1
|
Li D, Yuan G, Wang YO, Wang H, Zhang Q, Wang YA, Gu Y, Zhang H, Zhang Y, Song J, Fu Z, Lin K, Qiu C, Zhou Y, Fan M, Zhao Y, Guo J, Jiang N, Ai J, Liu H, Zhang W. Clinical Characteristics, Treatment, and Prognosis of Osteoarticular Brucellosis: A Retrospective Real-World Study in Shenyang, China, 2014-2019. Foodborne Pathog Dis 2024. [PMID: 38608217 DOI: 10.1089/fpd.2023.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Abstract
This study aimed to assess the clinical characteristics, treatment, and prognosis of osteoarticular brucellosis. We conducted a retrospective study enrolling brucellosis patients from the Sixth People's Hospital of Shenyang between September 2014 and June 2019. A total of 1917 participants were admitted during this period. After applying propensity score matching, we retrospectively analyzed 429 patients with osteoarthritis and 429 patients without osteoarthritis. The primary outcome was treatment completion. The secondary outcome was symptom disappearance and seroconversion. Brucellosis patients with osteoarthritis had longer treatment course (160 [134.3-185.7] vs. 120 [102.3-137.7] d, p = 0.008) than those without osteoarthritis. The most common involved site was lumbar vertebrae (290 [67.6%]) in brucellosis patients with osteoarthritis. Longer symptom duration (90 [83.0-97.0] vs. 42 [40.2-43.8], p < 0.001) along with no significant difference in seroconversion (180 [178.8-181.2] vs. 180 [135.1-224.9], p = 0.212) was observed in osteoarthritis patients with treatment course >90 d. Peripheral joint involvement (adjusted hazard ratio [95% confidence interval] 1.485 [1.103-1.999]; p = 0.009) had a shorter symptom duration compared with shaft joint involvement. No significant differences were observed in treatment therapy between doxycycline plus rifampin (DR) or plus cephalosporins (DRC) in treatment course (p = 0.190), symptom persistence (p = 0.294), and seroconversion (p = 0.086). Lumbar vertebra was the most commonly involved site. Even if all symptoms disappeared, Serum agglutination test potentially remained positive in some patients. Compared with peripheral arthritis, shaft arthritis was the high-risk factor for longer symptom duration. The therapeutic effects were similar between DR and DRC. In summary, our study provided important insights into the clinical characteristics, treatment, and outcomes of osteoarticular brucellosis. Clinical Trial Registration number: NCT04020536.
Collapse
Affiliation(s)
- Dan Li
- The Sixth People's Hospital of Shenyang, Shenyang, China
- Emergency Treatment and Innovation Center of Public Health Emergencies, Shenyang, China
| | - Guanmin Yuan
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan O Wang
- The Sixth People's Hospital of Shenyang, Shenyang, China
- Emergency Treatment and Innovation Center of Public Health Emergencies, Shenyang, China
| | - Hongyu Wang
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiran Zhang
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan A Wang
- The Sixth People's Hospital of Shenyang, Shenyang, China
- Emergency Treatment and Innovation Center of Public Health Emergencies, Shenyang, China
| | - Ye Gu
- The Sixth People's Hospital of Shenyang, Shenyang, China
- Emergency Treatment and Innovation Center of Public Health Emergencies, Shenyang, China
| | - Haocheng Zhang
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, China
| | - Yi Zhang
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, China
| | - Jieyu Song
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhangfan Fu
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, China
| | - Ke Lin
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, China
| | - Chao Qiu
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, China
| | - Yang Zhou
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, China
| | - Mingxiang Fan
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuanhan Zhao
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, China
| | - Jinxin Guo
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, China
| | - Ning Jiang
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, China
| | - Jingwen Ai
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, China
| | - Hongyan Liu
- The Sixth People's Hospital of Shenyang, Shenyang, China
- Emergency Treatment and Innovation Center of Public Health Emergencies, Shenyang, China
| | - Wenhong Zhang
- Department of Infectious Diseases, National Medical Center for Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Huashan Hospital, Fudan University, Shanghai, China
- Huashen Institute of Microbes and Infections, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
2
|
Mercer HL, Rodriguez D, Mikola E, Mercer D. The Septic Elbow Joint: Treatment Approaches for Improved Patient Outcomes. Orthop Clin North Am 2024; 55:247-255. [PMID: 38403370 DOI: 10.1016/j.ocl.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Septic arthritis of the elbow is a serious problem requiring prompt, accurate diagnosis and urgent surgical intervention. Achieving successful patient outcomes depends heavily on early diagnosis and efficient streamlined surgical treatment. Essential tactics for treating the septic elbow joint include immediate joint irrigation and debridement in addition to administration of appropriate antibiotics. This comprehensive review delves into the cause of the septic elbow joint, identifies associated risk factors, and provides a comprehensive approach encompassing the diagnosis and treatment of the septic elbow. The aim of this review is to optimize patient care and outcomes.
Collapse
Affiliation(s)
- Heather L Mercer
- Institute of Microbiology and Infection, School of Biosciences, University of Birmingham, Edgbaston, B15 2TT, Birmingham, England, United Kingdom
| | - Diego Rodriguez
- Department of Orthopaedics and Rehabilitation, University of New Mexico Health Sciences Center, MSC10 5600, Albuquerque, New Mexico 87131, USA
| | - Elizabeth Mikola
- Department of Orthopaedics and Rehabilitation, University of New Mexico Health Sciences Center, MSC10 5600, Albuquerque, New Mexico 87131, USA
| | - Deana Mercer
- University of New Mexico Health Sciences Center, 1 University of New Mexico MSC 10-5600, Albuquerque, New Mexico 87131, USA.
| |
Collapse
|
3
|
Miao Y, Li X. A case report of acute renal failure caused by anti-brucellosis treatment. Medicine (Baltimore) 2024; 103:e37560. [PMID: 38552041 PMCID: PMC10977587 DOI: 10.1097/md.0000000000037560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/20/2024] [Indexed: 04/02/2024] Open
Abstract
RATIONALE Rifampicin, as a main chemotherapy drug treating brucellosis, is widely used in clinical practice. Rifampicin-associated ARF is not rare, especially in those rifampicin re-exposure patients. However, this was rare complication of severe renal involvement due to multiple factors including rifampicin, nephrotoxic gentamicin, and contrast medium, and few studies have reported it. PATIENT CONCERNS A 59-year-old male presented to our hospital with acute renal failure (ARF) caused by anti-brucellosis treatment with rifampicin (675 mg/day), gentamicin (320 mg/day), and doxycycline (200 mg/day). He had a contrast-enhanced CT of the upper abdomen before the onset of. After stopping rifampicin and undergoing integrated therapy, the patient's renal function gradually recovered. DIAGNOSES Considering that the patient had a history of using rifampicin for pulmonary tuberculosis in the past, based on the examination results, the patient was diagnosed with rifampicin-associated ARF. INTERVENTIONS Symptomatic treatment such as hemodialysis, and anti-brucella treatment with doxycycline and moxifloxacin were given. OUTCOMES The patient had significant anuric and polyuric periods and acute tubular necrosis is considered. After treatment, his renal function and urine volume returned to normal, and Brucella melitensis was not isolated from blood cultures. LESSONS The case reveals that severe renal involvement due to multiple factors including rifampicin, nephrotoxic gentamicin, and contrast medium. Misdiagnosis and mistreatment can deteriorate the patient's condition. Renal function should be closely monitored in the susceptible patients. Early recognition can provide appropriate therapy to patients. If unexplained renal failure during the use of rifampicin, especially in those rifampicin re-exposure patients, rifampicin-associated ARF should be considered.
Collapse
Affiliation(s)
- Yuanyi Miao
- Department of Nephrology, Weihai Municipal Hospital, Weihai, China
| | - Xuegang Li
- Department of Nephrology, Weihai Municipal Hospital, Weihai, China
| |
Collapse
|
4
|
Yasin P, Yimit Y, Abliz D, Mardan M, Xu T, Yusufu A, Cai X, Sheng W, Mamat M. MRI-based interpretable radiomics nomogram for discrimination between Brucella spondylitis and Pyogenic spondylitis. Heliyon 2024; 10:e23584. [PMID: 38173524 PMCID: PMC10761805 DOI: 10.1016/j.heliyon.2023.e23584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
Background Pyogenic spondylitis (PS) and Brucella spondylitis (BS) are commonly seen spinal infectious diseases. Both types can lead to vertebral destruction, kyphosis, and long-term neurological deficits if not promptly diagnosed and treated. Therefore, accurately diagnosis is crucial for personalized therapy. Distinguishing between PS and BS in everyday clinical settings is challenging due to the similarity of their clinical symptoms and imaging features. Hence, this study aims to evaluate the effectiveness of a radiomics nomogram using magnetic resonance imaging (MRI) to accurately differentiate between the two types of spondylitis. Methods Clinical and MRI data from 133 patients (2017-2022) with pathologically confirmed PS and BS (68 and 65 patients, respectively) were collected. We have divided patients into training and testing cohorts. In order to develop a clinical diagnostic model, logistic regression was utilized to fit a conventional clinical model (M1). Radiomics features were extracted from sagittal fat-suppressed T2-weighted imaging (FS-T2WI) sequence. The radiomics features were preprocessed, including scaling using Z-score and undergoing univariate analysis to eliminate redundant features. Furthermore, the Least Absolute Shrinkage and Selection Operator (LASSO) was employed to develop a radiomics score (M2). A composite model (M3) was created by combining M1 and M2. Subsequently, calibration and decision curves were generated to evaluate the nomogram's performance in both training and testing groups. The diagnostic performance of each model and the indication was assessed using the receiver operating curve (ROC) with its area under the curve (AUC). Finally, we used the SHapley Additive exPlanations (SHAP) model explanations technique to interpret the model result. Results We have finally selected 9 significant features from sagittal FS-T2WI sequences. In the differential diagnosis of PS and BS, the AUC values of M1, M2, and M3 in the testing set were 0.795, 0.859, and 0.868. The composite model exhibited a high degree of concurrence with the ideal outcomes, as evidenced by the calibration curves. The nomogram's possible clinical application values were indicated by the decision curve analysis. By using SHAP values to represent prediction outcomes, our model's prediction results are more understandable. Conclusions The implementation of a nomogram that integrates MRI and clinical data has the potential to significantly enhance the accuracy of discriminating between PS and BS within clinical settings.
Collapse
Affiliation(s)
- Parhat Yasin
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Yasen Yimit
- Department of Radiology, The First People’s Hospital of Kashi Prefecture, Kashi, Xinjiang, 844000, China
| | - Dilxat Abliz
- Department of Orthopedic, The Eighth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Muradil Mardan
- Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Department of Spine Center, Shanghai, 200092, China
| | - Tao Xu
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Aierpati Yusufu
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Xiaoyu Cai
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Weibin Sheng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Mardan Mamat
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| |
Collapse
|
5
|
Zhao C, Nie S, Sun Y, An C, Fan S, Luo B, Chang W, Liu K, Shao Z. Detrended seasonal relationships and impact of climatic factors combined with spatiotemporal effect on the prevalence of human brucellosis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:104043-104055. [PMID: 37698797 DOI: 10.1007/s11356-023-29699-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/31/2023] [Indexed: 09/13/2023]
Abstract
Human brucellosis (HB) is a seasonal and climate-affected infectious disease that is posing an increasing threat to public health and economy. However, most of the research on the seasonal relationships and impact of climatic factors on HB did not consider the secular trend and spatiotemporal effect related to the disease. We herein utilized long-term surveillance data on HB from 2008 to 2020 using sinusoidal models to explore detrended relationships between climatic factors and HB. In addition, we assessed the impact of such climatic factors on HB using a spatial panel data model combined with the spatiotemporal effect. HB peaked around mid-May. HB was significantly correlated with climatic factors with 1-5-month lag when the respective correlations reached the maximum across the different lag periods. Each 0.1 °C increase in temperature led to 0.5% decrease in the 5-month lag incidence of HB. We also observed a positive spatiotemporal effect on the disease. Our study provides a detailed and in-depth overview of seasonal relationships and impact of climatic factors on HB. In addition, it proposes a novel approach for exploring the seasonal relationships and quantifying the impacts of climatic factors on various infectious diseases.
