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

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          Abstract

          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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          Most cited references 3

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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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              Correspondence

                (1999)
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                Author and article information

                Journal
                NEF
                Nephron
                10.1159/issn.1660-8151
                Nephron
                S. Karger AG
                1660-8151
                2235-3186
                2002
                May 2002
                02 May 2002
                : 91
                : 1
                : 156-158
                Affiliations
                Departments of aNephrology and bMicrobiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
                Article
                57618 Nephron 2002;91:156–158
                10.1159/000057618
                12021533
                © 2002 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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

                Cardiovascular Medicine, Nephrology

                CAPD, Brucellosis, Peritonitis

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