International Medical Case Reports Journal (Oct 2019)
Imported Brucellosis In The Era Of Dramatically Increasing Immigrants And Foreign Travelers From Endemic Areas: Occupational Hazards Of Secondary Infection Among Laboratory Technicians In A Nonendemic Country
Abstract
Takahiko Fukuchi,1,2 Nobue Yanagihara,3 Koichi Imaoka,4 Hitoshi Sugawara1 1Division of General Medicine, Jichi Medical University Saitama Medical Center, Omiya, Saitama, Japan; 2Division of General Internal Medicine, Fukaya Red Cross Hospital, Fukaya, Saitama, Japan; 3Department of Clinical Laboratory, Fukaya Red Cross Hospital, Fukaya, Saitama, Japan; 4Laboratory of Reservoir Control of Zoonoses, Department of Veterinary Science, National Institute of Infectious Diseases, Shinjuku, Tokyo, JapanCorrespondence: Takahiko FukuchiJichi Medical University Saitama Medical Center, Division of General Medicine, 1-847, Amanumacho, Omiya-ku, Saitama 330-8503, JapanTel +81 48 647 2111Fax +81 48 644 8617Email [email protected]: Brucellosis, an important zoonotic disease, is endemic in various parts of the world. Patients diagnosed with brucellosis in developed countries are often travelers and immigrants from endemic areas. This pathogen is listed as biosafety level 3, which means that it is highly contagious and therefore a risk to clinical laboratory technicians.Case presentation: A 43-year-old Chinese man, who could not understand Japanese, visited our hospital because of an intermittent fever that had persisted for 5 months. Associated symptoms included muscle pain whenever he had a fever. He reported currently working as a welder in Japan. However, his previous employment working in animal husbandry in Heilongjiang, mainland China was not determined at the initial visit owing to language barriers. Two sets of blood culture showed nonfermenting gram-negative bacilli, initially misidentified as Ochrobactrum anthropi and subsequently identified as Brucella abortus. Six-week doxycycline and rifampicin were administered, with intravenous gentamicin for the initial 1 week. The patient recovered without relapse, confirmed by the negative result of a Brucella agglutination test. The patient’s wife and three laboratory technicians were required to undergo blood examinations, which revealed no evidence of infection; however, they received prophylaxis with 3 weeks’ doxycycline and rifampicin.Conclusion: In nonendemic countries, immigrants with imported brucellosis can be treated, to prevent secondary brucellosis infection, an occupational hazard among laboratory technicians. Greater attention is needed for positive findings of blood cultures, which may initially be misidentified as O. anthropi. When providing medical care for immigrants with fever of unknown origin, it is especially important for primary care physicians to overcome language barriers so as to assess pertinent information regarding their home country, such as previous employment, to prevent the spread the imported zoonoses in the era of a dramatically increasing number of immigrants and foreign travelers.Keywords: imported brucellosis, Brucella abortus, zoonosis, Ochrobactrum anthropi, laboratory exposure, laboratory-acquired infection
