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      Brucella Peritonitis in a Patient on Continuous Ambulatory Peritoneal Dialysis with Acute Brucellosis

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          Peritonitis is an uncommon complication of brucellosis. Brucella peritonitis in chronic ambulatory peritoneal dialysis (CAPD) patients has not been reported before. A male patient is presented with peritonitis caused by Brucella melitensis who was on CAPD. The source of infection was thought to be unpasteurized, unsalted cheese eaten a month before the onset of symptoms. At the beginning, antibiotic therapy with doxycyline and rifampicin led to a rapid clinical improvement, with disappearance of the organism in the peritoneal fluid. However, peritonitis relapsed after discontinuation of antimicrobial therapy. Successful management required a combination of medical therapy and removal of the Tenckhoff catheter.

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          Complications associated with Brucella melitensis infection: a study of 530 cases.

          We carried out a prospective study of 530 patients older than 14 years of age with brucellosis. We describe the incidence and clinical features of the focal forms of the disease, analyzing some of the possible factors associated with their appearance. One hundred sixty-nine patients (31.9%) had a focal form or complication. Osteoarticular complications were the most frequent, totaling 113 cases (66%), followed by genitourinary with 18 cases (5.1% of males), hepatic (2.5%), neurologic (1.7%), and heart (1.5%). Nine patients (1.7%) had more than 1 complication. In a multivariate analysis, diagnostic delay greater than 30 days (OR 2.0), ESR > 40 mm/hr (OR 1.9), and levels of alpha-2 globulin > 7.5 g/L (OR 6.8) were statistically significant independent variables associated with the presence of focal forms. Twenty-five patients with complications (14.8%) required surgical treatment. The relapse rate was 3.6% for those patients without complications and 4.1% for patients with focal forms (p > 0.05). However, when therapeutic failure, relapses, and mortality were considered together, the risk of an unfavorable evolution was significantly greater in patients with focal forms (10.6% versus 3.6% in patients without complications; OR 1.9, 95% CI 1.4-7.1, p < 0.005). Given the worse prognosis, knowledge and early diagnosis of the focal forms of B. melitensis infection is especially important.
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            Brucellosis outbreak attributed to ingestion of umpasteurized goat cheese.

            In six cases of Brucella melitensis infections the common etiologic factor was the ingestion of raw goat cheese. Presenting complaints were variable, but a constant feature was persistent fevers that frequently were present for months. Evidence of liver cell dysfunction was present in each case, and in two, biopsy disclosed diffuse hepatitis with focal necrosis. The diagnoses were initially based on high titers of Brucella agglutinins and later confirmed by positive blood cultures. A good clinical response was induced by antibiotic therapy ( tetracycline plus streptomycin sulfate), but in two cases a Jarish-Herxheimer reaction occurred during the first 24 hours of treatment.
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                Author and article information

                S. Karger AG
                May 2002
                02 May 2002
                : 91
                : 1
                : 156-158
                Departments of aNephrology and bMicrobiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
                57618 Nephron 2002;91:156–158
                © 2002 S. Karger AG, Basel

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                Page count
                References: 11, Pages: 3
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/57618
                Case Report

                Cardiovascular Medicine, Nephrology

                CAPD, Brucellosis, Peritonitis


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