Collapse
Affiliation(s)
- Chenxi Zhao
- Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, Xi'an, 710032, China
- Department of Pediatrics, Xijing Hospital, the Fourth Military Medical University, Xi'an, China
| | - Shoumin Nie
- Department of Plague and Brucellosis, Shaanxi Center for Disease Control and Prevention, Xi'an, 710054, China
| | - Yangxin Sun
- Department of Plague and Brucellosis, Shaanxi Center for Disease Control and Prevention, Xi'an, 710054, China
| | - Cuihong An
- Department of Plague and Brucellosis, Shaanxi Center for Disease Control and Prevention, Xi'an, 710054, China
| | - Suoping Fan
- Department of Plague and Brucellosis, Shaanxi Center for Disease Control and Prevention, Xi'an, 710054, China
| | - Boyan Luo
- Department of Plague and Brucellosis, Shaanxi Center for Disease Control and Prevention, Xi'an, 710054, China
| | - Wenhui Chang
- Department of Plague and Brucellosis, Shaanxi Center for Disease Control and Prevention, Xi'an, 710054, China
| | - Kun Liu
- Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, Xi'an, 710032, China
| | - Zhongjun Shao
- Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, Xi'an, 710032, China.
| |
Collapse
|
6
|
Jeyaraman N, Jeyaraman M, Nallakumarasamy A, K S, Adhikari S, Rijal R, Asija A, Sedhai YR, Sah S, Mohanty A, Bonilla-Aldana DK, Sah R. A proposed management classification for spinal brucellosis from India. Travel Med Infect Dis 2023; 54:102614. [PMID: 37392982 DOI: 10.1016/j.tmaid.2023.102614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION The myriad presentation of osteoarticular brucellosis make the patient seek the help of general practitioners, orthopaedic and rheumatology specialists. Moreover, the lack of disease-specific symptomatology is the leading cause of the delay in diagnosing osteoarticular brucellosis. Given the increasing number of spinal brucellosis cases across the country, no literature is presented on the systematic management of spinal brucellosis. However, with our experience, we formulated a classification for managing spinal brucellosis. METHODS A single-centred prospective observational study was conducted with 25 confirmed cases of spinal brucellosis. Patients were analysed and graded clinically, serologically, and radiologically and were managed with antibiotics for 10-12 weeks, and if necessary, stabilisation and fusion were done based on the treatment classification devised. All patients were followed up to ensure disease clearance at serial follow-up with relevant investigations. RESULTS The mean age of the study participants was 52.16 ± 12.53 years. According to spondylodiscitis severity code (SSC) grading, four patients belong to grades 1, 12 to grade 2 and 9 to grade 3 at presentation. Erythrocyte sedimentation rate (p = 0.02), c-reactive protein (p < 0.001), Brucella agglutination titers (p < 0.001), and radiological outcomes improved statistically by six months. The treatment duration was individualised according to the patient's response to the treatment, with a mean time of 11.42 ± 2.66 weeks. The mean follow-up period was 14.42 ± 8 months. CONCLUSION High index of suspicion of patients from endemic regions, proper clinical assessment, serological evaluation, radiological assessment, appropriate decision-making (medical/surgical) in treatment, and regular follow-up were the key to successful comprehensive management of spinal brucellosis.
Collapse
Affiliation(s)
- Naveen Jeyaraman
- Department of Orthopaedics, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth, Chengalpet, 603108, Tamil Nadu, India
| | - Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, 600056, Tamil Nadu, India
| | - Arulkumar Nallakumarasamy
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India
| | - Shanmugapriya K
- Department of Respiratory Medicine, Sri Lalithambigai Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, 600095, Tamil Nadu, India
| | | | - Rishikesh Rijal
- Department of Gastroenterology, University of Louisville, Kentucky, USA
| | | | - Yub Raj Sedhai
- Division of Pulmonary Disease and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, USA
| | - Sanjit Sah
- Research Scientist, Global Consortium for Public Health and Research, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, 442001, India; SR Sanjeevani Hospital Kalyanpur-10, Siraha, Nepal
| | - Aroop Mohanty
- Department of Clinical Microbiology, All India Institute of Medical Sciences, Gorakhpur, 273008, Uttar Pradesh, India
| | | | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Kathmandu, 46000, Nepal; Department of Clinical Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, 411000, Maharashtra, India; Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, 411018, Maharashtra, India
| |
Collapse
|
7
|
Akkoc G, Tekerek S. Osteoarticular Involvement in Childhood Brucellosis: Evaluation of Clinical, Laboratory and Radiologic Features of 185 Cases. Pediatr Infect Dis J 2023; 42:381-388. [PMID: 36795549 DOI: 10.1097/inf.0000000000003844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUNDS Brucellosis is a systemic zoonotic disease. Osteoarticular (OA) system involvement is a common complication and the predominant manifestation of brucellosis in children. We aimed to evaluate the epidemiologic, demographic, clinical characteristics, and laboratory and radiologic findings of children with brucellosis and how these related to OA involvement. METHODS This retrospective cohort study consisted of all consecutive children and adolescents diagnosed as having brucellosis who were admitted to the pediatric infectious disease department of University of Health Sciences Van Research and Training Hospital between August 1, 2017, and December 31, 2018, in Turkey. RESULTS A total of 185 patients diagnosed as having brucellosis were evaluated, 50.8% had OA involvement (n = 94). Seventy-two patients (76.6%) exhibited peripheral arthritis involvement, among of them, hip arthritis (63.9%; n = 46) was the most common manifestation, followed by arthritis of knee (30.6%; n = 22), shoulder (4.2%; n = 3) and elbow (4.2%; n = 3). A total of 31 patients (33.0%) had sacroiliac joint involvement. Seven patients (7.4%) had spinal brucellosis. Erythrocyte sedimentation rate level above 20 mm/h at admission and age were independent predictor of OA involvement (respectively odds ratio [OR] = 2.82; 95% confidential interval [CI] = 1.41-5.64, OR peryear = 1.10; 95% CI: 1.01-1.19). Increasing age was associated types of OA involvement. CONCLUSION A half of brucellosis cases had OA involvement. These results can help physicians to make early identification and diagnosis of childhood OA brucellosis who present with arthritis and arthralgia to enable the disease to be treated in time.
Collapse
Affiliation(s)
- Gulsen Akkoc
- From the Department of Pediatric Infectious Disease, University of Health Sciences Van Research and Training Hospital Van, Van, Turkey
- Department of Pediatric Infectious Disease, University of Health Sciences, Haseki Training and Research Hospital Istanbul, Istanbul, Turkey
| | - Serhat Tekerek
- Department of Radiology, University of Health Sciences Van Research and Training Hospital Van, Van, Turkey
- Department of Radiology, University of Health Sciences Antalya Research and Training Hospital Antalya, Antalya, Turkey
| |
Collapse
|
8
|
Arockiaraj J, AlDawood M, Al Mufarriji R, Attia WI, AlMusrea KN. Brucellosis of the spine - A global public health problem - An analysis of 37 patients from a 'high risk' region. J Clin Orthop Trauma 2023; 38:102124. [PMID: 36811034 PMCID: PMC9939258 DOI: 10.1016/j.jcot.2023.102124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/30/2022] [Accepted: 02/03/2023] [Indexed: 02/05/2023] Open
Abstract
Background Brucellosis is a global public health issue. Brucellosis of the spine presents as a wide spectrum. The aim was to present the outcome analysis of patients treated for Spinal Brucellosis in the endemic region. Secondly to assess the accuracy of IgG and IgM Elisa in the diagnosis. Results A retrospective study of all patients who were treated for Brucellosis of the spine from 2010 to 2020 was conducted. Confirmed cases of Brucellosis of spine and who had adequate follow up after completion of treatment were included. The outcome analysis was based on clinical, laboratory and radiological parameters. There were 37 patients enrolled with a mean age of 45 and an average follow up of 24 months. All of them presented with pain and 30% had neurological deficits. Surgical intervention was done in 24%(9/37patients). All the patients were treated with triple drug regimen for an average duration of 6 months. Those patients with relapse had a 14month period of triple drug regimen. The sensitivity and specificity of IgM was 50% and 85.71%. The sensitivity and specificity of IgG was 81.82% and 7.69%.76% of them had good functional outcome and 82% of them had near normal neurological recovery and 97.3%(36 patients) were healed of the disease with relapse in one patient(2.7%). Conclusions Majority (76%) of the patients with Brucellosis of the spine were treated conservatively. Average duration of treatment of triple drug regimen was 6 months. The sensitivity of IgM & IgG was 50% and 81.82% The specificity of IgM and IgG was 85.71% and 7.69% respectively.
Collapse
Affiliation(s)
- Justin Arockiaraj
- Department of Spine Surgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, 11525, Kingdom of Saudi Arabia
| | - Mohammad AlDawood
- Department of Spine Surgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, 11525, Kingdom of Saudi Arabia
| | - Razan Al Mufarriji
- Department of Spine Surgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, 11525, Kingdom of Saudi Arabia
| | - Walid Ismail Attia
- Department of Spine Surgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, 11525, Kingdom of Saudi Arabia
| | - Khaled N. AlMusrea
- Department of Spine Surgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, 11525, Kingdom of Saudi Arabia
| |
Collapse
|
9
|
OGUL Y, AYYILDIZ VA, GÜZEL M, AKPINAR O, ORHAN H. Contribution to Diagnosis of Magnetic Resonance Imaging and Inflammatory Markers in Musculoskeletal Involvement of Brucellosis. KONURALP TIP DERGISI 2022. [DOI: 10.18521/ktd.1112409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
ABSTRACT
Objective: Musculoskeletal involvement in brucellosis is very important. This study aimed to evaluate the magnetic resonance imaging (MRI) findings and hematological parameters as a predictive value for the diagnosis of musculoskeletal brucellosis.
Methods: This prospective case-control study was conducted between June 2011 and November 2019 in a university hospital. Ninety-nine patients with the confirmed diagnosis of brucellosis without musculoskeletal involvement and forty-three brucellosis patients with musculoskeletal involvement were examined. The hematological, biochemical parameters, and radiological imaging findings of both groups were recorded. These parameters were statistically compared between the two groups.
Results: The mean age of the patients (non-involvement group) and musculoskeletal involvement groups was 44.04 ± 23.11 and 37.92 ± 24.80 years, respectively (P = 0.062). C-reactive protein (CRP) and alkaline phosphatase (ALP) levels were significantly higher in the musculoskeletal involvement group (P < 0.05). The lower lymphocyte level was statistically significant in this group. Based on the receiver operating characteristic (ROC) analysis, the sensitivity and specificity were 70% and 65% for ALP, 77% and 58% for CRP, 83% and 45% for lymphopenia, respectively. There was no statistically significant difference between the two groups in terms of the other hematological and biochemical parameters. Spondylodiscitis (34.8%) was the most common MRI finding in patients with musculoskeletal involvement.
