Skip to main content
  • ASM
    • Antimicrobial Agents and Chemotherapy
    • Applied and Environmental Microbiology
    • Clinical Microbiology Reviews
    • Clinical and Vaccine Immunology
    • EcoSal Plus
    • Eukaryotic Cell
    • Infection and Immunity
    • Journal of Bacteriology
    • Journal of Clinical Microbiology
    • Journal of Microbiology & Biology Education
    • Journal of Virology
    • mBio
    • Microbiology and Molecular Biology Reviews
    • Microbiology Resource Announcements
    • Microbiology Spectrum
    • Molecular and Cellular Biology
    • mSphere
    • mSystems
  • Log in
  • My alerts
  • My Cart

Main menu

  • Home
  • Articles
    • Current Issue
    • Accepted Manuscripts
    • COVID-19 Special Collection
    • Archive
    • Minireviews
  • For Authors
    • Submit a Manuscript
    • Scope
    • Editorial Policy
    • Submission, Review, & Publication Processes
    • Organization and Format
    • Errata, Author Corrections, Retractions
    • Illustrations and Tables
    • Nomenclature
    • Abbreviations and Conventions
    • Publication Fees
    • Ethics Resources and Policies
  • About the Journal
    • About JCM
    • Editor in Chief
    • Editorial Board
    • For Reviewers
    • For the Media
    • For Librarians
    • For Advertisers
    • Alerts
    • RSS
    • FAQ
  • Subscribe
    • Members
    • Institutions
  • ASM
    • Antimicrobial Agents and Chemotherapy
    • Applied and Environmental Microbiology
    • Clinical Microbiology Reviews
    • Clinical and Vaccine Immunology
    • EcoSal Plus
    • Eukaryotic Cell
    • Infection and Immunity
    • Journal of Bacteriology
    • Journal of Clinical Microbiology
    • Journal of Microbiology & Biology Education
    • Journal of Virology
    • mBio
    • Microbiology and Molecular Biology Reviews
    • Microbiology Resource Announcements
    • Microbiology Spectrum
    • Molecular and Cellular Biology
    • mSphere
    • mSystems

User menu

  • Log in
  • My alerts
  • My Cart

Search

  • Advanced search
Journal of Clinical Microbiology
publisher-logosite-logo

Advanced Search

  • Home
  • Articles
    • Current Issue
    • Accepted Manuscripts
    • COVID-19 Special Collection
    • Archive
    • Minireviews
  • For Authors
    • Submit a Manuscript
    • Scope
    • Editorial Policy
    • Submission, Review, & Publication Processes
    • Organization and Format
    • Errata, Author Corrections, Retractions
    • Illustrations and Tables
    • Nomenclature
    • Abbreviations and Conventions
    • Publication Fees
    • Ethics Resources and Policies
  • About the Journal
    • About JCM
    • Editor in Chief
    • Editorial Board
    • For Reviewers
    • For the Media
    • For Librarians
    • For Advertisers
    • Alerts
    • RSS
    • FAQ
  • Subscribe
    • Members
    • Institutions
Photo Quiz

Answer to February 2018 Photo Quiz

Jürgen Held, Heiko Schweizer, Sabine Zange, Marcus Panning, Winfried V. Kern, Dirk Wagner
P. Bourbeau, Editor
Jürgen Held
aInstitute for Microbiology and Hygiene, Medical Center—University of Freiburg, Freiburg, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Heiko Schweizer
bRenal Division, Department of Internal Medicine, Medical Center—University of Freiburg, Freiburg, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sabine Zange
cBundeswehr Institute of Microbiology, Munich, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Marcus Panning
dInstitute for Virology, Medical Center—University of Freiburg, Freiburg, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Winfried V. Kern
eDivision of Infectious Diseases, Department of Medicine II, Medical Center—University of Freiburg, Freiburg, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Dirk Wagner
eDivision of Infectious Diseases, Department of Medicine II, Medical Center—University of Freiburg, Freiburg, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
P. Bourbeau
Roles: Editor
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
DOI: 10.1128/JCM.03353-15
  • Article
  • Info & Metrics
  • PDF
Loading

Answer: Brucella melitensis. Biochemical differentiation by Vitek 2 and Brucella-specific multiplex PCR (1) identified the pathogen as Brucella melitensis. Low levels of anti-Brucella IgM and IgG were detected by enzyme-linked immunosorbent assay (ELISA), and Brucella DNA was also amplified by real-time-PCR from sputum samples (2). Blood cultures (BacT/Alert FA/FN bottles; bioMérieux) taken on days 0, 2, and 3 after the start of antibiotic therapy with cefuroxime remained sterile after 7 days of incubation.

