Research Article
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Eighty-three cases of brucella infection from an endemic region

Year 2019, Volume: 11 Issue: 2, 101 - 106, 01.06.2019
https://doi.org/10.21601/ortadogutipdergisi.543853

Abstract

Aim: Brucellosis is the most common bacterial zoonosis
in all around the world and still a public health threat with high rates of incidence
in Turkey. In the present study, we evaluated the brucella infection cases, manifested
in Sirnak, one of the regions that brucellosis is common in our country.



Materials and Methods: We retrospectively collected data of 83 outpatients
and inpatients who admitted infectious disease department of a second-line hospital
between dates of October 2017 and December 2018. We have evaluated possible risk
factors for brucellosis, complaints of the patients, the initiation time of the
complaints, clinical signs, complications and treatment regimes.



Results: 61.4% (51/83) of the patients included in the
study were female. The mean age of the patients was 35.3 (15-84). Brucella infection
was most common among housewives (39.7%) and the most common risk factor was fresh
dairy cheese consumption (78.3%). The most common symptom was muscle and joint pain.
We have applied 13 different treatment regimens in the form of double and triple
drug combinations, and treatment of 13.2% of the patients was switched because of
various reasons. 30.1% of the patients infected with brucella had hepatitis and
13.2% had osteoarticular involvement. Erythrocyte sedimentation rate (p = 0.009)
and C reactive protein (p = 0.046) were statistically significant high in patients
with osteoarticular involvement compared to without. The correlation between higher
Erythrocyte sedimentation rate (p = 0.009), C reactive protein (p = 0.046) values
and osteoarticular involvement was statistically significant. Epididymoorchitis
was developed in three patients (3,6%). The rate of relapse was 26.5%.



Conclusion: Brucella infection should be kept in mind in
patients presenting with nonspecific symptoms, especially in areas where brucella
infection is common like our region and patients should be examined for brucellosis.

