111 Bruselloz olgusunun etyoloji, klinik seyir ve komplikasyonlarının değerlendirilmesi; bir retrospektif çalışma

Öz

Amaç: Bruselloz dünyada en sık görülen bakteriyel zoonotik enfeksiyon hastalığıdır. Çalışmamızda hastalığın endemik olarak görüldüğü Güneydoğu Anadolu bölgesinde ikinci basamak bir hastaneye başvuran ve bruselloz tanısı ile takip edilen 111 bruselloz olgusunun değerlendirilmesi amaçlandı. Yöntem: Çalışmada ikinci basamak bir hastanenin Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji polikliniğine Aralık 2018 – Aralık 2019 tarihleri arasında başvuran bruselloz tanısı ile ayaktan veya yatarak takip edilen 111 olgunun demografik özellikleri, klinik bulguları, olası bulaş yolları, tedavi rejimleri, komplikasyon verileri ve relaps oranları retrospektif olarak incelendi. Bulgular: Hastaların 77’si (%69.3) kadın ve olguların yaş ortalaması 36.4 (yaş aralığı 14-94) idi. Meslek dağılımı açısından, hastaların 69’u (%62.1) ev hanımıydı, 17’si (%15.3) hayvancılıkla uğraşmaktaydı. Olguların 88’inde (%79.2) taze peynir yeme öyküsü vardı. Hastalarda en sık görülen semptomlar, halsizlik (%92.7) ve artralji (%87.3) olarak saptandı. Çalışmaya alınan hastalarda CRP yüksekliği %39.6, anemi %37.8 oranı ile en sık görülen laboratuvar bulguları olarak tespit edildi. Etkilenen organ ve sistemler incelendiğinde olguların 49’unda (%44) hematolojik tutulum, 23’ünde (%20.7) karaciğer tutulumu, 11’inde (%10) osteoartiküler tutulum görüldü. Bir (%0.9) hastada brusellozun nadir bir komplikasyonu olarak izole perikardit, bir (%0.9) hastada da brusella epididimoorşiti saptandı. Çalışmaya dahil edilen hastaların 12’sinde (%10.3) tedavileri bittikten sonraki bir yıllık izlemde relaps saptandı. Sonuç: Bruselloz birçok organ ve dokuyu etkileyebilmektedir. Bu nedenle çok değişik klinik belirti ve bulgularla ortaya çıkabilmekte ve birçok hastalıkla karışabilmektedir. Endemik bölgelerde yaşayan nonspesifik semptom ve bulgular ile başvuran hastalar mutlaka bruselloz açısından değerlendirilmelidir.

Anahtar Kelimeler

• bruselloz
• epidemiyoloji
• komplikasyon

Evaluation of etiology, clinical course and complications of 111 brucellosis cases; a retrospective study

Öz

Aim: Brucellosis is the most common bacterial zoonotic infection disease in the world. In our study, we aimed to evaluate 111 brucellosis cases who were admitted to a secondary-line hospital by followed up with the diagnosis of brucellosis in the Southeastern Anatolia region where the disease was seen as endemic. Method: In this study, demographic characteristics, clinical findings, possible transmission routes, treatment regimens, complication data and relapse rates of 111 patients who were admitted to an infectious diseases and clinical microbiology clinic of a second-line hospital between December 2018 and December 2019 were examined retrospectively. Results: Seventy-seven of the patients (69.3%) were female and the mean age of the patients was 36.4 (age range 14-94). In terms of profession distribution, 69 (62.1%) of the patients were housewives, 17 (15.3%) of the patients were engaged in animal husbandry. There was a history of eating fresh cheese in 88 (79.2%) patients. The most common symptoms of the patients were malaise (92.7%) and arthralgia (87.3%). The most common laboratory findings in patients included in the study were 39.6% CRP elevation and 37.8% anemia. When the affected organs and systems are examined, hematological involvement was observed in 49 (44%) patients, liver involvement in 23 (20.7%) patients, osteoarticular involvement in 11 (10%) patients. There was found to one patient (0.9%) had isolated pericarditis that was a rare complication of brucellosis, and brucella epididymoorchitis in one (0.9%) patient. In the one-year follow-up after treatment, relapses were detected in 12 patients (10.3%). Conclusion: Brucellosis can affect many organs and tissues. For this reason, it can appear with many different clinical signs and symptoms and can be confused with many diseases. In patients presenting with nonspecific symptoms and signs, who were living in endemic regions, brucellosis infection should definitely be considered, and patients should be evaluated for brucellosis.

