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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.
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Affiliation(s)
- Yuanyi Miao
- Department of Nephrology, Weihai Municipal Hospital, Weihai, China
| | - Xuegang Li
- Department of Nephrology, Weihai Municipal Hospital, Weihai, China
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Silva SN, Cota G, Xavier DM, de Souza GM, Souza MRF, Gonçalves MWA, Tuon FF, Galvão EL. Efficacy and safety of therapeutic strategies for human brucellosis: A systematic review and network meta-analysis. PLoS Negl Trop Dis 2024; 18:e0012010. [PMID: 38466771 PMCID: PMC10978012 DOI: 10.1371/journal.pntd.0012010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/28/2024] [Accepted: 02/20/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Human brucellosis is a neglected, re-emerging, and endemic zoonosis in many countries. The debilitating and disabling potential of the disease is a warning about its morbidity, generating socioeconomic impact. This review aims to update the current evidence on the efficacy and safety of therapeutic options for human brucellosis using the network meta-analysis (NMA). METHODOLOGY A systematic search was conducted in four different databases by independent reviewers to assess overall therapy failure, adverse events, and time to defervescence associated with different therapies. Randomized clinical trials (RCTs) evaluating any therapeutic drug intervention were selected, excluding non-original studies or studies related to localized forms of the disease or with less than 10 participants. Data were analyzed by frequentist statistics through NMA by random effects model. The risk of bias and certainty of evidence was assessed, this review was registered at PROSPERO. RESULTS Thirty-one (31) RCTs involving 4167 patients were included. Three networks of evidence were identified to evaluate the outcomes of interest. Triple therapy with doxycycline + streptomycin + hydroxychloroquine for 42 days (RR: 0.08; CI 95% 0.01-0.76) had a lower failure risk than the doxycycline + streptomycin regimen. Doxycycline + rifampicin had a higher risk of failure than doxycycline + streptomycin (RR: 1.96; CI 95% 1.27-3.01). No significant difference was observed between the regimens when analyzing the incidence of adverse events and time to defervescence. In general, most studies had a high risk of bias, and the results had a very low certainty of evidence. CONCLUSIONS This review confirmed the superiority of drugs already indicated for treating human brucellosis, such as the combination of doxycycline and aminoglycosides. The association of hydroxychloroquine to the dual regimen was identified as a potential strategy to prevent overall therapy failure, which is subject to confirmation in future studies.
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Affiliation(s)
- Sarah Nascimento Silva
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Gláucia Cota
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Diego Mendes Xavier
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina Minas Gerais, Brazil
| | - Glaciele Maria de Souza
- Programa de Pós-Graduação em Odontologia Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina Minas Gerais, Brazil
| | - Marina Rocha Fonseca Souza
- Programa de Pós-Graduação em Odontologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Endi Lanza Galvão
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina Minas Gerais, Brazil
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Woods CR, Bradley JS, Chatterjee A, Kronman MP, Arnold SR, Robinson J, Copley LA, Arrieta AC, Fowler SL, Harrison C, Eppes SC, Creech CB, Stadler LP, Shah SS, Mazur LJ, Carrillo-Marquez MA, Allen CH, Lavergne V. Clinical Practice Guideline by the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA): 2023 Guideline on Diagnosis and Management of Acute Bacterial Arthritis in Pediatrics. J Pediatric Infect Dis Soc 2024; 13:1-59. [PMID: 37941444 DOI: 10.1093/jpids/piad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023]
Abstract
This clinical practice guideline for the diagnosis and treatment of acute bacterial arthritis (ABA) in children was developed by a multidisciplinary panel representing the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA). This guideline is intended for use by healthcare professionals who care for children with ABA, including specialists in pediatric infectious diseases and orthopedics. The panel's recommendations for the diagnosis and treatment of ABA are based upon evidence derived from topic-specific systematic literature reviews. Summarized below are the recommendations for the diagnosis and treatment of ABA in children. The panel followed a systematic process used in the development of other IDSA and PIDS clinical practice guidelines, which included a standardized methodology for rating the certainty of the evidence and strength of recommendation using the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation) (see Figure 1). A detailed description of background, methods, evidence summary and rationale that support each recommendation, and knowledge gaps can be found online in the full text.
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Affiliation(s)
- Charles R Woods
- Department of Pediatrics, University of Tennessee Health Sciences Center College of Medicine Chattanooga, Chattanooga, Tennessee
| | - John S Bradley
- Division of Infectious Diseases, Department of Pediatrics, University of California San Diego, School of Medicine, and Rady Children's Hospital, San Diego, California
| | - Archana Chatterjee
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Matthew P Kronman
- Division of Pediatric Infectious Diseases, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Sandra R Arnold
- Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Lawson A Copley
- Departments of Orthopaedic Surgery and Pediatrics, University of Texas Southwestern, Dallas, Texas
| | - Antonio C Arrieta
- Division of Infectious Diseases, Children's Hospital of Orange County and University of California, Irvine, California
| | - Sandra L Fowler
- Division of Infectious Diseases, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | | | - C Buddy Creech
- Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Laura P Stadler
- Department of Pediatrics, Division of Infectious Diseases, University of Kentucky, Lexington, Kentucky
| | - Samir S Shah
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lynnette J Mazur
- Department of Pediatrics, University of Texas McGovern Medical School, Houston, Texas
| | - Maria A Carrillo-Marquez
- Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Coburn H Allen
- Department of Pediatrics, University of Texas at Austin Dell Medical School, Austin, Texas
| | - Valéry Lavergne
- Department of Medical Microbiology and Infection Control, Vancouver General Hospital, Vancouver, British Columbia, Canada
- University of Montreal Research Center, Montreal, Quebec, Canada
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Spernovasilis N, Karantanas A, Markaki I, Konsoula A, Ntontis Z, Koutserimpas C, Alpantaki K. Brucella Spondylitis: Current Knowledge and Recent Advances. J Clin Med 2024; 13:595. [PMID: 38276100 PMCID: PMC10816169 DOI: 10.3390/jcm13020595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
The most prevalent zoonotic disease is brucellosis, which poses a significant threat for worldwide public health. Particularly in endemic areas, spinal involvement is a major source of morbidity and mortality and can complicate the course of the disease. The diagnosis of Brucella spondylitis is challenging and should be suspected in the appropriate epidemiological and clinical context, in correlation with microbiological and radiological findings. Treatment depends largely on the affected parts of the body. Available treatment options include antibiotic administration for an adequate period of time and, when appropriate, surgical intervention. In this article, we examined the most recent data on the pathophysiology, clinical manifestation, diagnosis, and management of spinal brucellosis in adults.
