Brucella Melitensis As Causative Agent for Neck Abscess in an Endemic Area

Abstract

Background: Brucellosis, a zoonotic disease, is very common in the Mediterranean basin and a major concern in livestock areas. We present a rare case of a Brucella-caused abscess in the neck of a stock-breeder in an endemic Greek area. Case Report: A 39-year-old male, living in the rural area of Thessaly, presented with a mass in the left area of his neck. Clinical examination and imaging tests revealed an abscess in the left sternocleidomastoid muscle. Sampling of the abscess by fine-needle aspiration yielded inflammatory fluid (17x103 cells/μL). Molecular sequencing (16S rRNA polymerase chain reaction) performed directly in the clinical sample identified the presence of Brucella melitensis within 24 hours after material sampling. The microorganism was isolated in agar media four days later. The Rose-Bengal test was negative, while the Brucellacapt test showed titer 1/320. Given the results obtained with these molecular techniques, the patient was offered treatment with streptomycin (1 g for 3 weeks) and oral doxycycline (100 mg twice daily for 6 weeks), concurrently. Conclusion: In areas endemic for brucellosis, the investigation of a patient with a neck abscess should include Brucella spp. among possible causative agents.

Keywords

• Brucella melitensis, neck abscess, molecular microbiology

References

1. 1. European Centre for Disease Prevention and Control. Annual epidemiological report 2014 -food- and waterborne diseases and zoonoses. Stockholm: ECDC; 2014.
2. 2. Dougas G, Lamprou A, Patrinos S. Brucellosis: the epidemiological situation. Zoonosis Office & Surveillance System Co-ordination Office. HCDCP May 2012. Available: http://www2.keelpno.gr/blog/?p=1751
3. 3. Moreno E. Retrospective and prospective perspectives on zoonotic brucellosis. Front Microbiol 2014;5:213.
4. 4. Yin Z, He E, Ding H, Chen J. Brucella infection of the thoracic vertebral arch presenting with an epidural abscess: a case report. J Med Case Rep 2015;9:237.
5. 5. Li J, Li Y, Wang Y, Huo N, Wan H, Lin X, et al. Renal abscess caused by Brucella. Int J Infect Dis 2014;28:26-8.
6. 6. Yilmaz M, Arslan F, Başkan O, Mert A. Splenic abscess due to brucellosis: a case report and a review of the literature. Int J Infect Dis 2014;20:68-70.
7. 7. Foroulis CN, Gerogianni I, Kouritas VK, Karestsi E, Klapsa D, Gourgoulianis K, et al. Direct detection of Clostridium sordellii in pleural fluid of a patient with pneumonic empyema by a broad-range 16S rRNA PCR. Scand J Infect Dis 2007;39:617-9.
8. 8. Garshasbi M, Ramazani A, Sorouri R, Javani S, Moradi S. Molecular detection of Brucella species in patients suspicious of Brucellosis from Zanjan, Iran. Braz J Microbiol 2014;45:533-8.

9. 9. Arabacı F, Oldacay M. Evaluation of serological diagnostic tests for human Brucellosis in an endemic area. JMID 2012;2:50-6.
10. 10. Kaya O, Akcam FZ, Uyar C, Tuz M, Kapucuoglu N. Neck abscess caused by Brucella sp. Infection 2007;35:479-80.