occurred.

Topics: Adolescent; Arthritis, Infectious; Brucellosis; Child; Child, Preschool; Drug Administration Schedule; Drug Combinations; Female; Food Contamination; Humans; Male; Retrospective Studies; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Adult; Aged; Bone Diseases; Brucellosis; Drug Combinations; Female; Humans; Joint Diseases; Male; Middle Aged; Retrospective Studies; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

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

Bilateral kidney enlargement and renal failure are described in a five-years-old girl with brucellosis. The diagnosis was made on the basis of a rising brucella agglutination titre. Both the function and the size of the kidneys returned to normal after four weeks treatment with co-trimoxazole. Renal brucellosis may stimulate renal tuberculosis or chronic pyelonephritis and should be considered in areas where brucellosis is endemic.

Topics: Acute Kidney Injury; Brucellosis; Drug Combinations; Female; Humans; Infant; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Acute Kidney Injury; Adult; Brucellosis; Doxycycline; Drug Combinations; Humans; Male; Rhabdomyolysis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

From 1973 to 1983 nine cases of Brucella melitensis infection were hospitalised at the Centre hospitalier universitaire vaudois (CHUV), Lausanne. In each case, the infection was acquired in a Mediterranean country (4 cases in Italy, 2 in Spain, 2 in Portugal and 1 in Greece). In 6 of the cases the disease was acquired by ingestion of dairy products and in 2 cases by direct animal contact. Despite classical initial symptomatology (fever, rigors, weakness), the time from first symptoms to diagnosis varied between 10 days and 5 months. This delay probably explains why 6 of 9 patients were admitted because of septic complications: orchi-epididymitis, arthritis, meningitis and endocarditis. With prolonged antibiotherapy, the evolution was favourable in all cases. The patient who presented with endocarditis required emergency aortic valve replacement. Culture of the valve showed the presence of 10(9) B. melitensis/g of tissue. Cure was achieved by the administration of streptomycin and tetracycline for 6 weeks, followed by cotrimoxazole for one year. These cases show that the diagnosis of Brucella infection is becoming rare in Switzerland. It is often not suspected, and prompt diagnosis is delayed until further complications occur. Serology and blood cultures should be done in every patient presenting with fever after a stay in endemic countries.

Topics: Adult; Aortic Valve Insufficiency; Arthritis, Infectious; Blood; Brucella; Brucellosis; Cerebrospinal Fluid; Child; Drug Combinations; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Sepsis; Streptomycin; Sulfamethoxazole; Synovial Fluid; Tetracyclines; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

It has been studied in a series of 30 children affected of brucellosis, the most important epidemiologic, clinical and biologic characteristics. It has been emphasized the good response to the combined treatment of tetracycline and streptomycin.

Topics: Adolescent; Age Factors; Brucellosis; Child; Child, Preschool; Drug Combinations; Drug Therapy, Combination; Female; Humans; Male; Spain; Streptomycin; Sulfamethoxazole; Tetracyclines; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

During April/Mai 1982 15 patients were affected with acute Malta fever around Goettingen an area known the be brucellosis-free until then. The source of infections were local flocks of sheep. The infections were mainly acquired when assisting at lamb birth or abortions. Between onset and diagnosis of the disease intervals up to 3 month occurred. Diagnostically crucial were blood cultures and serological tests. Therapy with tetracyclines or co-trimoxazole were effective in all cases. In patients with status febrilis and anamnestic contact with brucellosis-prone animals brucellosis should be considered, even if the local area appears to be brucellosis-free.

Topics: Animals; Antibodies, Bacterial; Brucella; Brucellosis; Disease Outbreaks; Doxycycline; Drug Combinations; Germany, West; Humans; Sheep; Sheep Diseases; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

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