46-year-old man with recurrent Fever and chills.
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Article: Brucellosis.New England Journal of Medicine 07/2005; 352(22):2325-36. · 54.42 Impact Factor
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ABSTRACT: Instances of overt laboratory-associated infection recorded in published reports and additional cases disclosed by questionnaires and personal communications have been tabulated. Of a total of 3921 cases, 2465 occurred in the United States and 164 were fatal. Only 64% of the cases were reported in the literature. Analysis of the available information revealed that only 18% of the infections were due to known accidents; 42% were caused by bacteria; 27% by viruses; 15% by rickettsiae; 9% by fungi; 3% by chlamydiae; and 3% by parasites. It may be significant that fewer infections have been recorded in the past decade than in any of the four preceding decades. Possible reasons for this apparent decrease are discussed.Health laboratory science 05/1976; 13(2):105-14.
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ABSTRACT: From 1973 through 1992, 426 cases of human brucellosis were reported in California, of which 98% were laboratory confirmed. Brucella melitensis was identified in 185 cases (78.7% of the bacteriologically typed cases). Hispanics accounted for 81% of the cases from 1983 to 1992 compared with 65% during the previous decade (P < .01). The population-adjusted average annual incidence was higher in Hispanics, especially in children and teenagers, compared with non-Hispanic whites and African Americans. Slaughterhouse cases decreased from 25% during 1973-1982 to < 3% during the following decade. Changes in case distribution were characterized by a decreasing incidence in the Central Valley and an increasing incidence in the San Francisco Bay area and the southern Coast Range. Hispanics were more likely to report being infected by consumption of milk and cheese in Mexico during 1983-1992 than during the previous 10 years (relative risk, 1.45). Between 1973 and 1992, human brucellosis in California evolved from an occupational to a foodborne illness.The Journal of Infectious Diseases 11/1994; 170(5):1216-23. · 5.85 Impact Factor
P H O T O Q U I Z
Philip A. Mackowiak, Section Editor
A 46-Year-Old Man With Recurrent Fever and Chills
(See pages for the Answer to the Photo Quiz.)
A 46-year-old man, an animal skinner at a local meat factory,
was referred to an ambulatory clinic with recurrent fever and
chills. He had been in his usual state of health until a year and
a half previously, when he fell and subsequently developed left
upper quadrant pain. At that time, he noted fever and chills
and was treated with an unknown antimicrobial agent. He did
well for the next 6 months until he again developed fever and
chills associated with low back pain. He was again treated with
antibiotics that produced a resolution of his symptoms. There-
after, he experienced multiple recurrent episodes of fever and
chills lasting for 2–3 weeks that occurred at a frequency of
every 3 months. Due to nonresolving symptoms, he presented
for a further workup. He had no other chronic illnesses and
no history of tuberculosis exposure. He had traveled to the
Philippines and Japan several years prior. His examination
was remarkable for mild left upper quadrant tenderness to
deep palpation. A complete blood cell count was within normal
limits, and his erythrocyte sedimentation rate was 18 mm/h.
Abdominal radiography was performed (Figure 1A).
The patient underwent exploratory laparotomy with splenec-
tomy. A section of the resected spleen is shown (Figure 1B).
Pathological analysis revealed chronic granulomatous inflam-
mation. An acid-fast bacillus stain was negative. A culture of
the spleen is shown (Figure 1C).
What is your diagnosis?
? The Author 2012. Published by Oxford University Press on behalf of the Infectious Diseases
Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@
A, Abdominal radiograph. B, Resected spleen specimen. C, Tissue culture from the resected spleen.
Clinical Infectious Diseases2012;55(3):413
PHOTO QUIZ • CID 2012:55 (1 August) • 413
at Mayo Clinic Library on August 6, 2012