Clinical manifestations, complications, and treatment of brucellosis: evaluation of 72 cases

AIM

Brucellosis is an important disease in developing countries. We aimed to determine the epidemiologic, clinical, and laboratory characteristics of brucellosis, which still has a high morbidity in Turkey.

MATERIALS AND METHODS

Seventy-two patients with brucellosis, monitored at our clinic from January 2004 to July 2010, were reviewed retrospectively.

RESULTS

The average age was determined to be 44.8 ± 18 years, and 40 of the patients were female (55.6%). The most frequent transmission route was the use of raw milk and dairy products, in 45 of the patients (62.5%). The most frequent complaints were joint pain, high fever, weakness, low back pain, and gastrointestinal symptoms, whereas the most frequent physical examination findings were fever, osteoarticular involvement, splenomegaly, hepatomegaly, and lymphadenopathy. All of the patients were positive for Rose Bengal testing. The standard tube agglutination titer was 1/160 or higher in 64 (88.9%) patients. Brucella melitensis was isolated from blood cultures of 13 (18.1%) patients and bone marrow cultures of 7 (9.7%) patients. Complications of sacroiliitis in 6 (8.3%), spondylodiscitis in 4 (5.6%), endocarditis in 2 (2.8%), neurobrucellosis in 1 (1.4%), and epididymo-orchitis in 1 (1.4%) of the patients were observed.

CONCLUSION

Brucellosis has various clinical presentations. It should be included in the differential diagnosis of high fever and joint pains in endemic countries.

Prevalence of hepatitis B and C viruses among asylum seekers in Izmir

Hepatitis B and C virus infections are known to be an important health problem all over the World. According to the data from World Health Organization, 350 million people are estimated to have been chronically infected by hepatitis B virus and 180 million people have been infected by hepatitis C virus. Most of the patients are not aware of their illnesses. Hepatitis B and C virus infections are the most common cause of sequel liver disease related to decompensate liver cirrhosis and hepatocellular carcinoma. Many people are obliged to leave their country due to political, economic and social reasons. In Turkey, where there is refugee and asylum seeker problem because of geographical location, we aimed to specify the demographic characteristics of asylum seekers in Izmir and to evaluate the asylum seekers in terms of blood-borne and sexually transmitted diseases such as hepatitis B and C.

Presentation of two cases diagnosed with Brucella endocarditis

Brucellosis is an important disease in developing countries. Endocarditis is a complication of brucellosis with the highest mortality. Although the most generally accepted therapy is the combination of medication and surgery, it has been reported that antibiotic treatment only might also be adequate. We present two cases for whom antibiotic treatments were initiated, and a follow-up surgery was planned for one of them. The surgery could not be done due to death of the patient, but the other patient fully recovered with antibiotic treatment only. Optimum treatment and prognostic criteria are not well defined for brucella endocarditis, but medical therapy alone can be considered for some chosen patients.

[Case report: two imported Plasmodium falciparum cases]

A 23 year-old Pakistani man presented at the emergency clinic of Tepecik Research and Training Hospital with the symptoms such as fever (39.3 degrees C), blurred consciousness, subicteric sclera and splenomegalia. In the laboratory examination, a slightly increase of the liver enzymes and anemia were detected. The gametocytes and trophozoites of Plasmodium falciparum were seen in a bone marrow aspiration and treatment was started with quinine and doxycycline but since resistance was detected to these medicines, mefloquine was chosen as alternative therapy. He was cured and discharged. The second case was also a Pakistani 20-year old man and he was a friend of first case. He presented at our hospital with the symptoms such as fever (39.4 degrees C), closed consciousness, icteric sclera and systolic soufflé in all cardiac foci. During the laboratory examination, severe anemia and trombocytopenia, and an increase in the liver enzymes were found. P. falciparum gametocytes and young trophozoites were seen in a blood smear stained with Giemsa. For treatment, mefloquine was used but unfortunately the patient died due to an adult respiratory distress syndrome (ARDS) complication. In this study, two cases with different clinical manifestations were presented to emphasize the importance of timing in starting the correct treatment.