Conclusions: Our study results show that CRP, ALP, and lymphopenia can be used as valuable markers in the preliminary diagnosis of musculoskeletal brucellosis.
Collapse
Affiliation(s)
| | | | | | - Orhan AKPINAR
- SÜLEYMAN DEMİREL ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ ENSTİTÜSÜ
| | | |
Collapse
|
10
|
Kazemi S, Afshar S, Karami M, Saidijam M, Keramat F, Hashemi SH, Alikhani MY. Association between risk of brucellosis and genetic variations in MicroRNA-146a. BMC Infect Dis 2021; 21:1070. [PMID: 34656082 PMCID: PMC8520608 DOI: 10.1186/s12879-021-06775-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 10/08/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Single nucleotide polymorphisms (SNPs) are the most common types of DNA changes in the human genome that leading to phenotypic differences in humans. MicroRNAs (miRNAs) are usually affected by various bacterial infections, and they are involved in controlling the immune responses. MicroRNA-146a (miR-146a) plays an essential role in the development of infectious and inflammatory diseases. The aim of the present study was to investigate the association between risk of brucellosis and genetic variations in miR-146a. METHODS This case-control study was conducted on 108 Brucellosis patients and 108 healthy controls. We genotyped two SNPs (rs2910164 and rs57095329) of the miR-146a using tetra-primer amplification refractory mutation system-polymerase chain reaction (T-ARMS-PCR) and restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR) methods. RESULTS The rs2910164 SNP was significantly associated with brucellosis in co-dominant [OR = 4.27, 95% CI = (2.35-7.79, P = 0.001] and dominant [OR = 3.52, 95% CI = (1.97-6.30, P = 0.001] models. Co-dominant (P = 0.047) and recessive (P = 0.018) models were significant at position rs57095329 between the two groups of patient and healthy. The A C haplotype (rs2910164 and rs57095329) was associated with brucellosis in the assessed population [OR (95% CI) = 1.98 (1.22-3.20), P = 0.0059]. CONCLUSIONS Consequently, our study demonstrated significant differences in genotype and haplotype frequencies of miR-146a variants between brucellosis patients and controls. Further studies on the larger sample sizes are required to verify the observed associations.
Collapse
Affiliation(s)
- Sima Kazemi
- Department of Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Saeid Afshar
- Research Center for Molecular Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Manoochehr Karami
- Department of Biostatistics and Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Massoud Saidijam
- Research Center for Molecular Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fariba Keramat
- Brucellosis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyed Hamid Hashemi
- Brucellosis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Yousef Alikhani
- Department of Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. .,Brucellosis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| |
Collapse
|
11
|
KERAMAT FARIBA, MAMANI MOJGAN, ADABI MARYAM, KHAZAEI SALMAN, SHIVAPOOR ZAHRA, KARAMI MANOOCHEHR. Establishment of brucellosis relapse and complications registry: a study protocol. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E496-E500. [PMID: 34604591 PMCID: PMC8451354 DOI: 10.15167/2421-4248/jpmh2021.62.2.1422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 05/17/2021] [Indexed: 12/04/2022]
Abstract
Brucellosis is an endemic bacterial zoonotic disease in developing countries; that is a serious public health problem in Iran. Brucellosis is a life-threatening multi-system disease in human with different clinical manifestations, complications and relapse. The incidence of brucellosis in Hamadan province, west of Iran is high. In addition, there is few reliable and population-based studies regarding relapse and complications of brucellosis in developing countries, therefore establishment of the registry system in areas with adequate occurrence of cases is needed to better understand the predictors of brucellosis relapse and complications and management of the disease. Detecting occurrence of relapse and complications over time and by geographical area provide information for further investigations and identification of health system deficiencies in the management of patients.
Collapse
Affiliation(s)
- FARIBA KERAMAT
- Brucellosis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - MOJGAN MAMANI
- Brucellosis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - MARYAM ADABI
- Brucellosis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - SALMAN KHAZAEI
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - ZAHRA SHIVAPOOR
- Vice-Chancellor for Research and Technology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - MANOOCHEHR KARAMI
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
- Correspondence: Manoochehr Karami, Fahmide St., Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, 65178-3-8736 Hamadan, Iran - Tel.: + 98 81 38380755 - E-mail:
| |
Collapse
|
12
|
SHIRZADI MOHAMMADREZA, MOHAMMADI PARVIN, MORADI GHOBAD, GOODARZI ELHAM, KHAZAEI SALMAN, MOAYED LEILI, KHAZAEI ZAHER. The Incidence and Geographical Distribution of Brucellosis in Iran Using Geographic Information System and Prediction of its Incidence in 2021. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E635-E634. [PMID: 34909491 PMCID: PMC8639131 DOI: 10.15167/2421-4248/jpmh2021.62.3.1699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 05/17/2021] [Indexed: 03/02/2023]
Abstract
BACKGROUND Brucellosis is one of the most challenging health issues in many developing countries including Iran. The purpose of this study is to investigate the incidence and geographical distribution of brucellosis using Geographic Information System (GIS) and to predict its incidence in Iran in 2021. METHOD This is a descriptive-analytical cross-sectional study, which contains spatial and climatic information along with the prevalence rate of brucellosis in Iran. Disease information was obtained from the National Center for Infectious Diseases Management during 2011-2015. Then, Arc GIS version 9.3 was used to plot the geographical maps for the incidence and frequency of the disease. Using the Raster calculator tool, the disease prediction map for the future was plotted. For proper spatial distribution of hot and cold spots, Getis-Ord-Gi statistic was employed. FINDINGS The highest incidence of brucellosis during 2009-2015 was observed in the western provinces of Iran (North Khorasan, South Khorasan and Razavi Khorasan provinces). The incidence of brucellosis in Iran decreased from 2009 to 2011 but it exhibited an increasing trend from 2011 to 2014. The provinces of Kurdistan, Lorestan, Ilam, Zanjan and Kermanshah may be among the hot spots in terms of brucellosis incidence in 2021. CONCLUSION We predicted significant variations in brucellosis risk distribution in Iran in the coming years. In the western and northwestern provinces, which are among the high risk areas for the incidence of this disease in the future, this disease can pose a serious health threat to the residents of these areas.
Collapse
Affiliation(s)
- MOHAMMAD REZA SHIRZADI
- Communicable Diseases Management Center, Ministry of Health and Medical Education, Tehran, Iran
| | - PARVIN MOHAMMADI
- Department of medical sciences, Sanandaj baranch, Islamic Azad University, Sanandaj, Iran
| | - GHOBAD MORADI
- Associate Professor, Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - ELHAM GOODARZI
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - SALMAN KHAZAEI
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - LEILI MOAYED
- Iranian Research Center on Healthy Aging, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - ZAHER KHAZAEI
- Department of Public Health, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran
- Correspondence: Zaher Khazaei (MSc), Department of Public Health, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran -
| |
Collapse
|
13
|
Arockiaraj J, Arockiaraj M, Attia WI, Almusrea KN. Brucellosis of the Spine in Children-An Analysis of 5 Children From an Endemic Setting. Int J Spine Surg 2021; 15:840-847. [PMID: 34266937 DOI: 10.14444/8108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Brucellosis of the spine is quite common among adults in endemic regions. The incidence of brucellosis of the spine affecting children is very rare. This article describes the clinical characteristics, diagnosis, management and outcome of children with brucellosis of the spine. It also aims to create awareness among all health care professionals, especially spine surgeons, regarding this rare entity. METHODS This was a retrospective study of children aged less than 15 years who were diagnosed and treated for brucellosis of the spine. Confirmed cases of brucellosis in children who had completed a full course of a triple-drug regimen as per Centers for Disease Control and Prevention (CDC) guidelines were included. Outcome analysis included both clinical and radiological measures. Clinical measures included pain, neurological status, and return to school. Resolution of the abscess and sclerosis of the involved vertebra were taken as the radiological measure. RESULTS A total of 5 children (4 boys and 1 girl) with an average age of 10 years, ranging from 6 to 14 years, fulfilled the inclusion criteria. The mean follow-up period was 32 months. All children presented with fever, back pain, and constitutional symptoms. Two of them had neurological deficits, and posttreatment, they improved to near normal neurological status. Only 1 child with an epidural abscess compressing the lumbar canal required surgical intervention. All the children were treated with a triple-drug regimen. Longer duration of treatment (14 months) was given for 2 children with history of relapse. All children were healed of the disease without any sequalae or relapse. CONCLUSIONS Blood culture and standard agglutination tests are mandatory for the diagnosis of brucellosis. Children tolerated the triple-drug regimen well. Prolonged duration of treatment was required for children with relapse. Health education to all treating health care professionals and parents is of paramount importance for treatment and control of this endemic disease.
Collapse
Affiliation(s)
- Justin Arockiaraj
- Spine Surgery Department, National Neurosciences Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Magdalenal Arockiaraj
- Paediatric Emergency Department, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Walid Ismail Attia
- Spine Surgery Department, National Neurosciences Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Khaled N Almusrea
- Spine Surgery Department, National Neurosciences Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
14
|
Serum changes in pyridinoline, type II collagen cleavage neoepitope and osteocalcin in early stage male brucellosis patients. Sci Rep 2020; 10:17190. [PMID: 33057028 PMCID: PMC7560669 DOI: 10.1038/s41598-020-72565-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 08/24/2020] [Indexed: 11/09/2022] Open
Abstract
Musculoskeletal changes are the most common clinical manifestation of brucellosis. The main objective of this study was to provide a better understanding of this disease, while also attempting to identify potential markers that can identify the early stage musculoskeletal changes associated with human brucellosis. In this case–control study, 41 male early-stage brucellosis patients (within 6 months of diagnosis) who had not received drug therapy and 44 matched controls were examined. Venous blood samples were collected and serum pyridinoline (PYD), type II collagen cleavage neoepitope (C2C) and osteocalcin (OC) levels were quantified using an enzyme-linked immunosorbent assay (ELISA). In the brucellosis group, the median serum levels of PYD (278.53 µg/L), C2C (82.23 µg/L) and OC (8.41 µg/L) were significantly elevated relative to the control group (Z = 5.686, 3.997, 3.579; P = 0.000). Serum PYD, C2C, and OC levels were increased in early-stage male brucellosis patients, and these factors appear to have promise as potential indicator biomarkers that can reflect the osteoarticular changes that occur in the early stage of human brucellosis.