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Affiliation(s)
| | - Apostolos Karantanas
- Department of Medical Imaging, University Hospital of Heraklion, 71500 Heraklion, Greece;
- Advanced Hybrid Imaging Systems, Institute of Computer Science, FORTH, 71500 Heraklion, Greece
- Department of Radiology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Ioulia Markaki
- Internal Medicine Department, Thoracic Diseases General Hospital Sotiria, 11527 Athens, Greece;
| | - Afroditi Konsoula
- Department of Pediatrics, General Hospital of Sitia, 72300 Sitia, Greece;
| | - Zisis Ntontis
- Department of Orthopaedics and Trauma Surgery, Venizeleio General Hospital of Heraklion, 71409 Heraklion, Greece;
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece;
| | - Kalliopi Alpantaki
- Department of Orthopaedics and Trauma Surgery, Venizeleio General Hospital of Heraklion, 71409 Heraklion, Greece;
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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.
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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
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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.
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Affiliation(s)
| | | | | | - Orhan AKPINAR
- SÜLEYMAN DEMİREL ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ ENSTİTÜSÜ
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Gowe I, Parsons C, Vickery S, Best M, Prechter S, Haskell MG, Parsons E. Venous thrombosis, peripheral aneurysm formation, and fever in a feral pig hunter with Brucellosis. IDCases 2022; 27:e01449. [PMID: 35198390 PMCID: PMC8844863 DOI: 10.1016/j.idcr.2022.e01449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/09/2022] [Accepted: 02/09/2022] [Indexed: 01/18/2023] Open
Abstract
Brucellosis is a systemic bacterial zoonotic disease with potential endovascular complications including endocarditis, although multifocal vasculopathy is rare. Moreover, swine-associated human infections are less common since brucellosis was eradicated in commercial swine in U.S. states and territories. However, feral swine continue to serve as a reservoir for Brucella suis. We describe the case of a feral swine hunter who presented with fever and respiratory symptoms and was diagnosed with pulmonary embolus. Blood cultures revealed growth of Brucella, later confirmed as Brucella suis. Despite initial appropriate antimicrobial therapy, he maintained fever with worsening knee pain, and magnetic resonance imaging and two-dimensional echocardiography subsequently confirmed the presence of a thrombosed popliteal artery aneurysm and mitral valve vegetation, respectively. To our knowledge, this is the first report of contemporaneous venous and arterial thromboembolism attributable to B. suis infection.
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Affiliation(s)
- Ivan Gowe
- Infection Prevention and Control Department, Margaret R Pardee Hospital, 800 North Justice Street, Hendersonville, NC 28791, USA
| | - Christopher Parsons
- Pardee Hospital Center for Infectious Diseases, 705 6th Avenue West, Suite D, Hendersonville, NC 28739, USA
| | - Stephen Vickery
- Wingate University School of Pharmacy, 805 6th Avenue West, Suite 200, Hendersonville, NC 28739, USA
| | - Michael Best
- Department of Microbiology, Margaret R. Pardee Memorial Hospital, 800 North Justice Street, Hendersonville, NC 28791, USA
| | - Scott Prechter
- Department of Radiology, Margaret R. Pardee Memorial Hospital, 800 North Justice Street, Hendersonville, NC 28791, USA
| | | | - Eveline Parsons
- Department of Animal Science, Berry College, P.O. Box 493259, Mount Berry, GA 30149, USA
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Youssef N, Youssef Y, Noun D, Abboud M, Dbaibo G. Brucellosis causing bone marrow aplasia in an 11-year-old patient with complete recovery after treatment. IDCases 2022; 29:e01531. [PMID: 35761797 PMCID: PMC9233216 DOI: 10.1016/j.idcr.2022.e01531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/27/2022] Open
Abstract
Brucellosis is one of the most prevalent zoonotic infections in the Middle East. The disease may present with a range of symptoms from a simple febrile illness to severe invasive infections affecting different organ systems (meningitis, osteomyelitis). In this paper we present an eleven-year-old girl who was diagnosed with “idiopathic bone marrow aplasia” and planned for hematopoietic stem cell transplant (HSCT), when pre-transplant work-up showed high brucella titers. The patient was started on doxycycline, rifampin and gentamicin initially, with discontinuation of the latter 3 weeks into therapy. She recovered completely after 8 months of treatment.
