Volume 22, Number 4—April 2016
Letter
Ritual Slaughter as Overlooked Risk Factor for Brucellosis
, Lidia Osyntsov, Yael Refaely, Pnina Ciobotaro, and Oren Zimhony
Table
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.
"Et al" found after fewer than 6 authors. Please check reference (in reference 7 "Henning, Miller, Pak, Lindsay, Fisher, et al., 2012").
Reference has only first page number. Please provide the last page number if article is longer than one page. (in reference 9 "Nabukenya, Kaddu-Mulindwa, Nasinyama, 2013").