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An unusual case of Brucella melitensis-related wound infection
Ozge Alkan Bilik1, Fatma Meral Ince2, Nida Ozcan3
1Medical Microbiology Laboratory, Selahaddin Eyyubi State Hospital, Diyarbakir, Turkey.
Background:
Brucellosis is an anthropo-zoonotic infectious disease caused by various Brucella species. It is usually transmitted through contact with infected animals or consumption of contaminated animal products. Brucellosis most commonly affects the musculoskeletal and reticuloendothelial system with additional involvement observed in gastrointestinal system, urinary tract, reproductive system, central nervous system, and cardiovascular system. Skin involvement is extremely rare in brucellosis. Here, we report a rare case of Brucella melitensis infection developing in a back wound following a lumbar disc herniation surgery over 14 years ago.
Case:
A 34-year-old male patient, who had a herniated disc surgery 14 years ago, was admitted to the hospital with complaints of joint pain, sweating and discharge at the surgery site. Wound culture revealed the presence of Gram negative cocobacilli which was identified as Brucella melitensis. The subsequent diagnostic tests, including the Rose-Bengal and Brucella Capture test positivity at a titer of 1/320 confirmed the diagnosis. The patient received six weeks of doxycycline (200 mg/day, orally) and rifampin (600 mg/day orally) treatment, accompanied by wound care procedures. Daily cleaning, sterile dressing, and wound debridement were employed. Following treatment, the patient's condition improved, and wound discharge ceased. Continuous monitoring showed no signs of relapse, achieving complete remission.
Conclusion:
Brucella spp. should be considered as a potential cause of wound infections developing after surgery or trauma in brucellosis-endemic areas. This report also emphasizes the importance of promptly determining the cause of infection before initiating antibiotic treatment.
Insights
This case report details a rare instance of Brucella melitensis infection in a surgical wound. Prompt diagnosis and treatment led to complete remission, highlighting the importance of considering Brucella in endemic areas.
Area of Science:
- Infectious Diseases
- Microbiology
- Surgery
Background:
- Brucellosis is an anthropo-zoonotic disease caused by Brucella species, typically transmitted via animal contact or contaminated products.
- While commonly affecting musculoskeletal and reticuloendothelial systems, skin involvement in brucellosis is exceptionally rare.
- This report focuses on a unique case of Brucella melitensis infection in a chronic surgical wound.
Observation:
- A 34-year-old male presented with joint pain, sweating, and surgical site discharge 14 years post-lumbar disc herniation surgery.
- Wound cultures identified Gram-negative cocobacilli as Brucella melitensis.
- Diagnostic tests, including Rose-Bengal and Brucella Capture tests, confirmed the infection with a titer of 1/320.
Findings:
- The patient underwent a six-week treatment regimen of doxycycline and rifampin, combined with meticulous wound care including debridement and sterile dressing.
- Clinical improvement was observed, with cessation of wound discharge and achievement of complete remission.
- Continuous monitoring revealed no signs of relapse, indicating successful treatment.
Implications:
- Brucella species should be considered in the differential diagnosis of wound infections in patients from brucellosis-endemic regions, especially following surgery or trauma.
- This case underscores the necessity of accurate etiological diagnosis before commencing antibiotic therapy for persistent wound infections.
- Early and appropriate intervention is crucial for managing rare presentations of brucellosis and preventing long-term complications.
