Images of Infectious Diseases
86M MN with fever / confusion. PE unremarkable. PMH: self-limiting fever, night sweats, weight loss in his 20s. Retired abattoir worker / slaughtered pigs. CT abdomen (photo).
What is the most likely diagnosis? #MayoIDQ nextβ¦
86M MN with fever / confusion. PE unremarkable. PMH: self-limiting fever, night sweats, weight loss in his 20s. Retired abattoir worker / slaughtered pigs. CT abdomen (photo).
What is the most likely diagnosis? #MayoIDQ nextβ¦
2/
Thank you #IDTwitter for your excellent DDx: TB, Brucella, Coxiella, Trichinella, Echinococcus, othersβ¦
This case: blood culture yielded #Brucella suis.
Which of the following choices is a recommended Rx?
Thank you #IDTwitter for your excellent DDx: TB, Brucella, Coxiella, Trichinella, Echinococcus, othersβ¦
This case: blood culture yielded #Brucella suis.
Which of the following choices is a recommended Rx?
3/
Chronic Splenic #Brucellosis
Reported by our faculty Dr. Enzler and his visiting student
MCQ answer: doxycycline + RIF
In this case: TMP-SMX was also added
nejm.org
Chronic Splenic #Brucellosis
Reported by our faculty Dr. Enzler and his visiting student
MCQ answer: doxycycline + RIF
In this case: TMP-SMX was also added
nejm.org
4/
#Brucellosis
500,000 cases annually worldwide
100-200 US cases/year
Contact with infected animals (sheep, cattle, pigs, goats)
- Contact with tissue/fluids
- Unpasteurized milk products
- Inhalation (lab workers and meat shop workers)
cdc.gov
#Brucellosis
500,000 cases annually worldwide
100-200 US cases/year
Contact with infected animals (sheep, cattle, pigs, goats)
- Contact with tissue/fluids
- Unpasteurized milk products
- Inhalation (lab workers and meat shop workers)
cdc.gov
5/
#Brucellosis
Clinical manifestations
- Undulant fever: fever, malaise, sweats (βmoldyβ odor #IDBR), arthralgia, back pain
- Hepatosplenomegaly
- Lymphadenopathy
#Brucellosis
Clinical manifestations
- Undulant fever: fever, malaise, sweats (βmoldyβ odor #IDBR), arthralgia, back pain
- Hepatosplenomegaly
- Lymphadenopathy
6/
Organ involvement #brucellosis
- Bone / joints #IDBR (sacroiliac / spine); spondylitis
- GU: orchitis, prostatitis
- Neuro: meningitis
- CV: endocarditis
Organ involvement #brucellosis
- Bone / joints #IDBR (sacroiliac / spine); spondylitis
- GU: orchitis, prostatitis
- Neuro: meningitis
- CV: endocarditis
7/
Diagnosis #brucellosis
1. Culture (bone marrow #IDBR > blood): occupational exposure among lab personnel (during manipulation of culture plates) - let the lab know if you suspect!
2. Serology (does not detect RB51 strain)
3. PCR
cdc.gov
Diagnosis #brucellosis
1. Culture (bone marrow #IDBR > blood): occupational exposure among lab personnel (during manipulation of culture plates) - let the lab know if you suspect!
2. Serology (does not detect RB51 strain)
3. PCR
cdc.gov
8/
#Brucellosis Rx in general
1. Doxy 6w + strep 2-3w
2. Doxy 6w + genta 7-10d
3. Doxy 6w + rifampin 6w (MCQ answer)
If end-organ: longer courses, multiple drugs
#Brucellosis Rx in general
1. Doxy 6w + strep 2-3w
2. Doxy 6w + genta 7-10d
3. Doxy 6w + rifampin 6w (MCQ answer)
If end-organ: longer courses, multiple drugs
9/
#Brucellosis #IDClinicalPearl
1. Unpasteurized milk/ contact animal fluids/tissue
2. Undulant fever (moldy sweat); bone/joints: sacroilitis spondylitis
3. Vaccine-derived disease: RB51
4. BM, blood, tissue culture / serology
5. Doxy + RIF /streptomycin (vaccine disease RIF-R)
#Brucellosis #IDClinicalPearl
1. Unpasteurized milk/ contact animal fluids/tissue
2. Undulant fever (moldy sweat); bone/joints: sacroilitis spondylitis
3. Vaccine-derived disease: RB51
4. BM, blood, tissue culture / serology
5. Doxy + RIF /streptomycin (vaccine disease RIF-R)
/10
BONUS tweet:
#Brucellosis due to RB51 #Pearls
- RIF / PCN resistant B. abortus
- Live attenuated vaccine: shed in milk β> unpasteurized milk intake
- RB51 does not stimulate an Ab that is detectable by routine serology
- Rx: doxycycline + TMP-SMX
doi.org
BONUS tweet:
#Brucellosis due to RB51 #Pearls
- RIF / PCN resistant B. abortus
- Live attenuated vaccine: shed in milk β> unpasteurized milk intake
- RB51 does not stimulate an Ab that is detectable by routine serology
- Rx: doxycycline + TMP-SMX
doi.org
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