Prospective Evaluation of 140 Patients With Brucellosis in the Southern Region of Turkey

Brucellar Epididymo-Orchitis in a Brucellosis Hyperendemic Region in Türkiye

Objective

Brucellosis is one of the most prevalent zoonoses worldwide and is endemic in Türkiye. It is a multisystemic infection that can affect various organ systems. Epididymo-orchitis is the most common form of genitourinary involvement. This study aimed to evaluate the incidence, clinical characteristics, laboratory values, and treatment outcomes of brucellar epididymo-orchitis (BEO) in the East Anatolian region, where brucellosis is hyperendemic.

Materials and Methods

This study was conducted between January 1, 2018, and April 30, 2019. All male patients diagnosed with brucellosis at the infectious disease clinic were evaluated for epididymo-orchitis according to clinical findings (testicular pain, swelling, erythema). In addition, to identify BEO patients, all epididymo-orchitis cases admitted to the urology outpatient clinic according to the study protocol were referred to the infectious diseases clinic for Brucella infection. Patients were enrolled prospectively, and data were analyzed retrospectively.

Results

Brucella infection was diagnosed in 326 patients during the study period, of whom 208 (63.8%) were male. Brucellar epididymo-orchitis was diagnosed in 18 patients at the end of sixteen months. The incidence of epididymo-orchitis in patients with Brucella infection was 8.7%. The mean age of the patients was 36.9±11.5 years. The majority of patients had occupational animal contact (83.3%) and consumption of fresh cheese made from raw milk (55.5%). Acute brucellosis was diagnosed in 17 (94.4%) patients; all patients presented with scrotal pain and swelling. Unilateral epididymo-orchitis was observed in 16 (88.8%) patients. Most patients (88.3%) applied to outpatient clinics other than infectious diseases, especially the urology clinic (77.7%).Double or triple combined treatments with aminoglycoside/doxycycline/rifampicin were given to the patients. Hydrocelectomy was performed in three patients, orchiectomy in one patient, and relapse was seen in one patient.

Conclusion

Brucella infection should be considered in patients presenting with epididymo-orchitis in endemic regions. Awareness of brucellosis by urologists will ensure that the disease is diagnosed without complications.

Childhood Brucellosis: A Single-Center Experience from the Central Mediterranean Region of Turkey

Objective Brucellosis is an important zoonotic disease in developing countries, which can occur with varying clinical findings and cause complications. The aim of this study was to evaluate cases diagnosed with brucellosis that were followed up in our clinic over the last 10 years.

Methods A retrospective evaluation was made of cases diagnosed with brucellosis and then followed up and treated as inpatients or outpatients in our clinic between January 2011 and 2021. Patient data were obtained from the hospital automated records system.

Results This study included 81 cases comprising 43 (53.1%) males and 38 (46.9%) females with a mean age of 10.7 ± 4.5 years (range, 13 months–18 years). There was a history of consuming unpasteurized milk and/or dairy products in 69 (85.2%) patients, living in a rural location in 66 (81.3%), and the family keeping livestock in 49 (60.5%) cases; there was a family history of brucellosis in 31 (38.3%) cases. The most common complaint at presentation was joint pain in 71.6%, the most common finding on physical examination was fever (59.3%), and the most common laboratory finding was elevated C-reactive protein (71.6% of cases). Brucella spp. were isolated from 12 of 43 patients who had blood cultures performed. Complications occurred in 33 (40.7%) cases, most commonly involving the osteoarticular system.

Conclusion Priority should be given to family education about not consuming raw animal products. Animals should be checked, vaccinated, and treated with a multidisciplinary approach. Until the clinical condition in endemic areas is proven to be due to a different cause, patients should be examined with the suspicion that any clinical finding may be due to brucellosis.

Different Clinical Presentations of Brucellosis

Background

Brucellosis is one of the important multi-organ zoonotic infectious diseases. The forms of the clinical course of brucellosis in humans are acute, sub-acute and chronic.

Objectives

The present study aimed to retrospectively analyze the clinical characteristics and complications in the clinical forms of human brucellosis in Iran.

Patients and Methods

The population included 957 patients admitted in the infectious diseases clinic affiliated to Babol University of Medical Sciences, Babol, Iran, within the past two decades. Data for the patients were obtained and documented in questionnaires. Patients were divided into three groups according to their history, symptoms and clinical presentation time: acute (0 - 2 months), sub-acute (3 - 12 months), and chronic (> 1 year).

Results

Most of the patients (73.8%) were in the acute stages of brucellosis, 22.6% had sub-acute brucellosis and 3.7% had chronic brucellosis. The most frequently observed symptoms were arthralgia (71%), sweating (66.7%), fever (57.2%) and backache (39.3%). The most common complication was arthritis (13.2%) in this study.

Conclusions

This infection was observed with a diversity of clinical manifestations. Therefore, diagnostic difficulty because of the various clinical presentations and the way to find undiagnosed complications should be investigated in the differential diagnosis of other diseases.

A long-term survey of brucellosis: Is there any marker to predict the complicated cases?

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.

Celecoxib for the treatment of mild-to-moderate depression due to acute brucellosis: a double-blind, placebo-controlled, randomized trial

WHAT IS KNOWN AND OBJECTIVE

Depression is a debilitating complication of brucellosis and how best to treat this is a matter of debate. Inflammatory processes are involved in the pathogenesis of both brucellosis and depression. Therefore, we hypothesized that celecoxib could be beneficial for the treatment of depression due to brucellosis.

METHODS

Forty outpatients with depression due to brucellosis with a Hamilton Depression Rating Scale score (HDRS) <19 participated in a randomized, double-blind, placebo-controlled trial and underwent 8 weeks of treatment with either celecoxib (200 mg bid) or placebo as an adjunctive to antibiotic therapy. Patients were evaluated using HDRS at baseline and weeks 4 and 8.

