Brucellosis is a zoonosis with non-specific clinical symptoms involving multiple systems and organs. Its prevalence is low in most of EU countries, which can lead to the difficulties in laboratory and clinical diagnostic. Due to its relationship to the Ochrobactrum spp., it may be misclassified in rapid identification systems. We present a case of a 13-year-old immunocompetent girl who was examined several times for fever, fatigue, night sweats and weight loss; laboratory results showed mildly elevated C-reactive protein, anaemia and leukopenia. Four weeks before the onset of symptoms, she had been on a family holiday in Egypt. Given her symptoms, a haemato-oncological or autoimmune disease was considered more likely. The diagnosis of Brucella spondylitis was made after 4 months. The main reasons for this delay were as follows: low specificity of clinical symptoms, delay in completing the travel history, inconclusive initial serological results and misidentification of the blood culture isolate as Ochrobactrum sp. Even in countries with a low incidence of brucellosis, it is essential to educate healthcare professionals about the disease. Low specificity of symptoms and limited experience of laboratory staff may lead to late diagnosis with risk of complications and poor outcome. If Ochrobactrum spp. is detected in clinical specimens by rapid identification, careful re-evaluation must follow and all measures to prevent laboratory-acquired infections must be taken until Brucella spp. is unequivocally excluded.

Department of Infectious Diseases 2nd Faculty of Medicine Charles University and University Hospital Bulovka Prague Czech Republic

Department of Medical Microbiology 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic

Department of Pediatric Hematology and Oncology Motol University Hospital Prague Czech Republic

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Anjana A, Adhikary R, Bhavana M et al (2023) Two case reports of Ochrobactrum anthropi bacteremia: an overlooked pathogen. J Lab Physicians. https://doi.org/10.1055/s-0042-1757235 PubMed DOI

Attard L, Tadolini M, De Rose D et al (2018) Overview of fever of unknown origin in adult and paediatric patients. Clin Exp Rheumatol Suppl 110:10–24

Bardon J, Pijácek M, Harna J, Bzdil J, Vyroubalová S, Skalka P (2012) Brucella suis–a little-known zoonotic agent. Klin Mikrobiol Infekc Lek 18:53–54 PubMed

Buzgan T, Karahocagil MK, Irmak H et al (2010) Clinical manifestations and complications in 1028 cases of brucellosis: a retrospective evaluation and review of the literature. Int J Infect Dis https://doi.org/10.1016/j.ijid.2009.06.031

Çiftdoğan DY, Bayram M, Vardar F (2011) Brucellosis as a cause of fever of unknown origin in children admitted to a tertiary hospital in the Aegean region of Turkey. Vector Borne Zoonotic Dis https://doi.org/10.1089/vbz.2010.0147

Corbel MJ (2006) Brucellosis in humans and animals. Food and Agriculture Organization of the United Nations, World Health Organization & World Organisation for Animal Health. https://iris.who.int/handle/10665/43597 . Accesed 26 June 2024

Dean AS, Crump L, Greter H et al (2012) Clinical manifestations of human brucellosis: a systematic review and meta-analysis. PLoS Negl Trop Dis https://doi.org/10.1371/journal.pntd.0001929

ECDC (2023) Brucellosis. Surveillance Atlas of Infectious Diseases. https://www.atlas.ecdc.europa.eu/public/index.aspx . Accesed 19 July 2024

ECDC (2024) Brucellosis. Annual epidemiological report for 2022. European Centre for Disease Prevention and Control. https://www.ecdc.europa.eu/sites/default/files/documents/BRUC_AER_2022 . Accesed 24 June 2024

EUOH (2023) Zoonoses Report. The European Union One Health 2022. https://doi.org/10.2903/j.efsa.2023.8442 Accesed 26 June 2024

Gigi R, Flusser G, Kadar A et al (2017) Ochrobactrum anthropi-caused osteomyelitis in the foot mimicking a bone tumor: case report and review of the literature. J Foot Ankle Surg https://doi.org/10.1053/j.jfas.2017.02.008