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Wang W, Wang Z, Jia K, Tang J, Wang L. Clinical and laboratory characteristics of childhood brucellosis in high-risk area of Western China. Jpn J Infect Dis 2021; 75:127-132. [PMID: 34470971 DOI: 10.7883/yoken.jjid.2021.388] [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: 01/18/2023]
Abstract
Childhood brucellosis present various non-specific clinical symptoms, and limited laboratory data exist for clinical diagnosis. A better understanding of these clinical and laboratory characteristics can avoid clinical misdiagnosis and mistreatment. In this case-series study, a total of 78 children with confirmed diagnosis of brucellosis were evaluated retrospectively. We observed that the incidence rate was higher in the first two quarters every year. The most common symptom was fever. Osteoarticular involvement was found in 44.87% of the patients. Laboratory tests showed that the values of erythrocyte sedimentation rate(ESR), C-reactive protein(CRP), Hemoglobin(Hb), Neutrophils(NEU), Alanine aminotransfease(ALT) and Ferritin in childhood brucellosis with osteoarticular involvement had significant differences than those without osteoarticular involvement or control group (P<0.05). Childhood brucellosis without osteoarticular involvement often accompanied by decrease of NEU , increase of CRP and ALT compared with that control group (P<0.05). The Receiver Operating Curves (ROC) analysis revealed that NEU, CRP and ALT can be used as adjunct parameters in the differential diagnosis of childhood brucellosis. These data suggest that clinical and laboratory characteristics are very important for every clinician, which may have a complementary role in diagnosis of childhood brucellosis.
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Affiliation(s)
- Wei Wang
- The Affiliated Children's Hospital of Xi'an Jiaotong University, Xi'an Children's Hospital, China
| | - Zengguo Wang
- The Affiliated Children's Hospital of Xi'an Jiaotong University, Xi'an Children's Hospital, China
| | - Kai Jia
- The Affiliated Children's Hospital of Xi'an Jiaotong University, Xi'an Children's Hospital, China
| | - Jianyong Tang
- The Affiliated Children's Hospital of Xi'an Jiaotong University, Xi'an Children's Hospital, China
| | - Lin Wang
- The frist Affiliated Hospital of Northwest University, Xi'an NO.1 Hospital, China
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Risk Factor Analysis of Brucellosis in Hulunbuir, China, Using the Propensity Score Matching Method. Jundishapur J Microbiol 2021. [DOI: 10.5812/jjm.113528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Brucellosis is the most widespread zoonosis worldwide and one of the most neglected zoonotic diseases. At present, large-scale farms are growing rapidly, increasing the risk of disease transmission. Objectives: In this study, the propensity score matching (PSM) method was used to analyze the epidemiological characteristics of brucellosis and explore the risk factors of brucellosis infection in Hulunbuir, Inner Mongolia, China. Methods: A questionnaire for brucellosis was designed based on general knowledge and the protection of key groups of brucellosis. Epidata 13.0 software was used to establish the questionnaire, and propensity score matching was used to select cases that met the requirements of case-controls. Results: A total of 152 cases and 456 controls were included. The results of the study show that feeding livestock, carrying lambs regularly, and raising livestock without protective measures can increase the risk of brucellosis infection. Conclusions: Behavioral factors are the main risk factors for brucellosis, and livestock keepers should strengthen self-protection when working.
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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.
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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
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Mendo T, Norte S, Alves P, Tavares D, Pinto M, Gouveia C. An Eleven-year-old Boy With Arthritis of the Hip Joint, and an 8-year-old Boy With Sacroiliitis. Pediatr Infect Dis J 2021; 40:694-696. [PMID: 33410649 DOI: 10.1097/inf.0000000000003040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Tânia Mendo
- From the Infectious Diseases Unit, Hospital Dona Estefânia, CHULC-EPE, Lisbon, Portugal
| | - Susana Norte
- Pediatric Orthopedic Unit, Hospital Dona Estefânia, CHULC-EPE, Lisbon, Portugal
| | - Pedro Alves
- Centro Tecnológico e Biomédico, Radiodiagnóstico, Hospital Dona Estefânia, CHULC-EPE, Lisbon, Portugal
| | - Delfin Tavares
- Pediatric Orthopedic Unit, Hospital Dona Estefânia, CHULC-EPE, Lisbon, Portugal
| | - Margarida Pinto
- Patologia Clinica, Hospital Dona Estefânia, CHULC-EPE, Lisbon, Portugal
| | - Catarina Gouveia
- From the Infectious Diseases Unit, Hospital Dona Estefânia, CHULC-EPE, Lisbon, Portugal
- Faculdade de Ciências Médicas, Nova Medical School, Lisbon, Portugal
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13
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Qasim SS, Alshuwaier K, Alosaimi MQ, Alghafees MA, Alrasheed A, Layqah L, Baharoon S. Brucellosis in Saudi Children: Presentation, Complications, and Treatment Outcome. Cureus 2020; 12:e11289. [PMID: 33274162 PMCID: PMC7707957 DOI: 10.7759/cureus.11289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Brucellosis, an endemic disease in Saudi Arabia, has an infection rate of 70 per 100,000 people, with a varying morbidity rate in different parts of the country. The aim of this study was to assess the epidemiological and clinical features, laboratory findings, treatment modalities, complications, and outcomes in children with brucellosis. Materials and methods The medical records of 153 patients attending King Abdullah Specialist Children’s Hospital in Riyadh, Saudi Arabia, from January 2015 to January 2019 were reviewed retrospectively. Demographic data, laboratory test results, serum agglutination test titer, and the results of the blood cultures were obtained. The diagnosis of brucellosis was based on compatible signs and symptoms with a positive serology titer of ≥1:160 or a blood culture positive for Brucella species. Results The majority of the sample (69.6%, n=107) were males, with a mean age of 7.75 ± 3.28 years. Ingestion of unpasteurized camel dairy products was the most frequent transmission risk factor. The most prevalent presenting symptoms were constitutional and musculoskeletal symptoms. Six patients (3.9%) had complicated brucellosis, with neurobrucellosis diagnosed in three cases. Hospitalization for brucellosis was required in 15% of the patients. The majority (99.35%, n=152) of the patients had a serum agglutination test (SAT) titer of ≥1:160. A blood culture was positive in 52 (34%) of the 111 patients tested. The most frequently prescribed regimen was rifampicin + co-trimoxazole in 81 (52.9%) patients. Relapse occurred in a small proportion (4.6%, n=7), and the majority (95.4%, n=146) had a complete remission. Conclusions The main route of transmission was the ingestion of unpasteurized dairy products. Brucellosis had a wide range of clinical presentation, involving multiple organ systems. Neurobrucellosis was the most frequent complication. The SAT was the most useful and reliable test for the diagnosis of brucellosis. Most patients were successfully treated with rifampicin and co-trimoxazole for six weeks.
