Year: 2014
Type: article
Study design: Case Report
Abstract: Brucellosis, with 500,000 new cases occurring annually is one of the most common zoonotic diseases in the world. (1) In Turkey its incidence is 0.59/100000 and seropositivity rate is 1.8% in the healthy population. (2) Incidence of the disease is high among the people who live in rural areas, consume raw milk and dairy products, livestock raisers, farmers, veterinarians, butchers and laboratory workers. The clinical features of brucellosis depend on the stage of the disease, and the organs and systems involved. Brucella has been reported to compromise the central and peripheral nervous system, and the gastrointestinal (GI), hepatobiliary, genitourinary (GU), musculoskeletal, cardiovascular and integumentary systems. (3) Osteoarticular involvements are the most common complications of human brucellosis. Osteoarticular manifestations (sacroiliitis, spondylitis, peripheral arthritis and osteomyelitis) account for over half of the focal complications. GU complications (epididymo-orchitis, prostatitis, glomerulonephritis and renal abscesses) can be found in about 1-22 % of patients. Epididymo-orchitis is the most common presentation of GU involvement due to brucellosis. (4) Brucellosis as a cause of prostatitis is quite rare, it is only reported as a few case reports in the literature. (5) In this case report diagnoses and treatment of prostatitis cases of brucellosis are discussed. CASE REPORT A 50 years old male patient who is dealing with the slaughterhouse livestock sector, with no previously known disease and no history of surgical procedure, with almost 3 months low back pain, left-sided chest pain, loss of appetite, weight loss, intermittent fever heights, and for the last one month with complaints of dysuria, pollakiuria, nocturia, and difficulty in urination applied to our clinic. Physical examination revealed, International prostate symptom score (IPSS) of 17, prostate volume on transrectal ultrasonography (TRUS) 40 mL, digital rectal examination grade 1 positive and there was a 1 × 1 cm nodule in the right lobe, and normal vital signs. Laboratory investigations revealed, serum total/free prostate specific antigen (PSA) level of 9.1/1.19, white blood cell 9800/mm 3 , C-reactive protein, 17 mg/dL, erythrocyte sedimentation rate 51 mm/h, alkaline phosphatase 185 U/L and blood chemistry and urine examination were normal. Transrectal ultrasound-guided 10 cores prostate needle biopsies were taken from the patient. Pathologic examination demonstratedhyperplastic prostate aciniwith widely stromal lymphocyte infiltration (benign prostatic hyperplasia). At 12th hour after prostate biopsy patient developed fever (39 o C) and consultation with an infectious diseases specialist was requested. Blood cultures which analyzed using an automated system (Organon Tecnica BacT/ Alert BioMerieux, France) and urine cultures were taken by infectious diseases specialist’s recommendation, then the meropenem therapy was started. The patient's urine culture was negative, but gram-negative coccobacilli yielded in the blood cultures at the 4th day. The bacterium was identified as Brucella spp. by conventional laboratory methods. (6) The patient’s serum sample was tested by Wright agglutination test using B. abortus S99 antigen (Pendik Veterinary Institute, Istanbul, Turkey) for brucellosis. Sample dilutions started from 1/10 for Wright agglutination test. Patient’s Wright agglutination test was positive at 1/640 titer.The patient was transferred to the infectious diseases clinic with the diagnosis of brucellosis. As the results, meropenem was stopped and then doxycycline 100 mg (twice daily) and rifampin 600 mg (once in a day) were started per orally and his fever begin to reduce. Abdominal ultrasonography and lumbar magnetic resonance imaging (MRI) were performed because the patient had low back pain. Abdominal ultrasound showed no pathology other than hepatomegaly. In the lumbar MRI, at the range of L1-L2, was suspicious for discovertebral infection and an 8 mm abscess in the left psoas wasseen. Streptomycin 1 g (once in a day) intramuscularly was added to the treatment because of abscess in the psoas. Due to the lack of follow-up problem, the outpatient antibiotic therapy was planned as doxycycline and rifampin for 3 months and streptomycin for three weeks. The patient was discharged by infectious diseases clinic with planning the control by urology and infectious diseases clinics after 3 months.
Source: Urology journal./Urology jornal.
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W2185107452