Abstract
Brucellosis is a major worldwide bacterial zoonotic infection caused by Brucella spp. In Belgium, the disease incidence is low, and the few yearly notified cases are of imported nature. Here, we report the case of a 4-year-old Belgian boy initially diagnosed and treated for uncomplicated brucellosis, which nine months later relapsed to neurobrucellosis. Confirmatory diagnosis of the acute disease occurred end of July 2021 through a combined assessment of serology and positive blood culture. The isolated strain was identified as Brucella melitensis bv3. Antimicrobial susceptibility testing did not highlight resistant phenotypes and combination therapy of trimethoprim/sulfamethoxazole and rifampicin was administered for 6 weeks. The epidemiological investigation pointed to ‘endemic’ contamination due to regular consumption of raw-milk-derived cheeses sold within a participative Belgian market. Multiple Locus Variable-Number Tandem Repeat Analysis (MLVA) and core-genome multilocus sequence typing (cgMLST) traced back the genetic background to a clade of Sicilian strains. In June 2022, the child was re-admitted to the pediadric intensive care unit (PICU) for fever and seizures. Less than 24h after admission, when neurobrucellosis was highly suspected, he was treated with IV ceftriaxone, rifampicin, trimethoprim- sulfamethoxasone and dexamethasone with the aim to give 6 weeks of tritherapy followed by a bitherapy for a total duration of 1 year. The clinical and neurological progress was excellent and the patient was discharged on home at day 12. Our case is a call of attention to both public health authorities and clinicians. Raw milk and its products have become increasingly desirable for many European families as a natural and better nutrition food. Awareness about the hazards associated with the consumption of raw milk and its products should be promoted among end-users. On the other hand, patient management in the context of pediatric brucellosis remains challenging, given the paucity of reported data. Diagnosis of chronic cases is yet difficult and specific laboratory tests/biomarkers to confirm chronic brucellosis are needed. The surveillance of brucellosis in the food chain could be upgraded considering the growing evolution of the social economy in Belgium and the European Union.
