BRUCELLOSIS IN ENDEMIC AREA: FIFTEEN YEARS EXPERIENCE
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BRUCELLOSIS IN ENDEMIC AREA: FIFTEEN YEARS EXPERIENCE S. Bolukcu 1 , A. Inan 1 , S.Ç. Ozyürek 1 , S. Senbayrak Akcay 1 , O. Barkay 1 , E. Karagül 1 . Objectives Brucellosis is caused by various species of the genus Brucella, Gram-negative, facultative intracellular bacteria (coccobacillus or short rods). Each Brucella species is associated most often with certain mammalian hosts. Brucellosis is a systemic infection with a broad clinical spectrum, ranging from asymptomatic disease to severe and/or fatal illness. Brucella can involve multiple organs and tissues. Clinical and laboratory features vary widely . The main presentations are acute febrile illness with or without signs of localization, and chronic infection. We aimed to review the clinical and laboratory features of patients with brucellosis. Metods In the present study, we retrospectively evaluated demographic, clinical and laboratory data, treatment modalities of the patients with brucellosis between January 1998 and December 2012. The diagnosis of brucellosis was made by positive Wright test (titer>= 1/160) and/or by isolation of brucella in blood In the present study, we retrospectively evaluated demographic, clinical and laboratory data, treatment modalities of the patients with brucellosis between January 1998 and December 2012. The diagnosis of brucellosis was made by positive Wright test (titer>= 1/160) and/or by isolation of brucella in blood culture. Result 166 patients were included in the study, of those 85 (51,2 %) of were female and 81 (51,2 %) were male. Mean age was 44 ± 18. Seventy (42,2%) patients applied at subacute period, 72(43,4%) at acute period and 24 (14,5%) at chronic period. Eighty two (49,4%) of patients developed complications. The complications were encountered most commonly between the age 15 - 45 (n=91 54,8%). Osteoarticuler complications were the most common complication (n=35 38%) (g. Patients who were older than 45 years were not under a significant risk (p= 0,2) for complications although osteoarticular complications in this age group were more common significantly (p=0,008) and also this group were diagnosed in the chronic phase of the disease (p=0,03). Low back pain(p=0,002) and arthralgia (p=0,004) at the subacute period, nausea and vomiting at the acute period were the most common complaints (p=0,004). When laboratory tests were evaluated in terms of the period of the disease, AST and ALT levels were found significantly higher at the acute period (p=0,001 ve p=0,03) (Table 1). Incidence of fever and rash was found significantly increased in the cases who applied at acute period (p=0,001). All treatment combinations included doxycycline but one case rifampisin and streptomycin were combinated. Treatment was successful in 157 of 166 cases but relapse Conclusions Brucellosis may present with different symptoms and clinical signs. It should not be forgotten that if it is not diagnosed in time, it can advance to chronic disease in older ages and osteoarticuler complications can occur. For cases who live in endemic areas and who live in non-endemic areas with a travelling history to endemic areas presenting with complaints such as fever, rash, low back pain, nausea, vomitting brucellosis should be kept in mind. Table 1. Laboratory Findings : The Comparison of Acute, Subacute and Chronic Phases of the Disease Subacute Acute Chronic Total p n(%) n(%) n(%) n(%) Leukocytosis 3(1,8%) 3(1,8%) 1(0,6%) 7(4,2%) 0,9 Leukopenia 15(9%) 18(10,8%) 5(3%) 38(22,9%) 0,8 ESR 42(25,3%) 51(30,7%) 16(9,6%) 109(65,7%) 0,3 CRP 51(30,7%) 61(36,7%) 17(10,2%) 129(77,7%) 0,1 Thrombocytopeni a 61(36,7%) 53(31,9%) 18(10,8%) 132(79,5%) 0,1 Pancytopenia 12(7,2%) 6(3,6%) 1(0,6%) 19(11,4%) 0,1 ALT 13(7,8%) 34(20,5%) 8(4,8%) 55(33,1%) 0,001 AST 15(9%) 30(18,1%) 7(4,2%) 52(31,3%) 0,03 Anemia 49(29,5%) 53(31,9%) 14(58,3%) 116(69,9%) 0,3 Graphic 1. Complications of Brucellosis %7 %4 %4 %18 %20 %9 %38 Osteoarticuler Hepatitis Nervous system infections Pancytopenia Endocarditis Pleurisy Epididymitis-orchitis
Transcript of BRUCELLOSIS IN ENDEMIC AREA: FIFTEEN YEARS EXPERIENCE
BRUCELLOSIS IN ENDEMIC AREA: FIFTEEN YEARS EXPERIENCE S. Bolukcu1, A. Inan1, S.Ç. Ozyürek1, S. Senbayrak Akcay1, O. Barkay1, E. Karagül1.
