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CASE REPORT
Year : 2002  |  Volume : 20  |  Issue : 4  |  Page : 221-222
 

Brucellosis in association with HIV infection- A case report


Department of Microbiology, Sir Ronald Ross Institute of Tropical and Communicable Diseases, Hyderabad - 500 044, Andhra Pradesh, India

Correspondence Address:
Department of Microbiology, Sir Ronald Ross Institute of Tropical and Communicable Diseases, Hyderabad - 500 044, Andhra Pradesh, India

 ~ Abstract 

An unusual presentation of brucellosis is being reported in a patient infected with the human immunodeficiency virus, who sought medical advice for fever of long duration accompanied with myalgia and headache.

How to cite this article:
Sarguna P, Bilolikar A K, Rao A, Mathur D R. Brucellosis in association with HIV infection- A case report. Indian J Med Microbiol 2002;20:221-2


How to cite this URL:
Sarguna P, Bilolikar A K, Rao A, Mathur D R. Brucellosis in association with HIV infection- A case report. Indian J Med Microbiol [serial online] 2002 [cited 2020 Oct 28];20:221-2. Available from: https://www.ijmm.org/text.asp?2002/20/4/221/6962


 Brucellosis More Details is an important zoonotic disease of worldwide distribution.[1] In India the disease has been found wherever it is looked for.[2]  Brucellosis More Details has been described rarely in patients infected with HIV.[3] The clinical manifestations of human  Brucellosis More Details are variable and only if a high index of suspicion is maintained, will the disease be identified. Clinical diagnosis is often impossible and the laboratory aid is therefore essential.[4] The present case is being reported for the rare occurrence of  Brucellosis More Details in patients infected with the human immunodeficiency virus (HIV).

 ~ Case report Top

A 21-year-old male, milk vendor who rears cattle, presented with complaints of fever with chills and rigors -on and off in nature over a period of 15 days, in addition to vomiting, body pains, headache. General physical examination did not reveal any abnormality, except for tenderness in the right hypochondrium. Liver was palpable per abdomen. Routine haematological examination revealed, mild leucopenia of 52% with a relative lymphocytosis of 45%, although the total cell count of 7600/mm3 was within normal limits. Urine examination was within normal limits. Peripheral smear for malarial parasite was negative. HIV antibodies by Tridot method was reactive for HIV 1 which was confirmed by ELISA. Routine blood culture (brain heart infusion broth, Himedia) did not show any bacterial growth even after 8 weeks of incubation and widal test titers were insignificant. Attempts to isolate any infecting organisms from blood were unsuccessful.
As the clinical symptoms continued to persist, the serological tests for  Brucellosis More Details were done. The serum was subjected to slide agglutination test with a drop of  Brucella More Details abortus plain antigen (IVPM, Ranipet). Presence of agglutination was assessed by naked eye examination. Positive agglutination was further subjected to the standard agglutination test (SAT) by tube dilution method.[5] The patient had high agglutinin titers of 640, which is considered as significant. The patient was treated with tetracycline 250mg, four times a day for six weeks along with streptomycin, 1gm / day for three weeks. The patient responded well to the above drug regime.

 ~ Discussion Top

 Brucellosis More Details is an occupational zoonotic disease that may vary from an acute febrile disease to a low-grade, ill defined disease. The diagnosis of chronic  Brucellosis More Details is frequently difficult to prove and  Brucellosis More Details has been described rarely in patients with HIV. Despite the fact that intracellular  Brucella More Detailse are largely dependent on cell-mediated immunity, these patients have relatively preserved immunity.[3]
Although the presentation of this case was not unusual, the association with HIV is a rare occurrence. The patient had a relatively preserved immunity as per the symptoms and clinical findings. He had a clear epidemiologic antecedent for acquisition of  Brucellosis More Details, as he was a milk vendor by profession coming in contact with infection from raw milk and the body fluids of infected cattle. The results of SAT for  Brucellosis More Details correlated with epidemiological, clinical data, and other laboratory information. Clinical symptoms included fever, arthromyalgia without any focal disease. He presented with high  Brucella More Details agglutinin titers, and responded to treatment with tetracycline and streptomycin. This is comparable with the study of Moreno et al,[3] who has stated that most cases of  Brucellosis More Details occur in asymptomatic patients with relatively preserved immunity. The epidemiology, clinical presentation, diagnosis, response to therapy and outcome are similar to those observed in non-HIV infected patients. Similar manifestations of  Brucellosis More Details in patients with HIV infection have been reported earlier.[6],[7],[8],[9]
The combination of potential exposure, consistent clinical features and raised levels of  Brucella More Details antibodies with or without positive blood culture confirms the diagnosis of  Brucellosis More Details

 ~ References Top

1.Abdussalam M, Fein DA. Brucellosis as a world problem. International symposium on brucellosis (II) Rabat 1975. Development in biological standardisation 1976;31:9-31.   Back to cited text no. 1    
2.Stephen S, Indrani R, Rao AKN. Brucellosis in coastal Karnataka. Indian J Microbiology 1978;18:28-31.  Back to cited text no. 2    
3.Moreno S, Ariza J, Espinosa FJ, Podzamczer D, Miro JM, Rivero A, Herrero F. Brucellosis in patients infected with the human immunodeficiency virus. Eur J Clin Microbiol Infect Dis 1998;17(5):319-326.  Back to cited text no. 3    
4.Hemashettar BM, Yenni VV, Gizare DV, Phonde PS. Isolation of Brucella melitensis from a benign cystic teratoma-ovary. Indian J Med Microbiol 1997;15(2):87-88.  Back to cited text no. 4    
5.Farrell ID. Brucella. Chapter 13. In: Mackie & McCartney. Practical Medical Microbiology, 14th ed. Collee JG, Duguid JP, Fraser AG, Marmion BP, Eds. (Churchill Livigstone, London) 1996;473-478.   Back to cited text no. 5    
6.Thornes RD. Acquired immune suppression in chronic brucellosis. Ir Med J 1983;6(5):225.  Back to cited text no. 6    
7.Pedro-Botet J, Coll J, Auguet T, Rubies-Prat J. Brucellosis with HIV infection:a casual association? AIDS 1992;6(9):1039-1040.  Back to cited text no. 7    
8.Martin I, Ramos C, Gutierrez A, Arazo P, Aguirre JM. HIV infection and chronic brucellosis. Enferm Infecc Microbiol Clin 1992;10(9):566-567.   Back to cited text no. 8    
9.Valladares M, Viciana P, Martin A, Del Nozel M. Acute brucellosis and HIV infection: a new particularity. Enferm Infecc Microbiol Clin 1993;11(9):511-512.  Back to cited text no. 9    
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