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Li P, Zhang L, Li X, Zhang X. Rhodococcus equi and Brucella pulmonary mass in immunocompetent: A case report and literature review. Open Life Sci 2024; 19:20220888. [PMID: 38911933 PMCID: PMC11193395 DOI: 10.1515/biol-2022-0888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/24/2024] [Accepted: 05/09/2024] [Indexed: 06/25/2024] Open
Abstract
Rhodococcus equi, predominantly recognized as an opportunistic pathogen affecting immunocompromised hosts, and Brucella, a widespread zoonotic bacterium, infrequently co-infect immunocompetent adults, thereby posing a distinctive diagnostic challenge. Here, we describe a case involving a 53-year-old male with a history of goat farming, who presented with persistent chest tightness, cough, and notable weight loss, absent fever. Radiological and bronchoscopic assessments showed a right hilar mass, extensive vertebral destruction, and bronchial lesions, deviating from the typical symptoms associated with either pathogen. Laboratory analyses confirmed a co-infection involving R. equi and Brucella. Initial therapy with levofloxacin and vancomycin proved ineffective; however, a subsequent treatment regimen comprising azithromycin, etimicin, minocycline, and moxifloxacin resulted in substantial clinical improvement. This case accentuates the intricacies involved in diagnosing and managing atypical co-infections in immunocompetent individuals and underscores the importance of careful microbiological testing to inform effective therapeutic strategies.
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Affiliation(s)
- Pengfei Li
- Department of General Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Lifang Zhang
- Department of General Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xicheng Li
- Department of General Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xuejuan Zhang
- Department of General Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Yılmaz GR, Kaya O, Öztürk Ö, Temel EN, Ünal O, Pekbay B, Akçam FZ. Pleurisy due to brucellosis. Eur J Clin Microbiol Infect Dis 2024:10.1007/s10096-024-04839-2. [PMID: 38856827 DOI: 10.1007/s10096-024-04839-2] [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: 08/21/2023] [Accepted: 04/25/2024] [Indexed: 06/11/2024]
Abstract
Any system or organ involvement can be seen in brucellosis, which is still a significant public health problem in developing countries. The rate of respiratory system involvement is lower than that of other systems and which is also difficult to document. Brucellosis-associated pleurisy is a rare complication even in endemic regions. In this case report, a 78-year-old male patient who was assessed for pleural effusion etiology is presented. Brucella spp. were isolated on the 14th day of the pleural fluid incubation in the blood culture set and the patienthas been treated successfully for brucellosis. Based on our experience we think that it is important to use blood culture media for sterile body fluids, particularly for microorganisms that are difficult to isolate such as Brucella spp.
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Affiliation(s)
- Gül Ruhsar Yılmaz
- Faculty of Medicine Infectious Diseases and Clinical Microbiology, Süleyman Demirel University, Isparta, Turkey.
| | - Onur Kaya
- Faculty of Medicine Infectious Diseases and Clinical Microbiology, Süleyman Demirel University, Isparta, Turkey
| | - Önder Öztürk
- Faculty of Medicine, Süleyman Demirel University, Chest Diseases, Isparta, Turkey
| | - Esra Nurlu Temel
- Faculty of Medicine Infectious Diseases and Clinical Microbiology, Süleyman Demirel University, Isparta, Turkey
| | - Onur Ünal
- Faculty of Medicine Infectious Diseases and Clinical Microbiology, Süleyman Demirel University, Isparta, Turkey
| | - Begüm Pekbay
- Faculty of Medicine Infectious Diseases and Clinical Microbiology, Süleyman Demirel University, Isparta, Turkey
| | - Füsun Zeynep Akçam
- Faculty of Medicine Infectious Diseases and Clinical Microbiology, Süleyman Demirel University, Isparta, Turkey
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Dogan F, Celik M, Cosandal BA, Turac B, Ceylan MR, Dincer NG. Evaluation of liver and spleen stiffness measurement with shear wave elastography in brucellosis. Ir J Med Sci 2024; 193:1521-1526. [PMID: 38055148 DOI: 10.1007/s11845-023-03577-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Human brucellosis, which is endemic in the eastern region of Turkey, infects the reticulo-endothelial system. Acute brucellosis may cause hepatomegaly or splenomegaly. AIMS The main purpose of this study was to investigate the effectiveness of the point shear wave elastography (pSWE) method in identifying and detecting liver and spleen stiffness in acute brucellosis. METHODS This case-control study included 40 patients with acute brusellosis and 60 healthy individuals as a control group. The demographic data, abdominal ultrasonography (USG) and pSWE results of the patient and control groups were evaluated. Statistical and ROC analyses were performed. RESULTS The liver pSWE value was 3.8395 ± 1.171 kPa in the patient group and 1.6619 ± 0.495 kPa in the control group. The spleen pSWE value was 3.2431 ± 1.803 kPa in the patient group and 1.3793 ± 0.622 kPa in the control group. The mean liver and spleen pSWE values were statistically significantly higher in the patient group than in the control group (p < 0.001). Cut-off values were determined as 2.524 for the liver pSWE and 1.62667 for the spleen pSWE. From the AUC values (0.959, 0.903), the diagnostic performance of liver and spleen pSWE values were seen to be excellent in distinguishing between patient and control groups. CONCLUSIONS The study results showed that liver and spleen stiffness were high in acute brucellosis patients and had predictive significance above certain cut-off values. It can be considered that pSWE, which evaluates liver and spleen stiffness in acute brucellosis, may provide diagnostic benefit as a reliable, non-invasive technique.