Collapse
|
15
|
Brucellar Spondylitis in Kermanshah as an Endemic Area in West of Iran. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2019. [DOI: 10.5812/archcid.93707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
16
|
Kazemi S, Vaisi-Raygani A, Keramat F, Saidijam M, Soltanian AR, Alahgholi-Hajibehzad M, Hashemi SH, Alikhani MY. Evaluation of the relationship between IL-12, IL-13 and TNF-α gene polymorphisms with the susceptibility to brucellosis: a case control study. BMC Infect Dis 2019; 19:1036. [PMID: 31818255 PMCID: PMC6902342 DOI: 10.1186/s12879-019-4678-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/29/2019] [Indexed: 12/18/2022] Open
Abstract
Background The cytokine gene polymorphism is important for the genetic susceptibility of infectious diseases. The aim of the present study was to investigate the relationship between TNF-α, IL-12, and IL-13 gene polymorphisms and predisposition to brucellosis. Methods In this study, 107 patients with brucellosis and 107 healthy individuals were evaluated. The SNPs of TNF-α)- 238 G/A) and IL-12 (+ 1188 A/C) were done by amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) and IL-13 genotyping at positions − 1512 (A/C) and − 1112 (C/T) were analysis by restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR) methods. IL-12, IL-13 and TNF-α serum levels were measured by a sandwich enzyme-linked immunosorbent assay (ELISA). Results IL-13 (−1512A/C) was associated with Brucellosis risk in dominant model (OR (95% CI) = 2.17 (1.02–4.62)), P-value = 0.041. However, there was no difference in allele and genotype frequencies of TNF-α)- 238 G/A), IL-12 (+ 1188 A/C) and IL-13 [− 1512 (A/C) and − 1112 (C/T)] between patients and controls. Serum levels of IL-12 and TNF-α were significantly more frequent in the patients than in the control groups. Conclusions The IL-13 gene polymorphism can be used as a biomarker for detecting susceptibility to Brucella disease.
Collapse
Affiliation(s)
- Sima Kazemi
- Department of Microbiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Asad Vaisi-Raygani
- Department of Clinical Biochemistry, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fariba Keramat
- Brucellosis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Massoud Saidijam
- Research Center for Molecular Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Reza Soltanian
- Department of Biostatistics and Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Seyed Hamid Hashemi
- Brucellosis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Yousef Alikhani
- Department of Microbiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. .,Brucellosis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| |
Collapse
|
17
|
Current therapeutic strategy in osteoarticular brucellosis. North Clin Istanb 2019; 6:415-420. [PMID: 31909392 PMCID: PMC6936947 DOI: 10.14744/nci.2019.05658] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/02/2019] [Indexed: 01/03/2023] Open
Abstract
Brucellosis is a common zoonotic disease with high morbidity. In the majority of human cases, the causative agent is B. melitensis. Infection is transmitted to humans by direct/indirect contact with the contaminated animal products (e.g., consumption of unpasteurized milk), infectious aerosols and aborted fetus. Brucellosis often affects middle-aged adults and young people. Patients with brucellosis tend to have non-specific symptoms, including fever, chills, night sweats, joint pain and myalgia. Brucellosis affects various organs and tissues. The osteoarticular system is one of the most commonly described affected systems in humans. In several clinical studies, the prevalence of Osteoarticular Brucellosis (OB) is reported as 2-77%. Most important osteoarticular clinical forms osteomyelitis, spondylitis, sacroiliitis, arthritis and bursitis. Spondylitis and spondylodiscitis are the most frequent complications. Spondylodiscitis often affects the lumbar (especially at the L4- L5 levels) and low thoracic vertebrae than the cervical spine. Back pain and sciatica radiculopathy are the most common complaints about patients. Sacroiliitis is associated with severe pain, especially back pain in affected individuals. Spinal destructive brucellar lesions are also reported in adults in previous studies. Brucellosis is diagnosed with clinical inflammatory signs (eg. tenderness, pain) of the affected joints together with positive serological tests and positive blood/synovial fluids cultures. Serological test measures the total amount of IgM/IgG antibodies. Standard agglutination test (SAT) titer ≥1:160 is in favor of brucellosis diagnosis. Enzyme-Linked Immunosorbent Assay (ELISA) and Polymerase chain reaction (PCR) are other types of diagnostic tests. Radiological assessments, such as joint sonography, computed tomography, magnetic resonance imaging, are the most helpful radiological methods to diagnose spinal brucellosis. The agents commonly used in the treatment of brucella spondylitis are doxycycline, streptomycin, gentamicin, ciprofloxacin, trimethoprim/sulfamethoxazole and rifampicin. The recommended regimens for treatment of brucella involve two or three antibiotics combinations. No standard treatment, physicians prescribe drugs based on conditions of the disease. Patients need a long-term (usually at three months) antibiotic therapy for mainly aiming to prevent relapses. Surgery may be required for patients with spinal abscess. This review focused on physicians’ awareness for osteoarticular involvement, clinical presentation, diagnosis and current treatment of OB.
Collapse
|
18
|
Hip osteoarticular complication due to delay in diagnosis and treatment of brucellar hip arthritis: two cases report. BMC Infect Dis 2019; 19:412. [PMID: 31088383 PMCID: PMC6518787 DOI: 10.1186/s12879-019-4045-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/29/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Brucellosis is a systemic infectious disease frequently associated with osteoarticular involvement. While sacroiliitis is a common manifestation of brucellosis, septic osteoarthritis is less frequent. Here, we report two cases of septic osteoarthritis caused by Brucella melitensis. CASE PRESENTATION Both patients had a history of contact with goats before admission. Upon clinical examination, they showed marked pain and limited movement in the hip. Imaging findings revealed obvious osteonecrosis of the right femoral head. Inflammatory markers, including erythrocyte sedimentation rate and C-reactive protein level, were elevated. The tube agglutination test results of both patients were positive (1:160 and 1:200). Real-time polymerase chain reaction analysis of synovial fluid revealed the presence of B. melitensis. We deduced that septic osteoarthritis could explain these clinical and radiological findings. Both patients were followed-up for 12 months. They returned to their normal routine after completing a standard antibiotic regimen, including doxycycline (100 mg, daily) and rifampicin (600 mg), for 6 weeks. CONCLUSIONS Brucellar hip arthritis is a serious clinical manifestation of brucellosis, presenting mainly as marked joint pain and limited mobility. It is characterized by joint effusion, synovitis, and soft-tissue swelling on magnetic resonance images. Physicians should consider brucellosis as one of the differential diagnoses of arthritis.
Collapse
|
19
|
Adetunji SA, Ramirez G, Foster MJ, Arenas-Gamboa AM. A systematic review and meta-analysis of the prevalence of osteoarticular brucellosis. PLoS Negl Trop Dis 2019; 13:e0007112. [PMID: 30657765 PMCID: PMC6355028 DOI: 10.1371/journal.pntd.0007112] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 01/31/2019] [Accepted: 12/26/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Infection of bones and joints remains one of the most commonly described complications of brucellosis in humans and is predominantly reported in all ages and sexes in high-risk regions, such as the Middle East, Asia, South and Central America, and Africa. We aimed to systematically review the literature and perform a meta-analysis to estimate the global prevalence of osteoarticular brucellosis (OAB). METHODOLOGY Major bibliographic databases were searched using keywords and suitable combinations. All studies reporting the incidence and clinical manifestations of osteoarticular brucellosis in humans, and demonstrated by two or more diagnostic methods (bacteriological, molecular, serological, and/or radiographic) were included. Random model was used, and statistical significance was set at 0.05. PRINCIPAL FINDINGS A total of 56 studies met the inclusion criteria and were included in the systematic review and meta-analysis. There was an evidence of geographical variation in the prevalence of osteoarticular disease with estimates ranging from 27% in low-risk regions to 36% in high-risk regions. However, the difference was not significant. Thus, brucellosis patients have at least a 27% chance of developing osteoarticular disease. CONCLUSIONS The prevalence of OAB is not dependent on the endemicity of brucellosis in a particular region. Hence, further research should investigate the potential mechanisms of OAB, as well as the influence of age, gender, and other socioeconomic factor variations in its global prevalence, as this may provide insight into associated exposure risks and management of the disease.
Collapse
Affiliation(s)
- Shakirat A. Adetunji
- Department of Veterinary Pathobiology, Texas A&M University, College Station, Texas, United States of America
| | - Gilbert Ramirez
- School of Public Health, Texas A&M University, College Station, Texas, United States of America
| | - Margaret J. Foster
- Medical Sciences Library, Texas A&M University, College Station, Texas, United States of America
| | - Angela M. Arenas-Gamboa
- Department of Veterinary Pathobiology, Texas A&M University, College Station, Texas, United States of America
| |
Collapse
|
20
|
Balın ŞÖ, Tartar AS, Akbulut A. The predictive role of haematological parameters in the diagnosis of osteoarticular brucellosis. Afr Health Sci 2018; 18:988-994. [PMID: 30766564 PMCID: PMC6354860 DOI: 10.4314/ahs.v18i4.19] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Brucellosis is a zoonosis that affects several systems, especially with the osteoarticular involvement. OBJECTIVES This study aims to compare the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), mean platelet volume (MPV) and red blood cell distribution (RDW) in patients with the osteoarticular involvement and those with non-localised brucellosis and evaluate their predictive value for the diagnosis of osteoarticular brucellosis. METHODS We enrolled 140 patients with brucellosis, 70 with the osteoarticular involvement and 70 without any localised involvement. We collected patients' data retrospectively and compared haematological parameters between both groups. In patients with osteoarticular brucellosis, a correlation of the NLR with the ESR and CRP and correlation of the MLR with the ESR and CRP were assessed. Furthermore, the predictive performance of the ESR, CRP, NLR and MLR on the osteoarticular involvement was evaluated. RESULTS The NLR, MLR, ESR, CRP, neutrophil and monocyte levels were higher in the patient group than the control group. CONCLUSION The NLR, MLR, ESR and CRP are useful parameters to estimate the clinical course of patients with brucellosis, and the NLR and MLR are alternative to inflammatory markers in the osteoarticular involvement.
Collapse
Affiliation(s)
- Şafak Özer Balın
- Fırat University Medical Faculty Hospital, Department of Infectious Disease, Elazig, 23000, Turkey
| | - Ayşe Sağmak Tartar
- Fırat University Medical Faculty Hospital, Department of Infectious Disease, Elazig, 23000, Turkey
| | - Ayhan Akbulut
- Fırat University Medical Faculty Hospital, Department of Infectious Disease, Elazig, 23000, Turkey
| |
Collapse
|
21
|
Shi Y, Gao H, Pappas G, Chen Q, Li M, Xu J, Lai S, Liao Q, Yang W, Yi Z, Rouzi Z, Yu H. Clinical features of 2041 human brucellosis cases in China. PLoS One 2018; 13:e0205500. [PMID: 30476930 PMCID: PMC6258468 DOI: 10.1371/journal.pone.0205500] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 09/26/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Human brucellosis has become a major public health problem in China. However, the available clinical data on brucellosis cases are limited. METHODS We retrospectively reviewed medical charts of 2041 patients with confirmed human brucellosis and prospectively recorded their outcomes by telephone interview. These patients were admitted to the Sixth People's Hospital of the Xinjiang Uygur Autonomous region between 1st January and 31st December 2014. Data on these patients were collected from hospital medical records. RESULTS Many patients presented with fatigue (67%), fever (64%), arthralgia (63%) and sweating (54%). High erythrocyte sedimentation rate (ESR) (69%), high C-reactive protein (CRP) (39%), high alanine aminotransferase (ALT) (33%) and high aspartate aminotransferase (AST) (20%) were the most common laboratory findings, especially in acute patients. There was evidence of focal involvement in 90% of patients. A total of 61.5% of brucellosis patients recovered. Multivariate logistic regression analyses suggested that the risk factors key to unfavorable prognosis were: age≥45 years (OR = 1.75, 95% CI 1.36-2.24), back pain (OR = 1.50, 95% CI 1.16-1.94) and joint tenderness (OR = 1.73, 95% CI 1.13-2.65). The increasing duration of the illness increased the risk of poor prognosis. CONCLUSION Patients with brucellosis showed different characteristics in different clinical stages. In China, the chronicity rate of human brucellosis is high. The risk of poor prognosis is increased in patients aged 45 years or older, patients who have had brucellosis for a substantial period of time, and patients with back pain or joint tenderness. The clinical management of brucellosis should be improved to include sensitive diagnostic methods for subacute and chronic brucellosis.
