Osh state university international medical faculty

Introduction

Brucellosis is reported to be the most frequent zoonotic disease worldwide and it is estimated that 500,000 new cases occur annually1. Among Brucella species, Brucella melitensis is mostly implicated as the causative agent of the disease. Brucellosis may mimic various systemic diseases and usually diagnostic delays occur due to the lack of a rapid and precise diagnos- tic method. Although serum agglutination tests are widely used, when they yield false negative results the diagnosis may be limited. In clinical presentation, bru- cellosis may cause systemic or focal disease. Systemic involvement may present with nonspecific symptoms

Fig. 1. On coronal post-contrast T1 weighted gradient echo image, contrast enhancement is demonstrated on the superior part of the sacroiliac joint and its capsule.

height was 158 cm (75-90thpercentile). Body tempera- ture was 38.5 °C, heart rate 70/min, blood pressure 110/70 mm Hg and respiratory rate 20/min. Labo- ratory analysis showed hemoglobin level of 120 g/L and white blood cell count 8.3x109/L, erythrocyte sedimentation rate was 23 mm/hour and C-reactive protein level was 29 mg/L (upper reference limit: 5 mg/L). Peripheral blood smear examinations showed 38% of polymorphonuclear leukocytes, 55% of lym- phocytes and 6% of monocytes without any atypical cell. Renal and liver function tests were within the normal limits. The patient had a positive history of brucellosis cases in his family and of consuming cheese produced by unpasteurized milk. According to these clinical and laboratory findings, with an initial diagnosis of brucellosis, further serologic tests were studied. The Rose-Bengal test was positive, while the Brucella standard tube agglutination test was negative. Cardiologic evaluation and echocardiographic inves- tigation that were performed because of the bradycar- dia episodes seen on the initial days of hospitalization were both normal. Although direct x-rays of vertebral and sacroiliac joints were reported as normal, con- trast enhanced magnetic resonance imaging (MRI) revealed spondylitis at the 10th thoracic vertebra and unilateral sacroiliitis (Figs. 1 and 2). Owing to the iso- lation of Brucella spp. in blood culture, agglutination tests were repeated with immunocapture method and

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Fig. 2. On sagittal T2 weighted short tau inversion re- covery (STIR) image, prominent heterogeneous increase in signal intensity is demonstrated in the posterior aspect of the body of the 10th thoracic vertebra.

yielded positive result at a titer of 1/320. Ultimately, the patient was diagnosed as brucellosis with sacro- iliitis and spondylitis. treatment with streptomycin, rifampicin and doxycycline was started. He received streptomycin for 2 weeks and the other drugs for 12 weeks. During one-year follow up, no complication or relapse occurred.