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Affiliation(s)
- Ferit Dogan
- Department of Radiology, Harran University, Sanliurfa, 63300, Turkey.
| | - Mehmet Celik
- Department of Radiology, Harran University, Sanliurfa, 63300, Turkey
| | | | - Burak Turac
- Department of Radiology, Harran University, Sanliurfa, 63300, Turkey
| | | | - Nevin Guler Dincer
- Department of Statistics, Faculty of Science, University of Mugla Sıtkı Kocman, Mugla, Turkey
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Liu B, Ji YX, Zhao CS, Zhang Q. Real-time polymerase chain reaction detection and surgical treatment of thoracic and lumbar spondylitis due to Brucella infection: two typical case reports. Front Public Health 2024; 12:1396152. [PMID: 38841672 PMCID: PMC11150549 DOI: 10.3389/fpubh.2024.1396152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/02/2024] [Indexed: 06/07/2024] Open
Abstract
Background Spondylitis caused by Brucella infection is a rare but challenging condition, and its successful management depends on timely diagnosis and appropriate treatment. This study reports two typical cases of thoracic and lumbar brucellosis spondylitis, highlighting the pivotal roles of real-time polymerase chain reaction (real-time PCR) detection and surgical intervention. Case presentation Case 1 involved a 49-year-old male shepherd who presented with a 6-month history of fever (40°C), severe chest and back pain, and 2-week limited lower limb movement with night-time exacerbation. Physical examination revealed tenderness and percussion pain over the T9 and T10 spinous processes, with grade 2 muscle strength in the lower limbs. CT showed bone destruction of the T9 and T10 vertebrae with narrowing of the intervertebral space, whereas MRI demonstrated abnormal signals in the T9-T10 vertebrae, a spinal canal abscess, and spinal cord compression. The Rose Bengal plate agglutination test was positive. Case 2 was a 59-year-old man who complained of severe thoracolumbar back pain with fever (39.0°C) and limited walking for 2 months. He had a 2.5 kg weight loss and a history of close contact with sheep. The Rose Bengal test was positive, and the MRI showed inflammatory changes in the L1 and L2 vertebrae. Diagnosis and treatment: real-time PCR confirmed Brucella infection in both cases. Preoperative antimicrobial therapy with doxycycline, rifampicin, and ceftazidime-sulbactam was administered for at least 2 weeks. Surgical management involved intervertebral foraminotomy-assisted debridement, decompression, internal fixation, and bone grafting under general anesthesia. Postoperative histopathological examination with HE and Gram staining further substantiated the diagnosis. Outcomes: both patients experienced significant pain relief and restored normal lower limb movement at the last follow-up (4-12 weeks) after the intervention. Conclusion Real-time PCR detection offers valuable diagnostic insights for suspected cases of brucellosis spondylitis. Surgical treatment helps in infection control, decompression of the spinal cord, and restoration of stability, constituting a necessary and effective therapeutic approach. Prompt diagnosis and comprehensive management are crucial for favorable outcomes in such cases.
