Journal of Emerging and Rare Diseases

ISSN 2517-7397

Brucellosis related to exposure with camels

Humberto Guanche Garcell1*, Reynol Rubiera Jimenez2, Elias Guilarte Garcia3, Pedro Vazquez Pueyo4, Isis Rodriguez Martin4

1Specialist in Epidemiology, Auxiliary professor and researcher, Hospital Joaquín Albarrán, La Habana, Cuba

2Specialist in Intensive Medicine, Assistant Professor, Cmdt Manuel, Fajardo Hospital, La Habana, Cuba

3Specialist in Microbiology, Pedro Kouri Institute of Tropical Medicine, Cuba.

4Bachelor of Microbiology, Cuban Hospital, Qatar.

Corresponding author

Humberto Guanche Garcell
Specialist in Epidemiology
Auxiliary professor and researcher
Hospital Joaquín Albarrán
La habana, Cuba
Tel: +5355013515
Email: humbertoguanchegarcell@yahoo.es
guanche@infomed.sld.cu

  • Received Date: February 05, 2018
  • Accepted Date: March 16, 2018
  • Published Date: March 28, 2018

DOI:   10.31021/jer.20181108

Article Type:   Research Article

Manuscript ID:   JER-1-108

Publisher:   Boffin Access Limited.

Volume:   1.2

Journal Type:   Open Access

Copyright:   © 2018 Garcell HG, et al.
Creative Commons Attribution 4.0


Citation

Garcell HG, Jimenez RR, Garcia EG, Pueyo PV, Martin IR. Brucellosis related to exposure with camels. J Emerg Rare Dis. 2018 Mar;1(2):108.

Abstract

Objective: To describe clinical and epidemiological characteristics of patients confirmed with brucellosis in the Cuban Hospital (Qatar) during 2014 to June 2016.

Methods: Clinical and laboratory data were collected from the medical records of 41 confirmed cases of Brucellosis.

Results: Patients were from six nationalities, predominantly Qatari (56.1%). Fever of prolonged course (85.7%), muscle and joint pain were the most common symptoms. 61% of patients had high titers in serology for Brucella melitensis or abortus, while 12.2% and 14.6% had positive blood culture and serology. The predominance of high figures for liver enzymes (AST and ALT) and Protein C-reactive were observed.

Conclusion: The clinical and epidemiological characteristics would be a reference for clinicians and especially when provides care to patients from countries with active transmission of the disease

Keywords

Brucellosis; Human; Brucella spp.; Qatar.

Introduction

Brucellosis is a zoonosis transmitted to humans through contact with fluids of infected animals (sheep, cattle, goats, camels, or other animals) or foods products such as unpasteurized milk and cheese. It is one of the most widespread zoonoses in the world [1]. Brucellosis has a high morbidity, both for humans and animals; and it is a major cause of economic losses and public health problems in many developing countries [2]. The prevalence of brucellosis has been increasing due to the international migration and the dynamic of human populations; however, the incidence in the eastern area of Saudi Arabia decreased according to the report from 1983 to 2007 [3].

Qatar is a non-endemic area for Brucellosis with a low incidence compared to the neighboring countries [4]. A decreasing trend in incidence was reported between 2004- 2012, with the highest figures in 2006 (4.2 cases per 100,000 inhabitants) [5].

The Cuban Hospital in Qatar serves an area of population in the western part of the country, where the largest populations of camels and rams are found. We aim to describe clinical and epidemiological characteristics of patients with Brucellosis attended in a community hospital in Qatar.

Methods

A descriptive study of case series of brucellosis reported in the Cuban Hospital in Qatar during the years 2014 to June 2016.

The cases were confirmed using the clinical and laboratory criteria, which included:

  • Clinical criteria: fever of acute onset or prolonged course associated with night sweats, arthralgia, headache, fatigue, anorexia, myalgia, weight loss, arthritis or spondylitis, and may include focalization symptoms (e.g. meningeal, hepatic, others).
  • Laboratory criteria: culture and identification of Brucella species in clinical samples, the titre of antibodies greater than or equal to 160 in standard agglutination test in tubes for Brucella species. In addition, the presence of IgM antibodies was determined by ELISA. All the diagnostic tests were performed in accredited corporate laboratories [6,7].
  • The following information was collected from the patient’s medical records: demographic data, clinical picture, liver enzymes results, C-reactive protein, cultures of clinical samples and serological test. The laboratory tests were performed using the following methods: Alanine Aminotransferase (ALT/TGP) and Aspartate Aminotransferase (AST/TGO) by kinetic methods (Abbot architect) with reference values (VR) according to age and sex, C-reactive protein by immunoturbidimetric assay (Abbot architect) (vr. <5 mg/L), quantitative tube agglutination test for Brucella spp. antibodies (vr. ≥ 1:80) and detection of IgM and IgG antibodies for brucella spp. by ELISA.

    The data were analyzed using the statistical technique of frequency distribution analysis.

    Results

    We report 41 patients confirmed with Brucella spp. from six nationalities of which 56.1% were Qatari nationals [Figure 1]. The patients were of male sex (90.2%) and average age 32.8 years (minimum 5 years, maximum 72 years). The 25% of the patients were under 15 years old. Most of the patients had earlier contact with camels, especially the ingestion of raw milk, and less frequent contact with rams.

