title: [Undulant fever and autoimmune hemolytic anemia in a 20-year-old exchange student from Jordan - the human brucellosis as an important differential diagnosis in migrants].
abstract: METHODS
  A 20-year-old Jordanian exchange student presents with recurrent fever, night sweats, cough, and swelling and redness around the ankle. Physical examination further reveals bilateral ankle arthritis and painful cervical lymphadenopathy.
  
  
  METHODS
  Laboratory tests show signs of autoimmune hemolytic anemia, elevated liver function tests, and moderate laboratory signs of inflammation. All blood cultures reveal growth of gram-negative coccoid rods which are initially identified by mass spectrometry as Moraxella lacunata and Ochrobactrum anthropi. However, antimicrobial therapy with imipenem / cilastatin does not improve the patient's clinical condition. Based on the travel history including consumption of yogurt from unpasteurized sheep's milk, we perform serological tests with a strongly positive result for Brucella species, and additional work-up of blood culture isolates confirm the definitive diagnosis of brucellosis (Malta fever, infection by Brucella melitensis).
  
  
  METHODS
  After initiation of antimicrobial therapy with doxycycline and rifampin the patient shows complete resolution of fever. Arthritis, autoimmune hemolytic anemia and accompanying hepatitis improve in the course.
  
  
  CONCLUSIONS
  Thus, since brucellosis is endemic to countries like Jordan, it should be considered as a possible agent of fever of unknown origin especially in migrants unresponsive to empiric therapy and appropriate diagnostic tests including meticulous validation of blood cultures should be performed. Standard therapy is a combination of doxycycline with rifampin for at least 6 weeks.
authors.affiliation: Fachbereich Infektions- und Tropenmedizin, Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig.
authors.forename: Henning
authors.initials: H
authors.lastname: Trawinski
authors.affiliation: Institut für Medizinische Mikrobiologie und Infektionsepidemiologie, Universitätsklinikum Leipzig.
authors.forename: Sandra
authors.initials: S
authors.lastname: Gräber
authors.affiliation: Sektion Rheumatologie, Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig.
authors.forename: Michael
authors.initials: M
authors.lastname: Leifels
authors.affiliation: Fachbereich Infektions- und Tropenmedizin, Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schubert
authors.affiliation: Fachbereich Infektions- und Tropenmedizin, Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig.
authors.forename: Christoph
authors.initials: C
authors.lastname: Lübbert
mesh_terms: D000744:Anemia, Hemolytic, Autoimmune / Q000175:diagnosis*; D000818:Animals; D002006:Brucellosis / Q000175:diagnosis* / Q000635:transmission; D015897:Comorbidity; D003937:Diagnosis, Differential; D054242:Emigrants and Immigrants; D005516:Food Microbiology; D005858:Germany; D006801:Humans; D007393:International Educational Exchange; D007597:Jordan / Q000208:ethnology; D008297:Male; D008892:Milk / Q000382:microbiology; D061352:Pasteurization; D012756:Sheep; D015014:Yogurt / Q000382:microbiology; D055815:Young Adult