Imported brucellosis and Q-fever coinfection in Croatia: a case report

  • Ljiljana Peric Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
  • Dario Sabadi Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
  • Ilija Rubil Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
  • Maja Bogdan Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
  • Marija Guzvinec University Hospital for Infectious Diseases "Dr Fran Mihaljevic", Zagreb, Croatia
  • Oktavija Dakovic Rode University Hospital for Infectious Diseases "Dr Fran Mihaljevic", Zagreb, Croatia
  • Bernard Kaic Croatian Institute of Public Health, Zagreb, Croatia
  • Irena Tabain Croatian Institute of Public Health, Zagreb, Croatia
  • Tatjana Vilibic-Cavlek
Keywords: brucellosis, Q-fever, coinfection, Croatia

Abstract

The brucellosis and Q-fever coinfection is very rarely reported. To our knowledge, this is the first case report of concomitant brucellosis and Q-fever, most likely imported in Croatia. A 30-year-old male agricultural worker was hospitalized on 22 April 2017 after a ten days fever up to 40°C with chills, shivering, excessive sweating, general weakness, loss of appetite and headache. A month and a half prior to the hospitalization he lost 18 kg of body weight. Three weeks before hospitalization the patient returned from Kupres (Bosnia and Herzegovina) where he was working for the past year on a sheep farm and consumed unpasteurized dairy products of sheep origin. At admission, his condition was moderately severe due to pronounced dehydration. Routine laboratory tests showed slightly elevated erythrocyte sedimentation rate, anemia, thrombocytopenia and elevated liver transaminases. The chest X-ray showed an inhomogeneous infiltrate of the lower right lung. Three sets of blood culture were cultivated. After 48 hours incubation, bacterial growth was detected in aerobic bottles. Gram-stained smear revealed small, gram-negative coccobacilli. Specimens were subcultured on blood and chocolate agar plates. Using a Vitek GN identification card, the isolated organism was identified as Brucella melitensis. 16S rRNA gene sequencing of the isolate confirmed it as a Brucella sp. Rose-Bengal test was positive, while Wright agglutination test showed a significant increase in antibody titer from 80 to 640 in paired sera. Using indirect immunofluorescence assay (IFA), Coxiella burnetii phase II IgM/IgG titers were 50 and 1024, respectively indicating acute Q-fever. The patient was treated with doxycycline and rifampicin. So far, there has been no relapse or signs of chronic infection.

Author Biographies

Ljiljana Peric, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia

Faculty of Medicine

Dario Sabadi, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia

Faculty of Medicine

Ilija Rubil, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia

Faculty of Medicine

Maja Bogdan, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia

Faculty of Medicine

Marija Guzvinec, University Hospital for Infectious Diseases "Dr Fran Mihaljevic", Zagreb, Croatia

Department of Clinical Microbiology

Oktavija Dakovic Rode, University Hospital for Infectious Diseases "Dr Fran Mihaljevic", Zagreb, Croatia

Department of Virology

Bernard Kaic, Croatian Institute of Public Health, Zagreb, Croatia

Department of Epidemiology

Irena Tabain, Croatian Institute of Public Health, Zagreb, Croatia

Department of Virology

Published
2018-06-30
How to Cite
1.
Peric L, Sabadi D, Rubil I, Bogdan M, Guzvinec M, Dakovic Rode O, Kaic B, Tabain I, Vilibic-Cavlek T (2018) Imported brucellosis and Q-fever coinfection in Croatia: a case report. J Infect Dev Ctries 12:499-503. doi: https://doi.org/10.3855/jidc.10151
Section
Case Reports