Collapse
Affiliation(s)
- Yujing Shi
- Division of Infectious Diseases, Key Laboratory of Surveillance and Early–warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Gao
- The Sixth People's Hospital of the Xinjiang Uygur Autonomous Region, Urumqi, China
| | | | - Qiulan Chen
- Division of Infectious Diseases, Key Laboratory of Surveillance and Early–warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mei Li
- The Sixth People's Hospital of the Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Jun Xu
- The Sixth People's Hospital of the Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Shengjie Lai
- Division of Infectious Diseases, Key Laboratory of Surveillance and Early–warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Qiaohong Liao
- Division of Infectious Diseases, Key Laboratory of Surveillance and Early–warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenwen Yang
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Zhongtao Yi
- The Sixth People's Hospital of the Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Zulaguli Rouzi
- The Sixth People's Hospital of the Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Hongjie Yu
- Division of Infectious Diseases, Key Laboratory of Surveillance and Early–warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| |
Collapse
|
22
|
Liu X, Li H, Jin C, Niu G, Guo B, Chen Y, Yang J. Differentiation Between Brucellar and Tuberculous Spondylodiscitis in the Acute and Subacute Stages by MRI: A Retrospective Observational Study. Acad Radiol 2018; 25:1183-1189. [PMID: 29609954 DOI: 10.1016/j.acra.2018.01.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/24/2018] [Accepted: 01/28/2018] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to reveal the distinctive features of magnetic resonance imaging (MRI) for distinguishing brucellar spondylodiscitis (BSD) from tuberculous spondylodiscitis (TSD) in the acute and subacute stages. METHODS This study involved 14 patients with BSD and 18 patients with TSD from May 2011 to January 2015. BSD was diagnosed based on ≥1/160 titers of a Brucella agglutination test or isolation of Brucella spp. TSD was diagnosed based on the isolation of tuberculosis bacteria. All patients underwent T1- and T2-weight imaging (T1WI and T2WI) and fat suppression T2WI (FS T2WI). The height and the signal intensity (SI) of the vertebra and intervertebral disc were assessed. The distinctive MRI features were compared using the chi-square test. The SI of the vertebra between BSD and TSD was observed in terms of histogram characteristics of kurtosis, skewness, and percentile (75%-25%) on FS T2WI. RESULTS Twenty-nine (76.3%) vertebrae of BSD were infected throughout the whole vertebra, and 49 (90.7%) vertebrae of TSD were infected near the osseous end plate (P <.001). Compared to TSD, the vertebral height of BSD was nearly intact (P <.001), owing to the new bone formation in the end plate without vertebral collapse. Furthermore, significant differences in the SI of the vertebra were observed between patients with BSD and TSD in terms of homogeneous characteristics on FS T2WI, that is, kurtosis (BSD vs TSD, 0.107 vs -0.250, P = .023), skewness (BSD vs TSD, -0.021 vs 0.266, P = .017), and percentile (75%-25%) (BSD vs TSD, 54.498 vs 79.399, P = .00049). CONCLUSIONS The nearly intact vertebra with homogeneous high signal on FS T2WI was an important MRI feature for distinguishing BSD from TSD in the acute and subacute stages.
Collapse
Affiliation(s)
- Xinxin Liu
- Department of Radiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China; Department of Magnetic Resonance Imaging, Hong Hui Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Hua Li
- Department of Magnetic Resonance Imaging, Second Hospital of Yulin City, Yulin, Shaanxi Province, China
| | - Chao Jin
- Department of Radiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Gang Niu
- Department of Radiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
| | - Baoqin Guo
- Department of Magnetic Resonance Imaging, Second Hospital of Yulin City, Yulin, Shaanxi Province, China
| | - Yi Chen
- Department of Magnetic Resonance Imaging, Second Hospital of Yulin City, Yulin, Shaanxi Province, China
| | - Jian Yang
- Department of Radiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
| |
Collapse
|
23
|
Patra S, Ke V, Tellapragada C, Mukhopadhyay C. Human brucellosis: Experience from a tertiary care hospital in southern India. Trop Doct 2018; 48:368-372. [PMID: 30149785 DOI: 10.1177/0049475518788467] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of our study was to examine and compare the clinical presentations, complications, laboratory findings, treatment and outcome of patients with acute, subacute and chronic forms of brucellosis in a tertiary care setting. This hospital-based observational study was undertaken between April 2015 and March 2017. Patients diagnosed with brucellosis, either by blood culture and/or serology, were recruited. A total of 94 cases of brucellosis of acute, subacute and chronic forms were observed in 78.7%, 15.9% and 5.3%, respectively. Blood culture grew Brucella spp. in 70.2% cases. Serological tests showed positivity in 96.8% of the patients. Using multivariate logistic regression analysis, fever and upper back pain were significant predictors for both acute and chronic forms of the disease, respectively. There is a need to increase awareness and understand the local sero-epidemiological pattern of brucellosis as it is still little known.
Collapse
Affiliation(s)
- Sudipta Patra
- 1 PhD Scholar, Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vandana Ke
- 2 Professor, Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Chaitanya Tellapragada
- 3 Assistant Professor, Manipal Centre for Virus Research, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Chiranjay Mukhopadhyay
- 4 Professor, Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
24
|
Abstract
Septic arthritis refers to an infection in a joint due to a bacterial, mycobacterial, or fungal cause. Joint infections are a serious cause of morbidity and mortality and constitute a true musculoskeletal emergency. The estimated incidence of septic arthritis in the general population is between 2 and 6 cases per 100,000 people per year. The most common presentation is an acute monoarthritis. Identification of organisms in the synovial fluid is the criterion standard for diagnosis. Synovial fluid aspiration should be performed prior to initiating antibiotics. While no diagnostic cutoff exists for synovial fluid white blood cell count, increasing leukocytosis is associated with a higher likelihood of an infectious cause of arthritis, and patients commonly present with values greater than 50,000/μL. The cornerstones of treating septic bacterial arthritis are adequate drainage and antimicrobials. Joint drainage is always recommended in septic arthritis; however, no clear guidelines or strong evidence exist to guide the preferred method of drainage. Options for joint drainage include daily needle aspiration, arthroscopy, or open surgical drainage via arthrotomy.
Collapse
|
25
|
Majzoobi MM, Hashemi SH, Mamani M, Keramat F, Poorolajal J, Ghasemi Basir HR. Effect of hydroxychloroquine on treatment and recurrence of acute brucellosis: a single-blind, randomized clinical trial. Int J Antimicrob Agents 2017; 51:365-369. [PMID: 28826825 DOI: 10.1016/j.ijantimicag.2017.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/09/2017] [Accepted: 08/01/2017] [Indexed: 12/25/2022]
Abstract
Brucellosis is associated with a high recurrence rate and requires more than one course of standard treatment; therefore, more research is required to find more effective treatments that lead to prompt recovery, and reduce the relapse of disease. This single-blind, randomized study was designed to evaluate the effect of the standard treatment for brucellosis in combination with hydroxychloroquine. A total of 177 patients with acute brucellosis were randomly assigned to one of two treatment groups: doxycycline-streptomycin (DS) and doxycycline-streptomycin-hydroxychloroquine (DSH). Clinical symptoms and signs, serological tests, and side effects of therapy were compared between the two groups during the treatment course and at three and six months after the end of drug therapy. Of the 177 patients, with a mean age of 40.5 ± 16.9 years, 66.1% were males. The mean duration of clinical signs prior to admission was 43.4 ± 41.1 days. Appropriate clinical responses, relapse, treatment failure, and adverse drug reactions were seen in 98.9%, 1.2%, 0.0%, and 12.6% of patients, respectively, in the DSH group vs. 86.7%, 11.6%, 2.3%, and 19.8% of patients, respectively, in the DS group. There were significant differences in clinical response and relapse rates between the two groups. The addition of hydroxychloroquine to a doxycycline-streptomycin regimen appears to increase the efficacy of treatment, accelerate improvement of clinical symptoms, and significantly reduce the rate of relapse of brucellosis.
Collapse
Affiliation(s)
| | - Seyyed Hamid Hashemi
- Brucellosis Research Centre, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mojgan Mamani
- Brucellosis Research Centre, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Fariba Keramat
- Brucellosis Research Centre, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Jalal Poorolajal
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | | |
Collapse
|
26
|
Epidemiology of brucellosis in Iran: A comprehensive systematic review and meta-analysis study. Microb Pathog 2017; 109:239-247. [DOI: 10.1016/j.micpath.2017.06.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/03/2017] [Accepted: 06/06/2017] [Indexed: 12/30/2022]
|
27
|
Naseri Z, Alikhani MY, Hashemi SH, Kamarehei F, Arabestani MR. Prevalence of the Most Common Virulence-Associated Genes among Brucella Melitensis Isolates from Human Blood Cultures in Hamadan Province, West of Iran. IRANIAN JOURNAL OF MEDICAL SCIENCES 2016; 41:422-9. [PMID: 27582592 PMCID: PMC4967487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Brucellosis is a widespread zoonotic disease causing considerable economic and public health problems. Despite animal vaccination, brucellosis remains endemic in some areas such as Iran, especially in the western Iranian province of Hamadan. We sought to detect some of the most common virulence-associated genes in Brucella isolated from human blood cultures to determine the prevalence of some virulence genes among Brucella isolates. Fifty-seven isolates were studied from patients with a clinical diagnosis of brucellosis who referred to the Infectious Diseases Ward of Sina Hospital in Hamadan Province, Iran, between April 2013 and July 2014. Blood samples were collected for the diagnosis of brucellosis using the BACTEC blood culture system. All of these isolates were confirmed by the bcsp31 Brucella-specific gene. We detected 11 virulence-associated genes of Brucella, namely cβg, virB, znuA, ure, bvfA, omp25, omp31, wbkA, mviN, manA, and manB, which are important for the pathogenesis of this bacterium in the intracellular environment by multiplex PCR. Totally, 149 patients with a clinical diagnosis of brucellosis were enrolled in this study. Fifty-seven (38.3%) patients had positive blood cultures. On biochemical and molecular testing, all of the isolates were Brucella melitensis. Ten of the virulence genes were detected among all of the 57 isolates, but the bvf gene was detected in 53 (93%) isolates. The high prevalence of virulence-associated genes among the Brucella isolates detected in Hamadan Province, Iran, underscores the pathogenicity of this bacterium in this region.
