Brusellozlu Hastalarda Klinik ve Laboratuvar Bulgularının Değerlendirilmesi

Abstract

Amaç: Bu çalışmanın amacı bruselloz tanısı konulan hastaların demografik verilerini, klinik ve laboratuvar bulgularını ve organ tutulumlarını değerlendirmektir. Araçlar ve Yöntem: Hastalar cinsiyete (kadın/erkek) ve yaşa (≤40 yıl/>40 yıl ve ≤30 yıl, 31-44 yıl, 45-59 yıl ve ≥60 yıl) göre gruplara ayrıldı. Bulgular: Toplam 238 hasta değerlendirildi. Bunların %57.5'i (n=137) erkekti ve yaş ortalaması 43.8±15.0 yıldı. En sık görülen klinik semptomlar artralji (%93.7, n=223), miyalji (%84.9, n=202) ve yorgunluk (%84.5, n=201) idi. Kadın hastalarda miyalji (%92.1'e karşı %79.6, p=0.008), yorgunluk (%92.1'e karşı %78.8, p=0.005), baş ağrısı (%38.6'ya karşı %25.5, p=0.031) ve bulantı (%32.7'ye karşı %13.9, p=0.001) daha yaygındı, iştahsızlık (%43.5'e karşı %59.9, p=0.013) ise daha az yaygındı. Daha genç hastalarda (≤40 yaş) kilo kaybı (%48.0'e karşı %34.3, p=0.034) ve sakroileit (%13.2'ye karşı %5.0, p=0.029) daha yaygındı, spondilodiskit (%2.0'ye karşı %9.3, p=0.039) ise daha az yaygındı. Kilo kaybı ≤30 yaş grubunda 31-44 yaş grubuna (55.8% - %32.8, p=0.013) ve 45-69 yaş grubuna (55.8% - %35.3, p=0.019) göre daha yaygındı. Ateş ≤30 yaş grubunda 45-59 yaş grubuna (32.7% - %54.1, p=0.015) göre daha az yaygındı. Sonuç: Endemik bölgelerde, artralji, miyalji, yorgunluk, lökopeni veya lökositoz ve yüksek ESR ve CRP'li hastaların ayırıcı tanısında bruselloz düşünülmelidir. Brusellozlu ≤40 yaş hastalar sakroiliit açısından değerlendirilmeli ve >40 yaş hastalar spondilodiskit komplikasyonları açısından değerlendirilmelidir.

Keywords

• brusella
• cinsiyet
• sakroileit
• spondilodiskit
• yaş

Evaluation of Clinical and Laboratory Findings in Patients with Brucellosis

Abstract

Purpose: The purpose of this study is to evaluate the demographic data, laboratory and clinical findings and organ involvement of patients diagnosed with brucellosis. Materials and Methods: The patients were divided into groups according to sex (female/male) and age (≤40 years/>40 years and ≤30 years, 31-44 years, 45-59 years, and ≥60 years). Results: A total of 238 patients were assessed. Among those, 57.5% (n=137) were male, and the mean age was 43.8±15.0 years. Arthralgia (93.7%, n=223), myalgia (84.9%, n=202), and fatigue (84.5%, n=201) were the most common clinical symptoms. In female patients, myalgia (92.1% vs. 79.6%, p=0.008), fatigue (92.1% vs. 78.8%, p=0.005), headache (38.6% vs. 25.5%, p=0.031), and nausea (32.7% vs. 13.9%, p=0.001) were more common, whereas loss of appetite (43.5% vs. 59.9%, p=0.013) was less common. Weight loss (48.0% vs. 34.3%, p=0.034) and sacroiliitis (13.2% vs. 5.0%, p=0.029) were more common, whereas spondylodiscitis (2.0% vs. 9.3%, p=0.039) was less common in younger patients (≤40 years). Weight loss was more common in the ≤30 age group compared to the 31-44 age (55.8% vs. 32.8%, p=0.013) and 45-69 age groups (55.8% vs. 35.3%, p=0.019). Fever was less common in the ≤30 age group compared to the 45-59 age group (32.7% vs. 54.1%, p=0.015). Conclusion: In endemic areas, brucellosis should be considered in the differential diagnosis of patients with arthralgia, myalgia, fatigue, leukopenia or leukocytosis, and elevated ESR and CRP. Patients ≤40 years with brucellosis should be evaluated for sacroiliitis, and patients >40 years should be evaluated for spondylodiscitis complications.

