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Elmas A, Ulutaş F. Peripheral Arthritis and Tenosynovitis in a Patient With Brucellosis. Cureus 2023; 15:e35292. [PMID: 36968867 PMCID: PMC10037351 DOI: 10.7759/cureus.35292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 02/24/2023] Open
Abstract
Brucellosis is an infectious disease caused by Gram-negative bacteria. Musculoskeletal system involvement is common in patients with brucellosis. Herein we report a patient who presented with bilateral arthralgia in the ankles and diffuse swelling of the left hand in the follow-up. He had been diagnosed with brucellosis and improved well after a 10-week duration of antibiotic therapy. Rheumatic diseases may have many infectious mimickers. Brucellosis is one of those that should be considered in the differential diagnosis.
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Lin ZQ, Lin GY, He WW, Zhang C, Zhang R, Li YD, Wang F, Qin Y, Duan L, Zhao DD, Qu XJ, Gao H, Jiang H. IL-6 and INF-γ levels in patients with brucellosis in severe epidemic region, Xinjiang, China. Infect Dis Poverty 2020; 9:47. [PMID: 32381058 PMCID: PMC7203901 DOI: 10.1186/s40249-020-00666-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/23/2020] [Indexed: 01/18/2023] Open
Abstract
Background The incidence of brucellosis, which is caused by the Brucella species of bacteria, is rapidly rising worldwide; however, few studies have investigated the immune response to this pathogen and clinical biochemical features. In this paper, we examined the levels of various cytokines and inflammatory factors as well as clinical course characteristics in patients with brucellosis, in order to provide evidence for the diagnosis, assessment, and prognosis of this infectious disease. Methods A total of 191 brucellosis inpatients (50 acute cases and 141 chronic cases), as well as 60 healthy control subjects, were included in the analysis. We investigated changes in the levels of six cytokines (IL-4, IL-6, IL-10, IL-17, TNF-α, INF-γ) and related clinical biochemical markers in patients with acute and chronic brucellosis in Xinjiang, China. Possible factors were statistically analyzed using the t test, χ2 test, z test and a multivariate logistic stepwise regression test. Results We found that IL-4, IL-6, IL-10, IL-17, IFN-γ, and TNF-α levels were higher in those with brucellosis than in controls (P < 0.05). With regard to disease progression, procalcitonin (PCT) and C-reactive protein (CRP) levels were significantly higher in those with an acute infection compared to chronic cases (P < 0.05). We found that the expression of all six cytokines tested was closely related to the degree of brucellosis using univariate logistic regression; however, only IL-6 and INF-γ levels were independent factors associated with the severity of brucellosis. Conclusions Assessing cytokine levels in patients with acute and chronic brucellosis is not only useful for detecting the immune response, but can also be indicative of the severity of brucellosis. In particular, we propose IL-6 and INF-γ levels may be useful independent predictive factors in the clinical evaluation and diagnosis of brucellosis.
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Affiliation(s)
- Zhi-Qiang Lin
- Department of Clinical Laboratory, Sixth People's Hospital, Urumqi, Xinjiang, Uygur Autonomous Region, China
| | - Guo-Yue Lin
- Department of Clinical Laboratory, Sixth People's Hospital, Urumqi, Xinjiang, Uygur Autonomous Region, China
| | - Wen-Wen He
- Department of Clinical Laboratory, Sixth People's Hospital, Urumqi, Xinjiang, Uygur Autonomous Region, China
| | - Chi Zhang
- Department of Clinical Laboratory, Sixth People's Hospital, Urumqi, Xinjiang, Uygur Autonomous Region, China
| | - Rui Zhang
- Department of Clinical Laboratory, Sixth People's Hospital, Urumqi, Xinjiang, Uygur Autonomous Region, China
| | - Yuan-Da Li
- Department of Clinical Laboratory, Sixth People's Hospital, Urumqi, Xinjiang, Uygur Autonomous Region, China
| | - Fan Wang
- Department of Clinical Laboratory, Sixth People's Hospital, Urumqi, Xinjiang, Uygur Autonomous Region, China
| | - Ying Qin
- Department of Clinical Laboratory, Sixth People's Hospital, Urumqi, Xinjiang, Uygur Autonomous Region, China
| | - Li Duan
- Department of Clinical Laboratory, Sixth People's Hospital, Urumqi, Xinjiang, Uygur Autonomous Region, China
| | - Dou-Dou Zhao
- Department of Clinical Laboratory, Sixth People's Hospital, Urumqi, Xinjiang, Uygur Autonomous Region, China
| | - Xiao-Juan Qu
- Department of Clinical Laboratory, Sixth People's Hospital, Urumqi, Xinjiang, Uygur Autonomous Region, China
| | - Hui Gao
- Department of Clinical Laboratory, Sixth People's Hospital, Urumqi, Xinjiang, Uygur Autonomous Region, China
| | - Hai Jiang
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Laboratory Diagnostic Procedures for Human Brucellosis: An Overview of Existing Approaches. Jundishapur J Microbiol 2019. [DOI: 10.5812/jjm.91200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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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: 28] [Impact Index Per Article: 4.7] [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.