Collapse
Affiliation(s)
- Zahra Naseri
- Brucellosis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Yousef Alikhani
- Department of Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyed Hamid Hashemi
- Brucellosis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farideh Kamarehei
- Department of Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Reza Arabestani
- Department of Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| |
Collapse
|
28
|
Torkaman Asadi F, Hashemi SH, Alikhani MY, Moghimbeigi A, Naseri Z. Clinical and Diagnostic Aspects of Brucellosis and Antimicrobial Susceptibility of Brucella Isolates in Hamedan, Iran. Jpn J Infect Dis 2016; 70:235-238. [PMID: 27580575 DOI: 10.7883/yoken.jjid.2016.133] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Current drug regimens for brucellosis are associated with relatively high rates of therapeutic failure or relapse. Reduced antimicrobial susceptibility of Brucella spp. has been proposed recently as a potential cause of therapeutic failure. The aim of this study was to evaluate the antibiotic resistance pattern of Brucella melitensis clinical isolates by E-test method in Hamadan, west of Iran. In a 15-month period, all patients with suspected brucellosis were enrolled. Blood specimens were collected for diagnosis of brucellosis by BACTEC system and serological tests. Antimicrobial susceptibility of clinical isolates to 7 antibiotics was assessed by the E-test method. One hundred forty-nine patients with brucellosis were evaluated. 38.3% of cultures of clinical samples were positive for BACTEC system, of which 91.2% were associated with a positive serological test result. No significant associations were found between serology and the culture method. All Brucella isolates were susceptible to doxycycline, streptomycin, gentamicin, ciprofloxacin, and moxifloxacin. However, decreased sensitivity to rifampin and trimethoprim-sulfamethoxazole was found in 35.1% and 3.5% of isolates, respectively. Because of the high rates of intermediate sensitivity to rifampin among Brucella isolates, this drug should be prescribed with caution. We recommend restricting the use of rifampin for treatment of brucellosis except as an alternative drug for special situations.
Collapse
Affiliation(s)
- Fatemeh Torkaman Asadi
- Brucellosis Research Center, Hamedan University of Medical Sciences.,Blood Transfusion Research Center, High Institute for Research; Education in Transfusion
| | - Seyyed Hamid Hashemi
- Brucellosis Research Center, Hamedan University of Medical Sciences.,Division of Infectious Diseases, Sina Hospital
| | | | | | - Zahra Naseri
- Blood Transfusion Research Center, High Institute for Research; Education in Transfusion
| |
Collapse
|
29
|
Gheita TA, Sayed S, Azkalany GS, El Fishawy HS, Aboul-Ezz MA, Shaaban MH, Bassyouni RH. Subclinical sacroiliitis in brucellosis. Clinical presentation and MRI findings. Z Rheumatol 2016; 74:240-5. [PMID: 25090956 DOI: 10.1007/s00393-014-1465-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE The aim of this work was to detect subclinical sacroiliac joint involvement in patients with brucellosis and study their clinical and laboratory features. PATIENTS AND METHODS The study included 100 brucellosis patients being followed-up in the Gastroenterology and Hepatology Unit, Theodor Bilharz Research Institute and Cairo University outpatient clinics. A thorough history, physical examination, routine laboratory tests, and abdominal ultrasound were obtained for all patients. Extended rheumatological examination was performed including clinical testing for sacroiliitis and enthesitis. None of the patients reported a history of back pain or any symptoms suggestive of sacroiliitis during the course of the infection. Plain x-ray and MRI scan of the sacroiliac joints were performed for all patients. RESULTS Asymptomatic sacroiliitis was present in 24 % of the brucellosis patients; none of the patients had tenderness over their spine with preserved lumbar spine mobility. Sacroiliitis was mainly unilateral being bilateral in 20.83 %. There was an obvious relationship with animal contact and occupation of the patients. Osteoarticular involvement was common (67 %) including arthralgias, arthritis, myalgias, spondylitis, enthesitis and bursitis, being clearly higher in those with sacroiliitis. The MRI scan showed blurring of the margins in 66.67 %, widening in 25 %, narrowing in 54.17 %, erosions in 20.83 %, and sclerosis in 12.5 %. CONCLUSION Osteoarticular manifestations of brucellosis are prevalent and subclinical sacroiliitis is evident, a finding that may classify these patients as having brucellar spondyloarthropathy (BSA). Referring brucellosis patients for rheumatological assessment has the advantage of early assessment of asymptomatic cases with sacroiliitis which is commonly overlooked.
Collapse
Affiliation(s)
- T A Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt,
| | | | | | | | | | | | | |
Collapse
|
30
|
Aouad P, Serhal A, Bleibel L, Haidar M, Mohanna A. Brucella osteomyelitis of the pubic bones. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2015.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
31
|
Kayaaslan B, Bastug A, Aydin E, Akinci E, But A, Aslaner H, Yetkin MA, Bodur H. A long-term survey of brucellosis: Is there any marker to predict the complicated cases? Infect Dis (Lond) 2015; 48:215-21. [PMID: 26568367 DOI: 10.3109/23744235.2015.1107187] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aimed to find markers to predict complicated cases in brucellosis. Patients with and without complications were compared in terms of epidemiological, clinical and laboratory properties. METHODS A total of 700 patients hospitalised at the Department of Infectious Diseases and Clinical Microbiology were evaluated retrospectively. RESULTS Of a total of 700 patients, 383 (54.7%) were male and mean age was 41.5 ± 17.0 years. Of the patients, 517 (73.8%) were classified as acute cases. Complications occurred significantly less frequently in acute infections (p < 0.001). Increased C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) occurred more frequently in patients with complicated cases (p = 0.005 and 0.021, respectively), whereas malaise, myalgia and blood culture positivity occurred significantly less frequently in those cases (p < 0.001, < 0.001 and 0.014, respectively). Fever at examination, loss of malaise and myalgia and blood culture negativity were statistically significant predictive factors for complicated patients in multivariate analysis (p < 0.001, for each). As compared to patients without orchitis, leukocytosis occurred more often in cases with orchitis (p < 0.001); leukopenia occurred more often in neurobrucellosis than in cases without neurobrucellosis (p = 0.008). Of patients who attended control regularly, 422 (98%) were treated successfully. All of the nine patients who did not recover fully were cases with osteoarticular involvement. CONCLUSIONS Fever was the most significant predictive marker of complications. Other classical symptoms of brucellosis like myalgia and malaise were absent in most of the complicated cases. Blood culture was of limited value in the diagnosis of complicated cases most of the time.
Collapse
Affiliation(s)
- Bircan Kayaaslan
- a Department of Infectious Diseases and Clinical Microbiology , Yıldırım Beyazıt University, Faculty of Medicine, Ankara Atatürk Education and Research Hospital , Ankara , Turkey
| | - Aliye Bastug
- b Department of Infectious Diseases and Clinical Microbiology , Ankara Numune Education and Research Hospital , Ankara , Turkey
| | - Emsal Aydin
- c Department of Infectious Diseases and Clinical Microbiology , Kafkas University, Faculty of Medicine , Kars , Turkey
| | - Esragul Akinci
- b Department of Infectious Diseases and Clinical Microbiology , Ankara Numune Education and Research Hospital , Ankara , Turkey
| | - Ayse But
- b Department of Infectious Diseases and Clinical Microbiology , Ankara Numune Education and Research Hospital , Ankara , Turkey
| | - Halide Aslaner
- b Department of Infectious Diseases and Clinical Microbiology , Ankara Numune Education and Research Hospital , Ankara , Turkey
| | - Meltem Arzu Yetkin
- b Department of Infectious Diseases and Clinical Microbiology , Ankara Numune Education and Research Hospital , Ankara , Turkey
| | - Hurrem Bodur
- b Department of Infectious Diseases and Clinical Microbiology , Ankara Numune Education and Research Hospital , Ankara , Turkey
| |
Collapse
|
32
|
Kazak E, Akalın H, Yılmaz E, Heper Y, Mıstık R, Sınırtaş M, Özakın C, Göral G, Helvacı S. Brucellosis: a retrospective evaluation of 164 cases. Singapore Med J 2015; 57:624-629. [PMID: 26768063 DOI: 10.11622/smedj.2015163] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Brucellosis is a public health problem that is prevalent in several developing countries. METHODS The clinical and laboratory characteristics of 164 cases of brucellosis in Bursa, Turkey, were retrospectively evaluated. RESULTS The ages of the 164 patients ranged from 15-85 years. All of the patients underwent the Rose Bengal test and 163 (99.4%) patients tested positive. 122 (74.4%) patients were diagnosed with acute brucellosis, 31 (18.9%) with subacute brucellosis and 11 (6.7%) with chronic brucellosis. Focal involvement was found in 101 (61.6%) patients. Although patients with focal involvement had a higher white blood cell count (p = 0.002), those without focal involvement had higher aspartate transaminase and alanine transaminase values, and lower platelet values (p = 0.005, 0.007 and 0.039, respectively). Spondylodiscitis was observed on imaging in 58 (66.7%) of the 87 patients who presented with back pain. Among the 118 patients who were examined within the first month of treatment, 79 (66.9%) responded to treatment. The relapse rate was 11.6% among all 164 patients. CONCLUSION Brucellosis should be considered as a differential diagnosis among patients who present with fever, and joint or back pain. Focal involvement should be investigated in the presence of leucocytosis, and subacute or chronic forms of brucellosis. To identify cases of spondylodiscitis, radiography should be performed in patients who present with back pain.
Collapse
Affiliation(s)
- Esra Kazak
- Infectious Diseases and Clinical Microbiology Department, Uludag University Medical School, Bursa, Turkey
| | - Halis Akalın
- Infectious Diseases and Clinical Microbiology Department, Uludag University Medical School, Bursa, Turkey
| | - Emel Yılmaz
- Infectious Diseases and Clinical Microbiology Department, Uludag University Medical School, Bursa, Turkey
| | - Yasemin Heper
- Infectious Diseases and Clinical Microbiology Department, Uludag University Medical School, Bursa, Turkey
| | - Reşit Mıstık
- Infectious Diseases and Clinical Microbiology Department, Uludag University Medical School, Bursa, Turkey
| | - Melda Sınırtaş
- Medical Microbiology Department, Uludag University Medical School, Bursa, Turkey
| | - Cüneyt Özakın
- Medical Microbiology Department, Uludag University Medical School, Bursa, Turkey
| | - Güher Göral
- Medical Microbiology Department, Uludag University Medical School, Bursa, Turkey
| | - Safiye Helvacı
- Infectious Diseases and Clinical Microbiology Department, Uludag University Medical School, Bursa, Turkey
| |
Collapse
|
33
|
Nannyonga B, Mwanga GG, Luboobi LS. An optimal control problem for ovine brucellosis with culling. JOURNAL OF BIOLOGICAL DYNAMICS 2015; 9:198-214. [PMID: 26105034 DOI: 10.1080/17513758.2015.1056845] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A mathematical model is used to study the dynamics of ovine brucellosis when transmitted directly from infected individual, through contact with a contaminated environment or vertically through mother to child. The model developed by Aïnseba et al. [A model for ovine brucellosis incorporating direct and indirect transmission, J. Biol. Dyn. 4 (2010), pp. 2-11. Available at http://www.math.u-bordeaux1.fr/∼pmagal100p/papers/BBM-JBD09.pdf. Accessed 3 July 2012] was modified to include culling and then used to determine important parameters in the spread of human brucellosis using sensitivity analysis. An optimal control analysis was performed on the model to determine the best way to control such as a disease in the population. Three time-dependent controls to prevent exposure, cull the infected and reduce environmental transmission were used to set up to minimize infection at a minimum cost.
