Brucellosis in laboratory workers at a Saudi Arabian hospital

Background: Saudi Arabia is hyperendemic for brucellosis, with more than 80 00 cases reported each year to public health authorities. During 1998, bruc ellosis ranked as the No. I reportable communicable disease (22.5%) in Saud i Arabian National Guard communities. King Fahad Hospital is the major refe rral center for National Guard personnel in the nation's central region. Methods and Results: From 1991 to 2000, brucellosis developed in 7 expatria te hospital employees. Six employees were bacteriology technologists, and o ne was a pathologist. Each had a clinical syndrome compatible with brucello sis (headache, fever, rigors, sweats, and myalgias) plus elevated Brucella sp serum agglutinin titers greater than or equal to1:1280; one patient also had positive blood cultures. All patients responded to anti-Brucella thera py. Two patients had relapses, and complications occurred in four patients (septic endophlebitis of the leg, infected prosthesis, epididymoorchitis, a nd lumbar spondylitis). In all these employees except the pathologist, the infection was associated with processing Brucella sp cultures. Conclusion: Despite the enforcement of stringent infection control measures including the use of a class II biosafety hood in the laboratory, the prob lem of nosocomial brucellosis persists because of the large number of infec ted specimens handled by the laboratory (17,500 specimens per year). Ultima tely, risk reduction depends on efforts to reduce disease endemicity in the country. In the meantime, conversion of the laboratory to biosafety level 3 is under way.