A rare disease in the differential diagnosis of acute pancreatitis: acute brucellosis

Research progress on complications of Brucellosis

Brucellosis is a common zoonotic disease that is widely spread worldwide and poses a major threat to human health. Clinically, it often presents with non-specific symptoms such as fever, excessive sweating, malaise, myalgia, arthralgia, loss of appetite, weight loss, and enlarged liver, spleen and lymph nodes. The disease has a long and recurrent course, often accumulating in multiple systems and organs. Of these, osteoarticular involvement is the most common complication, with a prevalence of approximately 2-77%, usually manifesting as spondylitis, sacroiliac arthritis and peripheral arthritis. Hepatosplenomegaly is seen in about 50% of patients with brucellosis, and gastrointestinal disturbances such as abdominal pain, nausea, and vomiting are common. Although respiratory involvement is less common, pneumonia, pleurisy, pleural effusion, and pulmonary nodules have been reported. Besides, approximately 2-20% of cases involve infections of the male genitourinary system, mainly manifesting as unilateral epididymal-orchitis and orchitis. The most serious complication facing brucellosis is cardiovascular involvement, and although the overall mortality rate of brucellosis is about 1% and the incidence of brucellosis endocarditis is less than 2%, more than 80% of deaths are associated with endocarditis. Furthermore, brucellosis is complicated by hematologic disease, with anemia occurring in approximately 20-53% of children during the acute phase. In addition, the neurological incidence of brucellosis is about 0.5-25%, mainly manifested as meningitis. In this study, we review the multisystem complications of brucellosis with the aim of improving early diagnosis, timely treatment and prevention of long-term complications.

Erectile dysfunction among patients with chronic brucellosis

OBJECTIVE

Only a single study investigated erectile dysfunction (ED) among patients with chronic brucellosis without including a control group. Our study objective was to determine the prevalence of ED among patients with chronic brucellosis compared to normal subjects, and to explore the predictors of ED.

MATERIALS AND METHODS

We included 93 chronic brucellosis patients and 92 subjects as a control, from June 2013 to August 2017. Chronic brucellosis was diagnosed based on persistent symptoms for ≥1 year with positive immunoglobulin G antibody titer (≥1:160) by standard tube agglutination test; the mean duration was 21 ± 6.2 months. Clinical evaluation (including an Arabic validated version of the five-item International Index of Erectile Function to diagnose ED; score of 5-21 was diagnostic), imaging studies (including scrotal ultrasonography) and laboratory investigations (including estimation of fasting serum level of glucose (after fasting for 8 h), lipids profile (after fasting for 14 h), and serum level of testosterone) were conducted. A fasting serum glucose level of ≥ 7 mmol/L defined diabetes mellitus (DM). Predictors of ED were identified using multivariate analysis (binary logistic regression).

RESULTS

The mean age of patients was 35.4 ± 13.7 years; 24.7% of them had DM, while low serum level of testosterone was detected among 54.8%. Among the patients, ED was significantly more frequent compared to the control subjects (69.9% vs. 19.6%, p < 0.001). Low serum level of testosterone (OR 4.8, 95% CI 1.7-29.3, p 0.008), and DM (OR 3.5, 95% CI 1.2-34.6, p 0.011) were the predictors of ED among the patients.

CONCLUSIONS

The prevalence of ED among patients with chronic brucellosis is high. Low serum level of testosterone and DM are associated with ED among such patients.

Brucellosis-related acute pancreatitis: A rare complication of a universal disease

OBJECTIVES

To determine the prevalence and determinants of acute pancreatitis in patients with acute brucellosis.

METHODS

Adult patients with brucellosis were retrospectively recruited. Brucellosis and acute pancreatitis were diagnosed according to standard criteria. Laboratory analyses included Wright agglutination titre, serum biochemical parameters and blood count.

RESULTS

Patients with acute pancreatitis (n = 21) had significantly higher Wright agglutination titres, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ-glutamyl transpeptidase, amylase, lipase and serum glucose concentrations, and significantly lower haemoglobin concentrations and haematocrit than patients with brucellosis alone (n = 326).

CONCLUSIONS

Hyperglycaemia, anaemia, and liver transaminase and cholestatic enzyme concentrations may represent new approaches for assessing disease severity in patients with brucellosis and acute pancreatitis.