Aug 2026· The Egyptian Journal of Internal Medicine· Vol 38· 0 citations· 18 references
TL;DR
This case underlines the importance of considering brucellosis in febrile patients with livestock exposure, even in non-endemic settings, and presents a rare and severe respiratory form of brucellosis in a patient with occupational exposure to livestock.
Abstract
Brucellosis is a zoonotic infection with diverse clinical manifestations. Pulmonary involvement is rare—occurring in less than 1% of cases—and typically limited to endemic regions. In Slovakia, where brucellosis is non-endemic, human cases are exceptional. We present a rare and severe respiratory form of brucellosis in a patient with occupational exposure to livestock. We describe a 40-year-old female dairy farm worker admitted with fever, chills, and dyspnea. Initial workup revealed mild laboratory abnormalities and chest infiltrates. Despite empirical antibiotics, her condition rapidly progressed to acute respiratory distress syndrome (ARDS), acute kidney injury, and septic shock. Mechanical ventilation and vasopressor support were required. Serological testing confirmed Brucella abortus infection. Antibiotic therapy was escalated to tigecycline and meropenem, with subsequent clinical improvement. Follow-up imaging showed significant regression of pulmonary infiltrates. The patient completed a six-week course of doxycycline and fully recovered. This case underlines the importance of considering brucellosis in febrile patients with livestock exposure, even in non-endemic settings. Severe pulmonary forms are rare but life-threatening. Early recognition, targeted antibiotic therapy, and multidisciplinary care are critical for favorable outcomes. Pulmonary brucellosis is rare (< 1% of cases) but can be life-threatening, even in non-endemic regions. Occupational exposure to livestock is the primary risk factor in non-endemic settings such as Slovakia. Tigecycline is a viable alternative in complicated brucellosis with renal failure due to its non-renal elimination. Multidisciplinary care and dynamic serological monitoring were crucial for successful patient management.
Background: Brucellosis is a zoonotic infection that remains endemic in many regions and represents a significant public health problem. Clinical manifestations in children are often nonspecific, and musculoskeletal involvement is among the most frequent focal complications. Combination therapy with rifampicin and doxycycline, or rifampicin and trimethoprim–sulfamethoxazole in pediatric patients, is recommended as first-line treatment. However, drug hypersensitivity may complicate management and limit therapeutic options.Case Presentation: We report the case of a previously healthy 10-year-old boy who presented with fever and left knee pain following close contact with sheep. Brucellosis was confirmed by positive standard agglutination and Coombs tests. He was initially treated with doxycycline and rifampicin. After two weeks, the patient developed fever, vomiting, pruritus, conjunctivitis, eosinophilia, and elevated transaminases. Symptoms resolved upon discontinuation of rifampicin and recurred after re-initiation of anti-brucellosis therapy, strongly suggesting rifampicin hypersensitivity. Pediatric allergy consultation confirmed the suspicion, and rifampicin was permanently withdrawn. The patient was successfully treated with doxycycline and gentamicin (14 days of gentamicin, doxycycline for 6 weeks), leading to full clinical and laboratory recovery.Conclusion: Rifampicin and doxycycline are essential first-line agents in the treatment of pediatric brucellosis in children older than 8 years, but hypersensitivity reactions, though rare, may mimic disease relapse or complications. To our knowledge, this is the first reported pediatric case of rifampicin hypersensitivity in brucellosis. Awareness of this possibility is crucial for timely recognition and appropriate management. Alternative regimens, such as doxycycline combined with aminoglycosides, can provide effective treatment in children unable to tolerate rifampicin.
Sema Yıldırım Arslan, Nergis Kendirci· Balıkesir medical journal· 0 citations
ABSTRACT
Pulmonary nocardiosis is an uncommon but potentially serious infection caused by aerobic actinomycetes of the genus Nocardia. It predominantly affects individuals with impaired immunity or underlying structural lung disease, but can also occur in apparently immunocompetent hosts. The clinical and radiological features often overlap with tuberculosis and fungal infections, particularly in endemic regions, leading to frequent misdiagnosis and delay in appropriate therapy. We present a series of three patients with microbiologically confirmed pulmonary nocardiosis, each representing different clinical backgrounds. The first case involved a middle-aged male with poorly controlled diabetes mellitus presenting with chronic cough and bilateral pulmonary infiltrates. Imaging revealed patchy peribronchial opacities, and bronchoalveolar lavage (BAL) demonstrated filamentous, weakly acid-fast organisms on modified acid-fast staining. The second case was an elderly female with underlying bronchiectasis who presented with increased cough and expectoration; imaging showed bronchiectatic changes with superimposed infiltrates, and BAL confirmed Nocardia infection. The third case involved an elderly male with recent immunosuppressive therapy who presented with acute respiratory symptoms and radiological evidence of multifocal consolidation; microbiological evaluation confirmed nocardiosis. All patients were treated with appropriate antimicrobial therapy, including trimethoprim-sulfamethoxazole as the backbone, with additional agents such as imipenem or linezolid in selected cases. Clinical improvement was observed in patients who adhered to therapy, with symptomatic relief and partial radiological resolution on follow-up. This case series underscores the varied clinical presentation and imaging spectrum of pulmonary nocardiosis. Diabetes mellitus, structural lung disease, and immunosuppressive therapy emerged as key predisposing factors. The condition often mimics tuberculosis or bacterial pneumonia, making microbiological confirmation using modified acid-fast staining crucial. Early diagnosis and prompt initiation of appropriate therapy significantly influence patient outcomes. Pulmonary nocardiosis should be considered in patients with nonresolving pulmonary infiltrates, especially in the presence of risk factors such as diabetes, bronchiectasis, or immunosuppression. A high index of suspicion, combined with timely microbiological diagnosis and appropriate antimicrobial therapy, is essential to improve prognosis and reduce morbidity.
