Abstract
Human brucellosis has become a rare disease in Germany since the eradication of bovine and ovine/caprine brucellosis in this country. Therefore, most physicians are unfamiliar with the illnesses clinical presentation, diagnostic tools, and therapeutic strategies. This retrospective study was carried out to evaluate the epidemiological, clinical, and laboratory features of human brucellosis in Germany in the years 2002 and 2003. Thirty-one bacterial isolates from 30 patients sent to the German national reference laboratory were characterized using the genus-specific bcsp31 real-time PCR, the species-specific AMOS-PCR, and standard microbiological methods for the detection and identification of Brucella spp. The medical records of all patients with bacteriologically confirmed brucellosis were evaluated. All 31 isolates proved to be Brucella (30 Brucella melitensis and 1 Brucella suis). Most of the brucellosis patients were infected in endemic countries while visiting friends and relatives during their summer holidays. One case of laboratory-acquired infection was identified. Brucellosis was transmitted mainly by the consumption of contaminated unpasteurized milk or cheese from goats and sheep. The patients presented primarily with flu-like symptoms, i.e. fever, chills, sweating, headaches, arthralgia, and myalgia. In most cases, however, symptoms and signs of focal complications, e.g. spondylitis, endocarditis, and meningoencephalitis, predominated. The rate of complications was much higher than that in endemic countries, presumably as a result of diagnostic delay due to a low index of suspicion. In summary, physicians in nonendemic countries such as Germany must be aware of brucellosis being a possible cause of fever of unknown origin in immigrants and tourists travelling from endemic countries.
Similar content being viewed by others
References
Corbel MJ (1997) Brucellosis: an overview. Emerg Infect Dis 3:213–221
Madkour MM (2001) Epidemiological aspects. In: Madkour MM (ed) Madkour’s brucellosis. Springer, Berlin, pp 21–32
Young EJ (1995) Brucellosis: current epidemiology, diagnosis, and management. Curr Clin Top Infect Dis 15:115–128
Cloeckaert A, Verger JM, Grayon M, Paquet JY, Garin-Bastuji B, Foster G, Godfroid J (2001) Classification of Brucella spp. isolated from marine mammals by DNA polymorphism at the omp2 locus. Microbes Infect 3:729–738
Jahans KL, Foster G, Broughton ES (1997) The characterisation of Brucella strains isolated from marine mammals. Vet Microbiol 57:373–382
Sohn AH, Probert WS, Glaser CA, Gupta N, Bollen AW, Wong JD, Grace EM, McDonald WC (2003) Human neurobrucellosis with intracerebral granuloma caused by a marine mammal Brucella spp. Emerg Infect Dis 9:485–488
Young EJ (1995) An overview of human brucellosis. Clin Infect Dis 21:283–289
Cooper CW (1992) Risk factors in transmission of brucellosis from animals to humans in Saudi Arabia. Trans R Soc Trop Med Hyg 86:206–209
Al Dahouk S, Tomaso H, Nöckler K, Neubauer H (2004) The detection of Brucella spp. using PCR-ELISA and real-time PCR assays. Clin Lab 50:387–394
Baily GG, Krahn JB, Drasar BS, Stoker NG (1992) Detection of Brucella melitensis and Brucella abortus by DNA amplification. J Tropical Med Hyg 95:271–275
Bricker BJ, Halling SM (1994) Differentiation of Brucella abortus bv. 1, 2, and 4, Brucella melitensis, Brucella ovis, and Brucella suis bv. 1 by PCR. J Clin Microbiol 11:2660–2666
