title: Invasive human brucellosis infection in travelers to and immigrants from the Horn of Africa related to the consumption of raw camel milk.
abstract: BACKGROUND
  Brucellosis is the commonest zoonosis worldwide and typically results from ingestion of unpasteurized goat and sheep milk and cheese. Consumption of camel milk is common in the Middle East and the Horn of Africa, but is an infrequently reported source of brucellosis.
  
  
  METHODS
  We report three immigrant patients seen in one hospital system between 2007 and 2013 with brucellosis due to the consumption of camel milk.
  
  
  RESULTS
  The case patients presented after 3-14 days of symptoms following travel to countries where Brucella is endemic. All three patients were bacteremic. One patient had definite infective endocarditis, one had possible endocarditis and one patient presented with acute brucellosis. The diagnoses were made expeditiously and appropriate treatment initiated.
  
  
  CONCLUSIONS
  Knowledge of travel, local customs and immigration patterns are keys to early Brucella diagnosis and optimal treatment. Previous reports implicating camel milk as the source of Brucella infection have been limited to patients living in or traveling to and from the Middle East. This report highlights the acquisition of Brucella infection in travelers to and immigrants from the Horn of Africa related to the consumption of camel milk.
authors.affiliation: Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN 55415, United States. Electronic address: heather.arnold.1@gmail.com.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Rhodes
authors.affiliation: Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN 55415, United States; University of Minnesota, Minneapolis, MMC 196, 420 Delaware St, SE, Minneapolis, MN 55455, United States. Electronic address: dainevw43@gmail.com.
authors.forename: David N
authors.initials: DN
authors.lastname: Williams
authors.affiliation: Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN 55415, United States; University of Minnesota, Minneapolis, MMC 196, 420 Delaware St, SE, Minneapolis, MN 55455, United States. Electronic address: glen.hansen@hcmed.org.
authors.forename: Glen T
authors.initials: GT
authors.lastname: Hansen
mesh_terms: D000328:Adult; D000818:Animals; D002006:Brucellosis / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D002162:Camelus; D015730:Djibouti; D054242:Emigrants and Immigrants; D005260:Female; D006041:Goats; D006801:Humans; D008297:Male; D008892:Milk / Q000382:microbiology*; D061352:Pasteurization; D066256:Raw Foods / Q000382:microbiology*; D012756:Sheep; D014195:Travel; D055815:Young Adult; D015047:Zoonoses / Q000453:epidemiology
keywords: Africa; Brucella; Immigrant; Travel; Unpasteurized milk