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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
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Clinical and laboratory findings of 97 pediatric brucellosis patients in central Turkey. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 48:446-9. [PMID: 25092047 DOI: 10.1016/j.jmii.2014.04.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 01/27/2014] [Accepted: 04/25/2014] [Indexed: 11/21/2022]
Abstract
Brucellosis is a disease transmitted to humans by consumption of unpasteurized animal milk, or through direct contact with infected animals. The aim of this study was to evaluate clinical, laboratory findings of pediatric patients with brucellosis. Data of 97 patients diagnosed with brucellosis between January 2000 and December 2010 were evaluated retrospectively.
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Nandagopal B, Sankar S, Lingesan K, Appu K, Sridharan G, Gopinathan A. Application of polymerase chain reaction to detect burkholderia pseudomallei and Brucella species in buffy coat from patients with febrile illness among rural and peri-urban population. J Glob Infect Dis 2012; 4:31-7. [PMID: 22529625 PMCID: PMC3326955 DOI: 10.4103/0974-777x.93759] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Context: Melioidosis and Brucellosis are important endemic infections among people in India, especially in rural settings. Conventional detection techniques have several limitations. Only a few studies exist on the prevalence of Melioidosis and Brucellosis in rural area especially in India. Aim: We sought to evaluate detection of Burkholderia pseudomallei and Brucella spp. among patients presenting febrile illness. Material and Methods: Previously described polymerase chain reaction (PCR) assays for both pathogens were evaluated with Deoxyribonucleic acid extracts of buffy coat samples collected from 301 patients recruited prospectively. Data was not amenable to statistical analysis. Results: The PCR showed specific amplification and no non-specific amplification with heterologous Gram-negative bacilli. The lower limit of detection of the assay for B. pseudomallei was determined to be 1 colony-forming unit /mL and for Brucella it was 1.95 × 103 plasmids per microliter. Blood culture in automated blood culture system was negative for all the samples. This prospective study carried out in southern India for the first time. PCR for Brucella was positive in 1% of the patient samples whereas 0.3% was positive for B. pseudomallei. Conclusion: The finding of Brucella and Burkholderia infections in our populations leads us to suggest that tests for Brucella and B. pseudomallei should also form part of a diagnostic platform for patients with Pyrexia of unknown origin in tropical developing countries.
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Affiliation(s)
- Balaji Nandagopal
- Division of Biomedical Research, Sri Narayani Hospital and Research Centre, Thirumalaikodi, Sripuram, Vellore, India
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Solís García del Pozo J, Solera J. Systematic review and meta-analysis of randomized clinical trials in the treatment of human brucellosis. PLoS One 2012; 7:e32090. [PMID: 22393379 PMCID: PMC3290537 DOI: 10.1371/journal.pone.0032090] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Accepted: 01/22/2012] [Indexed: 11/19/2022] Open
Abstract
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.
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Bosilkovski M, Krteva L, Dimzova M, Vidinic I, Sopova Z, Spasovska K. Human brucellosis in Macedonia - 10 years of clinical experience in endemic region. Croat Med J 2010; 51:327-36. [PMID: 20718086 PMCID: PMC2931438 DOI: 10.3325/cmj.2010.51.327] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 05/15/2010] [Indexed: 11/05/2022] Open
Abstract
AIM To present our 10-year clinical experience with brucellosis patients at the University Clinic for Infectious Diseases and Febrile Conditions in Skopje, Republic of Macedonia. METHODS A total of 550 patients with brucellosis treated between 1998 and 2007 were retrospectively assessed for their demographic, epidemiological, and clinical characteristics and outcomes. RESULTS Of the 550 patients, 395 (72%) were male. The median age was 34.5 years (range, 1-82). Direct contact with infected animals was recorded in 333 (61%) patients and positive family history in 310 (56%). The most frequently seen symptoms were arthralgia (438, 80%), fever (419, 76%), and sweating (394, 72%). The most common signs were fever and hepatomegaly, which were verified in 357 (65%) and 273 (50%) patients, respectively. Focal brucellosis was found in 362 patients (66%) and osteoarticular in 299 (54%). Therapeutic failures were registered in 37 (6.7%) patients. Of the 453 (82%) patients who completed a follow-up period of at least 6 months, relapses occurred in 60 (13%). CONCLUSION Due to non-specific clinical manifestation and laboratory parameters, brucellosis should be considered one of the differential diagnoses of any patient suffering from obscure involvement of various organs in a brucellosis-endemic region. High percentage of relapses and therapeutic failures in spite of the use of currently recommended therapeutic regimens indicates the seriousness of this zoonosis and the need to control it.