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Affiliation(s)
| | | | - Chang-song Zhao
- Department of Orthopaedics, National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Qiang Zhang
- Department of Orthopaedics, National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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Liu C, Liu Q, Zheng J, Niu N, Shi J, Yang Z. Selection of treatment strategies for lumbar Brucella spondylitis: a retrospective clinical study. Front Surg 2024; 11:1365498. [PMID: 38596166 PMCID: PMC11003786 DOI: 10.3389/fsurg.2024.1365498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024] Open
Abstract
Objective This study aims to investigate the treatment strategies for lumbar brucellar spondylitis by comparing the outcomes of pure pharmacological treatment with diseased intervertebral fixation fusion, with or without lesion clearance. Methods A total of 157 patients with lumbar brucellar spondylitis were categorized into three groups: Group A (52 cases) received pure pharmacological treatment, Group B (53 cases) underwent posterior vertebral fixation fusion, and Group C (52 cases) received posterior (or anterior) lesion clearance followed by posterior vertebral fixation fusion. Clinical data were analyzed, and the efficacy of the three treatment methods was evaluated. Results The surgical groups showed better outcomes at various time points compared to the pharmacological treatment group (P < 0.05). The pure fixation group outperformed the lesion clearance fusion group during the perioperative period (P < 0.05). The ESR, CRP, ODI scores, imaging evaluation and complications of the lesion clearance followed by fixation group were all better than those of the other two groups (P < 0.05). Surgical treatment groups showed no statistically significant difference in VAS scores (P > 0.05), and both were superior to the pharmacological treatment group. There were no statistically significant differences in clinical efficacy among the three groups at the last follow-up. Conclusion Surgical treatment achieves early recovery goals compared to pharmacological treatment for brucellar spondylitis. However, individualized treatment principles should guide surgical decisions to select the most suitable approach for patients.
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Affiliation(s)
- Changhao Liu
- Department of Orthopedics, Zhangye People’s Hospital Affiliated to Hexi University, Zhangye, Gansu, China
| | - Qiang Liu
- The First Clinical Medical College of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Jianping Zheng
- Department of Orthopedic, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Ningkui Niu
- Department of Orthopedic, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Jiandang Shi
- Department of Orthopedic, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Zongqiang Yang
- Department of Orthopedic, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
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Chen L, Lin X, Cai X, Zeng S, Yuan Y, Huang Z, Yan J, Li Y. The challenge of managing ischemic stroke in brucellosis: a case report. Front Immunol 2024; 15:1347216. [PMID: 38533516 PMCID: PMC10963473 DOI: 10.3389/fimmu.2024.1347216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/26/2024] [Indexed: 03/28/2024] Open
Abstract
A 64-year-old woman was admitted to the hospital for sudden weakness in one of her left limbs. The patient was diagnosed with acute ischemic stroke (IS) of undetermined cause and received intravenous thrombolysis. Following thrombolysis, the patient's left limb weakness improved, but she subsequently developed recurrent high fever and delirium. Further diagnostic tests revealed that she had been infected with Brucella melitensis. The patient showed significant improvement during anti-infection treatment for Brucellosis and secondary prevention treatment for IS. However, her condition unexpectedly worsened on the 44th day after admission due to a hemorrhagic stroke (HS), which required an urgent craniotomy. Immunohistochemical analysis of the hematoma sample collected during the operation showed the presence of CD4+ and CD8+ T lymphocytes surrounding the blood vessels. This case highlights the unique challenge of managing IS in brucellosis and sheds light on the potential role of T lymphocytes in the immune response related to stroke.
