A case of human brucellosis associated with unintentional inoculation of the animal vaccine S19

Brucellosis is a zoonotic disease caused by Brucella species that is a gram negative coccobacilli and can cause symptoms such as fever, diaphoresis, arthalgia and myalgia. Although humans become infected by contact with animals or consuming dairy products that are contaminated with Brucella, cases in which humans are infected by vaccination are rarely mentioned in the literature. Here, we present the a case of a 24-year old veterinarian who was diagnosed with brucellosis upon being exposed to Brucella abortus S19 while vaccinating a young cattle and accidentally inoculating the pathogen to the thumb of his left hand. He was admitted to the Kocaeli zel Konak hospital 36 hours after the inoculation with an edema and sensitivity to pressure in the innoculation site, while the other physical examination findings were normal. At this stage theserological tests (Rose Bengal and agglutination) were negative, while the routin biochemical tests were within normal range. In addition, samples collected from the inoculation site didn’t show any bacterial growth. Despite chemoprophylactic treatment with doxycycline, the patient developed fever, diaphoresis, and testicular pain 21 days after the contact. His body temperature was 38.3 OC and the patient complained about pain when the finger was bended during his second visit. Laboratory tests showed the aspartat aminotransferaz (AST) level was 32 U/L, alanin aminotransferaz (ALT) 25 U/L, and CRP 8.94 mg/dL. The serological tests conducted later showed that the RoseBengal and the standard serum agglutination test werepositive at 1/320, while the blood culture was negative.Based on clinical and serological findings, the patientwas diagnosed with brucellosis and treated successfullya combination of doxycycline (200 mg/day) andrifampicin (600 mg/day) for six weeks. The followingexaminations didn’t show any symptoms and no relapsewas noted. Veterinarians are at risk to be infected withBrucella during vaccination, therefore those infectedshould receive prophylactic treatment. However, postexposure prophylactic treatment won’t always preventprogress of the disease and patients need to be followedup closely.