Background Brucellosis is recognized as a neglected zoonotic disease and a major public health threat. The purpose of this study was to characterize epidemiological risk factors and healthcare utilization and compare clinical aspects of disease among adult and pediatric cases in North Texas. Methods A retrospective chart review of electronic medical records was completed at 3 large tertiary centers—Parkland Health and Hospital System, Clements University Hospital, and Children’s Medical Center—between January 1, 2007 and June 1, 2017. Demographic, clinical, and laboratory variables were collected. Cases were defined as confirmed or probable. Results Twenty-eight cases of brucellosis were identified: 26 confirmed (9 children, 17 adults) and 2 probable cases (1 child, 1 adult). Half (n = 14) were diagnosed in 2016 during an outbreak in Dallas County. Risk factors associated with infection were consumption of unpasteurized cheese (71%), recent travel (54%), close contact to a confirmed human brucellosis case (36%), and exposure to animals (11%). Median days of symptoms was 10 and 16 for children and adults, respectively. The majority (79%) of patients visited the emergency department before diagnosis and 93% were hospitalized. Fever was the most common symptom in children (80%) and adults (100%). Hepatitis (75% of children) and anemia (82% of adults) were the most common laboratory abnormalities. The most common complication in children was splenic lesions (40%), and the most common complication in adults was hepato/splenomegaly (39%). Conclusions The diagnosis of Brucella infection requires a high index of suspicion and should be considered in patients presenting with a febrile illness and a compatible exposure history.

Background. Developing countries, home to 80% of epilepsy patients, do not have comprehensive epilepsy surgery programs. Considering these needs we set up first epilepsy surgery center in Pakistan. Methods. Seventeen teleconferences focused on setting up an epilepsy center at the Aga Khan University (AKU), Karachi, Pakistan were arranged with experts from the University of Alberta Hospital, Alberta, Canada and the University of West Virginia, USA over a two-year period. Subsequently, the experts visited the proposed center to provide hands on training. During this period several interactive teaching sessions, a nationwide workshop, and various public awareness events were organized. Results. Sixteen patients underwent surgery, functional hemispherectomy (HS) was done in six, anterior temporal lobectomy (ATL) in six, and neuronavigation-guided selective amygdalohippocampectomy (SAH) using keyhole technique in four patients. Minimal morbidity was observed in ATL and, SAH groups. All patients in SAH group (100%) had Grade 1 control, while only 5 patients (83%) in ATL group, and 4 patients (66%) in HS group had Grade 1 control according to Engel's classification, in average followups of 12 months, 24 months and 48 months for SAH, ATL, and HS, respectively. Conclusion. As we share our experience we hope to set a practical example for economically constrained countries that successful epilepsy surgery centers can be managed with limited resources.

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Background While the epidemiology of Brucellosis is well described in systematic reviews and retrospective analyses in endemic countries, there is a paucity of similar data in the United States (US). With a recent outbreak of Brucellosis reported in Dallas County in 2016, we sought to characterize cases of Brucellosis at two Dallas teaching hospitals over the past 10 years.Methods A retrospective chart review of electronic medical records at Parkland Health and Hospital System and Clements University Hospital was completed for all patients over 18 who were diagnosed with Brucellosis, as defined by ICD9/10 codes, problem lists, and/or positive microbiologic or serologic data, between 1/1/2007 - 2/6/2017. Demographic, epidemiologic, and clinical characteristics were collected.ResultsOut of 104 charts reviewed, 16 cases of Brucellosis (14 definite, 2 probable) were identified. Fifty-six percent were male, the mean age was 45, and 94% were of Hispanic ethnicity. Recent travel was reported in 6/16 cases (5 to Mexico, 1 to India) and exposure to unpasteurized cheeses was reported in 13/16 cases. The majority of cases were seen in the summer months, and a sharp increase in incidence was noted in 2016 (Figure 1). Common symptoms included fever (16/16), chills (8/16), diarrhea (4/16), headache (4/16), malaise (4/16), and body aches (4/16). Laboratory abnormalities included leukopenia, thrombocytopenia, and elevated liver function tests. Other complications included epididymitis and/or orchitis (2/16), hepatomegaly (5/16), splenomegaly (4/16), and other splenic abnormalities (2/16). Brucella discitis/osteomyelitis with spinal epidural abscess (1/16), possible neurobrucellosis (1/16) and recurrent disease (2/16) were also identified. The most common treatment regimen used was doxycycline/rifampin +/- gentamicin.Conclusion This case series represents one of the largest contemporary Brucella experiences described in the US. While not endemic in the US, the diagnosis of Brucellosis requires a high index of suspicion and should be considered in patients presenting with a febrile illness and a compatible travel history or exposure history, particularly to unpasteurized dairy products.Disclosures All authors: No reported disclosures.

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