Failure of Doxycycline Postexposure Prophylaxis in Human Brucellosis Contracted Through Needlestick Injury

Abstract

Abstract Although brucellosis has a relatively high global prevalence rate, the highest number of reports is often presented in developing countries. Occupational risk factors for brucellosis are well recognized, with individuals working directly or indirectly with animals or in laboratories classified as high risk. This article presents the case of a high-risk male patient who incurred a needlestick injury as part of his work as a veterinary assistant. The patient was treated with a 21-day course of doxycycline upon first presentation but nonetheless developed brucellosis infection. It is proposed that a dual prophylaxis of doxycycline and rifampin prescribed on the day of exposure would have been a more effective intervention compared with monotherapy of doxycycline and that symptom monitoring and serological follow-up should have been carried out to reduce the risk of complications. This article recommends improvements in the enforcement of prevention procedures within high-risk occupational settings to reduce the risk of brucellosis infection, and adds a value to the importance of the prophylaxis for the countries that do not follow postexposure prophylaxis.