N. Raja, V. Jereen, A. Arthi et al.· Annals of African medicine· 0 citations
Q fever, caused by
Coxiella burnetii
, rarely presents as severe disseminated disease, and timely diagnosis can be difficult because clinical manifestations are nonspecific and routine microbiological tests are often unrevealing. We report a 68-year-old man with rheumatoid arthritis receiving long-term immunosuppressive therapy who presented with persistent unexplained fever, pancytopenia, hepatic dysfunction, polyserosal effusions, and sepsis with multisystem involvement, without a clear epidemiological exposure history. Blood cultures and routine respiratory pathogen testing were negative. Peripheral-blood metagenomic next-generation sequencing (mNGS) detected
C. burnetii
nucleic acid sequences, and subsequent antibody testing and targeted qPCR supported the diagnosis of acute Q fever with disseminated manifestations. Doxycycline-based targeted therapy was followed by defervescence and marked clinical and laboratory improvement. This case suggests that, in selected immunocompromised patients with severe infection and persistently negative conventional investigations, mNGS may serve as an adjunctive tool to facilitate timely pathogen identification and guide targeted antimicrobial therapy.
Yaozong Xia, Lin Fu, Xiuen Cao et al.· Frontiers in Medicine· 0 citations
This case underscores that NTM infection should be considered in the differential diagnosis of unexplained chronic gastrointestinal symptoms and highlights the pivotal role of modern molecular techniques in reaching a precise diagnosis.
Lan Wu, Jiayao Wang, Jin Zhu et al.· BMC Infectious Diseases· 0 citations
Leptospirosis is a bacterial zoonotic disease caused by spirochetes of the genus Leptospira and belongs to the group of Neglected Tropical Diseases that often go undiagnosed, particularly in areas with a history of flooding. This case report presents a 20-year-old man who presented with a five-day history of weakness prior to hospital admission, accompanied by persistent fever, nausea, vomiting with every meal, and dizziness, with a history of repeated flood exposure in his residential environment. Physical examination revealed a generally ill appearance, bilateral icteric sclera, anemic conjunctiva, and jaundice of the skin. Laboratory findings showed progressive leukocytosis, thrombocytopenia, mild anemia, hyponatremia, hypokalemia, and elevated urea and creatinine levels that improved during treatment, as well as hyperbilirubinemia with a cholestatic pattern and mild elevations in SGOT/SGPT. Serological testing for Leptospira yielded positive results, while HBsAg, Anti-HCV, and HIV tests were negative. Chest radiography demonstrated findings consistent with bronchopneumonia, while abdominal ultrasonography showed increased cortical echogenicity of both kidneys suggestive of a chronic process, accompanied by cystitis and bilateral pleural effusion. The patient was diagnosed with severe leptospirosis (Weil's disease) complicated by acute kidney injury and bronchopneumonia, and received intravenous ceftriaxone antibiotic therapy, hemodialysis, and supportive management, with subsequent clinical and laboratory improvement. This case underscores the importance of maintaining early clinical suspicion for leptospirosis in patients with a history of flood exposure, given that delayed diagnosis and management are closely associated with a worsening prognosis.
Melioidosis, caused by the gram-negative bacillus Burkholderia pseudomallei - a Tier 1 Select Biological agent - remains a significant cause of severe community-acquired infection in tropical regions, but with recent expanding recognition in temperate climates, including the United States. Pulmonary involvement is the most frequent clinical manifestation, ranging from subclinical nodules to fulminant necrotizing pneumonia and acute respiratory distress syndrome. Despite its clinical severity, melioidosis remains underdiagnosed due to its radiologic mimicry of tuberculosis, broad clinical manifestations, and limited laboratory capacity in many endemic areas. Special Operations Forces (SOF) participating in field exercises or operations in B. pseudomallei endemic countries are at significantly increased risk of infection. Accordingly, SOF medical providers should maintain a high index of suspicion for melioidosis and be familiar with its clinical recognition, diagnosis, and management.
Chase Goldberg, Akira A. Shishido· Journal of special operation...· 0 citations
