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Volume 22, Number 4—April 2016

Ritual Slaughter as Overlooked Risk Factor for Brucellosis

Inbal FuchsComments to Author , Lidia Osyntsov, Yael Refaely, Pnina Ciobotaro, and Oren Zimhony
Author affiliations: Clalit Health Services, Beer Sheva, Israel (I. Fuchs); Ben-Gurion University of the Negev, Beer Sheva (I. Fuchs):; Soroka University Medical Center, Beer Sheva (L. Osyntsov, Y. Refaely); Kaplan Medical Center, Rehovot, Israel (P. Ciobotaro, O. Zimhony)

Main Article


Characteristics, treatment, and outcomes of patients with brucellosis who engaged in ritual slaughter, Israel*Pt no.

Age, y/sex Clinical features Laboratory findings at admission Chest imaging Alternative diagnoses Fever-to- diagnosis interval, d Complication Treatment and outcome
1 68/M Cervical neck pain; cough; night sweats; 38°C Hb, 11.9 mg/dL; leukocytes, 16.3 × 103 /μL; AST, 63 U/L; ALT, 118 U/L CT: apical lung finding, new onset Asthma exacerbation; lung malignancy 21 Focal lung lesion; relapse: epididymo-orchitis; suspected osteomyelitis C6: increased uptake bone scan STR/2 wk, dox + cipro/6 wk; relapse: rising Brucella titers + epididymitis; same 3 drugs/12 wk; recovery
2 70/M 1st admission: fever; productive cough Hb,14.9 mg/dL; leukocytes, 12 x 103 cells/μL; platelets, 136 x 103/μL; AST, 61 U/L; ALT, 47 U/L Chest radiograph: retrocardial infiltrate Asthma exacerbation; bronchitis NA Inhalatants: IV solumedrol, then oral prednisone
2nd admission: hypothermia: 35.7°C; pulse oximetry, 94% on room air Hb: 12 mg/dL; leukocytes, 2.8 x 103 cells/ μL, 3.7 x 103 cells/μL; platelets, 38 x 103/μL; Na, 129 meq/L; AST, 134 U/L; ALT, 100 U/L CT: multiple RUL pulmonary nodules; mediastinal lymphadenopathy TB 92 Sepsis STR/2 wk, dox/6 wk: recovery
3 45/M Fever; prolonged headache Hb, 11.7 mg/dL; AST, 58 U/L; ALT, 102 U/L; Na, 133 meq/L; ESR, 70 mm Hg/h Chest radiograph: diffuse bilateral pulmonary nodules rule out miliary TB TB; cryptococcal meningitis 21 Suspected discitis C5–6 per MRI Genta/wk, dox + cotrim/12 wk; recovery
4 55/M Cough; fever; low back pain Hb, 11.8 mg/dL; AST, 86 U/L; ALT, 120 U/L; ESR, 90 mm Hg/h; CRP, 92.6 mg/L Chest radiograph: peribronchial thickening Pneumonia (rx cefuroxime); temporal arteritis 28 Genta/2 wk, dox/6 wk; persistent low back pain
5 49/F Cough; fever Hb, 9.5 mg/dL; leukocytes, 3.7 x 103 cells/μL; platelets, 116 x 103/μL Chest radiograph: no pathologic changes; CT: no pathologic changes TB; infective endocarditis caused by Actinobacillus ureae 90 Genta/2 wk; dox + rif/7 wk; recovery

*Pt, patient; lab, laboratory; Hb, hemoglobin; leukocyte: leukocytes; AST, aspartate aminotransferase; ALT, alanine aminotransferase; CT, computed tomographic scan; C6, cervical vertebra 6; STR, streptomycin; dox, doxycycline; cipro, ciprofloxacin; NA, not available; IV, intravenous; Na, sodium; RUL, right upper lobe; TB, tuberculosis; ESR, erythrocyte sedimentation rate; MRI, magnetic resonance imaging; genta, gentamicin; cotrim, cotrimoxazole; CRP, C-reactive protein; rx, prescription; rif, rifampin.

Main Article

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Page created: March 16, 2016
Page updated: March 16, 2016
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