Collapse
Affiliation(s)
- B Nannyonga
- a Department of Mathematics , Makerere University , PO Box 7062 , Kampala , Uganda
| | | | | |
Collapse
|
34
|
Koubaa M, Maaloul I, Marrakchi C, Lahiani D, Hammami B, Mnif Z, Ben Mahfoudh K, Hammami A, Ben Jemaa M. Spinal brucellosis in South of Tunisia: review of 32 cases. Spine J 2014; 14:1538-44. [PMID: 24331843 DOI: 10.1016/j.spinee.2013.09.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 08/31/2013] [Accepted: 09/19/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Brucellosis remains an important economic and public health problem in some parts of the world. The spine is the most common site of musculoskeletal involvement of brucellosis. PURPOSE Assess the clinical, laboratory, radiological findings, and outcomes of vertebral involvement in brucellosis. STUDY DESIGN A retrospective study. PATIENT SAMPLE Thirty-two patients with spinal brucellosis during a period of 21 years (1990-2010) were included. OUTCOME MEASURES Clinical and radiological improvement. METHODS Diagnosis made on clinical presentation, laboratory findings, radiographic evidence, and the Brucellar etiology was considered when seroagglutination tests were positive at a titer of 1/160 or higher, and/or Brucella spp were isolated in the blood or sample cultures. RESULTS The mean age of patients was 51±15.85 years (23 males, 9 females; age range, 19-74 years). The median diagnostic delay was 3 months. Back or neck pain (100% of patients), fever (78%), and sweats (68.6%) were the most common symptoms. Cultures of blood specimens from five patients (15.6%) were positive for Brucella melitensis. Four patients (12.5%) had motor weakness or paralysis. Magnetic resonance imaging was performed in 24 (75%) cases. Paravertebral masses, epidural masses, and psoas abscesses were detected in 65.6%, 59.4%, and 28.1% of patients, respectively. The lumbar vertebra was the most frequently involved region with the rate of 68.7%, followed by thoracal (18.7%), cervical (6.3%), lumbosacral (6.3%), and thoracolumbar (3.1%) segments. The duration of antimicrobial therapy of brucellosis (median, 6 months; range, 3-13 months) varied according to clinical response and the presence of epidural and paravertebral masses. There were no deaths or severe sequelae in this study. CONCLUSIONS Brucellar spondylitis should be considered in patients with back pain and fever in endemic areas. A high index of suspicion and clinical, laboratory, and radiological examinations help to confirm the diagnosis of vertebral involvement.
Collapse
Affiliation(s)
- Makram Koubaa
- Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax 3029, Tunisia.
| | - Imed Maaloul
- Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax 3029, Tunisia
| | - Chakib Marrakchi
- Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax 3029, Tunisia
| | - Dorra Lahiani
- Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax 3029, Tunisia
| | - Boussaima Hammami
- Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax 3029, Tunisia
| | - Zeinab Mnif
- Department of Radiology, Hedi Chaker and Habib Bourguiba University Hospital, Sfax 3029, Tunisia
| | - Kaireddine Ben Mahfoudh
- Department of Radiology, Hedi Chaker and Habib Bourguiba University Hospital, Sfax 3029, Tunisia
| | - Adnane Hammami
- Department of Microbiology, Habib Bourguiba University Hospital, Sfax 3029, Tunisia
| | - Mounir Ben Jemaa
- Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax 3029, Tunisia
| |
Collapse
|
35
|
Serum annexin A2 levels in acute brucellosis and brucellar spondylodiscitis. Eur J Clin Microbiol Infect Dis 2014; 33:1855-9. [DOI: 10.1007/s10096-014-2155-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 05/05/2014] [Indexed: 11/27/2022]
|
36
|
Magnetic resonance imaging findings of musculoskeletal brucellosis. Clin Imaging 2014; 38:719-23. [PMID: 24849195 DOI: 10.1016/j.clinimag.2014.04.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/18/2014] [Accepted: 04/14/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this retrospective study was to determine the magnetic resonance imaging (MRI) findings of patients with musculoskeletal brucellosis. MATERIALS AND METHODS Sixty-eight among 304 patients with musculoskeletal brucellosis, aged 12-82 years (average, 50.2 years), were included in the study. Patients were diagnosed based on clinical findings, Brucella agglutination tests, and MRI findings. MRI was performed to all of the patients with sacroiliitis, spondylitis-spondylodiscitis, and peripheral arthritis. RESULTS Brucella serum agglutination test was >1/160 in all cases and blood cultures were positive in twelve cases. The most commonly affected site was the spine (57.3%), wherein lumbar vertebrae were found to be most commonly affected. The second most common affected site was sacroiliac joint (26.4%), whereas peripheral joints were affected in 11 cases (16.1%). CONCLUSION Brucellosis may affect various sites in musculoskeletal system. The spine was the most frequently affected site in our study. Sacroiliac joints and the other peripheral joints were less commonly involved sites. Brucellosis should be included in the differential diagnosis of a patient with arthralgia or symptoms of musculoskeletal system disorders especially in endemic areas.
Collapse
|
37
|
Ekici MA, Ozbek Z, Kazancı B, Güçlü B. Collapsed L4 vertebral body caused by brucellosis. J Korean Neurosurg Soc 2014; 55:48-50. [PMID: 24570819 PMCID: PMC3928349 DOI: 10.3340/jkns.2014.55.1.48] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Revised: 06/26/2013] [Accepted: 12/16/2013] [Indexed: 11/27/2022] Open
Abstract
Brucellosis is caused by gram-negative, aerobic, non-motile, facultative, intracellular coccobacilli belonging to the genus Brucella. A 50-year-old man working as an employee was admitted to neurosurgery clinic with severe low back, radicular right leg pain and hypoesthesia in right L4-5 dermatomes for 2 months. Brucella tube agglutination (Wright) test was positive in serum sample of the patient with a titer of 1/640. Brucella melitensis was isolated from blood culture. X-ray and MRI of the lomber spine showed massive collapse of L4 vertebral body. Neural tissue was decompressed and then posterior L3-5 short segment transpedicular screw fixation and stabilization was performed. Brucella melitensis was isolated from microbiologic culture of pathologic specimen. Antibiotic therapy was given as doxycycline 200 mg/day and rifampicin 600 mg/day for 6 months. Brucellosis is a systemic zoonotic infection and still an important public health problem in many geographical parts of the world. Vertebral body collapse caused by brucellosis occurs very rarely but represents a neurosurgical emergency because of its potential for causing rapidly progressive spinal cord compression and permanent paralysis. Neurosurgeons, emergency department personnel as well as infectious disease specialists should always keep a high index of suspicion and include brucellosis in the differential diagnosis of vertebral body collapse.
Collapse
Affiliation(s)
- Mehmet Ali Ekici
- Department of Neurosurgery, Şevket Yılmaz Training and Research Hospital, Bursa, Turkey
| | - Zühtü Ozbek
- Department of Neurosurgery, Yunus Emre State Hospital, Eskişehir, Turkey
| | - Burak Kazancı
- Department of Neurosurgery, Şevket Yılmaz Training and Research Hospital, Bursa, Turkey
| | - Bülent Güçlü
- Department of Neurosurgery, Şevket Yılmaz Training and Research Hospital, Bursa, Turkey
| |
Collapse
|
38
|
Darton Y, Richard I, Truc MC. Osteomyelitis variolosa: A probable mediaeval case combined with unilateral sacroiliitis. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2013; 3:288-293. [PMID: 29539566 DOI: 10.1016/j.ijpp.2013.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 05/28/2013] [Accepted: 05/31/2013] [Indexed: 05/25/2023]
Abstract
Osteoarticular sequelae of smallpox (osteomyelitis variolosa) are uncommon today. Such lesions may be observed occasionally, however, in countries where the disease has been endemic. Without other forms of documentation, it is possible to suggest a diagnosis of smallpox in ancient skeletal remains and thus make a significant contribution to understanding the history of this disease. We have examined a subadult male (Skeleton 833), 15-17 years old at the time of death, who presents bilateral bone manifestations of the elbows suggestive of smallpox. No other bone is similarly affected. In addition, he presents a left sacroiliitis deemed to be a brucellar manifestation. Skeleton 833 is one of at least 730 individuals from an exhaustive excavation of a mediaeval necropolis at Pont-sur-Seine (Aube, north-eastern France). Radiocarbon dating of his bones yields a date of between AD 1022 and 1155 (calibrated), thus apparently the oldest case described to date. The other published cases correspond to more recent periods with a well established historical context. We argue that this example of osteomyelitis variolosa.
Collapse
Affiliation(s)
- Yves Darton
- CEPAM (UMR 7264, CNRS/UNS), Pôle universitaire Saint-Jean d'Angély - SJA3, 24, avenue des Diables Bleus, 06357 Nice cedex 4, France.
| | - Isabelle Richard
- CEPAM (UMR 7264, CNRS/UNS), Pôle universitaire Saint-Jean d'Angély - SJA3, 24, avenue des Diables Bleus, 06357 Nice cedex 4, France; INRAP Grand Est Nord, 12, rue de Méric, 57063 Metz cedex 2, France
| | | |
Collapse
|
39
|
The antibodies cyclic citrullinated peptides (anti-CCP) positivity could be a promising marker in brucellosis patients presented with peripheric arthritis. Mod Rheumatol 2013. [DOI: 10.1007/s10165-013-0857-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
40
|
Abstract
OBJECTIVE Brucellosis remains as a widespread zoonosis, both worldwide and in our country that causes serious public health problems with the potential to create disease in humans and animals. The aim of the present study was to examine the characteristics of brucellosis patients followed in our clinic and to compare these cases with those reported in the literature. METHODS Four hundred and forty-seven patients who were treated in our clinic between March 2004 and March 2011 for a diagnosis of brucellosis and who were followed for one year after the completion of treatment were retrospectively examined. Data for the patients were obtained using brucellosis follow-up forms. RESULTS Of the 447 patients, 261 (58.4%) were women, and the mean age was 48±17 years. Focal organ involvement was detected in 178 (40%) cases, with the musculoskeletal system being the leading site (30.6%), followed by the central nervous system (5.4%). Spondylodiscitis exhibited a significant correlation with an advanced age, a high erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) level on admission (p=0.001, p=0.0001 and p=0.001, respectively). A significant correlation was found between sacroiliitis and a younger age (p=0.003). Relapse was observed in 35 (7.8%) cases. CONCLUSION The present study allowed us to scrutinize the characteristics and complications of patients with brucellosis. Focal organ involvement of the musculoskeletal system was observed in the present cases, particularly spondylodiscitis and sacroiliitis. Spondylodiscitis was detected in elderly patients with high CRP and ESR values, whereas sacroiliitis was seen in younger patients. We believe that age, symptom duration and laboratory parameters should be evaluated in patients with brucellosis and that older patients in particular should be precisely examined for bone and joint complications.