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Affiliation(s)
- Linfa Chen
- Department of Neurology, Huizhou Third People’s Hospital, Guangzhou Medical University, Huizhou, China
| | - Xiaolong Lin
- Department of Pathology, Huizhou Third People’s Hospital, Guangzhou Medical University, Huizhou, China
| | - Xiuqu Cai
- Department of Neurology, Huizhou Third People’s Hospital, Guangzhou Medical University, Huizhou, China
| | - Shiting Zeng
- Department of Neurology, Huizhou Third People’s Hospital, Guangzhou Medical University, Huizhou, China
| | - Yanquan Yuan
- Department of Neurology, Huizhou Third People’s Hospital, Guangzhou Medical University, Huizhou, China
| | - Zhiyong Huang
- Department of Neurology, Huizhou Third People’s Hospital, Guangzhou Medical University, Huizhou, China
| | - Jinjin Yan
- Department of Neurology, Huizhou Third People’s Hospital, Guangzhou Medical University, Huizhou, China
| | - You Li
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
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Shi QN, Qin HJ, Lu QS, Li S, Tao ZF, Fan MG, Aishan MH, Kou ZQ, Chen QL, Yin WW, Zhang YP. Incidence and warning signs for complications of human brucellosis: a multi-center observational study from China. Infect Dis Poverty 2024; 13:18. [PMID: 38374211 PMCID: PMC10877768 DOI: 10.1186/s40249-024-01186-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/01/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Brucellosis is a severe zoonotic disease that is often overlooked, particularly in impoverished countries. Timely identification of focal complications in brucellosis is crucial for improving treatment outcomes. However, there is currently a lack of established indicators or biomarkers for diagnosing these complications. Therefore, this study aimed to investigate potential warning signs of focal complications in human brucellosis, with the goal of providing practical parameters for clinicians to aid in the diagnosis and management of patients. METHODS A multi-center cross-sectional study was conducted in China from December 2019 to August 2021. The study aimed to investigate the clinical characteristics and complications of patients with brucellosis using a questionnaire survey and medical record system. The presence of warning signs for complications was assessed using univariate and multivariate logistic regression models. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used for variable screening and model evaluation. RESULTS A total of 880 participants diagnosed with human brucellosis were enrolled. The median age of the patients was 50 years [interquartile range (IQR): 41.5-58.0], and 54.8% had complications. The most common organ system affected by complications was the osteoarticular system (43.1%), with peripheral arthritis (30.0%), spondylitis (16.6%), paravertebral abscess (5.0%), and sacroiliitis (2.7%) being the most prevalent. Complications in other organ systems included the genitourinary system (4.7%), respiratory system (4.7%), and hematologic system (4.6%). Several factors were found to be associated with focal brucellosis. These factors included a long delay in diagnosis [odds ratio (OR) = 3.963, 95% confidence interval (CI) 1.906-8.238 for > 90 days], the presence of underlying disease (OR = 1.675, 95% CI 1.176-2.384), arthralgia (OR = 3.197, 95% CI 1.986-5.148), eye bulging pain (OR = 3.482, 95% CI 1.349-8.988), C-reactive protein (CRP) > 10 mg/L (OR = 1.910, 95% CI 1.310-2.784) and erythrocyte sedimentation rate (ESR) elevation (OR = 1.663, 95% CI 1.145-2.415). The optimal cutoff value in ROC analysis was > 5.4 mg/L for CRP (sensitivity 73.4% and specificity 51.9%) and > 25 mm/h for ESR (sensitivity 47.9% and specificity 71.1%). CONCLUSIONS More than 50% of patients with brucellosis experienced complications. Factors such as diagnostic delay, underlying disease, arthralgia, eye pain, and elevated levels of CRP and ESR were identified as significant markers for the development of complications. Therefore, patients presenting with these conditions should be closely monitored for potential complications, regardless of their culture results and standard tube agglutination test titers.
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Affiliation(s)
- Qing-Nan Shi
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Chinese Center for Disease Control and Prevention, Changbai Road, Changping District, Beijing, 102206, China
| | - Hui-Jie Qin
- School of Public Health, Guangxi Medical University, Nanning, China
| | - Qiao-Shan Lu
- School of Public Health, Guangxi Medical University, Nanning, China
| | - Shu Li
- Nanning Center for Disease Control and Prevention, Nanning, China
| | - Zhong-Fa Tao
- Guizhou Center for Disease Control and Prevention, Guiyang, China
| | - Meng-Guang Fan
- Inner Mongolia Center for Disease Control and Prevention, Hohhot, China
| | - Mu-Heta Aishan
- Xinjiang Uighur Autonomous Region Center for Disease Control and Prevention, Urumqi, China
| | - Zeng-Qiang Kou
- Shandong Center for Disease Control and Prevention, Jinan, China
| | - Qiu-Lan Chen
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Chinese Center for Disease Control and Prevention, Changbai Road, Changping District, Beijing, 102206, China.
| | - Wen-Wu Yin
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Chinese Center for Disease Control and Prevention, Changbai Road, Changping District, Beijing, 102206, China.
