case 1.
a 14-years-old boy was brought to ayu general hospital, suspected of having brucellosis by local elders, who knew the diseases by its local name 'dukuba aneni', by exclusion of other endemic diseases like, malaria, typhoid, typhus, and acute meningitis.
the boy, at the out patient department, was evaluated by physical examination and laboratory investigations, which were negative for any form of infectious diseases even brucella titers of 1:640 were negative. his CBC revealed pancytopenia with relative lymphocytosis, which was consistent with brucellosis in 20% of cases, the weakness in his limbs suggested neurobrucellosis but lumbar puncture was not performed due to lack of cooperation from family members, however, the boy was again investigated for brucellosis with titers of 1:1280, a surprising result was witnessed at our department of a classic prozone phenomenon, according to literature is a manifestation of hyperantigenemia which is common in endemic areas.
the boy was admitted to the medical ward and started on anti brucella multi drug regimen and discharged improved after three days, due to financial constraints, despite medical advice to continue iv medications, the family was sent to senbete health center with the strongest advice not to discontinue his medications.
the lesson we learned was that negative titer could not rule-out brucellosis, at our teachers used to teach us 'when you are in dilemma, think of tuberculoma', now we could add 'when you are in dilemma think of brucella'.
the other thing we learned was that despite astronomic economic growth of our country, Ethiopia, we need help to be self sufficient in combating simple diseases like brucellosis.
