NDLI: Brucellosis infection presenting with cholestasis.

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Brucellosis infection presenting with cholestasis.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Fernández Fernández, M. A. García de Paso Mora, M. Mateos Checa, R. Croche, B. Porras Gonzalez, A. Obando Santaella, I.
Description	Country affiliation: Spain Author Affiliation: Fernández Fernández MA ( Virgen del Rocio University Hospital for Children, Av. Manuel Siurto s/n, Seville, Spain. drlolo13@hotmail.com)
Abstract	Brucellosis is a relatively common disease in the Mediterranean area and may present with prolonged fever without focus, however it remains an important diagnostic challenge to most pediatricians. We report the case of a 10-year-old male patient who presented with fever without a focus of 10-day duration, hepatomegaly, ascites, a small elevation in transaminases and acute-phase reactants indicating cholestasis, leukopenia, and thrombocytopenia. Imaging tests showed many small, rounded, hypodense focal lesions in the liver and spleen. After eliminating a wide range of diseases, positive results for the Rose Bengal test and indirect immunofluorescence assay for Brucella melitensis made it possible to establish a diagnosis of hepatosplenic brucellosis. A review of the family history revealed direct contact with farm animals. The patient made good progress on treatment with doxycycline and streptomycin, with complete resolution of both clinical symptoms and imaging signs. The prevalence of brucellosis is gradually increasing, mainly due to migratory movements. It should always be eliminated as a source of unknown fever in endemic areas and should also be taken into account in other geographical areas where it is not common whenever a patient presents with prolonged fever and unspecific symptoms. Standard therapy is highly effective, even in relapse cases, and early diagnosis leads to a rapid recovery and favorable outcome. The unusual presentation in the case reported here reminds us that it is possible to encounter a Brucella infection in a case of fever without a focus, irrespective of the existence of a clear epidemiological history, which is very often omitted by the family. All differential diagnostic protocols for fever without a focus should include a diagnostic test for Brucella in order to achieve early detection of the disease and initiate therapy promptly.
File Format	HTM / HTML
ISSN	12019712
e-ISSN	18783511
Journal	International Journal of Infectious Diseases
Issue Number	Suppl 3
Volume Number	14
Language	English
Publisher	Elsevier
Publisher Date	2010-09-01
Publisher Place	Canada
Access Restriction	Open
Subject Keyword	Discipline Communicable Diseases Brucella Melitensis Brucellosis Complications Diagnosis Cholestasis Animals Animals, Domestic Anti-bacterial Agents Therapeutic Use Drug Therapy Doxycycline Fever Etiology Streptomycin
Content Type	Text
Resource Type	Case study Article
Subject	Infectious Diseases Microbiology (medical)

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