Epidemiology, Clinical and Laboratory Manifestations, and Outcomes of Brucellosis Among 104 Patients in Referral Hospitals of Tehran, Iran

Background: Brucellosis is the most common zoonotic disease in Iran, imposing a significant financial burden on the healthcare system. The diversity of non-specific clinical manifestations of this disease can lead to misdiagnosis or delayed diagnosis. Therefore, it is important to pay attention to other aspects of this disease. Objectives: This study aimed to determine the epidemiology, clinical and laboratory manifestations, and outcomes of brucellosis. Methods: In this cross-sectional study, brucellosis patients, admitted to three hospitals, affiliated to Shahid Beheshti University of Medical Sciences (Tehran, Iran) from April 2015 to September 2020, were examined. The patients' medical records were reviewed for epidemiological, clinical, and laboratory findings. The outcomes of the disease were evaluated by phone calls. Results: Of the 104 patients included in this study, 53.8% were male, and 46.2% were female. The mean age of the patients was 43.07 ± 18.521 years. Unpasteurized dairy consumption and contact with livestock were reported in 60.6 and 27.9% of the patients, respectively. Also, 23.1% of the patients had high-risk occupations. The most common symptoms included fever (80.8%), chills (58.7%), backache (55.8%), and sweating (51%). The most common complication was osteoarticular involvement (21.2%), followed by neurobrucellosis (6.7%). Elevated alkaline phosphatase (89.7%), anemia (67.3%), increased C-reactive protein (57.7%), and increased erythrocyte sedimentation rate (48.1%) were common laboratory findings. The rates of improvement, treatment failure, and relapse were 86.9, 9.1, and 4%, respectively. There was no significant relationship between the rate of improvement and the antibiotic regimen. However, the most common cause of treatment failure was the patient’s poor compliance with treatment. Conclusions: The diversity of non-specific clinical manifestations of brucellosis is a diagnostic challenge. Therefore, physicians must request laboratory tests to evaluate brucellosis after taking a precise epidemiological and clinical history of suspected cases.

PECULIARITIES OF TLR-2 (ARG753GLN) AND TLR-4 (ASP299GLY) POLYMORPHISM PREVALENCE IN PATIENTS WITH ACUTE BRUCELLEIS AND CARDIOVASCULAR SYSTEM DISEASES

Currently, there are single data on the relationship between TLR-2 polymorphisms (Arg753Gln) and TLR-4 (Asp299Gly) polymorphisms and susceptibility to brucellosis. Therefore, the aim of the study was to determine the frequency of TLR-2 (Arg753Gln) and TLR-4 (Asp299Gly) polymorphisms in patients with acute brucellosis with cardiovascular lesions in the Republic of Azerbaijan. Materials and methods: 178 patients with a brucellosis clinic were examined. According to the criteria for inclusion in the study, only 120 people fully met all the criteria, which made up the main group. The control group consisted of 30 healthy individuals. TLR-2 (Arg753Gln) and TLR-4 (Asp299Gly) polymorphisms were also determined for all patients in both groups. In order to assess the state of the cardiovascular system, an electrocardiogram was recorded, blood pressure was measured, and an ultrasound scan of the heart was performed for all patients. Results: it was found that 93 patients (77.50±3.13 %) with acute brucellosis had some or other signs of impairment in the work of the cardiovascular system, identified clinically or as a result of functional examination. Among carriers of the Asp / Gly genotype of the TLR-4 gene, an increased risk of brucellosis with CVS diseases was determined (χ2=30.19; p <0.0001; OR=24.29; 95 % CI [5.45 – 108.37]), while the carriage of the homozygous genotype Asp / Asp, by contrast, had a protective effect on the development of brucellosis (OR=0.06, 95 % CI [0.02 – 0.20]). Among the carriers of the Arg / Gln genotype and the Gln / Gln genotype of the TLR-2 gene, a significantly increased risk of brucellosis with CVS diseases was determined (χ2=5.68; p=0.02; OR=3.10; 95 % CI [0.99 – 9.67]) and (OR=2.48; 95 % CI [0.53 – 11.61]), respectively. While the carriage of the homozygous Arg / Arg genotype, by contrast, was rarely seen in patients with brucellosis (OR=0.28, 95 % CI [0.10 – 0.74]). Conclusions: The Asp / Gly genotype of the TLR-4 gene was 12.7 times more frequently detected in patients with acute brucellosis with CVS diseases than in healthy individuals and 9.5 times more often than in patients without CVS diseases (p<0.05). The Arg / Gln genotype of the TLR-2 gene was 2.4 times more frequently detected in patients with acute brucellosis with CVS diseases than in healthy individuals (p<0.05).

IL-4 POLYMORPHISM IN PATIENTS WITH ACUTE BRUCELLOSIS IN THE REPUBLIC OF AZERBAIJAN

Currently, there are isolated data on the relationship between IL-4 polymorphism (C-589T) and susceptibility to brucellosis. Therefore, the purpose of the study was to determine the frequency of polymorphism of IL-4 (C-589T) in patients with acute brucellosis. Materials and methods: the article presents the results of surveys of 120 patients with acute brucellosis. The control group consisted of 30 practically healthy persons. The diagnosis of brucellosis was based on complaints, anamnesis, epidemiological and clinical data, and the results of a specific study. The definition of the polymorphism of IL-4 (C-589T) was performed for all patients in the main and control group. A detailed description of patients with brucellosis is presented. Among the observed prevailed men and young people of working age. Results: A mild degree was established in 74 (61.66 %) patients, while severe - only in 11 (9.17 %) patients. It was determined that the genotype CT (65.83 %) was significantly more common among patients with brucellosis than in the control group, where the frequency of this genotype was only 16.66 %. While the CC genotype was 3.2 times more common among healthy individuals than among patients in the main group (76.67 % versus 24.17 %), it was found that the CC genotype of the IL-4 gene was 13 times more common in patients for acute brucellosis with mild progress than with severe. Conclusions: The genotype IL-4 (C-589T) SS is significantly associated with the mild course of brucellosis.