Brucellosis complicating chronic non-infectious disorders: diagnostic and therapeutic dilemmas

1 Infectología, Hospital Cosme Argerich, Margall 750, 1155 Buenos Aires, Argentina 2 Hematología, Hospital de Clínicas José de San Martín, Avda Córdoba 2300, Buenos Aires, Argentina 3 Infectología, Hospital Donación Francisco Santojanni, Pilar 950, 1407 Buenos Aires, Argentina 4 Administración Nacional de Laboratorios e Institutos de Salud Dr C. G. Malbrán (ANLIS), Avda Velez Sarsfield 563, 1281 Buenos Aires, Argentina Correspondence Nidia E. Lucero nidia{at}elsitio.net Received 24 January 2008 Accepted 28 April 2008 There is little information in the literature on the clinical progress of brucellosis in patients affected by other non-infectious diseases; however, the infection can often trigger an exacerbation of existing underlying conditions in certain target organs. In this report we present four cases of brucellosis complicating previous diseases, and the difficulties in relation to their diagnosis and treatment. The study involved four patients with the following disorders: polycythaemia vera, pulmonary fibrosis, cirrhosis of the liver and arthritis of the knee. Brucellosis was diagnosed by classical serological and bacteriological methods. The strains involved could be isolated only in three of the four patients: two strains were Brucella abortus biovar 1 and one was Brucella suis biovar 1. Two patients relapsed 10 and 7 months after admission, another presented chronic brucellosis and received various therapy schemes, and one died. Since the best selection of antibiotics and the optimal duration of therapy remain unknown for patients having brucellosis complicated by previous pathologies, these remain at the discretion of the attending physician. Management of our patients was controversial in terms of the selection of antibiotics, duration of treatment and decision regarding surgery. Abbreviations: CELISA, competitive ELISA; FPA, fluorescence polarization assay; Hb, haemoglobin; OA, osteoarthritis; PF, pulmonary fibrosis; PV, polycythaemia vera.