References

  • Gul C, Erdem H. Brucellosis (Brucella species). In: Mandell, Douglas, and Benett’s principles and practice of infectious disease. 8th ed. Philadelphia, PA: Elsevier; 2015: 2584-2589.
  • Franco MP, Mulder M, Gilman RH, Smits HL. Human Brucellosis. Lancet Inf Dis. 2007; 7: 775-786.
  • Çetinkaya Z, Aktepe OC, Çiftçi İH, Demirel R. Seroprevalence of Human brucellosis in a rural Area of Western Anatolia, Turkey. J Health Popul Nutr. 2005; 23(2): 137-141.
  • Vigeant P, Mendelson J, Miller MA. Human to Human Transmission of Brucellosis. Can J Infect Dis. 1995; 6(3): 153-155.
  • Brucellosis: Transmission [İnternet]. Atlanta, GA: Centers for Disease Control and Prevention. [erişim 20.11.2018]. cc.
  • Colmenero JD, Reguera JM, Martod F, Sánchez-De-Mora D, Delgado M, Causse M Martín-Farfán A, Juárez C. Complications associated with Brucella melitensis infection: a study of 530 cases. Medicine. 1996; 75(4): 195-211.
  • Tuon FF, Gondolfo RB, Cerchiari N. Human to Human Transmission of Brucella- a Systemic Review. Tropical Medicine and International Health. 2017; 22(5): 539-546.
  • Buzgan T, Karahocagil MK, Irmak H ve ark. Clinic Manifestations and Complications in 1028 cases of Brucellosis: a Retrospective Evaluation and Review of The Literature. Int J Infect Dis. 2010: 4; 469-478.
  • Eales KM, Norton RE, Ketheesan N. Short Report: Brucellosis in Northern Australia. Am J Trop Med Hyg 2010; 83(4): 876–878.
  • Jia B, Zhang F, Lu Y ve ark. The clinical features of 590 patirnts with brucellosis in Xinjiang, China with the emphasis on the treatment of complication. PLoS Negl Trop Dis. 2017; 11(5): e0005577. https://doi.org/10.1371/journal.pntd.0005577
  • Akhvlediani T, Clark DV, Chubabria G, Zenaishvili O, Hepburn MJ. The changing pattern of human brucellosis: clinical manifestations, epidemiology, and treatment outcomes over three decads in Georgia. BMC Infect Dis. 2010; 10(346).
  • Kassiri H, Amani H, Lotfi M. Epidemiological, laboratory, diagnostic and public health aspects of human brucellosis in western Iran. Asian Pac J Trop Biomed. 2013: 3(8): 589-594.
  • Mermut G, Özgenç O, Avcı M ve ark. Clinical Diagnostic and Therapeutic Approaches to Complications of Brucellosis: An Experience of 12 Years. Med Princ Pract. 2012; 21: 46–50.
  • Hasanjani Roushan MR, Mohrez M, Smailnejad Gangi SM, Soleimani Amiri MJ, Hajıahmadi M. Epidemiological features and clinical manifestations in 469 adult patients with brucellosis in Babol, Northern Iran. Epidemiol Infect. 2004; 132: 1109–1114.
  • Gur A, Geyik MF, Dikici B ve ark. Complications of brucellosis in different age groups: a study of 283 cases Southeastern Anatolia of Turkey. Yonsei Med J. 2003; 44(1): 33-44.
  • Pourbagher MA, Pourbagher A, Savas L ve ark. Clinical pattern and abdominal sonographic findings in 251 cases of brucellosis in southern Turkey. AJR Am J Roentgenol. 2006; 187(2): 191-194.
  • Kaya O, Akçam FZ, Avşar K, Tığlı A, Yaylı G. Bruselloz: 75 olgunun klinik ve laboratuvar verilerinin değerlendirilmesi. Turkiye Klinikleri J Med Sci 2006; 26(6): 623-629.
  • Demiroğlu YZ, Turunç T, Alişkan H, Çolakoğlu S, Arslan H. Brucellosis: retrospective evaluation of the clinical, laboratory and epidemiological features of 151 cases. Mikrobiyoloji Bul. 2007; 41(4): 517-527.
  • Aydoslu A, Doğan Çelik A, Kuloğlu F, Tansel Ö, Akata F, Tuğrul M. Kısa bildiri: Trakya Üniversitesi Hastanesi’nde izlenen bruselloz olgularının değerlendirilmesi. Mikrobiyoloji Bul. 2006; 40: 257-263.
  • Işlak Demir M, Kader Ç, Yalçın Çolak N, Kocabıyık O, Erbay A, Eren Gök Ş. Bruselloz olgularının değerlendirilmesi. Bozok Tıp Derg. 2017; 7(3): 47-51.
  • Bosilkovski M, Krteva L, Caparoska S, Dimzova M. Osteoarticular Involvement in Brucellosis: Study of 196 Cases in the Republic of Macedonia. Croat Med J. 2004; 45(6): 727-733.
  • Aktug Demir N, Kolgelier D, Sumer S ve ark. Serum annexin A2 levels in acute brucellosis and brucellar spondylodiscitis. Eur J Clin Microbiol Infect Dis. 2014; 33(10): 1855-1859.
  • Hashemi SH, Keramat F, Mamani M, Farzam A, jamal-Omidi S. Osteoarticular complications of brucellosis in Hamedan, an endemic area in the west of Iran. Int J Infect Dis. 2007; 11: 496-500.
  • Meng F, Pan X, Tong W. Rifampicin versus streptomycin for brucellosis treatment in humans: A meta-analysis of randomized controlled trials. PLOSE ONE. 2018;13(2). https://doi.org/10.1371/journal.pone.0191993

Endemik olduğu bir bölgeden 83 olgu ile brusella enfeksiyonu

Year 2019, Volume: 11 Issue: 2, 101 - 106, 01.06.2019
https://doi.org/10.21601/ortadogutipdergisi.543853

Abstract

Amaç: Brusella enfeksiyonu; dünya genelindeki en
yaygın bakteriyel zoonoz olup ülkemizde de yüksek görülme oranları ile bir halk
sağlığı sorunu olmaya devam etmektedir. Biz de çalışmamızda brusellozun ülkemizde
sık görüldüğü bölgelerden biri olan Şırnak ilindeki olguları irdeledik.