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Affiliation(s)
- Mile Bosilkovski
- University Clinic for Infectious Diseases and Febrile Conditions, Skopje, Republic of Macedonia.
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Yingst SL, Huzella LM, Chuvala L, Wolcott M. A rhesus macaque (Macaca mulatta) model of aerosol-exposure brucellosis (Brucella suis): pathology and diagnostic implications. J Med Microbiol 2010; 59:724-730. [PMID: 20223898 PMCID: PMC3052509 DOI: 10.1099/jmm.0.017285-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The US Centers for Disease Control and Prevention lists Brucella as a potential bioterrorism threat requiring enhanced diagnostic capacity and surveillance (http://emergency.cdc.gov/bioterrorism/). Successful treatment and management of patients after exposure to biological threat agents depends on accurate and timely diagnosis, but many biothreat agents present with similar, vague clinical signs – commonly referred to as ‘flu-like illness’. Diagnosis of brucellosis is notoriously challenging, especially early in infection, and definitive diagnosis may require invasive methods, e.g. bone marrow biopsy. We studied the pathogenesis of Brucella suis aerosol infection in rhesus macaques in an effort to guide the diagnostic algorithm in case of possible intentional exposure of humans. Rhesus proved to be an excellent model for human brucellosis; the data showed that PCR DNA amplification testing of non-invasive diagnostic samples has the potential to definitively detect a point-source outbreak immediately and for several days after exposure.
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Affiliation(s)
- Samuel L Yingst
- US Army Medical Research Institute of Infectious Diseases, 1425 Porter Street, Fort Detrick, MD 21702, USA
| | - Louis M Huzella
- US Army Medical Research Institute of Infectious Diseases, 1425 Porter Street, Fort Detrick, MD 21702, USA
| | - Lara Chuvala
- Akimeka Technologies LLC, 1425 Porter Street, Fort Detrick, MD 21702, USA.,US Army Medical Research Institute of Infectious Diseases, 1425 Porter Street, Fort Detrick, MD 21702, USA
| | - Mark Wolcott
- US Army Medical Research Institute of Infectious Diseases, 1425 Porter Street, Fort Detrick, MD 21702, USA
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Buzgan T, Karahocagil MK, Irmak H, Baran AI, Karsen H, Evirgen O, Akdeniz H. Clinical manifestations and complications in 1028 cases of brucellosis: a retrospective evaluation and review of the literature. Int J Infect Dis 2009; 14:e469-78. [PMID: 19910232 DOI: 10.1016/j.ijid.2009.06.031] [Citation(s) in RCA: 307] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Revised: 06/02/2009] [Accepted: 06/25/2009] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- Turan Buzgan
- Directorate of Basic Health Services, Ministry of Health, Ankara, Turkey
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Helbok R, Broessner G, Pfausler B, Schmutzhard E. Chronic meningitis. J Neurol 2009; 256:168-75. [PMID: 19224317 DOI: 10.1007/s00415-009-0122-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Revised: 09/29/2008] [Accepted: 09/30/2008] [Indexed: 12/23/2022]
Abstract
Chronic meningitis is an inflammation of the meninges with subacute onset and persisting cerebrospinal fluid (CSF) abnormalities lasting for at least one month. Several non-infectious and infectious etiologies are known to be causative. The wide range of different etiologies renders the approach to patients with this syndrome particularly difficult. There is no standardized diagnostic procedure, thus, taking an in depth history combined with a complete physical examination is mandatory in every patient.This review aims to present the current knowledge on etiology, neurological course of disease, diagnostic and therapeutic management steps of patients presenting with clinical signs and symptoms of chronic meningitis and meningoencephalitis. Still, the etiology of one third of patients remains unclear, reflecting the diagnostic challenge of this syndrome for each physician or neurologist, respectively. However, most patients with idiopathic chronic meningitis have a relatively good outcome.
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Affiliation(s)
- Raimund Helbok
- Dept. of Neurology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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