Respiratory System Involvement in Brucellosis

Erdem, Hakan; İnan, Asuman; Elaldı, Nazif; Tekin, Recep; Gülsün, Serda; Ataman-Hatipoglu, Cigdem; Beeching, Nicholas J.; Deveci, Özcan; Yalçı, Aysun; Bölükçü, Sibel; Dagli, Ozgur

doi:10.1378/chest.13-0240

Cited by 35 publications

(32 citation statements)

References 37 publications

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“…Constitutional symptoms such as anorexia, asthenia, fatigue, weakness and excessive weight loss were indicative of brucellosis [3]. Although a variety of pulmonary complications have been reported in brucella infections including interstitial pneumonitis and bronchopneumonia, the frequency of such complications is low [12,13]. In contrast, pneumonia occurs in almost half of the patients with acute C. burnetii infection [14].…”

Section: Discussionmentioning

confidence: 99%

Imported brucellosis and Q-fever coinfection in Croatia: a case report

Perić

Sabadi

Rubil

et al. 2018

J Infect Dev Ctries

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The brucellosis and Q-fever coinfection is very rarely reported. To our knowledge, this is the first case report of concomitant brucellosis and Q-fever, most likely imported in Croatia. A 30-year-old male agricultural worker was hospitalized on 22 April 2017 after a ten days fever up to 40°C with chills, shivering, excessive sweating, general weakness, loss of appetite and headache. A month and a half prior to the hospitalization he lost 18 kg of body weight. Three weeks before hospitalization the patient returned from Kupres (Bosnia and Herzegovina) where he was working for the past year on a sheep farm and consumed unpasteurized dairy products of sheep origin. At admission, his condition was moderately severe due to pronounced dehydration. Routine laboratory tests showed slightly elevated erythrocyte sedimentation rate, anemia, thrombocytopenia and elevated liver transaminases. The chest X-ray showed an inhomogeneous infiltrate of the lower right lung. Three sets of blood culture were cultivated. After 48 hours incubation, bacterial growth was detected in aerobic bottles. Gram-stained smear revealed small, gram-negative coccobacilli. Specimens were subcultured on blood and chocolate agar plates. Using a Vitek GN identification card, the isolated organism was identified as Brucella melitensis. 16S rRNA gene sequencing of the isolate confirmed it as a Brucella sp. Rose-Bengal test was positive, while Wright agglutination test showed a significant increase in antibody titer from 80 to 640 in paired sera. Using indirect immunofluorescence assay (IFA), Coxiella burnetii phase II IgM/IgG titers were 50 and 1024, respectively indicating acute Q-fever. The patient was treated with doxycycline and rifampicin. So far, there has been no relapse or signs of chronic infection.

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Section: Discussionmentioning

confidence: 99%

Imported brucellosis and Q-fever coinfection in Croatia: a case report

Perić

Sabadi

Rubil

et al. 2018

J Infect Dev Ctries

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“…While the respiratory tract is a common portal of entry, pulmonary pathology and respiratory disease are not atypical features of Brucella spp. infection [30, 31]. In the rare cases in which respiratory disease is reported, the common presentations include pneumonia, bronchopneumonia, pleural effusion, and dry coughing [31].…”

Section: Discussionmentioning

confidence: 99%

“…In the rare cases in which respiratory disease is reported, the common presentations include pneumonia, bronchopneumonia, pleural effusion, and dry coughing [31]. Respiratory signs rarely occur in isolation, and patients often have concomitant disease such as hepatitis or spondylitis supporting the role of the lung as a portal of entry rather than a primary target [30, 31]. Clinical signs in mice with respiratory infection have not been reported [7].…”

Section: Discussionmentioning

confidence: 99%

Characterization of a novel intratracheal aerosol challenge model of Brucella melitensis in guinea pigs

Hensel

García-González

Chaki

et al. 2018

Preprint

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B. melitensis is considered the most virulent of the Brucella species, and a need exists for an improved laboratory animal model of infection that mimics natural transmission and disease. Guinea pigs are highly susceptible to infection with Brucella spp. and develop a disease syndrome that mimics natural disease after aerosol inoculation. Intratracheal inoculation is a targeted means of generating aerosols that offer advantages over aerosol chamber delivery. To establish this delivery method, female, Hartley guinea pigs were infected via intratracheal inoculation with PBS or 16M B. melitensis at low dose (101 to 103) or high dose (106 to 108) and monitored for 30 days for signs of disease. Guinea pigs in the high dose groups developed fever between 12-17 days post-inoculation. Bacteria were recovered from the spleen, liver, lymph nodes, lung, and uterus at 30-days post-inoculation and demonstrated dose dependent mean increases in colonization and pathologic changes consistent with human brucellosis. To study the kinetics of extrapulmonary dissemination, guinea pigs were inoculated with 107 CFU and euthanized at 2-hours post inoculation and at weekly intervals for 3 weeks. 5.8×105 to 4.2×106 CFU were recovered from the lung 2 hours post-inoculation indicating intratracheal inoculation is an efficient means of infecting guinea pigs. Starting at 1-week post inoculation bacteria were recovered from the aforementioned organs with time dependent mean increases in colonization. This data demonstrates that guinea pigs develop a disease syndrome that models the human manifestation of brucellosis, which makes the guinea pig a valuable model for pathogenesis studies.Author summaryBrucellosis is caused by a gram-negative, intracellular bacterial pathogen with a worldwide distribution and affects up to half a million people per year. It is a neglected zoonosis that impacts not only animal welfare, but also exert economic pressure on afflicted individuals through loss of wages and decreased productivity. In people, recurrent fever, malaise, and anorexia accompanied by enlargement of the spleen and lymph nodes are common clinical symptoms of infection. The mouse model has been used extensively to study the pathogenesis of brucellosis, but there are drawbacks to extrapolating studies in mice to develop vaccines or therapeutics for people. Mice are frequently inoculated via intraperitoneal injection, which is an artificial means of producing disease that does not mimic natural transmission or disease features, such as fever. An animal model is needed that can be infected through natural transmission routes and subsequently develop a syndrome that matches clinical disease seen in people in order to study the pathogenesis of disease and to develop vaccines and therapeutics. The guinea pig offers an improvement on the mouse model because it can be infected via aerosol inoculation and develops fever, a humoral immune response, systemic colonization, and macroscopic and microscopic lesions of disease. As such, guinea pigs could be used a more biologically relevant model for evaluation of host-pathogen interactions.

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“…Respiratory complications can also be observed. [2,[4][5][6][7][8] Although cardiovascular involvement is rare, accounting for only 1-2% of all cases, mortality risk is high due to cardiovascular complications. [9][10][11] Prevalence of cardiac involvement in brucellosis may be underestimated because thorough echocardiographic studies in patients with brucellosis are lacking.…”

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confidence: 99%