RESULT AND DISCUSSION

Repeated-measures analysis demonstrated significant effect for time × treatment interaction on the HDRS score [F (1·43, 57·41) = 37·22, P < 0·001]. Significantly greater response to treatment occurred in the celecoxib group than in the placebo group at the study end [10 patients (50%) vs. no patient (0%), respectively, P < 0·001]. No serious adverse event was observed.

WHAT IS NEW AND CONCLUSION

Celecoxib is a safe and effective treatment for depression due to brucellosis when compared with placebo.

Epidemiological and clinical aspects of human brucellosis in eastern Anatolia

BACKGROUND

We investigated the seroprevalence of human brucellosis and risk factors in a village in Eastern Anatolia, Turkey, where a brucellosis outbreak among cattle had recently occurred.

PATIENTS AND METHODS

All 501 inhabitants enrolled were screened with the Rose Bengal Test and were asked to fill out a questionnaire to determine the signs and symptoms of brucellosis and the risk factors. Patients' laboratory findings and clinical responses were also evaluated.

RESULTS

The Rose Bengal Test was positive in 44 persons. In comparison of age groups, fever (20.2%), arthralgia (19.2%) and weight loss (8.4%) were frequently seen in children (p<0.05). Hepatomegaly (17.9%) was also prevalent in the age group of 0 to 14 years (p<0.05). The consumption of dairy products, a family history of brucellosis, and raising livestock were significantly related to seropositivity (p<0.05). Rifampicin plus doxycyline was the most common regimen administered in these cases (54.5%) and also had the highest relapse rate (p<0.05).

CONCLUSION

Brucellosis remains an important public-health problem in the rural areas of Turkey. Appropriate public health measures and education must be pursued to eradicate human brucellosis.

Systematic review and meta-analysis of randomized clinical trials in the treatment of human brucellosis

Background

Brucellosis is a persistent health problem in many developing countries throughout the world, and the search for simple and effective treatment continues to be of great importance.

Methods and Findings

A search was conducted in MEDLINE and in the Cochrane Central Register of Controlled Trials (CENTRAL). Clinical trials published from 1985 to present that assess different antimicrobial regimens in cases of documented acute uncomplicated human brucellosis were included. The primary outcomes were relapse, therapeutic failure, combined variable of relapse and therapeutic failure, and adverse effect rates. A meta-analysis with a fixed effect model was performed and odds ratio with 95% confidence intervals were calculated. A random effect model was used when significant heterogeneity between studies was verified.

Comparison of combined doxycycline and rifampicin with a combination of doxycycline and streptomycin favors the latter regimen (OR = 3.17; CI95% = 2.05–4.91). There were no significant differences between combined doxycycline-streptomycin and combined doxycycline-gentamicin (OR = 1.89; CI95% = 0.81–4.39). Treatment with rifampicin and quinolones was similar to combined doxycycline-rifampicin (OR = 1.23; CI95% = 0.63–2.40). Only one study assessed triple therapy with aminoglycoside-doxycycline-rifampicin and only included patients with uncomplicated brucellosis. Thus this approach cannot be considered the therapy of choice until further studies have been performed. Combined doxycycline/co-trimoxazole or doxycycline monotherapy could represent a cost-effective alternative in certain patient groups, and further studies are needed in the future.

Conclusions

Although the preferred treatment in uncomplicated human brucellosis is doxycycline-aminoglycoside combination, other treatments based on oral regimens or monotherapy should not be rejected until they are better studied. Triple therapy should not be considered the current treatment of choice.

Clinical manifestations and complications in 1028 cases of brucellosis: a retrospective evaluation and review of the literature

INTRODUCTION

Brucellosis is the most prevalent bacterial zoonosis worldwide. In this study, we aimed to compare our 1028 brucellosis cases with other big series in the literature in view of epidemiological, clinical, and laboratory findings and therapeutic features.

METHODS

A total of 1028 brucellosis cases admitted to the Department of Infectious Diseases and Clinical Microbiology over a 10-year period were included in the study. A retrospective analysis was undertaken and patient files were reviewed for history, clinical and laboratory findings, and therapeutic features, as well as complications.

RESULTS

Of the 1028 patients, 539 (52.4%) were female and 489 (47.6%) were male. The mean age of patients was 33.7+/-16.34 years and 69.6% of cases were aged 13-44 years. Four hundred and thirty-five cases (42.3%) had a history of raising livestock and 55.2% of the cases were found to have no occupational risk for brucellosis. Six hundred and fifty-four of the cases (63.6%) had a history of raw milk and dairy products consumption. The most frequently seen symptoms were arthralgia (73.7%) and fever (72.2%), while the most common clinical findings were fever (28.8%) and hepatomegaly (20.6%). The most frequent laboratory finding was a high C-reactive protein level (58.4%). The standard tube agglutination (STA) test+Coombs STA test was positive in 1016 cases (98.8%). Focal involvement was present in 371 (36.1%) cases. The most frequent involvement was osteoarticular involvement with 260 cases (25.3%). The overall relapse rate for patients with brucellosis was 4.7%. The highest relapse rate, 8.5%, was observed in the group of patients with osteoarticular involvement. Regimens including doxycycline and streptomycin with or without rifampin appeared more effective than other regimens in osteoarticular involvement.

CONCLUSIONS

In humans, brucellosis may lead to serious morbidity, and it continues to be a major health problem in Turkey. There is no recommended treatment protocol for complicated brucellosis. Large multicenter studies are needed to determine the most appropriate treatment choices and durations in complicated brucellosis.