Gopalsamy S, Ramakrishnan A, Shariff MM et al (2021) Brucellosis initially misidentified as ochrobactrum anthropi bacteremia: a case report and review of the literature. Open Forum Infect Dis https://doi.org/10.1093/ofid/ofab473

Howley F, Abukhodair S, de Barra E et al (2024) Misidentification of Brucella melitensis as Ochrobactrum species: potential pitfalls in the diagnosis of brucellosis. BMJ Case Rep https://doi.org/10.1136/bcr-2024-260072

Hubálek Z, Křivanová A, Nesvadbová J et al (2023) Zoonotic potential of Brucella microti. Vector Borne Zoonotic Dis https://doi.org/10.1089/vbz.2022.0085

Jeyaraman M, Muthu S, Sarangan P et al (2022) Ochrobactrum anthropi - an emerging opportunistic pathogen in musculoskeletal disorders - a case report and review of literature. J Orthop Case Rep https://doi.org/10.13107/jocr.2022.v12.i03.2730

Jin M, Fan Z, Gao R et al (2023) Research progress on complications of Brucellosis. Front Cell Infect Microbiol https://doi.org/10.3389/fcimb.2023.1136674

Li N, Yu F, Peng F et al (2020) Probable sexual transmission of brucellosis. IDCases https://doi.org/10.1016/j.idcr.2020.e00871

Pappas G, Akritidis N, Bosilkovski M et al (2005) Brucellosis. N Engl J Med. https://doi.org/10.1056/NEJMra050570

Poonawala H, Marrs Conner T, Peaper DR (2018) The brief case: misidentification of Brucella melitensis as Ochrobactrum anthropi by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). J Clin Microbiol https://doi.org/10.1128/JCM.00914-17

Riley DS, Barber MS, Kienle GS et al (2017) CARE guidelines for case reports: explanation and elaboration document. J Clin Epidemiol https://doi.org/10.1016/j.jclinepi.2017.04.026

Robichaud S, Libman M, Behr M et al (2004) Prevention of laboratory-acquired brucellosis. Clin Infect Dis https://doi.org/10.1086/421024

Špačková M, Koštálová J, Mandáková Z et al (2023) Brucellosis: overview of current information on the disease and analysis of human cases in the Czech Republic, 1982–2022. Pracov Lék 75:37–43

Spernovasilis N, Karantanas A, Markaki I et al (2024) Brucella spondylitis: current knowledge and recent advances. J Clin Med https://doi.org/10.3390/jcm13020595

Stiakaki E, Galanakis E, Samonis G et al (2002) Ochrobactrum anthropi bacteremia in pediatric oncology patients. Pediatr Infect Dis J https://doi.org/10.1097/00006454-200201000-00018

Tanir G, Tufekci SB, Tuygun N (2009) Presentation, complications, and treatment outcome of brucellosis in Turkish children. Pediatr Int https://doi.org/10.1111/j.1442-200X.2008.02661.x

Trepa J, Mendes P, Goncalves R et al (2018) Brucella vertebral osteomyelitis misidentified as an Ochrobactrum anthropi infection. IDCases https://doi.org/10.1016/j.idcr.2018.01.010

Unuvar G, Kilic A, Doganay M (2019) Current therapeutic strategy in osteoarticular brucellosis. North Clin Istanb https://doi.org/10.14744/nci.2019.05658

Ushakova K, Perera Lerin AI, Sahagún Pareja I et al (2020) Identification of Brucella melitensis as Ochrobactrum anthropi by MALDI-TOF MS. Rev Esp Quimioter https://doi.org/10.37201/req/009.2020

Yagupsky P, Morata P, Colmenero DJ (2019) Laboratory diagnosis of human brucellosis. Clin Microbiol Rev https://doi.org/10.1128/cmr.00073-19

Zamani A, Kooraki S, Mohazab RA et al (2011) Epidemiological and clinical features of Brucella arthritis in 24 children. Ann Saudi Med https://doi.org/10.4103/0256-4947.81543