Brucellosis is a zoonotic infection that occurs worldwide. Areas of endemicity include Central and South America, Africa, Asia, and the Mediterranean. A high seroprevalence in Kazakhstan has been reported (3). Farm animals are the primary hosts of Brucella species; thus, people with direct contact with such animals or their products are at increased risk for infection. Our patient denied animal contact and consumption of dairy products. Therefore, inhalation of aerosolized bacteria is the most likely route of infection.

In Gram stains, Brucella species appear as Gram-negative coccobacilli and, except for Francisella tularensis organisms, are the smallest organisms to be seen under the microscope (diameter, 0.5 to 1 μm). Brucella species grow on most standard media, and colonies are first visible after 2 to 3 days of incubation. Antibiotic susceptibility testing is not recommended, due to the fact that resistance is rare (4).

Brucellosis has a variable clinical course, but symptomatic patients usually have fever and constitutional symptoms (e.g., weight loss). The most common complication is osteoarticular disease (e.g., arthritis). Lung disease is present in about 15% of patients and can present as interstitial or lobar pneumonia (5). Pulmonary nodules, as in our patient, are a common finding (6). Detection of Brucella melitensis from sputum confirmed pulmonary involvement in our patient.

Cutaneous disease occurs in 1 to 13% of brucellosis patients, most often as papulonodular lesions on the lower extremities. The histologic findings are an inflammatory infiltrate of the lymphocytes and histiocytes, with a focally granulomatous appearance. Cutaneous abscesses, as in our patient, are rare (7, 8).

In the end, the patient was successfully treated with rifampin, doxycycline, and gentamicin for 3 weeks, followed by rifampin and doxycycline maintenance therapy for another 8 weeks to avoid early relapse.

See https://doi.org/10.1128/JCM.03352-15 in this issue for photo quiz case presentation.

  • Copyright © 2018 American Society for Microbiology.

All Rights Reserved.

