Medizinische Klinik

, Volume 105, Issue 4, pp 286–290 | Cite as

37-jähriger Patient mit Fieber, Dyspnoe und erhöhten Transaminasen nach Mexikoaufenthalt

KASUISTIK
First Online:

Zusammenfassung

Fallbeschreibung:

Berichtet wird über einen 37-jährigen Patienten mit Cephalgien und Fieber nach Mexikoaufenthalt. Bei anhaltender Transaminasenerhöhung erfolgte die Durchführung einer Leberpunktion. Die histologischen Analysen zeigten das klassische Bild einer hepatischen Beteiligung einer granulomatösen Erkrankung. In serologischen Untersuchungen gelang der Nachweis von Anti-Brucellen-IgM. In Zusammenschau mit der typischen Anamnese ergab sich die Verdachtsdiagnose einer Brucellose. Durch eine Antibiotikatherapie mit Rifampicin und Doxycyclin für 45 Tage konnte eine vollständige Rekonvaleszenz des Patienten herbeigeführt werden.

Schlussfolgerung:

Brucellose ist eine weltweite Anthropozoonose. Potentielle Infektionsquellen sind insbesondere ungekochte/nicht pasteurisierte Milch und Milchprodukte erkrankter Tiere. Durch eine frühzeitige adäquate Antibiotikatherapie kann meist eine vollständige Ausheilung der Erkrankung erreicht werden.

Schlüsselwörter:

Brucellose Granulomatöse Erkrankung Mexikoauf - enthalt Erhöhte Transaminasen Fieber Dyspnoe 

A 37-Year-Old Patient with Fever, Dyspnea and Elevated Trans aminases after a Stay in Mexico

Abstract

Case Report:

A 37-year-old patient with cephalgia and fever after his return from Mexico is reported. Due to persistently elevated transaminases, a liver biopsy was performed. Histological examination revealed hepatic involvement of a granulomatous disease. Serologic analyses detected anti-Brucella IgM. The suspected diagnosis was thus brucellosis taking the typical anamnesis into account. Treatment with rifampicin and doxycycline led to a complete convalescence of the patient.

Conclusion:

Brucellosis is an anthropozoonosis that exists worldwide. Potential sources of infection are uncooked or unpasteurized milk and milk products of infected animals. Complete cure of most brucellosis-infected patients can be achieved by an early and adequate antibiotic treatment.

Key Words:

Brucellosis Granulomatous disease Stay in Mexico Elevated transaminases Fever Dyspnea 
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Literatur

  1. 1.
    Corbel MJ. Microbiological aspects. In: Madkour MM, ed. Madkour's brucellosis. New York: Springer, 2001:51–64.Google Scholar
  2. 2.
    Michaux-Charachon S, Bourg G, Jumas-Bilak E, et al. Genome structure and phylogeny in the genus Brucella. J Bacteriol 1997;179:3244–9.PubMedGoogle Scholar
  3. 3.
    Gándara B, López Merino A, Rogel MA, et al. Limited genetic diversity of Brucella spp. J Clin Microbiol 2001;39:235–40.CrossRefPubMedGoogle Scholar
  4. 4.
    Vassallo DJ. The Corps disease: Brucellosis and its historical association with the Royal Army Medical Corps. J R Army Med Corps 1992;138:140–50.PubMedGoogle Scholar
  5. 5.
    Williams E. The Mediterranean Fever Commission: its origin and achievements. In: Young EJ, Corbel MJ, eds. Brucellosis: clinical and laboratory aspects. Boca Raton: CRC Press, 1989:11–23.Google Scholar
  6. 6.
    Carmichael LE. Brucella canis. In: Nielsen K, Duncan JR, eds. Animal brucellosis. Boca Raton: CRC Press, 1990:335–50.Google Scholar
  7. 7.
    Robert Koch-Institut. Epidemiologisches Bulletin Nr. 39, 28. 9. 2009.Google Scholar
  8. 8.
    Gideon Informatics, Los Angeles. Internet-Homepage (Stand 10. 11. 2009).Google Scholar
  9. 9.
    Young EJ. Human brucellosis. Rev Infect Dis 1983;5:321–42.Google Scholar
  10. 10.
    Young EJ. Overview of brucellosis. Clin Infect Dis 1995;21:283–9.PubMedGoogle Scholar
  11. 11.
    Colmenero JD, Reguera JM, Martos F, et al. Complications associated with Brucella melitensis infection: a study of 530 cases. Medicine (Baltimore) 1996;75:195–211.Google Scholar
  12. 12.
    Spink WW, Hoffbauer FW, Walker WW, et al. Histopathology of the liver in human brucellosis. J Lab Clin Med 1949;34:40–58.PubMedGoogle Scholar
  13. 13.
    Yagupsky P, Peled N, Riesenberg K, et al. Exposure of hospital personnel to Brucella melitensis and occurrence of laboratory-acquired disease in an endemic area. Scand J Infect Dis 2000;32:31–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Young EJ. Serologic diagnosis of human brucellosis: analysis of 214 cases by agglutination tests and review of the literature. Rev Infect Dis 1991;13:359–72.PubMedGoogle Scholar
  15. 15.
    Joint FAO/WHO Expert Committee on Brucellosis (Sixth Report). Geneva: World Health Organization, 1986.Google Scholar
  16. 16.
    Young EJ. Brucella species (brucellosis). In: Yu VL, Weber R, Raoult D, eds. Antimicrobial therapy and vaccines, vol I, 2nd edn. Microbes. New York: Apple Trees Productions, 2002:121–40.Google Scholar
  17. 17.
    Solera J, Rodríguez-Zapata M, Geijo P, et al. Doxycycline-rifampin versus doxycycline-streptomycin in treatment of human brucellosis due to Brucella melitensis. Antimicrob Agents Chemother 1995;39:2061–7.PubMedGoogle Scholar
  18. 18.
    Lang R, Dagan R, Potasman I, et al. Failure of ceftriaxone in the treatment of acute brucellosis. Clin Infect Dis 1992;14:506–9.PubMedGoogle Scholar
  19. 19.
    Olsen C. Responses of adult cattle to vaccination with a reduced dose of Brucella abortus strain RB51. Res Vet Sci 2000;69:135–40.CrossRefPubMedGoogle Scholar
  20. 20.
    Corbel MJ. Brucellosis: epidemiology and prevalence worldwide. In: Young EJ, Corbel MJ, eds. Brucellosis: clinical and laboratory aspects. Boca Raton: CRC Press, 1989:76–80.Google Scholar

Copyright information

© Urban & Vogel, Muenchen 2010

Authors and Affiliations

  1. 1.Klinik und Poliklinik für Innere Medizin IUniversitätsklinikum RegensburgRegensburgGermany
  2. 2.Klinik und Poliklinik für Innere Medizin 1RegensburgGermany

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