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Hospital-Associated Transmission of Brucella melitensis outside the Laboratory1 - Volume 21, Number 1—January 2015 - Emerging Infectious Disease journal - CDC

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Hospital-Associated Transmission of Brucella melitensis outside the Laboratory1 - Volume 21, Number 1—January 2015 - Emerging Infectious Disease journal - CDC


Volume 21, Number 1—January 2015


Hospital-Associated Transmission of Brucella melitensis outside the Laboratory1

Christopher F. Lowe, Adrienne J. Showler, Suzette Perera, Susan McIntyre, Roohi Qureshi, Samir N. Patel, Vanessa Allen, H. Roslyn Devlin, and Matthew P. MullerComments to Author 
Author affiliations: University of Toronto, Toronto, Ontario, Canada (C.F. Lowe, A.J. Showler, R. Qureshi, S.N. Patel, V. Allen, H.R. Devlin, M.P. Muller)St. Michael’s Hospital, Toronto (S. Perera, S. McIntyre, R. Qureshi, H.R. Devlin, M.P. Muller)Li Ka Shing Knowledge Institute, Toronto (H.R. Devlin, M.P. Muller)Public Health Ontario, Toronto (S.N. Patel, V. Allen)


Brucella melitensis was identified in an aspirate obtained from a patient’s hip joint during a procedure at a hospital in Canada. We conducted an investigation into possible exposures among hospital workers; 1 worker who assisted with the procedure tested positive for B. melitensis. Aerosol-generating procedures performed outside the laboratory may facilitate transmission of this bacterium.
Brucellosis is the most common laboratory-acquired infection (1,2), and laboratory acquisition has been estimated to account for up to 2% of all Brucella infections (3). Infection rates among laboratory workers after exposure to Brucella spp. have been reported to be as high as 30% (4,5), although recent investigations have described lower attack rates (0–3.8%) (69). This difference may be the result of a broader definition of exposure, improved laboratory safety standards, and prompt administration of antimicrobial prophylaxis. Even so, laboratory personnel have experienced severe brucellosis manifestations such as osteomyelitis, meningitis, and death (9). Therefore, manipulation of Brucella isolates should occur under Biosafety Level 3 conditions. However, this practice is challenging to implement in developing countries because of lack of resources and high incidence of infection and in industrialized countries because of a low clinical suspicion for brucellosis. In response to the ongoing occurrence of laboratory exposures, the Centers for Disease Control and Prevention (CDC) issued guidelines for the identification and management of laboratory workers potentially exposed to Brucella spp., including recommendations for prophylaxis (9,10).

Dr. Lowe was a resident in medical microbiology at the University of Toronto at the time of the study. He is currently a staff medical microbiologist and infection prevention and control physician at Providence Health Care in Vancouver, British Columbia, Canada. His research interests are focused on identifying optimal methods for infection control of multidrug-resistant gram-negative organisms and hospital-acquired infections.


We thank the personnel at the microbiology laboratory at St. Michael’s Hospital.


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Suggested citation for this article: Lowe CF, Showler AJ, Perera S, McIntyre S, Qureshi R, Patel SN, et al. Hospital-associated transmission of Brucella melitensis outside the laboratory. Emerg Infect Dis [Internet]. 2015 Jan [date cited]. http://dx.doi.org/10.3201/eid2101.141247
DOI: 10.3201/eid2101.141247
1Preliminary results from this study were presented at the 2013 Association of Medical Microbiology and Infectious Disease Canada–Canadian Association for Clinical Microbiology and Infectious Diseases Annual Conference, April 3–6, 2013, Quebec City, Quebec, Canada.

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