Chronic brucellosis and obstacles in diagnosis
Theocharis LEPENOS, Haris LEPEN, Dimitrios AMORGIANOS, Dimitrios HOUTOS, Vasiliki PAPANDREADI, Maria KONSTANTINIDI, Ahmand KAMPAK and Evgenia ATHANASOPOULOU
Chronic brucellosis is a zoonosis where symptoms (fever, sweating, myalgia, arthralgia) can persist for months or yearsA 66-year-old woman employed as healthcare assistant in the local GP Practice, but also working part time in a family meat processing business, presented with severe bone pain, localized mostly in the sacroiliac area and lumbar spine, greatly restricting her mobility. She was previously seen by an orthopedic surgeon who prescribed treatment with NSAIDs, which however did not improve her symptoms. She was reviewed by the duty general practitioner, who in light of the occupational hazard from the meat processing business and the raised inflammatory markers recommended screening for chronic brucellosis, as well.The Brucella IGG & IGM antibodies were negative, however, her son, who was working in the local veterinarian laboratory took a blood sample from his mother, and run a Rose Bengal test which returned s strong positive result.The patient was hospitalized and received treatment for 3 months for chronic brucellosis. She improved significantly and regained her mobilityThe prozone phenomenon where too many antibodies overwhelm the bacteria, preventing them from effectively agglomerating, leading to a negative result is the most likely explanation for the false positive result of the test. To avoid this, it is recommended to dilute the serum to high dilutions (1/640) or to perform an indirect Coombs test or Brucellacapt test (specific for patients with chronic disease) or PCR.The family physician should be aware of this possibility when examining patients with an increased probability of Brucellosis.