REFERENCES

  1. 1.↵
    1. Mayer-Scholl A,
    2. Draeger A,
    3. Gollner C,
    4. Scholz HC,
    5. Nockler K
    . 2010. Advancement of a multiplex PCR for the differentiation of all currently described Brucella species. J Microbiol Methods 80:112–114. doi:10.1016/j.mimet.2009.10.015.
    OpenUrlCrossRefPubMed
  2. 2.↵
    1. Tomaso H,
    2. Kattar M,
    3. Eickhoff M,
    4. Wernery U,
    5. Al Dahouk S,
    6. Straube E,
    7. Neubauer H,
    8. Scholz HC
    . 2010. Comparison of commercial DNA preparation kits for the detection of Brucellae in tissue using quantitative real-time PCR. BMC Infect Dis 10:100. doi:10.1186/1471-2334-10-100.
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Grushina T,
    2. Atshabar B,
    3. Syzdykov M,
    4. Daulbaeva S,
    5. Tserelson L,
    6. Kuznetsov A,
    7. Baramova S,
    8. Seidakhmetova R,
    9. Sultanov A,
    10. Ospanov Y,
    11. Mikhalev A,
    12. Amireev S,
    13. Ospanov K,
    14. Kazakov S,
    15. Mizanbayeva S,
    16. Myrzabekov A,
    17. Rementsova M,
    18. Berezovskiy D,
    19. Akasheva R,
    20. Khasenov M,
    21. Nussipova Z,
    22. Yu W,
    23. Nielsen K
    . 2010. Universal indirect enzyme-linked immunosorbent assay for monitoring of human and animal brucellosis in Kazakhstan. Vaccine 28(Suppl 5):F46–F48. doi:10.1016/j.vaccine.2010.03.052.
    OpenUrlCrossRef
  4. 4.↵
    1. Winn W, Jr,
    2. Allen S,
    3. Janda W,
    4. Koneman E,
    5. Procop G,
    6. Schreckenberger P,
    7. Woods G
    (ed). 2006. Koneman's color atlas and textbook of diagnostic microbiology, 6th ed, p 429–548. Lippincott Williams & Wilkins, Philadelphia, PA.
  5. 5.↵
    1. Pappas G,
    2. Bosilkovski M,
    3. Akritidis N,
    4. Mastora M,
    5. Krteva L,
    6. Tsianos E
    . 2003. Brucellosis and the respiratory system. Clin Infect Dis 37:e95–e99. doi:10.1086/378125.
    OpenUrlCrossRefPubMed
  6. 6.↵
    1. Hatipoglu CA,
    2. Bilgin G,
    3. Tulek N,
    4. Kosar U
    . 2005. Pulmonary involvement in brucellosis. J Infect 51:116–119. doi:10.1016/j.jinf.2004.10.004.
    OpenUrlCrossRefPubMedWeb of Science
  7. 7.↵
    1. Ariza J,
    2. Servitje O,
    3. Pallares R,
    4. Fernandez Viladrich P,
    5. Rufi G,
    6. Peyri J,
    7. Gudiol F
    . 1989. Characteristic cutaneous lesions in patients with brucellosis. Arch Dermatol 125:380–383. doi:10.1001/archderm.1989.01670150070010.
    OpenUrlCrossRefPubMedWeb of Science
  8. 8.↵
    1. Metin A,
    2. Akdeniz H,
    3. Buzgan T,
    4. Delice I
    . 2001. Cutaneous findings encountered in brucellosis and review of the literature. Int J Dermatol 40:434–438. doi:10.1046/j.1365-4362.2001.01237.x.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top
Download PDF
Citation Tools
Answer to February 2018 Photo Quiz
Jürgen Held, Heiko Schweizer, Sabine Zange, Marcus Panning, Winfried V. Kern, Dirk Wagner
Journal of Clinical Microbiology Jan 2018, 56 (2) e03353-15; DOI: 10.1128/JCM.03353-15

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Print

Alerts
Sign In to Email Alerts with your Email Address
Email

Thank you for sharing this Journal of Clinical Microbiology article.

NOTE: We request your email address only to inform the recipient that it was you who recommended this article, and that it is not junk mail. We do not retain these email addresses.

Enter multiple addresses on separate lines or separate them with commas.
Answer to February 2018 Photo Quiz
(Your Name) has forwarded a page to you from Journal of Clinical Microbiology
(Your Name) thought you would be interested in this article in Journal of Clinical Microbiology.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Share
Answer to February 2018 Photo Quiz
Jürgen Held, Heiko Schweizer, Sabine Zange, Marcus Panning, Winfried V. Kern, Dirk Wagner
Journal of Clinical Microbiology Jan 2018, 56 (2) e03353-15; DOI: 10.1128/JCM.03353-15
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Top
  • Article
    • REFERENCES
  • Info & Metrics
  • PDF

KEYWORDS

Brucella
infection
skin

Related Articles

Cited By...

About

  • About JCM
  • Editor in Chief
  • Board of Editors
  • Editor Conflicts of Interest
  • For Reviewers
  • For the Media
  • For Librarians
  • For Advertisers
  • Alerts
  • RSS
  • FAQ
  • Permissions
  • Journal Announcements

Authors

  • ASM Author Center
  • Submit a Manuscript
  • Article Types
  • Resources for Clinical Microbiologists
  • Ethics
  • Contact Us

Follow #JClinMicro

@ASMicrobiology

       

ASM Journals

ASM journals are the most prominent publications in the field, delivering up-to-date and authoritative coverage of both basic and clinical microbiology.

About ASM | Contact Us | Press Room

 

ASM is a member of

Scientific Society Publisher Alliance

 

American Society for Microbiology
1752 N St. NW
Washington, DC 20036
Phone: (202) 737-3600

 

Copyright © 2021 American Society for Microbiology | Privacy Policy | Website feedback

Print ISSN: 0095-1137; Online ISSN: 1098-660X