Collapse
Affiliation(s)
- Ebru Kursun
- Infectious Diseases and Clinical Microbiology, Baskent University School of Medicine, Turkey.
| | | | | | | |
Collapse
|
41
|
Kaptan F, Gulduren HM, Sarsilmaz A, Sucu HK, Ural S, Vardar I, Coskun NA. Brucellar spondylodiscitis: comparison of patients with and without abscesses. Rheumatol Int 2012; 33:985-92. [PMID: 22842981 DOI: 10.1007/s00296-012-2491-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 07/13/2012] [Indexed: 12/15/2022]
Abstract
Brucellosis is an important cause of spondylodiscitis in endemic areas. Brucellar spondylodiscitis is a serious complication because of its association with abscess formation. Prospective studies comparing patients with and without abscesses are lacking. The objective of this study was to determine the frequency and demographic, clinical, laboratory, and radiological features of brucellar spondylodiscitis and to compare patients with and without abscesses regarding treatment and outcome. Out of 135 consecutive patients with brucellosis, 31 patients with spondylodiscitis were recruited for the study. Patients were grouped according to magnetic resonance imaging findings. The frequency of spondylodiscitis was 23.0 %. Sites of involvement were lumbar (58.1 %), lumbosacral (22.6 %), cervical (9.7 %), thoracolumbar (6.5 %), and thoracic (3.2 %). Abscesses occurred in 19 (61.3 %) patients and were associated with low hemoglobin levels. Medical treatment included a combination of streptomycin (for the first 3 weeks), doxycycline, and rifampin. The total duration of treatment was 12-39 (mean 17.0 ± 8.5 SD) weeks. By 12 weeks of treatment, evidence of clinical improvement (67 vs. 28 %) and radiological regression (92 vs. 50 %) was significantly greater in patients without abscesses. The duration of treatment was longer if an abscess was present. Two female patients with abscesses required surgical intervention. Both patients presented with high fever, neurologic deficit, and high Brucella standard tube agglutination test titers. Each patient should be evaluated individually, based on clinical findings, laboratory data, and radiological results, when undergoing treatment for brucellar spondylodiscitis. If abscesses are found, a longer course of treatment and even surgical intervention may be needed.
Collapse
Affiliation(s)
- Figen Kaptan
- Department of Infectious Diseases and Clinical Microbiology, Ataturk Training and Research Hospital, Izmir, Turkey.
| | | | | | | | | | | | | |
Collapse
|
42
|
Hashemi SH, Gachkar L, Keramat F, Mamani M, Hajilooi M, Janbakhsh A, Majzoobi MM, Mahjub H. Comparison of doxycycline-streptomycin, doxycycline-rifampin, and ofloxacin-rifampin in the treatment of brucellosis: a randomized clinical trial. Int J Infect Dis 2012; 16:e247-51. [PMID: 22296864 DOI: 10.1016/j.ijid.2011.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 10/02/2011] [Accepted: 12/05/2011] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Traditional regimens for the treatment of brucellosis are associated with significant relapse rates. The aim of this study was to compare the efficacy of ofloxacin plus rifampin (OFX-RIF) versus doxycycline plus streptomycin (DOX-STR) and doxycycline plus rifampin (DOX-RIF) regimens in the treatment of brucellosis. METHODS Two hundred and nineteen patients with brucellosis were enrolled in a randomized clinical trial; 28 cases were withdrawn because they did not attend the follow-up. Out of 191 patients with brucellosis, 64 received OFX-RIF, 62 received DOX-RIF, and 65 patients received DOX-STR regimens. All patients were assessed during the period of therapy in the second, fourth, and sixth weeks by clinical course and were also followed up clinically and serologically for 6 months after the cessation of therapy. RESULTS The highest clinical response (95.4%) was observed in the DOX-STR group (p=0.009). The results of multivariate analysis indicate that treatment with DOX-STR had the least therapeutic failures among the three groups (p=0.033). Adverse reactions were seen in 16.8% of patients, but there was no significant difference among the three groups (p=0.613). The lowest relapse rate (4.6%) was observed in the DOX-STR group (p=0.109). CONCLUSIONS We conclude that the DOX-STR combination should remain the first-line regimen for the treatment of brucellosis in our region; we recommend DOX-RIF and OFX-RIF combinations as the second-line regimens.
Collapse
Affiliation(s)
- Seyyed Hamid Hashemi
- Department of Infectious Diseases, Hamedan University of Medical Sciences, Hamedan, Iran
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Cerit ET, Aydın M, Azap A. A case of brucellar monoarthritis and review of the literature. Rheumatol Int 2011; 32:1465-8. [PMID: 21461852 DOI: 10.1007/s00296-011-1917-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 03/13/2011] [Indexed: 12/15/2022]
Abstract
Brucellosis is a systemic infectious disease, which constitutes a public health problem in Turkey. Brucellosis has a broad spectrum of clinical manifestations. Osteoarthicular manifestations are often seen in brucellosis but most of the brucellar monoarthritis cases are reactive rather than being septic. We report a case of brucellar (septic) monoarthritis of the knee in a 74-year-old cattleman and review of the literature.
Collapse
Affiliation(s)
- Ethem Turgay Cerit
- Department of Internal Medicine, Faculty of Medicine, Ankara University, 06 590, Sihhiye/Ankara, Turkey.
| | | | | |
Collapse
|
44
|
Turan H, Serefhanoglu K, Karadeli E, Togan T, Arslan H. Osteoarticular involvement among 202 brucellosis cases identified in Central Anatolia region of Turkey. Intern Med 2011; 50:421-8. [PMID: 21372451 DOI: 10.2169/internalmedicine.50.4700] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The musculoskeletal system is one of the most commonly affected systems in brucellosis. The objective of this study was to determine the frequency, types, and clinical features of osteoarticular involvement among cases with brucellosis in the Central Anatolia region of Turkey and to establish the differences between patients with and without osteoarticular involvement. METHODS Included in this study were 202 patients with Brucellosis presented between June 2003 and June 2009. The diagnosis of osteoarticular system complications was established by physical examination and radiological findings obtained by diagnostic imaging tools. Magnetic resonance images of thoracic, lumbar or sacral vertebrae were acquired from patients with back pain, low back pain and sacro-iliac joint pain. RESULTS Osteoarticular involvement was noted in 94 patients (46.5%). The most common sources of infection are employment in farming and/or consumption of un-pasteurized milk or dairy products, especially fresh cheese in 53 (75.7%) cases. The mean age is 46.7±18 years. Sacroiliitis is the most frequent osteoarticular involvement (60.6%), 82.4% of which is bilateral. Sacroiliitis was followed by spondylodiscitis in 36 (38.3%), peripheral arthritis in 15 (16%), bursitis in 1(1.1%) case. Patients with osteoarticular involvement received medical treatment for at least three months. CONCLUSION The ratio and anatomical region of osteoarticular involvement in brucellosis show variability among countries. In this study, it is demonstrated that sacroiliitis is the most common form of osteoarticular involvement in the Central Anatolia region of Turkey. In endemic countries such as Turkey, this disease should be included in the differential diagnosis for patients with symptoms of sacroiliitis, spondylodiscitis or those with articular pain.
Collapse
Affiliation(s)
- Hale Turan
- Department of Infectious Diseases and Clinical Microbiology, Baskent University Faculty of Medicine, Turkey.
| | | | | | | | | |
Collapse
|
45
|
Lopes CD, Silva NM, Ferro EAV, Sousa RA, Firminot ML, Bernardes ES, Roque-Barreira MC, Pena JDO. Azithromycin reduces ocular infection during congenital transmission of toxoplasmosis in the Calomys callosus model. J Parasitol 2010; 95:1005-10. [PMID: 20050006 DOI: 10.1645/ge-1765.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Toxoplasma gondii is a widely distributed obligatory intracellular parasite that causes severe disease to the fetus when transmitted during pregnancy. Drugs used to avoid congenital transmission have shown side effects, and their efficacy is controversial. The most widely used treatment for acute toxoplasmosis during pregnancy is pyrimethamine plus sulfadiazine, which has several side effects. In this work, we tested the efficacy of azithromycin in reducing congenital transmission of T. gondii in the large vesper mouse, Calomys callosus, a rodent. Females of C callosus were inoculated perorally with 20 cysts of ME49 strain of T. gondii on the day of fertilization, and fetuses were collected from the 15th to the 19th day of gestation. Azithromycin (300 mg/kg), in association with pyrimethamine (100 or 50 mg/kg) plus sulfadiazine (100 or 75 mg/kg) and folinic acid (15 mg/kg) (SPAf), or vehicle, were administered orally on different days after infection. Brain and ocular tissues were removed and processed for immunohistochemistry using a polyclonal antibody against T. gondii, or were processed for parasite DNA quantification. Toxoplasma gondii was detected in the brains of all females and in fetuses' eyes of C. callosus treated with SPAf. On the other hand, in females treated with azithromycin, there was a reduction of T. gondii in the brains of mothers, and no parasites were detected in eyes of fetuses, indicating that azithromycin may represent an alternative treatment for toxoplasmosis during pregnancy.
Collapse
Affiliation(s)
- Carla D Lopes
- Ocular Immunology Laboratory, Institute of Biomedical Sciences, Universidade Federal de Uberlândia, Av. Pará 1720, Uberlândia, MG, Brazil
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Aïnseba B, Benosman C, Magal P. A model for ovine brucellosis incorporating direct and indirect transmission. JOURNAL OF BIOLOGICAL DYNAMICS 2010; 4:2-11. [PMID: 22881067 DOI: 10.1080/17513750903171688] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In this work, we construct and analyse an ovine brucellosis mathematical model. In this model, the population is divided into susceptible and infected subclasses. Susceptible individuals can contract the disease in two ways: (i) direct mode - caused by contact with infected individuals; (ii) indirect mode - related to the presence of virulent organisms in the environment. We derive a net reproductive number and analyse the global asymptotic behaviour of the model. We also perform some numerical simulations, and investigate the effect of a slaughtering policy.
Collapse
Affiliation(s)
- Bedr'Eddine Aïnseba
- UMR CNRS 5251 IMB & INRIA sud-ouest Anubis, Université of Bordeaux, 146 rue Léo Saignat, 33076, Bordeaux, France.
| | | | | |
Collapse
|
47
|
Abstract
We report 2 cases of sacroiliitis in a 13-year-old girl and an 11-year-old boy as the sole manifestation of Brucella melitensis infection. This is a rare condition. Throughout the course of the disease, neither the girl nor the boy had other signs of brucellosis. Sacroiliitis was documented by positive results of technetium 99m scintigraphy and magnetic resonance imaging. Isolation of B. melitensis from the blood and positive results of serologic methods established the diagnosis. Treatment consisted of bed rest and a combination of rifampin plus co-trimoxazole with gentamicin. Brucellar sacroiliitis is uncommon in children, and accurate diagnosis is frequently delayed because of nonspecific clinical presentation. In the appropriate clinical setting, we suggest that the index of suspicion for brucellar sacroiliitis be raised in an unusual joint, especially in endemic regions.
Collapse
|
48
|
Alp E, Doganay M. Current therapeutic strategy in spinal brucellosis. Int J Infect Dis 2008; 12:573-7. [PMID: 18539496 DOI: 10.1016/j.ijid.2008.03.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Revised: 02/28/2008] [Accepted: 03/14/2008] [Indexed: 12/29/2022] Open
Abstract
Brucellosis is a systemic disease and may affect many organ systems. However, musculoskeletal involvement represents 10-85% of the focal complications. Involvement of the spine is one of the most common localized forms of human brucellosis, especially in elderly patients. It is a destructive disease that requires a correct and early diagnosis, and immediate treatment. However, controversy remains over the optimal duration and antimicrobial regimen required for the treatment of spinal brucellosis. Relapses and sequelae are still reported. In recent years, in order to improve outcomes, alternative regimens have been investigated. However, the classical regimen (doxycycline, 100mg twice daily, for at least 12 weeks combined with streptomycin, 1g daily, for the first 2 or 3 weeks) remains the first choice of antibiotic therapy. Alternative therapies (rifampin, fluoroquinolones, co-trimoxazole) should be considered when adverse reactions or contraindications to the above drugs (ototoxicity, nephrotoxicity, pregnancy, etc.) are reported.
Collapse
Affiliation(s)
- Emine Alp
- Department of Infectious Disease, Faculty of Medicine, Erciyes University, 38039 Kayseri, Turkey.
| | | |
Collapse
|