Gereç ve Yöntem: İkinci basamak bir hastanenin enfeksiyon hastalıkları
ve klinik mikrobiyoloji polikliğine Ekim 2017- Aralık 2018 tarihleri arasında başvuran,
ayaktan ve yatarak takip edilen 83 brusella ile enfekte hastanın olası risk faktörleri,
başvuru şikayetleri, şikayetlerin başlama zamanı, klinik bulguları, gelişen komplikasyonları
ve başlanan tedavileri retrospektif olarak incelendi.



Bulgular: Çalışmaya alınan 83 hastanın %61,4’ü (51/83)
kadındı. Hastaların yaş ortalaması 35,3 (15-84) saptandı. Brusella enfeksiyonuna
en çok ev hanımlarında rastlandı (%39,7) ve en yaygın risk faktörü taze peynir tüketimi
idi (%78,3). En sık görülen semptom ise yaygın kas ve eklem ağrısı idi. İkili ve
üçlü kombinasyonlar şeklinde 13 farklı tedavi rejimi uygulandı, hastaların %13,2’sinde
çeşitli nedenlerle tedavi değişikliği yapıldı. Brusella ile enfekte hastaların %30,1’inde
hepatit, %13,2’sinde kemik eklem tutulumu saptandı. Osteoartiküler tutulumu olanlarda;
eritrosit sedimantasyon hızı (p=0,009) ve C reaktif protein (p=0,046) yüksekliği,
olmayanlara göre istatistiksel olarak anlamlı saptandı. Üç hastada (%3,6) ise epididmoorşit
gelişmişti. Hastaların %26,5’inde relaps görüldü.



Sonuç: Özellikle bölgemiz gibi brusella enfeksiyonunun
yaygın olarak görüldüğü yerlerde nonspesifik semptom ve bulgular ile başvuran hastalarda
mutlaka brusella enfeksiyonu akılda tutulmalı ve hastalar bruselloz açısından tetkik
edilmelidir.

