Brucellosis in a patient with end-stage liver disease undergoing liver transplantation: successful treatment with tigecycline

Brucella infection combined with Nocardia infection: A case report and literature review

Human brucellosis is an infectious disease caused by Brucella and is often misdiagnosed for atypical manifestations including fever of unknown origin, headache, weakness, among else. Nocardiosis is a zoonotic disease caused by the genus Nocardia, which usually spreads through the respiratory tract, skin, and digestive tract. Limited research has documented cases of co-infection involving both Brucella and Nocardia pathogens in patients. A 55-year-old male was admitted to our hospital with intermittent high-grade fever. Following sputum and blood cultures, as well as other laboratory examinations, the patient was diagnosed with concurrent brucellosis and nocardiosis. According to recommendations of previous studies and reports, the patient was successively treated with levofloxacin, doxycycline, piperacillin sodium and sulbactam sodium, trimethoprim-sulfamethoxazole, rifampicin, and tigecycline, after which the patient recovered and was discharged. Brucella and Nocardia are both opportunistic pathogens and simultaneous infection of Brucella and Nocardia is relatively rare. If patients continue to experience persistent fever despite receiving empirical antibiotic therapy, it becomes necessary to conduct examinations to identify potential atypical pathogens, including Brucella and Nocardia. Sputum staining, sputum culture, and blood culture are critical auxiliary examinations during clinical practice. The treatment plan should be selected based on guidelines and the individual patient's condition. Regular reevaluation should be conducted, and antimicrobial agents should be adjusted accordingly.

Brucellosis After Cardiac Transplantation

Brucellosis is being increasingly recognized after solid organ transplantation but has not been reported after orthotopic heart transplantation. We present the case of a 51-year-old farmer who underwent orthotopic heart transplantation and was readmitted after 3 months in a severely immunosuppressed state with significant nonspecific complaints. He posed a diagnostic and management dilemma to all disciplines, but finally turned out to be harboring Brucella infection. He responded well to medical management and was discharged in a stable clinical status. Although rare, brucellosis should be included in the investigative workup for nonspecific symptoms after cardiac transplantation.

Tigecycline : a critical safety review

INTRODUCTION

The emergence of multidrug-resistant (MDR) infections has been extensively observed worldwide and has become a priority issue over past decade. Tigecycline , a broad spectrum antibiotic covering against many MDR organisms, has been widely used. However, recent meta-analysis studies have raised a concern for its efficacy and safety. Reviewing tigecycline safety data would enhance the appropriate use of this medication.

AREAS COVERED

This article reviews the safety profile of tigecycline, including its side effects and drug interactions.

EXPERT OPINION

The increased mortality associated with tigecycline is not yet well understood. Based on current evidence, alternative options must be prioritized over tigecycline if available. When tigecycline use is warranted, vigilant observation to identify any breakthrough infections and careful monitoring of progression of the original infection are highly recommended. Considering a second agent (either for synergism or enhancing coverage) may be required.

Brucellosis in a renal transplant recipient

Brucellosis is one of the most common systemic zoonotic diseases transmitted by consumption of unpasteurized dairy products or by occupational contact with infected animals. Brucellosis is rare in renal transplant recipients. Only 3 cases have been reported in the literature. We report a case of brucellosis with hematologic and hepatobiliary complications in a patient 3 years after renal transplantation. The mean time from transplantation to the diagnosis of brucellosis in these 4 reported patients was 5.1 years (range 17 months to 13 years). All patients had fever and constitutional symptoms, and all attained clinical cure after combination antibiotic therapy. Given the small number of patients, further study is needed to identify the characteristics of brucellosis in renal transplant recipients. Drug interactions and acute renal failure developed in our patient during antibiotic treatment. Therefore, we should monitor the levels of immunosuppressive agents frequently. Several studies have shown in vitro susceptibilities of Brucella melitensis to tigecycline. In our patient, fever finally subsided after tigecycline administration. The minimum inhibitory concentration of tigecycline using Etest was 0.094 μg/mL. Tigecycline may be a potential option for treatment of brucellosis in the setting of transplantation.

Investigation of rifampicin resistance mechanisms in Brucella abortus using MS-driven comparative proteomics

Mutations in the rpoB gene have already been shown to contribute to rifampicin resistance in many bacterial strains including Brucella species. Resistance against this antibiotic easily occurs and resistant strains have already been detected in human samples. We here present the first research project that combines proteomic, genomic, and microbiological analysis to investigate rifampicin resistance in an in vitro developed rifampicin resistant strain of Brucella abortus 2308. In silico analysis of the rpoB gene was performed and several antibiotics used in the therapy of Brucellosis were used for cross resistance testing. The proteomic profiles were examined and compared using MS-driven comparative proteomics. The resistant strain contained an already described mutation in the rpoB gene, V154F. A correlation between rifampicin resistance and reduced susceptibility on trimethoprim/sulfamethoxazole was detected by E-test and supported by the proteomics results. Using 12 836 MS/MS spectra we identified 6753 peptides corresponding to 456 proteins. The resistant strain presented 39 differentially regulated proteins most of which are involved in various metabolic pathways. Results from our research suggest that rifampicin resistance in Brucella mostly involves mutations in the rpoB gene, excitation of several metabolic processes, and perhaps the use of the already existing secretion mechanisms at a more efficient level.