Mrs. Dr. XYZ. B.V.Sc & A.H, 26 years female, working as a veterinary doctor in Andhra Pradesh State Government in a rural area, complained of low grade fever, vague aches and pains all over the body, particularly at sacroiliac region, general malaise for the past six months. She underwent treatment for Malaria, Typhoid, and Arthritis with appropriate medicines, besides pain relievers and supportive therapy with vitamins. She was a thin built dark lady. On clinical examination she was looking sick, restless and depressed. Pulse rate and body temperature were elevated. Heart and lungs were clear. Liver and spleen were not palpable. Superficial lymph glands were not palpable. Blood pressure was within normal limits. Monteux test was negative. Complete blood picture and complete urine examination did not reveal anything significant. Chest x-ray was normal. Erythrocyte sedimentation rate was 20mm/hour. Blood culture was sought. Advised to take Diclofanac sodium 50 mg twice daily and advised rest for 5 days. Brucella serology was done. Rose Bengal test was positive ++++.Standard agglutination test titer was 1:1280. 2mE agglutination titer 1:320. Blood culture for Brucella negative in 3weeks. She was put on Doxycycline 100 mg twice daily for 6 weeks and Streptomycin 0.75gms I/M once a day for 4 weeks. Three months later Brucella titers were repeated and were found to be considerably declined to 1:80 and 1:40. Patient feeling better and is not looking sick. Urine on examination was found to be positive for Beta HCG indicating pregnancy. It was a precious pregnancy. To retain or terminate pregnancy in view of the risk involved to the fetus due to Brucella infection and tetracycline. Ultra sonagraphy for antenatal check up was normal. Brucella titers declined to undetectable levels. She gave birth to a healthy female child by Cesarean section. Child developed jaundice? Serum Bilurubin was high. Cord blood by Rose Bengal Brucella test was positive. Is the child infected with Brucella? On further testing by standard agglutination test Brucellosis was negative, indicating false positivity of Rose Bengal Brucella test done with cord blood. Serum Bilurubin levels declined with photo therapy suggesting of physiological jaundice. Mother and child remained healthy. Mile stones of the child are normal now 10 years old and got a brother also. Brucellosis is an occupational disease acquired from animals. This disease in humans is regarded as a most deceptive disease. Veterinarians and their staff besides family members should avoid exposure to situations where Brucella are likely to be the cause of ROP, gynecological infections etc. High risk persons should get themselves tested periodically to get treated if infected and symptomatic. Early diagnosis results in prompt treatment and recovery, as in this case. (Study supported by Dr.R. Liza, M.D; Dr.V.Lakshmi, M.D; and Dr.N. Mrunalini. M.V.Sc) [Dr. Ramchandra Rao is a President of Veterinary Public Health Association with extensive 30+ years of experience in the field of Zoonosis (Animal borne Human diseases) and its treatment and management. He can be directly contacted at zoonosesonline@hotmail]
Posted on: Fri, 09 Aug 2013 23:44:20 +0000
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