References

  • Gul C, Erdem H. Brucellosis (Brucella species). In: Mandell, Douglas, and Benett’s principles and practice of infectious disease. 8th ed. Philadelphia, PA: Elsevier; 2015: 2584-2589.
  • Franco MP, Mulder M, Gilman RH, Smits HL. Human Brucellosis. Lancet Inf Dis. 2007; 7: 775-786.
  • Çetinkaya Z, Aktepe OC, Çiftçi İH, Demirel R. Seroprevalence of Human brucellosis in a rural Area of Western Anatolia, Turkey. J Health Popul Nutr. 2005; 23(2): 137-141.
  • Vigeant P, Mendelson J, Miller MA. Human to Human Transmission of Brucellosis. Can J Infect Dis. 1995; 6(3): 153-155.
  • Brucellosis: Transmission [İnternet]. Atlanta, GA: Centers for Disease Control and Prevention. [erişim 20.11.2018]. cc.
  • Colmenero JD, Reguera JM, Martod F, Sánchez-De-Mora D, Delgado M, Causse M Martín-Farfán A, Juárez C. Complications associated with Brucella melitensis infection: a study of 530 cases. Medicine. 1996; 75(4): 195-211.
  • Tuon FF, Gondolfo RB, Cerchiari N. Human to Human Transmission of Brucella- a Systemic Review. Tropical Medicine and International Health. 2017; 22(5): 539-546.
  • Buzgan T, Karahocagil MK, Irmak H ve ark. Clinic Manifestations and Complications in 1028 cases of Brucellosis: a Retrospective Evaluation and Review of The Literature. Int J Infect Dis. 2010: 4; 469-478.
  • Eales KM, Norton RE, Ketheesan N. Short Report: Brucellosis in Northern Australia. Am J Trop Med Hyg 2010; 83(4): 876–878.
  • Jia B, Zhang F, Lu Y ve ark. The clinical features of 590 patirnts with brucellosis in Xinjiang, China with the emphasis on the treatment of complication. PLoS Negl Trop Dis. 2017; 11(5): e0005577. https://doi.org/10.1371/journal.pntd.0005577
  • Akhvlediani T, Clark DV, Chubabria G, Zenaishvili O, Hepburn MJ. The changing pattern of human brucellosis: clinical manifestations, epidemiology, and treatment outcomes over three decads in Georgia. BMC Infect Dis. 2010; 10(346).
  • Kassiri H, Amani H, Lotfi M. Epidemiological, laboratory, diagnostic and public health aspects of human brucellosis in western Iran. Asian Pac J Trop Biomed. 2013: 3(8): 589-594.
  • Mermut G, Özgenç O, Avcı M ve ark. Clinical Diagnostic and Therapeutic Approaches to Complications of Brucellosis: An Experience of 12 Years. Med Princ Pract. 2012; 21: 46–50.
  • Hasanjani Roushan MR, Mohrez M, Smailnejad Gangi SM, Soleimani Amiri MJ, Hajıahmadi M. Epidemiological features and clinical manifestations in 469 adult patients with brucellosis in Babol, Northern Iran. Epidemiol Infect. 2004; 132: 1109–1114.
  • Gur A, Geyik MF, Dikici B ve ark. Complications of brucellosis in different age groups: a study of 283 cases Southeastern Anatolia of Turkey. Yonsei Med J. 2003; 44(1): 33-44.
  • Pourbagher MA, Pourbagher A, Savas L ve ark. Clinical pattern and abdominal sonographic findings in 251 cases of brucellosis in southern Turkey. AJR Am J Roentgenol. 2006; 187(2): 191-194.
  • Kaya O, Akçam FZ, Avşar K, Tığlı A, Yaylı G. Bruselloz: 75 olgunun klinik ve laboratuvar verilerinin değerlendirilmesi. Turkiye Klinikleri J Med Sci 2006; 26(6): 623-629.
  • Demiroğlu YZ, Turunç T, Alişkan H, Çolakoğlu S, Arslan H. Brucellosis: retrospective evaluation of the clinical, laboratory and epidemiological features of 151 cases. Mikrobiyoloji Bul. 2007; 41(4): 517-527.
  • Aydoslu A, Doğan Çelik A, Kuloğlu F, Tansel Ö, Akata F, Tuğrul M. Kısa bildiri: Trakya Üniversitesi Hastanesi’nde izlenen bruselloz olgularının değerlendirilmesi. Mikrobiyoloji Bul. 2006; 40: 257-263.
  • Işlak Demir M, Kader Ç, Yalçın Çolak N, Kocabıyık O, Erbay A, Eren Gök Ş. Bruselloz olgularının değerlendirilmesi. Bozok Tıp Derg. 2017; 7(3): 47-51.
  • Bosilkovski M, Krteva L, Caparoska S, Dimzova M. Osteoarticular Involvement in Brucellosis: Study of 196 Cases in the Republic of Macedonia. Croat Med J. 2004; 45(6): 727-733.
  • Aktug Demir N, Kolgelier D, Sumer S ve ark. Serum annexin A2 levels in acute brucellosis and brucellar spondylodiscitis. Eur J Clin Microbiol Infect Dis. 2014; 33(10): 1855-1859.
  • Hashemi SH, Keramat F, Mamani M, Farzam A, jamal-Omidi S. Osteoarticular complications of brucellosis in Hamedan, an endemic area in the west of Iran. Int J Infect Dis. 2007; 11: 496-500.
  • Meng F, Pan X, Tong W. Rifampicin versus streptomycin for brucellosis treatment in humans: A meta-analysis of randomized controlled trials. PLOSE ONE. 2018;13(2). https://doi.org/10.1371/journal.pone.0191993
There are 24 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Original article
Authors

Meyha Şahin 0000-0003-4147-3587

Selcan Cesur This is me 0000-0002-1504-7069

Serkan Enki This is me 0000-0001-5636-0708

Publication Date June 1, 2019
Published in Issue Year 2019 Volume: 11 Issue: 2

Cite

Vancouver Şahin M, Cesur S, Enki S. Endemik olduğu bir bölgeden 83 olgu ile brusella enfeksiyonu. otd. 2019;11(2):101-6.

e-ISSN: 2548-0251

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