| | - Yan-Ping Zhang
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Chinese Center for Disease Control and Prevention, Changbai Road, Changping District, Beijing, 102206, China
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Djibril ASD, Bothon FTD, Boko KC, Koutinhouin BG, Farougou S. Farmers' perceptions of bovine brucellosis in Benin. Vet World 2024; 17:434-447. [PMID: 38595653 PMCID: PMC11000487 DOI: 10.14202/vetworld.2024.434-447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/05/2024] [Indexed: 04/11/2024] Open
Abstract
Background and Aim Cattle are the main source of meat in Benin. To improve the attitudes and practices of cattle breeders in relation to bovine brucellosis, a study has been carried out in Benin according to different agroecological zones. This study aimed to assess farmers' knowledge and practices concerning bovine brucellosis to generate essential information for control programs and public health interventions. Materials and Methods The study was conducted from February to May 2022, during which 608 farmers were interviewed using a structured questionnaire that provided information on socioeconomic characteristics, knowledge, and practices related to bovine brucellosis. Analysis of variance, Poisson regression, and the proportion comparison test were used to compare these characteristics in the different agroecological zones. At the end of the surveys, three distinct and homogeneous groups of perceptions (hierarchical classification of Multiple Correspondence Analysis components of R software) of bovine brucellosis were identified (these groups only consider farmers who declared knowledge of the disease). Groups were formed by applying the multiple correspondence analysis function of the FactoMineR library in R software, followed by a hierarchical ascending classification using the hierarchical clustering on principal component function of the same software (Agrocampus Rennes, France). Results Only 38% of respondents were aware of brucellosis. Knowledge of brucellosis was not related to sex or education level but was higher among farmers in agroecological Zones 1 and 4. Ethnic Dendi herders (62.16%) had better knowledge of the disease than those from other sociolinguistic groups (Somba: 50%, Fulani: 40.91%, Baribas: 26.97%, and others: 8.82%). Reduced milk production (98.29%), presence of hygroma (87.18%), and abortion (56.84%) are the main signs reported by herders familiar with the disease. All three groups had good knowledge of the disease and its zoonotic nature. Groups 1 (96% of breeders) and 2 (2.14%) were aware of the risk factors (contact with affected animals, the consumption of raw milk, the handling of runts, and reproductive rejection). In the case of Brucella, they prefer to treat animals rather than sell them and use both traditional and modern medicines. Group 3 (1.71%) did not know the risk factors and preferred to sell animals in the event of illness. Conclusion Pastoralists need to be made aware of the mode of transmission of bovine brucellosis, its clinical manifestations, its impact on animal health, and the zoonotic nature of the disease (impact on public health) so that bovine brucellosis can be rapidly detected in herds.
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Affiliation(s)
- Adeyemi Sharafa Dine Djibril
- Research Unit on Communicable Diseases, Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, Cotonou, Benin
- Research Unit on Plant Extracts and Natural Flavors, Applied Chemistry Study and Research Laboratory, Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, Cotonou, Benin
| | - Fifa Théomaine Diane Bothon
- Research Unit on Plant Extracts and Natural Flavors, Applied Chemistry Study and Research Laboratory, Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, Cotonou, Benin
- Kaba Laboratory for Research in Chemistry and Applications; National Higher Institute of Industrial Technology, National University of Sciences, Engineering Technologies and Mathematics, Benin
| | - Kadoeto Cyrille Boko
- Research Unit on Communicable Diseases, Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, Cotonou, Benin
| | | | - Souaibou Farougou
- Research Unit on Communicable Diseases, Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, Cotonou, Benin
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Kou X, Xie W, Luo W, Wang N. Trauma accelerates Brucella invasion of the cervical spinal cord: A case report. Asian J Surg 2024; 47:1226-1228. [PMID: 38001002 DOI: 10.1016/j.asjsur.2023.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Affiliation(s)
- Xianshuai Kou
- The First Clinical Medical College of Gansu University of Chinese Medicine(Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Wendong Xie
- The First Clinical Medical College of Gansu University of Chinese Medicine(Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Wenyuan Luo
- Department of Orthopedics, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Neng Wang
- Department of Orthopedics, Gansu Provincial Hospital, Lanzhou, 730000, China.