Objectives
Brucellosis is caused by various species of the genus Brucella, Gram-negative, facultative intracellular b a c t e r i a ( c o c c o b a c i l l u s o r s h o r t rods). Each Brucella species is associated most often with certain mammalian hosts. Brucellosis is a systemic infection with a broad clinical spectrum, ranging from asymptomatic disease to severe and/or fatal illness. Brucella can involve multiple organs and tissues. Clinical and laboratory features vary widely . The main presentations are acute febrile illness with or without signs of localization, and chronic infection. We aimed to review the clinical and laboratory features of patients with brucellosis.
Metods
In the present study, we retrospectively evaluated demographic, clinical and laboratory data, treatment modalities of the patients with brucellosis between January 1998 and December 2012. The diagnosis of brucellosis was made by positive Wright test (titer>= 1/160) and/or by isolation of brucella in blood In the present study, we retrospectively evaluated demographic, clinical and laboratory data, treatment modalities of the patients with brucellosis between January 1998 and December 2012. The diagnosis of brucellosis was made by positive Wright test (titer>= 1/160) and/or by isolation of brucella in blood culture.
Result
166 patients were included in the study, of those 85 (51,2 %) of were female and 81 (51,2 %) were male. Mean age was 44 ± 18. Seventy (42,2%) patients applied at subacute period, 72(43,4%) at acute period and 24 (14,5%) at chronic period. Eighty two (49,4%) of patients developed complications. The complications were encountered most commonly between the age 15 - 45 (n=91 54,8%). Osteoarticuler complications were the most common complication (n=35 38%) (g. Patients who were older than 45 years were not under a significant risk (p= 0,2) for complications although osteoarticular complications in this age group were more common significantly (p=0,008) and also this group were diagnosed in the chronic phase of the disease (p=0,03). Low back pain(p=0,002) and arthralgia (p=0,004) at the subacute period, nausea and vomiting at the acute period were the most common complaints (p=0,004). When laboratory tests were evaluated in terms of the period of the disease, AST and ALT levels were found significantly higher at the acute period (p=0,001 ve p=0,03) (Table 1). Incidence of fever and rash was found significantly increased in the cases who applied at acute period (p=0,001). All treatment combinations included doxycycline but one case rifampisin and streptomycin were combinated. Treatment was successful in 157 of 166 cases but relapse
Conclusions
Brucellosis may present with different symptoms and clinical signs. It should not be forgotten that if it is not diagnosed in time, it can advance to chronic disease in older ages and osteoarticuler complications can occur. For cases who live in endemic areas and who live in non-endemic areas with a travelling history to endemic areas presenting with complaints such as fever, rash, low back pain, nausea, vomitting brucellosis should be kept in mind.
Table 1. Laboratory Findings : The Comparison of Acute, Subacute and Chronic Phases of the Disease
Subacute Acute Chronic Total p
n(%) n(%) n(%) n(%)
Leukocytosis 3(1,8%) 3(1,8%) 1(0,6%) 7(4,2%) 0,9
Leukopenia 15(9%) 18(10,8%) 5(3%) 38(22,9%) 0,8
ESR 42(25,3%) 51(30,7%) 16(9,6%) 109(65,7%) 0,3
CRP 51(30,7%) 61(36,7%) 17(10,2%) 129(77,7%) 0,1
Thrombocytopenia
61(36,7%) 53(31,9%) 18(10,8%) 132(79,5%) 0,1
Pancytopenia 12(7,2%) 6(3,6%) 1(0,6%) 19(11,4%) 0,1
ALT 13(7,8%) 34(20,5%) 8(4,8%) 55(33,1%) 0,001
AST 15(9%) 30(18,1%) 7(4,2%) 52(31,3%) 0,03
Anemia 49(29,5%) 53(31,9%) 14(58,3%) 116(69,9%) 0,3
Graphic 1. Complications of Brucellosis
%7%4%4
%18
%20%9
%38
OsteoarticulerHepatitisNervous system infections PancytopeniaEndocarditisPleurisyEpididymitis-orchitis
