Although pulmonary symptoms accompany up to 16% of cases of infection with Brucella melitensis, pleural effusion has rarely been reported. A 12 year old girl had brucellosis with pulmonary disease and a pleural effusion. The pleural fluid was clear and straw coloured with 2700 leucocytes/mm3 (93% lymphocytes), a protein level of 48 g/l, and a glucose concentration of 4-1 mmol/l. Culture of the pleural fluid grew Br melitensis. (Thorax 1994;49:89-90) Brucellosis, a zoonotic infection with microorganisms belonging to the genus Brucella, is a world wide public health problem. figure). Ultrasonographic examination of the chest demonstrated a large pleural effusion with septations and loculations. Spinal radiographs and a computed tomographic scan of the thorax showed compression and destruction of T12 vertebra and the bone scan showed a similar focus of increased uptake in T12. The Mantoux test was negative. A diagnostic pleural tap revealed clear and straw coloured fluid, with 2700 leucocytes/mm3 (93% lymphocytes), a protein level of 48 g/l, and a glucose concentration of 4-1 mmol/l. No bacteria (including mycobacteria) were identified by special stains. Culture of the pleural fluid grew Br melitensis. Serum agglutinating antibodies for Br melitensis were positive with a titre of 1:5120. Blood culture grew Br melitensis.Treatment was started with a six week course of oral tetracycline (30 mg/kg/day) and intramuscular streptomycin (25 mg/kg/day). The streptomycin was changed to rifampicin after five days when an audiogram revealed hearing loss in the left ear. Her clinical condition improved rapidly after initiation of treatment and she was discharged two weeks later. The child received two additional courses each of four weeks of antibiotics comprising rifampin and trimethoprim-sulphamethoxazole. The pleural effusion and infiltrate cleared gradually. Six months later chest radiographs were normal, there were only slight changes in the vertebra, and Br melitensis serological tests were negative.
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