• 1.

    Acha PN, Szyfres B, 2011. Brucellosis. Zoonoses and Communicable Diseases Common to Man and Animals. Washington, DC: Pan American Health Organization.

    • Search Google Scholar
    • Export Citation
  • 2.

    Mantur BG, Amarnath SK, Shinde RS, 2007. Review of clinical and laboratory features of human brucellosis. Indian J Med Microbiol 25: 188202.

  • 3.

    Gwida M, Al Dahouk S, Melzer F, Rosler U, Neubauer H, Tomaso H, 2010. Brucellosis: regionally emerging zoonotic disease? Croat Med J 51: 289295.

  • 4.

    Franco MP, Mulder M, Gilman RH, Smits HL, 2007. Human brucellosis. Lancet Infect Dis 7: 775786.

  • 5.

    Haran M, Agarwal A, Kupfer Y, Seneviratne C, Chawla K, Tessler S, 2011. Brucellosis presenting as septic shock. BMJ Case Reports. doi:10.1136/bcr.12.2010.3586.

    • Search Google Scholar
    • Export Citation
  • 6.

    Herrick JA, Lederman RJ, Sullivan B, Powers JH, Palmore TN, 2014. Brucella arteritis: clinical manifestations, treatment, and prognosis. Lancet Infect Dis 14: 520526.

    • Search Google Scholar
    • Export Citation
  • 7.

    Solis Garcia del Pozo J, Solera J, 2012. Systematic review and meta-analysis of randomized clinical trials in the treatment of human brucellosis. PLoS One 7: e32090.

    • Search Google Scholar
    • Export Citation
  • 8.

    Bayindir Y, Sonmez E, Aladag A, Buyukberber N, 2003. Comparison of five antimicrobial regimens for the treatment of brucellar spondylitis: a prospective, randomized study. J Chemother 15: 466471.

    • Search Google Scholar
    • Export Citation
  • 9.

    Bamaiyi PH, Hassan L, Khairani-Bejo S, Zainal Abidin M, Ramlan M, Adzhar A, Abdullah N, Hamidah NH, Norsuhanna MM, Hashim SN, 2015. The prevalence and distribution of Brucella melitensis in goats in Malaysia from 2000 to 2009. Prev Vet Med 119: 232236.

    • Search Google Scholar
    • Export Citation
  • 10.

    Department of Veterinary Services, 2010. Malaysian Veterinary Protocol: Melitensis Disease Available at: http://www.dvs.gov.my/documents/10157/5c0aa392-708d-4f94-bdcc-80ff39647523. Accessed April 8, 2015.

    • Search Google Scholar
    • Export Citation
  • 11.

    Jama'ayah MZ, Heu JY, Norazah A, 2011. Seroprevalance of brucellosis among suspected cases in Malaysia. Malays J Pathol 33: 3134.

  • 12.

    Hartady T, Saad MZ, Bejo SK, Salisi MS, 2014. Clinical human brucellosis in Malaysia: a case report. Asian Pac J Trop Dis 4: 150153.

  • 13.

    Sam IC, Karunakaran R, Kamarulzaman A, Ponnampalavanar S, Syed Omar SF, Ng KP, Mohd Yusof MY, Hooi PS, Jafar FL, Abubakar S, 2012. A large exposure to Brucella melitensis in a diagnostic laboratory. J Hosp Infect 80: 321325.

    • Search Google Scholar
    • Export Citation
  • 14.

    Seleem MN, Boyle SM, Sriranganathan N, 2010. Brucellosis: a re-emerging zoonosis. Vet Microbiol 140: 392398.

  • 15.

    Eales KM, Norton RE, Ketheesan N, 2010. Brucellosis in northern Australia. Am J Trop Med Hyg 83: 876878.

  • 16.

    Sewell DL, 1995. Laboratory-associated infections and biosafety. Clin Microbiol Rev 8: 389405.










Outbreak of Human Brucellosis from Consumption of Raw Goats' Milk in Penang, Malaysia

View More View Less
  • Penang General Hospital, Georgetown, Penang, Malaysia; Institute of Medical Research, Kuala Lumpur Federal Territory, Malaysia; Clinical Research Center, Penang General Hospital, Georgetown, Penang, Malaysia

We report the largest outbreak of brucellosis in Penang, Malaysia. Brucellosis is not endemic in this region. The index case was a 45-year-old goat farm owner presented with 3 weeks of fever, headache, severe lethargy, poor appetite, and excessive sweating. He claimed to have consumed unpasteurized goat's milk that he had also sold to the public. Tests were negative for tropical diseases (i.e., dengue fever, malaria, leptospirosis and scrub typhus) and blood culture showed no growth. Based on epidemiological clues, Brucella serology was ordered and returned positive. Over a period of 1 year, 79 patients who had consumed milk bought from the same farm were diagnosed with brucellosis. Two of these patients were workers on the farm. Four laboratory staff had also contracted the disease presumably through handling of the blood samples. The mean duration from onset of symptoms to diagnosis was 53 days with a maximum duration of 210 days. A combination treatment of rifampin and doxycycline for 6 weeks was the first line of treatment in 90.5% of patients. One-third of the patients had sequelae after recovering and 21% had a relapse. We highlight the importance of Brucellosis as a differential diagnosis when a patient has unexplained chronic fever.

Author Notes

* Address correspondence to Kar Nim Leong, Penang General Hospital, Residency Road, Georgetown, Penang, 10990 Malaysia. E-mail: karniml@gmail.com

Authors' addresses: Kar Nim Leong, Ting Soo Chow, and Peng Shyan Wong, Infectious Diseases Unit, Penang General Hospital, Georgetown, Penang, Malaysia, E-mails: karniml@gmail.com, tingsoochow@yahoo.com, and drwongps@yahoo.com. Siti Hawa Hamzah, Department of Microbiology, Penang General Hospital, Georgetown, Penang, Malaysia, E-mail: cthower@yahoo.com. Norazah Ahmad, Department of Microbiology, Institute of Medical Research, Kuala Lumpur Federal Territory, Malaysia, E-mail: norazah@imr.gov.my. Chin Chin Ch'ng, Clinical Research Center, Penang General Hospital, Georgetown, Penang, Malaysia, E-mail: chngcc@crc.gov.my.