RESUMO
We herein present the case of an adult male patient who consulted for lower extremity edema, a 2- month history of fever and oppressive chest pain radiating to the left arm. He referred neither contact with breeding animals nor consumption of unpasteurized dairy products. A diagnosis of endocarditis was confirmed by cardiac studies. Since the empirical treatment with cephalotin, ampicillin and gentamicin failed, the patient underwent aortic valve replacement. A total of four blood cultures were positive with a gram-negative rod. Bacterial identification was performed using the API 20 NE technique (bioMèrieux), the Phoenix automated method (BD) and conventional biochemical tests which were unable to classify the isolate as to genus and species. The strain was sent to the INEI-ANLIS "Dr. Carlos G. Malbrán" where it was identified as Brucella canis. The antimicrobial treatment was switched to doxycycline, rifampicin and trimethoprim-sulfamethoxazole with good evolution of the patient. The clinical significance of this case report lies in the possible failure of the empiric antibiotic therapy administered for endocarditis, since B. canis did not respond to the conventional antimicrobial treatment for this pathology.
Assuntos
Brucella canis/isolamento & purificação , Brucelose/microbiologia , Endocardite Bacteriana/microbiologia , Adulto , Valva Aórtica/microbiologia , Valva Aórtica/cirurgia , Argentina/epidemiologia , Bacteriemia/microbiologia , Técnicas de Tipagem Bacteriana , Brucella canis/efeitos dos fármacos , Brucelose/tratamento farmacológico , Brucelose/epidemiologia , Brucelose/cirurgia , Dor no Peito/etiologia , Terapia Combinada , Doxiciclina/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Edema/etiologia , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/cirurgia , Febre/etiologia , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Rifampina/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoRESUMO
We herein present the case of an adult male patient who consulted for lower extremity edema, a 2- month history of fever and oppressive chest pain radiating to the left arm. He referred neither contact with breeding animals nor consumption of unpasteurized dairy products. A diagnosis of endocarditis was confirmed by cardiac studies. Since the empirical treatment with cephalotin, ampicillin and gentamicin failed, the patient underwent aortic valve replacement. A total of four blood cultures were positive with a gram-negative rod. Bacterial identification was performed using the API 20 NE technique (bioMÞrieux), the Phoenix automated method (BD) and conventional biochemical tests which were unable to classify the isolate as to genus and species. The strain was sent to the INEI-ANLIS "Dr. Carlos G. Malbrán" where it was identified as Brucella canis. The antimicrobial treatment was switched to doxycycline, rifampicin and trimethoprim-sulfamethoxazole with good evolution of the patient. The clinical significance of this case report lies in the possible failure of the empiric antibiotic therapy administered for endocarditis, since B. canis did not respond to the conventional antimicrobial treatment for this pathology.
Assuntos
Brucella canis/isolamento & purificação , Brucelose/microbiologia , Endocardite Bacteriana/microbiologia , Adulto , Argentina/epidemiologia , Bacteriemia/microbiologia , Brucella canis/efeitos dos fármacos , Brucelose/cirurgia , Brucelose/epidemiologia , Brucelose/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Dor no Peito/etiologia , Doxiciclina/uso terapêutico , Edema/etiologia , Endocardite Bacteriana/cirurgia , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/tratamento farmacológico , Farmacorresistência Bacteriana Múltipla , Febre/etiologia , Humanos , Implante de Prótese de Valva Cardíaca , Masculino , Rifampina/uso terapêutico , Terapia Combinada , Técnicas de Tipagem Bacteriana , Valva Aórtica/cirurgia , Valva Aórtica/microbiologiaRESUMO
We herein present the case of an adult male patient who consulted for lower extremity edema, a 2- month history of fever and oppressive chest pain radiating to the left arm. He referred neither contact with breeding animals nor consumption of unpasteurized dairy products. A diagnosis of endocarditis was confirmed by cardiac studies. Since the empirical treatment with cephalotin, ampicillin and gentamicin failed, the patient underwent aortic valve replacement. A total of four blood cultures were positive with a gram-negative rod. Bacterial identification was performed using the API 20 NE technique (bioMÞrieux), the Phoenix automated method (BD) and conventional biochemical tests which were unable to classify the isolate as to genus and species. The strain was sent to the INEI-ANLIS "Dr. Carlos G. Malbrán" where it was identified as Brucella canis. The antimicrobial treatment was switched to doxycycline, rifampicin and trimethoprim-sulfamethoxazole with good evolution of the patient. The clinical significance of this case report lies in the possible failure of the empiric antibiotic therapy administered for endocarditis, since B. canis did not respond to the conventional antimicrobial treatment for this pathology.
Assuntos
Brucella canis/isolamento & purificação , Brucelose/microbiologia , Endocardite Bacteriana/microbiologia , Adulto , Valva Aórtica/microbiologia , Valva Aórtica/cirurgia , Argentina/epidemiologia , Bacteriemia/microbiologia , Técnicas de Tipagem Bacteriana , Brucella canis/efeitos dos fármacos , Brucelose/tratamento farmacológico , Brucelose/epidemiologia , Brucelose/cirurgia , Dor no Peito/etiologia , Terapia Combinada , Doxiciclina/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Edema/etiologia , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/cirurgia , Febre/etiologia , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Rifampina/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoRESUMO
Many episodes of canine brucellosis in dog kennels have been reported but recently an outbreak that involved pets and their owners has been described. The purpose of this study was to confirm that the outbreak had a common source and evaluate the evolution of 4 dogs involved in this outbreak after the measures implemented that included a survey of 41 animals from the same area. The variable number of tandem repeat (VNTR) analysis indicated that the B. canis isolated from the human clustered together with the isolates collected from the canine pups. Two dogs continued with bacteremia after the first antibiotic therapy and from one of them B. canis was also isolated from urine showing the importance of the later in the infection dissemination. In an effort to protect the public, stray dogs should be controlled and educational programs about the risk of this zoonotic disease should be implemented.