Running head: BRUCELLOSIS 1

Brucellosis

Name

Institution
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Brucellosis

Case

A father who reported that he had noted that the child seemed to be sick for a series of

five days brought a five years old American girl to the workplace, and the symptoms included

loss of appetite and abdominal pains, fever resulting up to 37 degrees and pain on the leg.

However, the child walked normally despite reporting the pain on the leg.

History of illness

The child had arrived recently from visiting her aunt who lived on the suburban side of

Texas near the American border with Mexico. It was reported that the child was always allowed

to play with the animals in her aunt's farm but was never allowed to come near or be present

during birth or slaughter of any animal. The symptoms of child's illness became evident two days

after she arrived at their home. Her parents denied consumption of unpasteurized milk or other

dairy products and denied having eaten undercooked meat by the child recently or by their

family as well.

The girl had not skipped any childhood immunization including influenza, and she had

not been using any vaccine up to the time of the illness. No relevant medical history of the child

existed except for some common colds and allergies. The patient resided at their home with her

parents, another child, and two dogs. There was no presence of illicit drugs, cigarette smoke,

alcohol, and guns as the father reported, since the family was Christian based.

Review of systems
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Fevers, myalgia, and chills were identified by the review of systems after it was

performed to the child. The parent reported that the girl had a running nose as well as a cough,

but he said that he had not observed any difficulty in breathing of the child. The child also

indicated that she had a stomachache, and she indicated that she had no appetite for any food and

that she had not defecated for the last three days. However, the parent denied vomiting by the

child. Urination by the girl was normal, though. Evidence of coloration in the urine did not show.

There were no rushes or any significant change on the patient's skin as the parent indicated. The

father told that although the child spoke of pain in the leg he believed that the girl was trying to

describe body aches.

Physical examination

The patient was 60 percentile for both weight and height. Relevant positive results during

this examination included hypertrophied tonsils excluding exudate, clear rhinorrhea,

temperatures of 36.8 degrees and a dry cough that did not produce sputum. Negative results of

the test were absence auscultation on the lungs and absence of palpable lymph nodes.

Overview of Brucellosis

Brucellosis is an infection that is transmittable from animals to humans (zoonosis) and is

commonly caused by bacteria. The risk factors of contracting these infections are very high in

rural areas than in urban centers. People can contract the disease through contact with blood,

amnion, milk, and other several products from infected animals. The other possible causes of

brucellosis infection also include consumption of unpasteurized products from animals such as

milk and eating of undercooked meat. (Kvinge, 1958)

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Several known animals carry species of Brucella, and they include cattle, goats, dogs and

sheep. Dogs carry species B. canis while goats carry B. melitensis, cattle carry B. abortus and

sheep carries B. ovis and B. melitensis together. There only two species that have been proved to

be infectious to humans being and these are B. melitensis and B. abortus. A confirmed

brucellosis diagnosis is only achievable through interpreting laboratory results along with

clinical symptoms, the occupation of the patient and history of any past infections of the patient.

("Brucellosis: Symptoms and Treatment," 2005)

Differential Diagnosis

Basing on physical examination and the history the most likely differential diagnosis

were strep throat, Kawasaki disease, seasonal influenza, brucellosis, tularemia, mononucleosis,

and viral upper respiratory infections. Tularemia, HIV, and Q fever were ruled out by looking at

the risk factors and blood test findings. Kawasaki disease was removed from the list since there

was an absence of rashes and swollen lymph nodes. Salmonella was also excluded because the

child had no symptoms or signs of chills, vomiting, headache, bloody feces or severe diarrhea.

Based on the subsequent negativity of the throat culture and the subsequent physical examination

the doctor ruled out Strep throat disease.

Description and prevalence

The infection has a wide clinical classification that has ranges from symptomatic disease

to acute or fatal infection. The symptoms of this infection usually occur within two to three

weeks of exposure to the causative agent but in several case symptoms can take up to three

months before they become visible. Severe brucellosis symptoms are very similar to those of flu,

and they include arthralgia, physical weakness and headache among others. The most evident
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symptoms of brucellosis are chills, fever and arthralgia. In some special instances, patients also

experience coughs, abdominal pains and dyspepsia. Brucella infection in children is less harmful

than in adults. ("Brucellosis: Symptoms and Treatment," 2005)

Ingestion of brucellae is highly facilitated by polymorph nuclear cells and macrophages.

It later passes to lymph nodes and in there they replicate within the cells and the bacteria from

the multiplied cells infect other cells in the human body. The bacterium has many survival

techniques that suppress the host’s immune system with destroying it. These bacteria can

withstand bactericidal substances meant to destroy them and elude macrophages actions. If not

treated appropriately brucellosis designs a very strong defense mechanism and becomes immune

of every drug administered.

Treatment prevention and management

The physician advised the parent to either use ibuprofen or acetaminophen to reduce the

patient's pain and fever too. The physician instructed the father to give the child more fluids in

order to prevent the child from dehydrating and to seek medical services if the fever did not

elapse in two to three days. If any worsening or new symptoms such as trouble breathing,

swollen lymph nodes, or confusion became evident, the nurse advised the father to return to the

clinic.

Three days afterwards, the child and the father returned to the hospital and stated that the

fever was persistence, and the body was aching too. The parent indicated that the child's

condition had worsened than before, and he seemed very concerned about that. At that particular

time the child registered a temperature of 39.4 degrees, pulse rate of 129 beats per minute, and

the blood pressure was very high (100/60 mm Hg). The results of the physical examination
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remained unchanged from the previous visit to the clinic. The nurse practitioner diagnosed the

girl with viral upper respiratory ailment.

The doctor prescribed antibiotics to treat the fever and the cough that had become

persistent since the girl did not show any signs of improving. Clavulanate/amoxicillin 600/42.5

mg suspension was to be administered at a dose of forty-five milligrams per day divided two

times a day for ten days. The child was also given ceftriaxone in the clinic. To rule out

pneumonia a chest radiograph was done. The girl and the mother returned for follow up the next

week and reported that the fever was gone, the girl's appetite had improved tremendously, and

she was then feeling better.

Outcome

The viral respiratory disease is self-reliant since the patients had recovered when they

visited the hospital again for checkup. Several tests performed on the child blood samples

revealed that she had a brucella infection. The amoxicillin dose previously administered to girl

was discontinued after five days because it was unable to treat the brucella infection that affected

the child and results on blood culture were negative. The doctor reemphasized on the need to

keep the clinic updated on the child’s progress.

Conclusion

Swift diagnosis and treatment of the disease (brucellosis) is needed to reduce the often

occurrence in both adults and children. There is also need to wear protective gear and use of

disinfectants while working with livestock because this reduces the transmission of the disease to

human beings. Families are also encouraged to consume pasteurized products from animals as

well as cooking meat well to avoid risks of contracting brucellosis. Clinicians should also
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maintain a particular index of suspicion when dealing with patients who travel long distances and

have a likely hood of being in contact with body fluids or products from farm animals.
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References

Brucellosis: Symptoms and Treatment. (2005). Retrieved from http://www.webmd.com/a-to-z-

guides/brucellosis-symptoms-treatment

Kvinge, V. (1958). Brucellosis. Retrieved from

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1512948/pdf/califmed00181-0093.pdf