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Affiliation(s)
- Salman S Qasim
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Khalid Alshuwaier
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Mohammed Q Alosaimi
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | - Abdullah Alrasheed
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Laila Layqah
- Pharmacy, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Salim Baharoon
- Internal Medicine, King Abdulaziz Medical City Riyadh, Riyadh, SAU
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A Young Adult from the Middle East with Septic Shock, Pancytopenia, and Systolic Dysfunction. Ann Am Thorac Soc 2020; 16:1052-1056. [PMID: 31368803 DOI: 10.1513/annalsats.201809-624cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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Cohen E, Katz T, Rahamim E, Bulkowstein S, Weisel Y, Leibovitz R, Fruchtman Y, Leibovitz E. Septic arthritis in children: Updated epidemiologic, microbiologic, clinical and therapeutic correlations. Pediatr Neonatol 2020; 61:325-330. [PMID: 32184066 DOI: 10.1016/j.pedneo.2020.02.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/12/2019] [Accepted: 02/15/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Septic arthritis (SA) is an infection characterized by significant epidemiologic and microbiologic differences between developed and developing regions and between age groups. OBJECTIVES To determine the epidemiologic, clinical, microbiologic and therapeutic aspects of pediatric SA in Southern Israel. METHODS A retrospective case-series study based on the records of children <16 years of age admitted with SA at Soroka Medical Center, Beer-Sheva, during 2006-2013. RESULTS 189 patients were enrolled. There were 119 (63%) Bedouin and 70 (37%) Jewish children. The knee (39.7%), hip (28%) and ankle (13.8%) were the most commonly involved joints. Blood and/or synovial fluid cultures were positive in 48 (25.4%) patients. Overall SA incidence among children <16 years and <5 years was 11.7 and 25.4/100,000, respectively, without changes throughout the study period. SA incidence among Bedouin children was higher than among Jewish children (15.4 vs. 8.3/100,000 cases). Staphylococcus aureus was the most commonly isolated pathogen (18, 19.5% of all patients), followed by Kingella kingae (10, 5.3%)-(37.5% and 20.8% among culture-positive patients, respectively). The number of children with culture-positive SA that required surgery was higher than those with culture-positive SA treated conservatively (P < 0.001). Hospitalization was longer in children treated surgically than in those treated conservatively (P < 0.001). CONCLUSION This study is the largest single-center series on pediatric SA published in the last five years and provided an updated picture on incidence and the microbiologic, clinical and therapeutic aspects of pediatric SA in Southern Israel. The study supports a regional presentation pattern of SA and may guide its therapeutic management.
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Affiliation(s)
- Eugen Cohen
- Orthopaedic Department, Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel
| | - Tiberiu Katz
- Orthopaedic Department, Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel
| | - Eldad Rahamim
- Orthopaedic Department, Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel
| | - Shlomi Bulkowstein
- Orthopaedic Department, Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel
| | - Yaron Weisel
- Orthopaedic Department, Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel
| | - Ron Leibovitz
- Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel
| | - Yariv Fruchtman
- Division of Pediatrics, Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel
| | - Eugene Leibovitz
- Division of Pediatrics, Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel.
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Bosilkovski M, Stojovski M, Siskova D, Ridov A, Kostoska E, Krstevski K. Brucellosis in pregnancy: case reports with different outcomes in an endemic region. Acta Clin Croat 2020; 59:338-343. [PMID: 33456122 PMCID: PMC7808227 DOI: 10.20471/acc.2020.59.02.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Different outcomes of brucellosis in pregnancy regarding the fetus/neonate and the mother are described. Medical records of five pregnant women with brucellosis were retrospectively analyzed. Patients were treated in several departments of infectious diseases in the Republic of Macedonia between 1995 and 2009. The diagnosis of brucellosis was based on clinical findings compatible with the disease supported by detection of specific antibodies. Pregnancy outcomes in patients were as follows: spontaneous abortion, intrauterine fetal death, premature delivery in two cases (one with twin pregnancy) and term delivery. One of the women experienced relapse. Follow-up results of neonates showed no infection and their normal growth and development. Brucellosis, especially if acquired in early pregnancy, can have an impact on pregnancy outcome. In endemic regions, in pregnant women with persisting fever and unspecific manifestations one should always have in mind brucellosis. In these areas, cases with unexplained spontaneous abortion, intrauterine fetal death and premature delivery should also be investigated for brucellosis.