Anahtar Kelimeler

• Brucellosis
• epidemiology
• complication

Kaynakça

1. 1. Gul C, Erdem H. Brucellosis (Brucellaspecies). In: Mandell, Douglas, and Benett’s principles and practice of infectious disease. 8th ed. Philadelphia, PA: Elsevier; 2015: 2584-2589.
2. 2. Bosilkovski M, Dimzova M, Grozdanovski K. Natural history of brucellosis in an endemic region in different time periods. Acta Clin Croat 2009;48(1):41-6.
3. 3. Buzgan T, Karahocagil MK, Irmak H, Baran AI, Karsen H, Evirgen O, et al. Clinical manifestations and complications in 1028 cases of brucellosis: a retrospective evaluation and review of the literature. Int J Infect Dis 2010;14(6):e469-478.
4. 4. Wise RI. Brucellosis in the United States. Past, present, andfuture. JAMA 1980;244:2318-22.
5. 5. Doganay M, Aygen B. Human brucellosis: an overview. Int J Infect Dis 2003;7:173-82.
6. 6. Pappas G, Papadimitriou P, Akritidis N, Christou L, Tsianos EV. The new global map of human brucellosis. Lancet Infect Dis 2006;6:91–9.
7. 7. Ceylan E, Irmak H, Buzğan T, Karahocagil MK, Evirgen Ö, Sakarya N, ve ark. Van iline bağlı bazı köylerde insan ve hayvan populasyonunda bruselloz seroprevalansı. Van Tıp Dergisi 2003; 10: 1–5.
8. 8. Demiroğlu YZ, Turunc T, Çalışkan H, Çolakoğlu Ş, Arslan H. Brucellosis: retrospective evaluation of the clinical, laboratory and epidemiological features in 151 cases. Mikrobiyol Bül 2007;41:517–27.