Al Dahouk S, Tomaso H, Nöckler K, Neubauer H, Frangoulidis D (2003) Laboratory-based diagnosis of brucellosis—a review of the literature. Part I: techniques for direct detection and identification of Brucella spp. Clin Lab 49:487–505
Alton GG, Jones LM, Angus RD, Verger JM (1988) Techniques for the brucellosis laboratory. Institut National de la Recherche Agronomique, Paris
Corbel MJ, MacMillan AP (1998) Brucellosis. In: Colloer LH, Balows A (eds) Topley & Wilson’s microbiology and microbial infections. Arnold, London, pp 2039–2068
Al Dahouk S, Tomaso H, Nöckler K, Neubauer H, Frangoulidis D (2003) Laboratory-based diagnosis of brucellosis – a review of the literature. Part II: serological tests for brucellosis. Clin Lab 49:577–589
Godfroid J, Käsbohrer A (2002) Brucellosis in the European Union and Norway at the turn of the twenty-first century. Vet Microbiol 90:135–145
Memish ZA, Balkhy HH (2004) Brucellosis and international travel. J Travel Med 11:49–55
Fosgate GT, Carpenter TE, Chomel BB, Case JT, DeBess EE, Reilly KF (2002) Time-space clustering of human brucellosis, California, 1973–1992. Emerg Infect Dis 8:672–678
White AC Jr, Atmar RL (2002) Infections in Hispanic immigrants. Clin Infect Dis 34:1627–1632
Eriksen N, Lemming L, Hojlyng N, Bruun B (2002) Brucellosis in immigrants in Denmark. Scand J Infect Dis 34:540–542
Statistisches Bundesamt Deutschland (2004) Bevölkerung nach Geschlecht und Staatsangehörigkeit. http://www.destatis.de/basis/d/bevoe/bevoetab4.php. Cited 8 July 2004
Forschungsgemeinschaft Urlaub und Reisen e.V. (2003) Die 33. Reiseanalyse RA 2003, Hamburg/Kiel. http://www.fur.de. Cited August 2003
Forschungsgemeinschaft Urlaub und Reisen e.V. (2004) Die 34. Reiseanalyse RA 2004, Hamburg/Kiel. http://www.fur.de. Cited October 2004
Taleski V, Zerva L, Kantardjiev T, Cvetnic Z, Erski-Biljic M, Nikolovski B, Bosnjakovski J, Katalinic-Jankovic V, Panteliadou A, Stojkoski S, Kirandziski T (2002) An overview of the epidemiology and epizootology of brucellosis in selected countries of Central and Southeast Europe. Vet Microbiol 90:147–155
Kilic D, Kaya I, Kamas A (2003) Distribution of inpatients by diseases at the hospital in Turkey, 2000. In: Research, Planning and Coordination Council (eds) Health statistics 2002. Ministry of Health, Ankara, Republic of Turkey, p 64
Namiduru M, Gungor K, Dikensoy O, Baydar I, Ekinci E, Karaoglan I, Bekir NA (2003) Epidemiological, clinical and laboratory features of brucellosis: a prospective evaluation of 120 adult patients. Int J Clin Pract 57:20–24
Mert A, Kocak F, Ozaras R, Tabak F, Bilir M, Kucukuglu S, Ozturk R, Aktuglu Y (2002) The role of antibiotic treatment alone for the management of Brucella endocarditis in adults: a case report and literature review. Ann Thorac Cardiovasc Surg 8:381–385
Colmenero JD, Reguera JM, Martos F, Sanchez-De-Mora D, Delgado M, Causse M, Martin-Farfan A, Juarez C (1996) Complications associated with Brucella melitensis infection: a study of 530 cases. Medicine (Baltimore) 75:195–211
Lulu AR, Araj GF, Khateeb MI, Mustafa MY, Yusuf AR, Fenech FF (1988) Human brucellosis in Kuwait: a prospective study of 400 cases. Q J Med 66:39–54
Hasanjani Roushan MR, Mohrez M, Smailnejad Gangi SM, Soleimani Amiri MJ, Hajiahmadi M (2004) Epidemiological features and clinical manifestations in 469 adult patients with brucellosis in Babol, Northern Iran. Epidemiol Infect 132:1109–1114
Memish Z, Mah MW, Al Mahmoud S, Al Shaalan M, Khan MY (2000) Brucella bacteraemia: clinical and laboratory observations in 160 patients. J Infect 40:59–63
