MUCOSAL BRUCELLA INFECTION IN HUMAN: A CASE REPORT DURING COVID-19 PANDEMIC

Brucellosis in human is an uncommon disease in Libya and usually diagnosed by serological assays. The clinicalsymptoms of this disease in many times are none specific and vague. This report describes a case of clinical humanbrucellosis in Libya. The patient was a sixteen years old girl, lives in a rural area. She was suffering from intermittentfever for several days associated with chills, mild cough, and headache. The patient had history of occasional drink ofgoat’s raw milk during the previous two months. She had no history of travel abroad and direct animal contacts.Comprehensive physical examination revealed the patient was generally unwell, pallor and, had tenderness and mildhepatosplenomegaly. Laboratory investigations revealed that the patient had pancytopenia (low number of blood cellscount) and a marked increase in C-reactive protein (CRP), Procalcitonin (PCT), Lactate dehydrogenase (LDH), Aspartate transaminase (AST). Viral screen tests were non-reactive for HCV, HBs Ag, HIV and covid-19. Provisionaldiagnosis on admission time was acute leukemia or aplastic anemia with common microbial infection. Empiricalantibiotic (Meropenem 1 gm) was prescribed intravenously every eight hours for seven days. The patient was alsogiven antipyretic, IV fluid hydration, and one unit of packed red blood cells. Following that, bacterial growth in aerobic blood culture was noticed and it was Gram-negative coccobacilli, non-motile. The bacterium was positive forcatalase, oxidase and urease tests. It could not clearly be identified by phoenix bacterial identification system. It wasprovisionally diagnosed Haemophilus spp., but as it was able to growth on blood agar plate, it was finally diagnosedas Brucella spp. and that was confirmed by collection of patient serum and performing Rose-Bengal pate test (RBPT)as was significantly increased (1:640). The patient general condition was improved and blood count recovered overone week. The patient was then discharged and asked for routine follow ups during the next six months.