Keywords

• age
• brucella
• gender
• sacroiliitis
• spondylodiscitis

References

1. 1. Qureshi KA, Parvez A, Fahmy NA, et al. Brucellosis: epidemiology, pathogenesis, diagnosis and treatment-a comprehensive review. Ann Med. 2023;55(2): 2295398.
2. 2. Gül HC, Erdem H. Brucellosis. Mandell GL, Bennett JE, Dolin R, ed. Principles and Practice of Infectious Diseases. 9 ed. Saunders, USA: Elsevier; 2020:2753-2758.
3. 3. Centers for Disease Control and Prevention. Estimates human Brucella infections could be four times higher than previously thought. https://www.food-safety.com/articles/8817-cdc-estimates-human-brucella-infections-could-be-four-times-higher-than-previously-thought. Access date 01 August, 2024.
4. 4. Pappas G, Papadimitriou P, Akritidis N, Christou L, Tsianos EV. The new global map of human brucellosis. Lancet Infect Dis. 2006;6(2):91-99.
5. 5. Alp E, Doganay M. Brucellosis. Topçu AW, Söyletir G, Doğanay M, ed. Infectious Diseases and Microbiology. 4 ed. Istanbul: Nobel Tıp Kitap Evleri; 2017:863-872.
6. 6. Yang Xinghong. Brucellosis. Kellerman RD, Rakel D, ed. Conn's Current Therapy. Saunders, USA: Elsevier; 2022:558-561.
7. 7. Skalsky K, Yahav D, Bishara J, Pitlik S, Leibovici L, Paul M. Treatment of human brucellosis: systematic review and meta-analysis of randomised controlled trials. BMJ (Clinical research ed). 2008;336(7646): 701-704.
8. 8. Buzgan T, Karahocagil MK, Irmak H, et al. Clinical manifestations and complications in 1028 cases of brucellosis: a retrospective evaluation and review of the literature. IJID. 2010;14(6):469-478.