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Affiliation(s)
| | - Marjan Stojovski
- 1Medical Faculty, Ss Cyril and Methodius University, Skopje, Republic of Macedonia; 2University Hospital of Obstetrics and Gynecology, Skopje, Republic of Macedonia; 3Department of Infectious Diseases, Shtip Medical Center, Shtip, Republic of Macedonia; 4Department of Infectious Diseases, Kavadarci Medical Center, Kavadarci, Republic of Macedonia; 5Department of Infectious Diseases, Prilep Medical Center, Prilep, Republic of Macedonia; 6Faculty of Veterinary Medicine, Ss Cyril and Methodius University, Skopje, Republic of Macedonia
| | - Dijana Siskova
- 1Medical Faculty, Ss Cyril and Methodius University, Skopje, Republic of Macedonia; 2University Hospital of Obstetrics and Gynecology, Skopje, Republic of Macedonia; 3Department of Infectious Diseases, Shtip Medical Center, Shtip, Republic of Macedonia; 4Department of Infectious Diseases, Kavadarci Medical Center, Kavadarci, Republic of Macedonia; 5Department of Infectious Diseases, Prilep Medical Center, Prilep, Republic of Macedonia; 6Faculty of Veterinary Medicine, Ss Cyril and Methodius University, Skopje, Republic of Macedonia
| | - Aleksandar Ridov
- 1Medical Faculty, Ss Cyril and Methodius University, Skopje, Republic of Macedonia; 2University Hospital of Obstetrics and Gynecology, Skopje, Republic of Macedonia; 3Department of Infectious Diseases, Shtip Medical Center, Shtip, Republic of Macedonia; 4Department of Infectious Diseases, Kavadarci Medical Center, Kavadarci, Republic of Macedonia; 5Department of Infectious Diseases, Prilep Medical Center, Prilep, Republic of Macedonia; 6Faculty of Veterinary Medicine, Ss Cyril and Methodius University, Skopje, Republic of Macedonia
| | - Emilija Kostoska
- 1Medical Faculty, Ss Cyril and Methodius University, Skopje, Republic of Macedonia; 2University Hospital of Obstetrics and Gynecology, Skopje, Republic of Macedonia; 3Department of Infectious Diseases, Shtip Medical Center, Shtip, Republic of Macedonia; 4Department of Infectious Diseases, Kavadarci Medical Center, Kavadarci, Republic of Macedonia; 5Department of Infectious Diseases, Prilep Medical Center, Prilep, Republic of Macedonia; 6Faculty of Veterinary Medicine, Ss Cyril and Methodius University, Skopje, Republic of Macedonia
| | - Kiril Krstevski
- 1Medical Faculty, Ss Cyril and Methodius University, Skopje, Republic of Macedonia; 2University Hospital of Obstetrics and Gynecology, Skopje, Republic of Macedonia; 3Department of Infectious Diseases, Shtip Medical Center, Shtip, Republic of Macedonia; 4Department of Infectious Diseases, Kavadarci Medical Center, Kavadarci, Republic of Macedonia; 5Department of Infectious Diseases, Prilep Medical Center, Prilep, Republic of Macedonia; 6Faculty of Veterinary Medicine, Ss Cyril and Methodius University, Skopje, Republic of Macedonia
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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: 26] [Impact Index Per Article: 5.2] [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.
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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
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A Systematic Review and Meta-Analysis of Epidemiology and Clinical Manifestations of Human Brucellosis in China. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5712920. [PMID: 29850535 PMCID: PMC5937618 DOI: 10.1155/2018/5712920] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/01/2018] [Indexed: 12/22/2022]
Abstract
Background. Brucellosis has a wide spectrum of clinical manifestations and it may last several days or even several years; however, it is often misdiagnosed and therefore may cause inadequate therapy and prolonged illness. Previous studies about meta-analysis of manifestations of brucellosis reported in English lacked the data published in Chinese, which did not provide details about the contact history, laboratory tests, and misdiagnosis. We undertake a meta-analysis of clinical manifestations of human brucellosis in China to identify those gaps in the literature. We have searched published articles in electronic databases up to December 2016 identified as relating to clinical features of human brucellosis in China. 68 studies were included in the analysis. The main clinical manifestations were fever, fatigue, arthralgia, and muscle pain (87%, 63%, 62%, and 56%, resp.). There are significant differences between adults and children. Rash, respiratory and cardiac complications, and orchitis/epididymitis were more prevalent in children patients. The common complications of brucellosis were hepatitis, followed by osteoarthritis, respiratory diseases, cardiovascular diseases, central nervous system dysfunction, hemophagocytic syndrome, and orchitis/epididymitis in male. In the nonpastoral areas, brucellosis has a high ratio of misdiagnosis. Our analysis provides further evidence for the accurate diagnosis, particularly in assessing severe, debilitating sequelae of this infection.
