Brucellosis as a cause of persistent fever in a health worker from Cali, Colombia. Case report. Brucelosis como causa de fiebre persistente en un trabajador de la salud de Cali, Colombia. Reporte de caso.

Abstract

Introduction. Brucellosis is the main zoonosis worldwide. It is transmitted to humans mainly through the consumption of unpasteurized products, as well as through occupational exposure. The manifestations are nonspecific, which leads to a diagnostic challenge for the clinician, being one of the causes that can explain the fever of unknown origin and which is not considered a relevant etiology given its low incidence in our environment, leaving it as a probable pathology once the most frequent and prevalent diseases have been ruled out.

Case Summary. We present a young male health worker with a history of keratoconus and urolithiasis who was admitted to the emergency department due to acute febrile symptoms associated with headache, myalgia and arthralgia with initial suspicion of dengue infection. However, given the persistence of fever for more than 96 hours after performing multiple negative tests and multiple visits to the emergency room requiring strict surveillance, and under the epidemiological suspicion of a possible zoonosis, screening tests were considered for brucellosis by agglutination by febrile antigens being positive for B. abortus in high titers of 1:160. Findings were corroborated by rose Bengal agglutination test and finally with enzyme-linked immunosorbent assay (ELISA) with positive results for IgM and IgG. Treatment with rifampin and doxycycline was given for 6 weeks with complete improvement without recurrence.

 Discussion. Brucellosis can present as a nonspecific febrile condition that, although it is very rare in our environment, should be considered as an etiological probability given the rural area and the few epidemiological and health surveillance measures in the adequate pasteurization process, even in the process of Industrialization. In this report we show that clinical suspicion and the use of indirect detection diagnostic aids allowed making the diagnosis without these being the ones with the best performance given their low specificity and the possibility of being present in multiple infectious processes, but in the case of this patient it was the key to achieving the origin of the fever of unknown origin. Although mortality is low, combined antibiotic therapy reduces recurrence and associated complications.