9. 9. Jiang W, Chen J, Li Q, et al. Epidemiological characteristics, clinical manifestations and laboratory findings in 850 patients with brucellosis in Heilongjiang Province, China. BMC Infect Dis. 2019;19(1):439.
10. 10. Gül HC, Coşkun Ö, Turhan V, et al. Brucellosis: Retrospective Investigation of 140 Patients. TAF Prev. Med. Bull. 2007;6(4):249-252.
11. 11. Savas L, Onlen Y, Savas N, Yapar AF, Aydin M, Tugal O. Prospective evaluation of 140 patients with brucellosis in the southern region of Turkey. Infect Dis Clin Pract. 2007;15(2):83-88.
12. 12. Uysal B, Mumcu N, Yildiz O, Aygen B. Comparison of the Methods Used in the Diagnosis of Brucellosis. KLIMIK J. 2021;34(3):164-174.
13. 13. Fritz CL, Nguyen A, Vugia DJ. Epidemiology of Brucellosis in California, 1993-2017: A Continuing Foodborne Disease Risk for Older Latinos. Clin. Infect. Dis. 2021;73(11):2023-2030.
14. 14. John K, Fitzpatrick J, French N, et al. Quantifying risk factors for human brucellosis in rural northern Tanzania. PloS one. 2010;5(4):9968.
15. 15. Schelling E, Diguimbaye C, Daoud S, et al. Brucellosis and Q-fever seroprevalences of nomadic pastoralists and their livestock in Chad. Prev. Vet. Med. 2003;61(4):279-293.
16. 16. Abdollahi A, Morteza A, Khalilzadeh O, Rasoulinejad M. Brucellosis serology in HIV-infected patients. IJID. 2010;14(10):904-906.
17. 17. Kalaajieh W. Epidemiology of human brucellosis in Lebanon in 1997. Med Mal Infect. 2000;30(1):43-46.
18. 18. Tumwine G, Matovu E, Kabasa JD, Owiny DO, Majalija S. Human brucellosis: sero-prevalence and associated risk factors in agro-pastoral communities of Kiboga District, Central Uganda. BMC Public Health. 2015;15:900.
19. 19. Köse Ş, Senger SS, Akkoçlu G, et al. Clinical manifestations, complications, and treatment of brucellosis: evaluation of 72 cases. Turk. J. Med. Sci. 2014;44(2): 220-223.
20. 20. Zerfu B, Medhin G, Mamo G, et al. Community-based prevalence of typhoid fever, typhus, brucellosis and malaria among symptomatic individuals in Afar Region, Ethiopia. PLoS Neglected Tropical Diseases. 2018;12(10):0006749.
21. 21. Torre I, Ribera G, Pavia M, Angelillo IF. A seroepidemiologic survey on brucellosis antibodies in southern Italy. Infection. 1997;25(3):150-153.
22. 22. Sümer H, Sümer Z, Alim A, Nur N, Özdemir L. Seroprevalence of Brucella in an elderly population in mid-Anatolia, Turkey. J. Health Popul. Nutr. 2003:21 (2):158-161.
23. 23. Hasanjani Roushan MR, Mohrez M, Smailnejad Gangi SM, Soleimani Amiri MJ, Hajiahmadi M. Epidemiological features and clinical manifestations in 469 adult patients with brucellosis in Babol, Northern Iran. Epidemiol Infect. 2004;132(6):1109-1114.
24. 24. Mwatondo A, Muturi M, Akoko J, et al. Seroprevalence and related risk factors of Brucella spp. in livestock and humans in Garbatula subcounty, Isiolo county, Kenya. PLoS Negl Trop Dis. 2023;17(10): 0011682.
25. 25. Ahmed MO, Elmeshri SE, Abuzweda AR, et al. Seroprevalence of brucellosis in animals and human populations in the western mountains region in Libya, December 2006 -January 2008. Euro Surveill. 2010;15(30):19625.
26. 26. Rahman AA, Dirk B, Fretin D, et al. Seroprevalence and risk factors for brucellosis in a high-risk group of individuals in Bangladesh. Foodborne Pathog Dis. 2012;9(3):190-197.
27. 27. Dean AS, Crump L, Greter H, Hattendorf J, Schelling E, Zinsstag J. Clinical manifestations of human brucellosis: a systematic review and meta-analysis. PLoS Negl Trop Dis. 2012;6(12):1929.
28. 28. Zheng R, Xie S, Lu X, et al. A Systematic Review and Meta-Analysis of Epidemiology and Clinical Manifestations of Human Brucellosis in China. Biomed Res Int. 2018;2018(1):5712920.
29. 29. Zaks N, Sukenik S, Alkan M, Flusser D, Neumann L, Buskila D. Musculoskeletal manifestations of brucellosis: a study of 90 cases in Israel. Semin Arthritis Rheum. 1995;25(2):97-102.
30. 30. Tsend S, Baljinnyam Z, Suuri B, et al. Seroprevalence survey of brucellosis among rural people in Mongolia. Western Pac Surveill Response J. 2014;5(4):13-20.
31. 31. Demiraslan H, Aksöz S, Metan G, Doğanay M. The Evaluation of Clinical/Laboratory Findings and Therapeutic Features of Patients with Brucellosis in a Secondary Care Hospital in Southeast Anatolia. Flora. 2011;16(4):152-159.
32. 32. Eroglu E, Kandemir B. Brucellosis: Evaluation of Two Hundred and Ten Cases with Different Clinical. Ann Acad Med Singapore. 2020;49:462-467.
33. 33. Aygen B, Doğanay M, Sümerkan B, Yildiz O, Kayabaş Ü. Clinical manifestations, complications and treatment of brucellosis: a retrospective evaluation of 480 patients. Med Mal Infect. 2002;32(9):485-493.