Objective: To highlight the ongoing presence of Brucella suis within feral swine in the southeastern U.S. and, using an illustrative case, demonstrate the ongoing potential for transmission of Brucella suis infection to human hosts from feral swine. Scope: Brucellosis is a bacterial zoonotic disease with potential for life-threatening complications including endovascular involvement and aneurysm formation. Swine-associated human brucellosis was felt previously rare since brucellosis had been eradicated in commercial swine in the U.S. However, feral swine living in the southeastern U.S. continue to serve as one of the most common reservoirs for Brucellasuis (B.suis) and therefore occupational or recreational exposure to feral swine in this area of the U.S. poses ongoing risk for Brucella infections and life-threatening brucellosis in human hosts residing in this part of the country. Results: We recently identified a case of human brucellosis in a feral swine trapper who presented with fever and respiratory symptoms. He was initially diagnosed with a pulmonary embolus, and subsequent blood cultures revealed growth of Brucella, later confirmed as B. suis. Despite initial appropriate antibiotic therapy, he maintained fever with worsening leg pain, and magnetic resonance imaging and two-dimensional echocardiography subsequently confirmed the presence of both a thrombosed popliteal artery aneurysm and mitral valve vegetation, respectively. Fortunately, the patient recovered following receipt of combination antibiotic therapy and surgical repair of the aneurysm. Multiple family members who had performed feral swine trapping with the patient, or who had received processed meat as a gift from him, were noted later to have detectable antibodies to Brucellasuis and received appropriate antibiotic prophylaxis without development of clinical illness. A review of available data revealed that a large proportion of feral swine in the southeastern U.S. are infected with Brucellasuis, and while some of these infections result in clinical illness or death for these swine, many infections are asymptomatic. Therefore, those with occupational or recreational exposure to feral swine may be largely unaware of their risk for exposure to Brucella. Conclusions: This case highlights the potential life-threatening complications of human brucellosis. It also illustrates the ongoing potential for human exposure to B. suis associated with hunting and handling of feral swine in the southeastern U.S., with need to educate the public about the risks and prevention measures associated with hunting, dressing, and preparation of feral swine.
Chris Parsons, MD, is the acting Medical Director of the Pardee Center for Infectious Diseases within the University of North Carolina Health System in the U.S. He graduated from Case Western Reserve University School of Medicine with Alpha Omega Alpha honors. He completed his internal medicine training within the Osler Medical Residency at Johns Hopkins Hospital, and his infectious diseases clinical fellowship and research training within the Division of Infectious Diseases and International Health at the University of Virginia. He has been awarded more than $10M in grant award funding from the U.S. National Institutes of Health and other foundations related to basic and translational research and clinical trials. He has received numerous teaching and research awards and has published > 50 original articles, reviews, and book chapters on a variety of infectious disease topics, including zoonotic infections. He is also the author of a recent book designed to assist community physicians with management of common infectious diseases commonly encountered in southeastern U.S.
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