Question

A 47-year old male presents in the clinic with a complaint of recurrent low-grade fevers, weight loss (about 20% of his body weight over a 6 month period), muscle and joint pains, episodes of profuse sweating, weakness and extreme fatigue (in spite of sleeping well at night he feels tired during the day). He eats healthy, but lately, he has no appetite. He disregarded all these symptoms and thought he was just getting old, but then a week ago he noticed his testicles got swollen, right then he knew it was time to see a doctor.

The patient report to be married, he said he has always been faithful to his wife and know his wife is also faithful to him, they are church people, they have 5 kids, they do not drink or smoke. He is a cattle rancher and usually does the slaughtering himself. Cattle’s blood and other body fluids often splash in his face, arms and hands. He had rheumatic fever as a child. He had all the usual childhood immunizations. He reports feeling good prior to the past 5 months.

On physical examination, the patient has a temperature of 101F. He has swollen lymph nodes in the neck and under the arms, and swollen testicles and scrotum. Physical examination shows he has blood pressure of 136/86, and a normal heart rate without a heart murmur. There is no evidence of acute respiratory or gastrointestinal infection.

   1-What would be your diagnosis for this patient? How did you arrive to this conclusion?

2-   What type of microorganisms cause this disease? Give the genus name

3-    How should this case be treated? (10 points)

4-   What could have been done to prevent this condition?

Answer 1

Answer 1:
Brucellosis. Also called by names like undulant fever, Malta fever or Mediterranean fever. It is a zoonotic disease

Brucellosis is an infectious disease common among people who handle cattle and their secretions. The patient is a rancher who slaughters animals by himself and comes in close contact with their blood while doing so.
Also, his symptoms including orchitis and swollen lymph nodes with fever suggest the same when combined with social history.

Answer 2:
Brucellosis is caused by bacteria belonging to genus Brucella.
These are Gram negative intracellular coccobacilli, facultative anaerobes, non-capsulated and non-motile.

Answer 3:
The treatment regimen for Brucellosis is combination of two drugs:
Streptomycin / Gentamycin - given for up to 2 weeks along with Doxycycline which should continue for 8 weeks depending on prognosis. Early detection and treatment betters the prognosis. The patient needs to be guided to prevent it from happening again, keeping in mind his profession.

Answer 4:
Reducing contact with animals may not be possible for a cattle rancher but taking basic precautions help in the long way. Face mask to avoid inhaling these bacteria, hand gloves while handling animals and their secretions reduce the contact with animals and their secretions. Patient should take maximum care while slaughtering cattle and avoid getting blood and other body fluids splashing on his body. Patient should be guided to get all his cattle vaccinated for Brucellosis so as to protect them as well as himself. Educating him about zoonotic diseases will provide a long term support system for the patient.