Brucellosis in a renal transplant recipient

Abstract

Brucellosis is one of the most common systemic zoonotic diseases transmitted by consumption of unpasteurized dairy products or by occupational contact with infected animals. Brucellosis is rare in renal transplant recipients. Only 3 cases have been reported in the literature. We report a case of brucellosis with hematologic and hepatobiliary complications in a patient 3 years after renal transplantation. The mean time from transplantation to the diagnosis of brucellosis in these 4 reported patients was 5.1 years (range 17 months to 13 years). All patients had fever and constitutional symptoms, and all attained clinical cure after combination antibiotic therapy. Given the small number of patients, further study is needed to identify the characteristics of brucellosis in renal transplant recipients. Drug interactions and acute renal failure developed in our patient during antibiotic treatment. Therefore, we should monitor the levels of immunosuppressive agents frequently. Several studies have shown in vitro susceptibilities of Brucella melitensis to tigecycline. In our patient, fever finally subsided after tigecycline administration. The minimum inhibitory concentration of tigecycline using Etest was 0.094 μg/mL. Tigecycline may be a potential option for treatment of brucellosis in the setting of transplantation.

Brucellosis in Immunocompromised Hosts

“…However, it is more frequent in renal transplant recipients than in recipients of liver transplantation. Brucellosis can develop as early as 2 months and as late as 17 years post SOT [105,117,118,[120][121][122][123]. The sources of Brucella infections in recipients of SOT include: (1) donor-derived infection, (2) blood transfusion-related infection, (30 reactivation of old infection due to the immunosuppressive therapy administered to prevent graft rejection, and (4) new infection in these patients who are vulnerable to various infectious complications due to their immunocompromised status [105,118,[122][123][124][125].…”

“…The following complications have been reported in SOT recipients: Brucella arthritis, neurobrucellosis, paraspinal abscess, Brucella endocarditis, Brucella bacteremia in addition to hematological and hepatobiliary complications [105,118,[120][121][122][123]. Brucellosis in recipients of SOT responds well to various combinations of the following antimicrobials: doxycycline, rifampicin, ciprofloxacin and TMP/SMZ.…”

“…Brucellosis in recipients of SOT responds well to various combinations of the following antimicrobials: doxycycline, rifampicin, ciprofloxacin and TMP/SMZ. However, complicated infections may require not only prolonged courses of antimicrobials for 6 to 12 weeks but also surgical intervention, particularly in the presence of BE or abscess formation [117,120,121,123]. Tigecycline is a potential therapeutic option in the treatment of brucellosis in SOT recipients [123].…”

“…However, complicated infections may require not only prolonged courses of antimicrobials for 6 to 12 weeks but also surgical intervention, particularly in the presence of BE or abscess formation [117,120,121,123]. Tigecycline is a potential therapeutic option in the treatment of brucellosis in SOT recipients [123]. Drug interactions between antimicrobials and immunosuppressive therapies have to be taken into consideration in recipients of SOT being treated for brucellosis [123].…”

“…Tigecycline is a potential therapeutic option in the treatment of brucellosis in SOT recipients [123]. Drug interactions between antimicrobials and immunosuppressive therapies have to be taken into consideration in recipients of SOT being treated for brucellosis [123].…”