Brucellosis 2003 proceedings - PHIDIAS

Poster Session
disclosed cervical adenomegaly, and laboratory tests revealed neutropenia and a
mild increase of hepatic enzymes. The patient denied close contact with dogs or
other animals. Blood samples were drawn for culture, which was positive for Brucella
canis. Conventional tests for antibodies to smooth brucellae yielded negative results,
but slide agglutination for B. canis was positive at 1:10 dilution. The patient received
oral doxycycline for 42 days and parenteral gentamicin for 10 days, and experienced
clinical recovery. Blood cultures performed 2 weeks after the end of antibiotic therapy
were negative for B. canis. Serological follow-up included slide agglutination and 3
ELISAs performed with a hot-saline extract of B. canis M- (HS), LPS-free cytoplasmic
proteins of B. abortus (CP) or recombinant Brucella lumazine synthase (rBLS).
Antibodies to all the 3 antigens were detected at the time of diagnosis. Antibodies to
CP and BLS reached negativization 103 days after diagnosis and antibodies to HS
(and slide agglutination) were negative at 200 days after diagnosis. Evidence of
cellular immune response to BLS and CP was also obtained with peripheral blood
mononuclear cells drawn at the time of diagnosis. The patient remained
asymptomatic at the time of the last clinical control, 4 years after initial diagnosis.
27- IMPORTED CASE OF BRUCELLOSIS COMPLICATED BY LIVER ABSCESS.
C. Mutini, M. Di Carlo, L. Coppolaro, A. Di Girolamo, E. Pizzigallo. Clinica Malattie Infettive, Università
degli Studi “G. d’Annunzio”, Chieti, Italy.
Hepatic involvement is a common feature of Brucella infection, but liver
abscess is a less frequent complication. We report a case of brucellar hepatic
abscess in a 42 year old man with a 4 week complaint of fever, abdominal pain,
anorexia, and weight loss. Forty days earlier he was back from a 2 years staying in
Albania. A detailed epidemiologic history showed that he consumed, about 2 week
before the onset of symptoms, fresh unpasteurized cheese. At admission the patient
was febrile (39°C), and tachycardic (100 bpm). Abdomen was diffusely painful,
especially in the right upper quadrant. Liver was 2 cm below the costal margin. Blood
tests showed mild neutrophilia (6 680 cells x mm³), anaemia (haemoglobin 10.6 g/dl),
and hypoalbuminemia (3 034 mg/dl), ESR 94 mm/h and C-reactive protein 15,1
mg/dl. Abdominal ultrasound scan showed an abscess within the VI hepatic segment
of about 55 mm in diameter which was promptly drained. Blood cultures were
positive for Streptococcus anginosus, but Wright test for Brucella was also positive at
high titer (>1600). Clinical course was complicated by right sided pleuric effusion that
needed evacuation. I.V. ciprofloxacin, doxycycline P.O., and metronidazole P.O.
were initially administered. Antibiotic regimen was then switched to doxicicline P.O.
and gentamicin I.V. for 6 weeks, accomplishing a progressive improvement of
general conditions. E. coli and Streptococcus anginosus were isolated from the
abscess drainage. Any attempt of isolating Brucella spp., including biomolecular
approaches, failed. Wright serology was repeated at discharge, showing a decrement
in titers. A review of published cases was done, finding a brucellar hepatic abscess
incidence of some 1%. Since the isolated strains in this patient did not clearly
indicate a brucellar etiology, some question could be raised on the real involvement
of Brucella spp. in this case. The possibility are that normal intestinal flora could
reach, by contiguity, the liver. Otherways, the initial brucellar colonization could have
been replaced, during abscess evolution, by superinfecting strains that made the
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