MUCOSAL BRUCELLA INFECTION IN HUMAN: A CASE REPORT DURING COVID-19 PANDEMIC

Eltaher Elshagman; Abdulfattah Elturki; Yuossef Swaisi; Ebrahim El Mahjoubi; Mohamed Baayou; Mohamed Elfagieh; Khaled S. Ben Salah

doi:10.36602/mmsj/2021.n07.05

Authors

Eltaher Elshagman Department of Microbiology, National Cancer Institute (NCI), Misurata, Libya
Abdulfattah Elturki Department of Medicine, National Cancer Institute (NCI), Misurata, Libya.
Yuossef Swaisi Department of Medicine, Faculty of Medicine, Misurata University, Libya
Ebrahim El Mahjoubi Department of Pathology, National Cancer Institute (NCI), Misurata, Libya
Mohamed Baayou Department of Medicine, Faculty of Medicine, Misurata University, Libya
Mohamed Elfagieh
Khaled S. Ben Salah

DOI:

https://doi.org/10.36602/mmsj/2021.n07.05

Keywords:

Brucellosis, Brucella, Human, Oral, Mucosa, Infection, Rose-Bengal test

Abstract

Brucellosis in human is an uncommon disease in Libya and usually diagnosed by serological assays. The clinical
symptoms of this disease in many times are none specific and vague. This report describes a case of clinical human
brucellosis in Libya. The patient was a sixteen years old girl, lives in a rural area. She was suffering from intermittent
fever for several days associated with chills, mild cough, and headache. The patient had history of occasional drink of
goat’s raw milk during the previous two months. She had no history of travel abroad and direct animal contacts.
Comprehensive physical examination revealed the patient was generally unwell, pallor and, had tenderness and mild
hepatosplenomegaly. Laboratory investigations revealed that the patient had pancytopenia (low number of blood cells
count) and a marked increase in C-reactive protein (CRP), Procalcitonin (PCT), Lactate dehydrogenase (LDH), Aspartate transaminase (AST). Viral screen tests were non-reactive for HCV, HBs Ag, HIV and covid-19. Provisional
diagnosis on admission time was acute leukemia or aplastic anemia with common microbial infection. Empirical
antibiotic (Meropenem 1 gm) was prescribed intravenously every eight hours for seven days. The patient was also
given antipyretic, IV fluid hydration, and one unit of packed red blood cells. Following that, bacterial growth in aerobic blood culture was noticed and it was Gram-negative coccobacilli, non-motile. The bacterium was positive for
catalase, oxidase and urease tests. It could not clearly be identified by phoenix bacterial identification system. It was
provisionally diagnosed Haemophilus spp., but as it was able to growth on blood agar plate, it was finally diagnosed
as Brucella spp. and that was confirmed by collection of patient serum and performing Rose-Bengal pate test (RBPT)
as was significantly increased (1:640). The patient general condition was improved and blood count recovered over
one week. The patient was then discharged and asked for routine follow ups during the next six months.