Sir.—Brucellosis is an infectious disease caused by a gram-negative coccobacillus passed from animals to humans by airborne spread, direct contact, and ingestion of infectious animal products. Infections with the species Brucella melitensis, associated with ingestion of contaminated goat and sheep milk products, are among the most invasive.1 Brucellosis is unusual in US children, accounting for fewer than 10% of reported US cases.2 Outbreaks are rare in brucellosis-free states, and Michigan had been brucellosis free since 1980.3 We describe aningestion-associated outbreak of B melitensis infections that initially presented in a 15-year-old patient with prolonged fever and hemophagocytosis.
Patient Report.—A previously healthy 15-year-old Hispanic boy presented with a 3-week history of fever, fatigue, weight Photomicrograph of bone marrow aspirate from the 15-year-old index patient demonstrating large activated histiocytes and erythrophagocytosis. loss, myalgias, lumbosacral pain, blurred vision, and epistaxis. Physical examination revealed mild hepatomegaly and a tender spleen