Abstract
The brucellosis and Q-fever coinfection is very rarely reported. To our knowledge, this is the first case report of concomitant brucellosis and Q-fever, most likely imported in Croatia. A 30-year-old male agricultural worker was hospitalized on 22 April 2017 after a ten days fever up to 40°C with chills, shivering, excessive sweating, general weakness, loss of appetite and headache. A month and a half prior to the hospitalization he lost 18 kg of body weight. Three weeks before hospitalization the patient returned from Kupres (Bosnia and Herzegovina) where he was working for the past year on a sheep farm and consumed unpasteurized dairy products of sheep origin. At admission, his condition was moderately severe due to pronounced dehydration. Routine laboratory tests showed slightly elevated erythrocyte sedimentation rate, anemia, thrombocytopenia and elevated liver transaminases. The chest X-ray showed an inhomogeneous infiltrate of the lower right lung. Three sets of blood culture were cultivated. After 48 hours incubation, bacterial growth was detected in aerobic bottles. Gram-stained smear revealed small, gram-negative coccobacilli. Specimens were subcultured on blood and chocolate agar plates. Using a Vitek GN identification card, the isolated organism was identified as Brucella melitensis. 16S rRNA gene sequencing of the isolate confirmed it as a Brucella sp. Rose-Bengal test was positive, while Wright agglutination test showed a significant increase in antibody titer from 80 to 640 in paired sera. Using indirect immunofluorescence assay (IFA), Coxiella burnetii phase II IgM/IgG titers were 50 and 1024, respectively indicating acute Q-fever. The patient was treated with doxycycline and rifampicin. So far, there has been no relapse or signs of chronic infection.
Highlights
Brucellosis is a zoonosis attributed to at least fourBrucella species in terrestrial mammals: B. melitensis, B. abortus, B. suis and B. canis
We report the first case of imported B. melitensis and C. burnetii co-infection most likely imported in Croatia
The only one study conducted in Afghanistan (Bamyan province) during the outbreak of brucellosis from May 2011 to the end of 2012 reported concurrent brucellosis and Q-fever infections [11]
Summary
Brucella species in terrestrial mammals: B. melitensis, B. abortus, B. suis and B. canis. In the last decade (2006-2016), a total of 39 cases of human brucellosis were notified in north-western and southern coastal counties (data from the Reference Center for Epidemiology Ministry of Health Republic of Croatia, Croatian Institute of Public Health; CIPH). In the last few years, sporadic cases were reported in the coastal Croatian counties with one small cluster (11 cases) in 2017 (data from the Reference Center for Epidemiology Ministry of Health Republic of Croatia, CIPH). We report the first case of imported B. melitensis and C. burnetii co-infection most likely imported in Croatia. The epidemiological history revealed that the patient returned from Kupres (southern Bosnia and Herzegovina) three weeks before hospitalization, where he was working for the past year on a sheep farm During that period he had direct contact with sheep and consumed unpasteurized dairy products of sheep origin.
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