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19
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Lazutkin A, Korem M, Weinberger JM, Eliashar R, Hirshoren N. Otolaryngology/head and neck region manifestations of Brucella. Laryngoscope 2018; 128:2056-2059. [PMID: 29332311 DOI: 10.1002/lary.27089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 12/10/2017] [Accepted: 12/18/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES/HYPOTHESIS Patients with Brucella infection present with nonspecific symptoms originating from different organs. In this study, we investigated the manifestations involving principally the otolaryngology/head and neck region. STUDY DESIGN Retrospective cohort chart review. METHODS A retrospective analysis of patients diagnosed with brucellosis in a tertiary medical center. Medical records of 55 patients treated for positive Brucella blood cultures between 2007 and 2016 were analyzed. Clinical manifestations localized to the otolaryngology/head and neck region were evaluated. RESULTS Most patients (78%) in our study group lived in rural areas. There was an almost equal gender distribution and a wide age range (2-77 years). Nonspecific symptoms, including fever (71%), fatigue (31%), weight loss (20%), and night sweats (32.7%) were the most common. Of the specific organ systems affected by Brucella, the osteoarthritic system was most commonly infected (45.5%). Three patients (5.5%) presented with predominantly localized otolaryngology/head and neck region symptoms, consisting of necrotic lymphadenopathy or a thyroid abscess. All patients underwent drainage procedures, and the diagnosis was confirmed by positive blood and pus cultures. Complete resolution was achieved with prolonged antibiotic treatment. CONCLUSIONS Brucella infection should be suspected in patients with nonspecific constitutional symptoms associated with neck lymphadenopathy or thyroid abscess, especially in those living in rural areas. A high index of suspicion is mandatory for proper diagnosis and treatment. Formal drainage and prolonged antibiotic treatments are required. We strongly recommend simple drainage and not excision as the mainstay of surgical treatment. LEVEL OF EVIDENCE 4. Laryngoscope, 128:2056-2059, 2018.
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Affiliation(s)
- Anna Lazutkin
- Department of Otolaryngology/Head and Neck Surgery, Hebrew University Hadassah Medical Center, Jerusalem, Israel
| | - Maya Korem
- Department of Clinical Microbiology, Hebrew University Hadassah Medical Center, Jerusalem, Israel
| | - Jeffrey M Weinberger
- Department of Otolaryngology/Head and Neck Surgery, Hebrew University Hadassah Medical Center, Jerusalem, Israel
| | - Ron Eliashar
- Department of Otolaryngology/Head and Neck Surgery, Hebrew University Hadassah Medical Center, Jerusalem, Israel
| | - Nir Hirshoren
- Department of Otolaryngology/Head and Neck Surgery, Hebrew University Hadassah Medical Center, Jerusalem, Israel
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Abstract
Macedonia is a multiethnic developing country with a new democratic political system in transition from a former communist country. The country gained independence as former Yugoslav Republic of Macedonia in 1991. Recent health reforms have privatized pediatric primary care and introduced family doctors alongside primary care pediatricians. Increasing privatization of hospitals have left the state-run hospitals short of pediatric specialists and subspecialists as doctors moved to private hospitals for better salaries and working conditions. There is little coordinated action between the Ministry of Health, health insurance fund, and Macedonian pediatricians to overcome the problems that now exist within the pediatric/child health system because of these recent reforms, which were politically driven without consultation with the Macedonian Pediatric Association. These recent decisions will have an adverse effect on the quality of care for children and families, which will likely continue for another 5-10 years.
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Affiliation(s)
- Velibor Tasic
- University Children's Hospital, Medical School, Skopje, Macedonia
| | - Dragan Danilovski
- Institute for Epidemiology and Biostatistics with Medical Informatics, Medical School, Skopje, Macedonia
| | - Zoran Gucev
- University Children's Hospital, Medical School, Skopje, Macedonia
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21
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Bosilkovski M, Kamiloski V, Miskova S, Balalovski D, Kotevska V, Petrovski M. Testicular infection in brucellosis: Report of 34 cases. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2016; 51:82-87. [PMID: 27036087 DOI: 10.1016/j.jmii.2016.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/09/2015] [Accepted: 02/01/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND/PURPOSE To present clinical and laboratory features, treatment options, and outcome in patients with brucellar testicular infection and to compare them with analogous in brucellar patients without testicular involvement. METHODS Thirty four brucellar patients with testicular infection treated in two general hospitals in the Republic of Macedonia, during the period 1998-2009, were retrospectively analyzed. Their clinical and laboratory characteristics were compared with analogous in 364 male brucellar patients without testicular infection, who were treated at the same hospitals during the same time period. RESULTS Brucellar testicular infection was evident in 34 (8.5%) out of 398 male patients with brucellosis. The median age of the patients was 46.5 years. In all patients testicular involvement was presented as an acute form with a median duration of 5 days (range, 2-14 days) prior to diagnosis. Twenty-three of the patients had at least one other simultaneous focal infection. After starting with the treatment testicular infection lasted a median 10 days, range 7-21 days. Brucellar patients with testicular infection when compared with other brucellar patients more frequently manifested fever (97% vs. 61%), concomitant spondylitis (32% vs. 16%), and urinary system involvement (12% vs. 2%). Also, the relapse rate in patients with testicular involvement was significantly higher (24% vs. 9%). CONCLUSION In endemic regions brucellosis should be taken into consideration in any patient with testicular infection. Brucellar testicular involvement is usually characterized with a severe acute clinical presentation and a high percentage of relapses which entails the need of timely recognition and proper treatment duration of at least 60 days.