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Li X, Li X, Cheng Z. Brucellosis involving the aorta and iliac arteries: a systematic review of 130 cases. Front Bioeng Biotechnol 2023; 11:1326246. [PMID: 38098968 PMCID: PMC10720085 DOI: 10.3389/fbioe.2023.1326246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
Objective: Brucellosis, the most common bacterial zoonosis, poses a serious threat to public health in endemic regions. Cardiovascular complications of brucellosis, mostly pericarditis or endocarditis, are the leading cause of brucellosis-related death. Complications involving the aorta and iliac arteries are extremely rare but can be life-threatening. Our objective was to identify and review all reported cases of aortic and iliac involvement in brucellosis to provide a deep, up-to-date understanding of the clinical characteristics and management of the disease. Methods: Online searches in PubMed, Web of Science, China National Knowledge Infrastructure, and the Chinese Wanfang database were conducted to collect articles reporting cases of brucellosis with aortic and iliac artery involvement. All data in terms of patient demographics, diagnostic methods, clinical manifestations, and treatment regimens and outcomes were extracted and analyzed in this systematic review. Results: A total of 79 articles were identified, reporting a total of 130 cases of brucellosis with aortic and iliac artery involvement. Of the 130 cases, 110 (84.5%) were male individuals and 100 (76.9%) were over 50 years old. The patients had an overall mortality rate of 12.3%. The abdominal aorta was most commonly involved, followed by the ascending aorta, iliac artery, and descending thoracic aorta. Arteriosclerosis, hypertension, and smoking were the most common comorbidities. There were 71 patients (54.6%) who presented with systemic symptoms of infection at the time of admission. Endovascular therapy was performed in 56 patients (43.1%), with an overall mortality rate of 3.6%. Open surgery was performed in 52 patients (40.0%), with an overall mortality rate of 15.4%. Conclusion: Aortic and iliac involvement in brucellosis is extremely rare but can be life-threatening. Its occurrence appears to be associated with the male gender, an older age, arteriosclerosis, and smoking. Although the number of reported cases in developing countries has increased significantly in recent years, its incidence in these countries may still be underestimated. Early diagnosis and therapeutic intervention are critical in improving patient outcomes. Endovascular therapy has become a preferred surgical treatment in recent years, and yet, its long-term complications remain to be assessed.
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Affiliation(s)
- Xiao Li
- Department of Vascular Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, China
| | - Xiaoyu Li
- Department of Otolaryngology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Zhihua Cheng
- Department of Vascular Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, China
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Wang J, Deng L, Ding Z, Zhang Y, Zhang Y, Li K, Zhao C, Zhang Q. Comparative Study on the Efficacy of Two Perioperative Chemotherapy Regimens for Lumbar Brucellosis. Drug Des Devel Ther 2023; 17:3523-3536. [PMID: 38046280 PMCID: PMC10691375 DOI: 10.2147/dddt.s427477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/15/2023] [Indexed: 12/05/2023] Open
Abstract
Objective The clinical efficacy of perioperative chemotherapy regimen (rifampicin, doxycycline, levofloxacin, ceftriaxone) was evaluated for lumbar brucellosis spondylitis patients with neurological injury. Methods In Beijing Ditan Hospital affiliated with Capital Medical University, 32 patients with lumbar brucellosis spondylitis underwent surgery and triple perioperative chemotherapy (rifampicin, doxycycline, levofloxacin) between 2011 and 2021 due to neurological injury, and 34 patients matched up with the triple group underwent rifampicin, doxycycline, levofloxacin, and ceftriaxone. Both groups were compared in terms of changes in inflammation index, low back/leg pain, lumbar function, neurological function, and adverse drug reactions. Results There was no significant difference in erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), low back pain visual analogue scale (VAS), leg pain VAS, lumbar Oswestry disability index (ODI) and nerve function injury rate between the two groups before chemotherapy (P>0.05). The ESR, CRP at 1 week and 2 weeks after chemotherapy and 1 week, 2 weeks, 1 month postoperatively in the quadruple group were significantly lower than those in the triple group, which is the same to ESR 3 months postoperatively (P<0.05). The low back pain VAS, leg pain VAS and lumbar ODI in the quadruple group were significantly lower than those in the triple group at 1 month and 3 months postoperatively (P<0.05). The recovery rate of neurological function in the quadruple group was significantly higher than that in the triple group at 3 and 6 months postoperatively (P<0.05). Both groups did not experience significantly different perioperative and postoperative adverse reactions (P>0.05). Conclusion For lumbar brucellosis spondylitis with neurological injury, quadruple perioperative chemotherapy of rifampicin, doxycycline, levofloxacin and ceftriaxone can significantly reduce perioperative inflammation, and improve low back/leg pain, as well as promoting neurological function recovery in the short term.
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Affiliation(s)
- Jie Wang
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Lei Deng
- Department of First School of Clinical Medicine, Henan University of Chinese Medicine, Henan, 450003, People’s Republic of China
| | - Zihao Ding
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Yaosheng Zhang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Yao Zhang
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Kangpeng Li
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Changsong Zhao
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Qiang Zhang
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
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