Brucelose- a propósito de um Caso Clínico

Abstract

Introduction Brucellosis is a zoonosis caused by a gram-negative coccobacillus bacterium of the genus Brucella, which can be transmitted by direct contact with animals or their secretions. Is an acute or subacute systemic disease that generally starts two to four weeks after inoculation. Its symptoms are nonspecific, but typically are presented with fever, night sweats, arthralgias or asthenia. Although being endemic in underdeveloped countries, is still an underdiagnosed and underreported disease. Case Report This is a 28 year old veterinarian assistant male, with close and frequent contact with cattle, sheep and goats. He is unaware of having ever been submitted to an aptitude test for work and, as personal protective equipment, uses gloves and a rubber apron only. He was observed in the hospital emergency department, due to recurrent testicular pain and constitutional symptoms. Serology test showed a borderline IgG for brucellosis. Therefore, the case was notified in the National System of Epidemiological Vigilance. The patient was treated with doxycycline and rifampicin, and the testicle was surgically removed. The surgical piece accused Brucella spp, which confirmed the diagnosis of brucellosis with orchiepididymitis. Discussion Considering that the symptoms of brucellosis are unspecific, a detailed clinical history, including occupational exposure/background, is fundamental for the diagnosis. The incidence of cases associated with occupational exposure is relevant, being veterinarians and large animal veterinary assistants among the professional groups with higher risk. Low adherence to personal protective equipment and lack of knowledge may be factors that perpetuate the infection. It is essential to facilitate access to Occupational Health services to ensure the health surveillance of these workers. Conclusion Brucellosis is one of the most neglected zoonosis worldwide, however, it’s one of the three most common in Portugal. This case report urges the healthcare professionals to acknowledge these less known work-related diseases, in particular zoonosis, that are often underdiagnosed. The professional risk assessment and the implementation of protective measures are fundamental in reducing occupational risk, being the assessment of working conditions by a qualified safety technician required. Thus, Occupational Health teams play a leading role in preventing professional illnesses, promoting health, implementing preventive measures and reducing morbidity and mortality. KEYWORDS: Occupational Health, Work Medicine, Work Security, Brucellosis, Veterinary.