Yinnon AM, Morali GA, Goren A, Rudensky B, Isacsohn M, Michel J, Hershko C (1993) Effect of age and duration of disease on the clinical manifestations of brucellosis. A study of 73 consecutive patients in Israel. Isr J Med Sci 29:11–16
Al-Ballaa SR, Al-Balla SR, Al-Aska A, Kambal A, Al-Hedaithy MA (1994) Seasonal variation of culture positive brucellosis at a major teaching hospital. Ann Saudi Med 14:12–15
Gur A, Geyik MF, Dikici B, Nas K, Cevik R, Sarac J, Hosoglu S (2003) Complications of brucellosis in different age groups: a study of 283 cases in southeastern Anatolia of Turkey. Yonsei Med J 44:33–44
Saltoglu N, Tasova Y, Midikli D, Aksu HS, Sanli A, Dundar IH (2004) Fever of unknown origin in Turkey: evaluation of 87 cases during a nine-year-period of study. J Infect 48:81–85
Aysha MH, Shayib MA (1986) Pancytopenia and other haematological findings in brucellosis. Scand J Haematol 36:335–338
Pappas G, Bosilkovski M, Akritidis N, Mastora M, Krteva L, Tsianos E (2003) Brucellosis and the respiratory system. Clin Infect Dis 37:e95–e99
McLean DR, Russell N, Khan MY (1992) Neurobrucellosis: clinical and therapeutic features. Clin Infect Dis 15:582–590
Yilmaz M, Ozaras R, Ozturk R, Mert A, Tabak F, Aktuglu Y (2002) Epileptic seizure: an atypical presentation in an adolescent boy with neurobrucellosis. Scand J Infect Dis 34:623–625
Dokuzoguz B, Ergonul O, Baykam N, Esener H, Kilic S, Celikbas A, Eren S, Esen B (2005) Characteristics of Brucella melitensis versus Brucella abortus bacteraemias. J Infect 50:41–45
Food and Agriculture Organization – World Health Organization (1986) Joint FAO/WHO Expert Committee on Brucellosis (6th report). WHO Technical Report Series No. 740. WHO, Geneva, pp 56–57
Food and Agriculture Organization—World Health Organization (1971) Joint FAO/WHO Expert Committee on Brucellosis (5th report). WHO Technical Report Series No. 464. WHO, Geneva, pp 34–36
Ariza J, Gudiol F, Pallares R, Viladrich PF, Rufi G, Corredoira J, Miravitlles MR (1992) Treatment of human brucellosis with doxycycline plus rifampin or doxycycline plus streptomycin. A randomized, double-blind study. Ann Intern Med 117:25–30
Solera J, RodrÃguez-Zapata M, Geijo P, Largo J, Paulino J, Sáez L, MartÃnez-Alfaro E, Sánchez L, Sepulveda MA, Ruiz-Ribó MD (1995) Doxycycline-rifampin versus doxycycline-streptomycin in treatment of human brucellosis due to Brucella melitensis. The GECMEI Group. Grupo de Estudio de Castilla-la Mancha de Enfermedades Infecciosas. Antimicrob Agents Chemother 39:2061–2067
Khan MY, Dizon M, Kiel FW (1989) Comparative in vitro activities of ofloxacin, difloxacin, ciprofloxacin, and other selected antimicrobial agents against Brucella melitensis. Antimicrob Agents Chemother 33:1409–1410
Lang R, Rubinstein E (1992) Quinolones for the treatment of brucellosis. J Antimicrob Chemother 29:357–363
Peery TM, Belter LF (1960) Brucellosis and heart disease. II. Fatal brucellosis: a review of the literature and report of new cases. Am J Pathol 36:673–697
Acknowledgements
We thank P. Bahn, A. Draeger, and C. Göllner for their excellent technical assistance and all attending physicians and microbiologists who helped to collect the data. We also thank Dr. L.D. Sprague for critical review of the manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Al Dahouk, S., Nöckler, K., Hensel, A. et al. Human brucellosis in a nonendemic country: a report from Germany, 2002 and 2003. Eur J Clin Microbiol Infect Dis 24, 450–456 (2005). https://doi.org/10.1007/s10096-005-1349-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10096-005-1349-z