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Abstract
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In Switzerland Brucellosis is a rare zoonotic infection that may present with atypical symptoms, delaying diagnosis and treatment. Cases are generally associated the consumption of unpasteurized dairy products in endemic regions. A detailed patient history including a travel history is a crucial part in clinical routine.
Case
A 65-years-old patient originating from Turkey presented with pain in the left knee and lower limb for the past 4 months. The patient had a history of a car accident 20 years ago with a fracture of the proximal tibia requiring internal fixation and the implant still in situ. The clinical examination only showed a slight pain over the scar on the proximal lateral tibia In the laboratory analysis CRP (32 mg/l) was slightly increased. A haematogenous low-grade implant-related infection was suspected. In a Single-Photon Emission Computed Tomography (SPECT/CT) a focal accumulation was detected at the tibial implant. Blood cultures drawn initially to detect a endocarditis lenta showed the growth of Brucella melitensis. The second pair taken four days apart proofed the consistent of continuous bacteraemia. Antibiotic therapy was started. A transoesophageal echocardiography was unremarcable. The implant was removed after two weeks of antibiotic treatment. In the sonication of the implant specific polymerase chain reaction (PCR) -analysis for Brucella melitensis was positive. In a detailed anamnesis, the patient reported consumption of unpasteurized milk during her last travel to Turkey, 1 months prior to the symptoms onset and 5 months prior to diagnosis.
Conclusion/Discussion
The presented case is representative for the classical features of brucellosis associated with a rare but relevant complication. Brucellosis is a zoonosis endemic in many parts of the world including the Mediterranean Basin. The most common mode of transmission is the consumption of unpasteurized dairy products. The incubation time ranges from 5 to 60 days. Most (90%) infections are asymptomatic. Symptoms include undulating fever, malaise, headache and fatigue. The infection may spread to the liver, spleen or bone. Cardiac involvement is rare. In the presented case with persistent bacteraemia, it remains speculative, if the initial asymptomatic infection lead to a localised symptomatic presentation and secondary endocarditis or vice versa. Brucellosis is considered a biological hazard and precaution measurements should be put in place.
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