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Affiliation(s)
- Mile Bosilkovski
- Medical Faculty "Ss Cyril and Methodius University", Skopje, Macedonia.
| | - Viktor Kamiloski
- Medical Faculty "Ss Cyril and Methodius University", Skopje, Macedonia
| | - Silvana Miskova
- Department for Infectious Diseases, Medical Center, Veles, Macedonia
| | - Danco Balalovski
- Department for Infectious Diseases, Medical Center, Bitola, Macedonia
| | - Vesna Kotevska
- Medical Faculty "Ss Cyril and Methodius University", Skopje, Macedonia; Institute for Clinical Microbiology, Skopje, Macedonia
| | - Mile Petrovski
- Medical Faculty "Ss Cyril and Methodius University", Skopje, Macedonia
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Yilmaz B, Ozdemir G, Aktas E, Komur B, Alfidan S, Memisoglu S, Duymuş TM. Brucellosis Suspicion is the Most Important Criterion for Diagnosis Particularly in Endemic Regions. Open Orthop J 2016; 10:7-11. [PMID: 27006730 PMCID: PMC4780486 DOI: 10.2174/1874325001610010007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 09/03/2015] [Accepted: 09/11/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction: Brucellosis is a zoonotic infectious disease that remains endemic in developing countries. The purpose of this study is to emphasize the need for considering brucellosis as a diagnosis, since this disease has a high risk of complications among young patients when not treated appropriately. Methodology: A total of 88 brucellosis cases with blood cultures that were positive for the pathogen were evaluated retrospectively in this study. Results: The patients included 33 males (37.5%) and 55 females (62.5%) with a median age of 8.9 years (range: 5-14 years). A total of 43.1% (n=38) of the cases included occupational exposure to animals as a possible infection source. The consumption of raw milk products, especially cheese, was present in 52.2% (n=46) of the cases. Clinically, 55 of the cases were acute (62.5%), 23 of the cases were subacute (26.2%) and 10 of the cases were chronic (11.3%). The distribution of the joint pain complaints was as follows: 62.5% (n=55) of patients reported hip pain, 22.7% (n=20) of patients reported knee pain, 11.4% (n=10) of patients reported lumbar-back pain and 3.4% (n=3) of patients reported pain in other joints. A total of 59.1% (n=52) of the cases had been examined by another doctor at least once and mistreated. Conclusion: Complication rates and the rate of chronic infection increase with delayed diagnosis, and clinical doubt is the most important criterion for diagnosis, particularly in endemic regions.
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Affiliation(s)
- Baris Yilmaz
- Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Guzelali Ozdemir
- Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Erdem Aktas
- Dr. A. Yurtaslan Ankara Onkology Training and Research Hospital, Ankara, Turkey
| | - Baran Komur
- Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
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Bosilkovski M, Zezoski M, Siskova D, Miskova S, Kotevska V, Labacevski N. Clinical characteristics of human brucellosis in patients with various monoarticular involvements. Clin Rheumatol 2016; 35:2579-84. [PMID: 26861030 DOI: 10.1007/s10067-016-3207-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/20/2015] [Accepted: 02/01/2016] [Indexed: 12/22/2022]
Abstract
The aim of the study was to determine the main demographic, epidemiological, clinical characteristics, and outcome in patients with various types of brucellar monoarticular involvement. Retrospectively, we analyzed medical histories of 331 patients with brucellar monoarticular involvement who were treated at the infectious diseases departments in Prilep, Shtip, and Veles, Republic of Macedonia, during the period 1990-2012. Their data were compared accordingly to the affected joint (sacroiliac, hip, knee, ankle, wrist, and shoulder).Patients with shoulder arthritis were significantly the oldest (mean ± standard deviation [SD] 46.0 ± 14.5 years) whereas sacroiliitis and hip arthritis were present predominantly in younger patients (mean ± SD 28.7 ± 14.1 and 28.3 ± 18.3 years, respectively) (p = 0.014). Shoulder arthritis duration was significantly the longest (mean ± SD 24.5 ± 12.4 days), and wrist arthritis duration was significantly the shortest (mean ± SD 4.1 ± 2.5 days) (p < 0.001), before establishing the diagnosis of brucellosis. With appropriate treatment, the need for restitution of the joint impairment was significantly longer when sacroiliitis and hip arthritis were present (mean ± SD 32.8 ± 23.0 and 24.6 ± 12.5 days, respectively) (p < 0.001). The relapses were noted in 14.5, 14, 16.5, 5.5, 6, and 5.5 % of the patients with sacroiliitis, hip-, shoulder-, knee-, ankle-. and wrist arthritis, respectively. In endemic areas, brucellosis should be included in the differential diagnostic consideration in patients with monoarticular involvement. Knee-, ankle-, and wrist arthritis seem to be more benign and with appropriate treatment result in short duration and satisfactory outcome. On the other hand, the involvement of sacroiliac, hip-, and shoulder joint deserves more serious approach due to longer arthritis duration and higher frequency of relapses.
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Affiliation(s)
- Mile Bosilkovski
- Medical Faculty "Ss Cyril and Methodius" University, ul "Bozidar Adzija" br. 18/1-6 1000, Skopje, Republic of Macedonia.