    Figure 1

    Figure 1: Proportion of patients according nationality

    A prolonged course of fever (85.7%), muscle and joint pains were the most frequent clinical symptoms observed, with lower frequencies for others symptoms presented in figure 2. The 61% of patients were confirmed by positive blood culture and positive Brucella serology. In 12.2% and 14.6% had positive blood culture and serology respectively were used to confirm the diagnosis. In 37 patients, the existence of co-infection of Brucella melitensis and Brucella abortus was demonstrated by serology [Table 1]. In a patient with liver cirrhosis of unknown etiology, Brucella spp. in peritoneal fluid, in addition to blood culture was the confirmatory test.

    Figure 2

    Figure 2:Terminal villi rush out disorderly with characteristics of immaturity


    Patient

    sex

    Age
    (years)

    Blood
    culture

    serology
    Antibody titer

    Brucella
    IgM
    B. abortus
    B. miletensis
    1
    M
    60
    positive
    640
    2
    M
    18
    positive
    positive
    640
    1280
    positive
    3
    F
    72
    positive
    positive
    1280
    640
    4
    M
    49
    positive
    positive
    640
    5
    M
    39
    positive
    6
    M
    45
    positive
    1280
    640
    positive
    7
    M
    15
    positive
    positive
    1280
    1280
    8
    M
    37
    positive
    positive
    640
    640
    positive
    9
    M
    10
    positive
    positive
    1280
    1280
    positive
    10
    M
    positive
    positive
    1280
    1280
    11
    M
    8
    positive
    positive
    1280
    1280
    positive
    12
    M
    23
    positive
    13
    M
    6
    positive
    positive
    640
    1280
    14
    M
    26
    positive
    positive
    640
    320
    positive
    15
    M
    7
    positive
    positive
    640
    640
    positive
    16
    F
    14
    positive
    640
    1280
    positive
    17
    M
    9
    positive
    positive
    320
    640
    18
    M
    10
    positive
    1280
    1280
    19
    M
    5
    positive
    20
    M
    6
    positive
    21
    M
    29
    positive
    640
    640
    22
    M
    30
    positive
    positive
    1280
    1280
    positive
    23
    M
    22
    positive
    positive
    2560
    2560
    positive
    24
    M
    42
    positive
    positive
    640
    640
    positive
    25
    M
    51
    positive
    1280
    320
    positive
    26
    M
    53
    positive
    160
    160
    positive
    27
    M
    49
    positive
    positive
    640
    640
    positive
    28
    M
    66
    positive
    positive
    1280
    320
    positive
    29
    M
    30
    positive
    positive
    320
    320
    positive
    30
    M
    52
    positive
    positive
    1280
    1280
    positive
    31
    M
    39
    positive
    640
    320
    positive
    32
    M
    34
    positive
    positive
    2560
    2560
    positive
    33
    M
    33
    positive
    positive
    1280
    1280
    positive
    34
    F
    52
    positive
    1280
    1280
    positive
    35
    M
    34
    positive
    640
    640
    positive
    36
    M
    35
    positive
    positive
    1280
    1280
    positive
    37
    M
    27
    positive
    positive
    5120
    5120
    positive
    38
    M
    40
    positive
    39
    F
    62
    positive
    640
    640
    positive
    40
    M
    31
    positive
    positive
    1280
    1280
    positive
    41
    M
    42
    positive
    positive
    1280
    1280
    positive

    Table 1: Description of demographics and laboratory test results in cases confirmed with brucelosis.

    The median of AST was 57 U/L with 75% of the patients had high figures, while for the ALT the median was 46 U/L, more than 50% the patients had high figures. For C-reactive protein, the median was 35 mg/L, with high figures in more than 75% of patients [Figure 3].

    Figure 3

    Figure 3:Box plot for selected laboratory test.

    Discussion

    Brucellosis is the most frequent zoonoses in Qatar and is endemic in countries of the Mediterranean region and the Middle East. The main source of infection in these countries are rams and camels, with B. melitensis and B. abortus being the most reported in different published studies [8,9]. Also, the main source of exposure is through the ingestion of raw camel milk, which was described in an outbreak of the disease in the country, where cultural issues promote the consumption of raw camel milk instead its consumption after boiling [10]. The slaughter of animals for human consumption or the performance of deliveries are additional sources of infections. It explains some of the cases in this study described since the patients (mainly non-Qatari nationals) are dedicated to animal care in areas located in western Qatar.

    The main clinical symptoms were fever, myalgia, and arthralgia; however, it is worth remembering that the disease has a clinical expression that includes uncomplicated and complicated forms [6]. In the case series, only one complicated case was detected when Brucella spp. was found in peritoneal fluid in a patient with liver cirrhosis. Previous reports had described cases of primary peritonitis due to Brucella spp. in patients with previous liver cirrhosis [11].

    The high figures of liver enzymes and C-reactive protein are very frequent laboratory findings in patients with Brucellosis, even though it depends on the clinical stage of the disease. The level of liver enzymes depends on the degree of severity of the disease, which can range from few clinical symptoms and mild liver involvement to definitive acute hepatitis [6]. The description of this series of cases of Brucellosis diagnosed in Qatar is a valuable reference for clinicians in general, and especially for those who care patients from endemic countries or with active transmission of the disease.

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