Clinical Spectrum, Susceptibility Profile, Treatment and Outcome of Culture-Confirmed Brucellosis from South India

Abstract

Brucellosis, a common zoonosis, is under reported in India despite its endemicity and increased exposure to livestock among the population. This study was conducted to determine the clinical manifestations, antibiotic susceptibility pattern, treatment and outcome of culture confirmed brucellosis. Adult patients with culture confirmed brucellosis who presented to a large teaching hospital in South India between 2009 and 2015 were included. A diagnosis of brucellosis was confirmed on automated culture. Clinical profile, laboratory parameters, drug susceptibility, treatment and outcome were documented by reviewing the medical records. The cohort comprised of 22 patients with mean ± SD age of 42 ± 13 years. Twenty one (95.5%) was male. Thirteen (59%) patients were from rural area and risk of acquisition of brucellosis including occupational exposure or consumption of unpasteurized milk was evident in 16 (72.7%) patients. The mean duration of symptoms before presentation was 54.5 ± 52 days. The commonest clinical presentation was prolonged fever without a definite focus in 18 patients (82%), whereas 2 (9%) patients had osteoarticular involvement and one patient (4.5%) each had genital involvement and endocarditis. Eighteen patients (82%) with uncomplicated brucellosis were treated with aminoglycoside and doxycycline for 6 weeks. There was no relapse or mortality at 18 ± 9 months of follow up. Brucellosis in this cohort had acute or subacute presentation with prolonged fever and bacteremia. High index of clinical suspicion based on significant epidemiological history along with automated blood culture improves the efficiency of diagnosis. Cure with lack of relapse among these cases suggests a combination therapy with doxycycline and aminoglycoside is highly effective for the treatment.

Standardization and Evaluation of an In-house Multiplex Real-time Polymerase Chain Reaction for Simultaneous Detection of Pathogenic Species of Brucella, Rickettsia, and Leptospira in Patients with Acute Febrile Illness

“…[9] In the high-risk group of patients, occupational exposure or consumption of unpasteurized milk was the major risk factor. [10][11][12] In the nearby state of Karnataka, an overall prevalence of brucellosis among veterinary health care workers was 7.04%. The prominent clinical symptoms observed were intermittent fever (71.62%) followed by joint pain and body aches.…”

Gram-negative infective endocarditis: a retrospective analysis of 10 years data on clinical spectrum, risk factor and outcome

“…A large proportion of gram-negative endocarditis in our cohort is also primarily as a result of healthcare-related events. Furthermore, the microbiological sensitivity patterns reveal that drug resistance is becoming a problem contributing to patient morbidity and the cost of treatment [36,37]. Epidemiology, microbiological profile, drug susceptibility, adverse drug effects, and management guidelines on IE are continually changing [35,[38][39][40].…”

Update of Antibiotic Therapy of Brucellosis

“…○ Doxycycline plus rifampin 300 mg every 12 h and gentamycin 5 mg/kg each day, the duration of therapy is uncertain usually for 6 weeks to 6 months [9].…”