| | - Marjan Zezoski
- Department for Infectious Diseases, Medical Center Prilep, Prilep, Republic of Macedonia
| | - Dijana Siskova
- Department for Infectious Diseases, Medical Center Shtip, Shtip, Republic of Macedonia
| | - Silvana Miskova
- Department for Infectious Diseases, Medical Center Veles, Veles, Republic of Macedonia
| | - Vesna Kotevska
- Medical Faculty "Ss Cyril and Methodius" University, ul "Bozidar Adzija" br. 18/1-6 1000, Skopje, Republic of Macedonia
- Institute for Microbiology, Skopje, Republic of Macedonia
| | - Nikola Labacevski
- Medical Faculty "Ss Cyril and Methodius" University, ul "Bozidar Adzija" br. 18/1-6 1000, Skopje, Republic of Macedonia
- Institute for Clinical Pharmacology, Skopje, Republic of Macedonia
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Bosilkovski M, Krteva L, Caparoska S, Labacevski N, Petrovski M. Childhood brucellosis: Review of 317 cases. ASIAN PAC J TROP MED 2015; 8:1027-1032. [PMID: 26706674 DOI: 10.1016/j.apjtm.2015.11.009] [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] [Received: 09/15/2015] [Revised: 10/20/2015] [Accepted: 11/03/2015] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To describe the main epidemiological, clinical, and laboratory features, treatment options and outcome in children with brucellosis. METHODS Retrospectively evaluated data were obtained from 317 pediatric patients with brucellosis that were treated at the University Clinic for Infectious Diseases and Febrile Conditions in Skopje, during the period from 1989 to 2011. The medical records and follow-up protocols were used for evaluation. RESULTS Childhood brucellosis composed 317 (18.7%) of 1691 patients with brucellosis. The patients were median 9 years old, ranging from 7 months to 14 years, and 201 (63.4%) were males. Family history was present in 197 (62.1%), and direct contact with animals occurred in 140 (44.2%) of the children. The dominant manifestations were fever in 248 (78.2%), joint pain in 228 (71.9%) and hepatomegaly in 216 (68.1%). Organ affection was present in 206 (65.0%) of the patients. One hundred and six (33.4%) of the patients were treated with combination composed of two, and 211 (66.6%) with three antimicrobial agents. Relapses were registered in 21 (6.6%), and therapeutic failures in 3 (0.9%) of the children. CONCLUSIONS In endemic regions childhood brucellosis represents a significant part of human cases. Wide spectrum of clinical manifestations, frequent affection of various organ systems and possibility of relapses show that brucellosis could be a serious disease in this age group. The presence of fever, joint pain, sweating, and affection of various systems in children from endemic regions should alert pediatricians for the possibility of brucellosis.
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Affiliation(s)
- Mile Bosilkovski
- Medical Faculty, 'Ss Cyril and Methodius' University, Skopje, Macedonia.
| | - Ljiljana Krteva
- University Clinic for Infectious Diseases and Febrile Conditions, Skopje, Macedonia
| | - Sonja Caparoska
- University Clinic for Infectious Diseases and Febrile Conditions, Skopje, Macedonia
| | - Nikola Labacevski
- Medical Faculty, 'Ss Cyril and Methodius' University, Skopje, Macedonia; Institute for Clinical Pharmacology, Skopje, Macedonia
| | - Mile Petrovski
- Medical Faculty, 'Ss Cyril and Methodius' University, Skopje, Macedonia; University Clinic for Pediatric Surgery, Skopje, Macedonia
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Abstract
Monoarthritis, defined as inflammation of a single joint, requires a thorough physical examination in children, as pain may be lacking in 10% to 30% of cases and joint stiffness may be the only symptom. Joint aspiration is a crucial diagnostic tool that remains markedly underused. Joint aspiration may be unnecessary, however, when the family history or other investigations provide the diagnosis. Radiographs of the involved joint may supply information on the severity of the lesions. In doubtful cases and in patients with arthralgia, B-mode and Doppler ultrasound or magnetic resonance imaging (MRI) may confirm the presence of synovitis. Although suspected septic arthritis is an emergency and occurs frequently, particularly before 2 years of age, acute monoarthritis is often a post-infectious manifestation and therefore associated with a good outcome. Lyme disease should be sought, particularly when a lower limb joint is involved, as tick bites often go unnoticed. Chronic monoarthritis is very often a manifestation of juvenile idiopathic arthritis (JIA), which exists as several variants. Oligoarthritis is a specifically pediatric joint disease, whereas the other patterns of JIA have corresponding forms in adults, despite a number of specific features due to their onset during childhood. Tests for antinuclear antibodies should be performed routinely in children with monoarthritis persisting longer than 3 weeks. A decline in general health or a fever should suggest arthritis revealing a malignancy, which is a hematological disease in most cases. Finally, suggestive symptoms are often present in patients with less common causes such as auto-inflammatory diseases and connective tissue diseases.
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Wong TM, Lou N, Jin W, Leung F, To M, Leung F. Septic arthritis caused by Brucella melitensis in urban Shenzhen, China: a case report. J Med Case Rep 2014; 8:367. [PMID: 25394500 PMCID: PMC4234531 DOI: 10.1186/1752-1947-8-367] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 09/01/2014] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Brucellosis is a systemic infectious disease which is still a challenging medical problem in rural areas such as northern China. It rarely occurs in urban areas such as Shenzhen in southern China. Osteoarticular involvements are frequently seen in brucellosis, and rarely is arthritis the only clinical presentation. We report a case of hip septic arthritis caused by Brucella melitensis in an urban area of Shenzhen, China. CASE PRESENTATION A 29-year-old Chinese woman, Han ethnical group presented to our hospital with left hip pain persisting for one month. She had a history of contact with goats one month before admission. Her clinical examination showed marked tenderness and limited movement of her left hip. Further imaging showed effusion of her left hip joint. Inflammatory markers including erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) were raised. Our clinical diagnosis was septic arthritis of the left hip. A left hip arthroscopy was performed and the culture was positive for Brucella melitensis. She returned to normal activity after completing a standard antibiotic regimen, including gentamicin at 120mg daily for 2 weeks, doxycycline at 100mg daily and rifampicin at 450mg for a total of 12 weeks. CONCLUSIONS Brucellosis is endemic in some rural areas of China, but rare in urban areas such as Shenzhen in southern China. However, more cases will be expected in urban areas due to increasing migration within China. Physicians should consider brucellosis as one of the differential diagnosis of arthritis. Early surgical intervention is recommended to prevent further joint destruction.
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Affiliation(s)
| | | | | | | | | | - Frankie Leung
- Department of Orthopedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, 102, Pokfulam Road, Hong Kong, China.
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