Brucellosis in pyrexia of unknown origin: Reminiscing the forgotten entity

Abstract

PurposeBrucellosis is one of the substantial yet forgotten entity of pyrexia of unknown origin, transmitted via contact with animals or animal products. Despite being an important etiological agent of PUO, it is under-reported owing to its non-specific and protean clinical presentations. Thereby, the present study intended to describe clinical profile and outcome of patients of brucellosis from a tertiary care center in North India. MethodsThis was a retrospective study and included all the patients that were reported positive for Brucella in automated blood culture system (BACTEC) and identified using MALDI-TOF MS over a period of 6 years (2014–2020). ResultsA total of nine cases were reported positive for Brucella during the study period. Fever was noted to be the most common symptom present in all the patients (PUO), followed by fatigue. The patients were managed with monotherapy using doxycycline or combination of cotrimoxazole, rifampicin and doxycycline. All the patients responded well to treatment. ConclusionThe present study highlights the significance of automated blood culture system in conjunction with MALDI-TOF MS for early and reliable identification of Brucella. In the present study, all cultures were reported positive within five days of incubation in automated blood culture system, underlining the significance of using the same which lessens the turnaround time and increases the sensitivity. Owing to the protean manifestations and low sensitivity of the available tests, the clinician needs to have a high level of suspicion to precisely diagnose the illness to prevent undue delay in management.