Current Understanding and Management of Chronic Hepatosplenic Suppurative Brucellosis

Abstract

To outline the characteristics and define appropriate management of chronic hepatosplenic suppurative brucellosis (CHSB), 905 patients with brucellosis were analyzed. Sixteen episodes of CHSB (14 in the liver and 2 in the spleen) were found in 15 patients. Six patients had had previous remote brucellosis. Twelve patients presented with systemic symptoms, and 12 with local symptoms. Cultures of blood samples yielded negative results in all cases except 1, and the results of cultures of pus specimens were positive for Brucella melitensis in only 2 cases. All patients showed calcium deposits surrounded by a hypodense area on computed tomography. Patients often had low titers of agglutinating antibody. In patients who were receiving conservative management, early response was successful in 50% and late response was successful in 33.3%. In the patients who underwent surgery and concomitant antibiotic therapy, early and late response was successful in 100%. Thus, CHSB mainly represents a local reactivation of previous brucellosis. Its diagnosis may be difficult to establish and surgery may be required to cure many patients.

From the discovery of the Malta fever?s agent to the discovery of a marine mammal reservoir, brucellosis has continuously been a re-emerging zoonosis

“…Despite many studies on the medical management of brucellosis over the past two decades, no major changes in the known therapeutic modalities have taken place [9,76,77]. The treatment recommended by the WHO for acute brucellosis in adults is rifampicin 600 to 900 mg and doxycycline 200 mg daily for a minimum of six weeks [6].…”

“…The treatment recommended by the WHO for acute brucellosis in adults is rifampicin 600 to 900 mg and doxycycline 200 mg daily for a minimum of six weeks [6]. However, although the most appropriate antibiotic combination is not known, other reports suggest that the combination of doxycline and an aminoglycoside is probably best and the addition of rifampicin may be a reasonnable option [9,55]. There is no consensus with regards to the best therapeutic regimen for chronic brucellosis in adults, simple or complicated brucellosis in children under 7 years of age and surgical management is only indicated in special cases [9,51,55,68,76,77].…”

Acute Abdomen Caused by Brucellar Hepatic Abscess

“…Therefore, the most appropriate therapeutic approach is unclear. 12 Large abscesses are unlikely to respond to medical therapy alone without drainage, either percutaneous or surgical. The combined treatment consisting of percutaneous drainage and systemic antibiotics therapy is safe and effective in patients with a pyogenic liver abscess.…”

Clinical Features, Complications and Treatment Outcome of Brucella infection: Ten Years' Experience in an Endemic Area

“…Hepatitis is common, usually manifesting as mild transaminasemia 13,14 . In our study 29% of patients had increased enzyme concentrations (ALT, AST).…”