Brucellosis is the most common laboratory-acquired bacterial infection, according to the Centers for Disease Control and Prevention (CDC), despite the rare incidence of Brucellosis in the population at large.
A 34-year-old man presented with pain and swelling of the left leg, where he had previously sustained an open tibia fracture one year prior. After the initial injury, he underwent 4 corrective surgeries (including bone graft and internal-fixation), and was asymptomatic for 6 months before these new symptoms developed. MRI revealed a 6.5 x 5.1 x 2.7 cm abscess and tibial osteomyelitis. Surgical staff performed an aggressive incision and drainage (I&D) with saucerization of the tibia, to treat what seemed to be a routine hardware infection. Five days later, tissue cultures grew Brucella melitensis. Upon further questioning, the patient described butchering a wild boar 10 days prior to symptom onset.
The CDC provides guidance on serological testing and post-exposure prophylaxis (PEP) for persons exposed to Brucella in the laboratory setting. Upon identification of this patient’s Brucella isolates, infection control staff identified all laboratory workers that met CDC criteria for “high risk” exposure, as well as other healthcare workers (HCW) exposed to aerosolized infectious material (including those workers in the operating room during pulse lavage of the abscess).
Staff identified 34 HCW with presumed high-risk exposure, including 19 lab personnel, 13 operating room personnel, and 2 patient care technicians. Baseline serology was obtained on all 34 HCW, and PEP with rifampin and doxycycline was prescribed for each. Nine of the exposed employees changed PEP therapy due to intolerance, and follow up serology was obtained on 32 of the 34 healthcare workers, with zero seroconversions found.
Brucellosis is a rare disease in clinical practice, so a high index of suspicion is necessary to enact appropriate precautions before widespread exposures. When exposure is identified after the fact, efficient protocols should be in place to identify all susceptible individuals. Due to the low infectious dose of Brucella melitensis, CDC guidance should be expanded to include aerosolizing procedures outside of the laboratory.
A. Novack, None
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