9. 9. Savas L, Onlen Y, Savas N, Yapar AF, Aydin M, Onder T. Prospective evaluation of 140 patients with brucellosis in the southern region of Turkey. Infect Dis Clin Pract 2007;15:83–8.
10. 10. Young EJ. Brucella species. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and practice of infectious diseases. 6th ed., Philadelphia: Churchill Livingstone; 2005. p. 2669–72.
11. 11. Şahin M, Cesur S, Enki S. Endemik olduğu bir bölgeden 83 olgu ile brusella enfeksiyonu. Ortadogu Tıp Derg 2019; 11(2): 101-106.
12. 12. Tartar Sağmak A. Bruselloz: Olguların Retrospektif Değerlendirilmesi. F.Ü.Sağ.Bil.Tıp Derg.2014; 28 (3): 111 - 115.
13. 13. Güler M, Avcı M, Gökgöz A. Ninety-six cases of brucellosis: a retrospective evaluation. Klimik Derg. 2019; 32(2): 168-73.
14. 14. Köse Ş, Serin Senger S, Akkoçlu G, Kuzucu L, Ulu Y, Ersan G, et al. Clinical manifestations, complications, and treatment of brucellosis: evaluation of 72 cases. Turk J Med Sci. 2014; 44(2): 220-223.
15. 15. Ibak G, Hamdi S, Onur K, Unal O, Guloglu G, Akcamet FZ. Brucellosis: Evaluation of 201 cases in an endemic area of Mediterranean Basin. Acta Medica Mediterranea 2014; 30: 121.
16. 16. Gürsoy B, Tekin-Koruk S, Sırmatel F, Karaağaç L. Bruselloz: 140 olgunun değerlendirilmesi. Klimik Derg. 2008; 21(3): 101-4.
17. 17. Yüce A, Alp-Çavuş S, Yapar N, Çakır N. Bruselloz: 55 Olgunun Değerlendirilmesi. Klimik Derg 2006; 19: 13-17.
18. 18. Kazak E, Akalın H, Yılmaz E, Heper Y, Mıstık R, Sınırtaş M, et al. Brucellosis: a retrospective evaluation of 164 cases. Singapore Med J. 2016; 57(11): 624-9.
19. 19. Demirdağ K, Özden M, Kalkan A, Çelik İ, Kılıç SS. Bruselloz: 146 olgunun retrospektif değerlendirilmesi. Flora 2002; 7(2): 120-5.
20. 20. Kursun E, Turunc T, Demiroglu Y, Arslan H. Evaluation of four hundred and forty seven brucellosis cases. Intern Med. 2013; 52(7): 745-50.
21. 21. Bosilkovski M, Krteva L, Dimzova M, Vidinic I, Sopova Z, Spasovska K. Human brucellosis in Macedonia - 10 years of clinical experience in endemic region. Croat Med J. 2010; 51(4):327–336.
22. 22. Esmaeilnejad-Ganji SM, Esmaeilnejad-Ganji SMR. Osteoarticular manifestations of human brucellosis: A review. World J Orthop. 2019 Feb 18; 10(2): 54–62. doi: 10.5312/wjo.v10.i2.54.
23. 23. Işlak Demir M, Kader Ç, Yalçın Çolak N, Kocabıyık O, Erbay A, Eren Gök Ş. Bruselloz Olgularının değerlendirilmesi. Evaluation of Brucellosis Cases. Bozok Tıp Dergisi. 2017; 7(3): 51-47.
24. 24. Demirtürk N, Demirdal T, Erben N, Demir S, Asci Z, Kilit TP, et al. Brucellosis: a retrospective evaluation of 99 cases and review of brucellosis treatment. Trop Doct. 2008 Jan;38(1):59-62. doi: 10.1258/td.2006.006266.
25. 25. Pappas G, Akritidis N, Bosilkovski M, Tsianos E. Brucellosis. N Engl J Med. 2005; 352:2325-2336. doi:10.1056/NEJMra050570.
26. 26. Colmenero JD, Reguera JM, Martos F, Sánchez-De-Mora D, Delgado M, Causse M, et al. Complications associated with Brucella melitensis infection: a study of 530 cases. Medicine (Baltimore) 1996;75(4):195-211.
27. 27. Ataman Hatipoglu C, Yetkin A, Ertem G.T, Tulek N. Unusual clinical presentations of brucellosis. Scand J Infect Dis. 2004;36(9):694-7.
28. 28. Gomez-Huelgas R, De Mora M, Parras JJ, Nuño E, SanRoman CM. Brucella and acute pericarditis: fortuitous or casual association. J Infect Dis 1986;154: 544.
29. 29. Cama BAV, Ceccarelli M, Venanzi Rullo E, Ferraiolo F, Paolucci IA, Maranto D, et al. Outbreak of Brucella melitensis infection in Eastern Sicily: risk factors, clinical characteristics and complication rate. New Microbiol. 2019 Jan;42(1):43-48.
30. 30. Taşova Y, Saltoğlu N, Yılmaz G, Ünal S, Aksu HS. Brucellosis: An evaluation of clinical, laboratory and treatment features of 238 adult cases. Turk J Infect.1998;12:307-12.
31. 31. Aygen B, Doganay M, Sumerkan B, Yildiz O, Kayaba U. Clinical manifestations, complications and treatment of brucellosis: a retrospective evaluation of 480 patients. Med Mal Infect. 2002;32:485–93. doi: 10.1016/S0399-077X(02)00403-1.
32. 32. Ayatollahi J. Epidemiological, clinical, diagnostic and therapeutic survey of 686 cases of brucellosis. Ann Saudi Med. 2004;24:398–9.
33. 33. Roushan MR, Gangi SM, Ahmadi SA. Comparison of the efficacy of two months of treatment with co-trimoxazole plus doxycycline vs. co-trimoxazole plus rifampin in brucellosis. Swiss Med Wkly. 2004;134:564–8.
34. 34. Solera J, Rodríguez-Zapata M, Geijo P, Largo J, Paulino J, Saez L, et al. Doxycycline-rifampin versus doxycycline-streptomycin in treatment of human brucellosis due to Brucella melitensis. The GECMEI Group. Grupo de Estudio de Castilla-la Mancha de Enfermedades Infecciosas. Antimicrob Agents Chemother. 1995;39:2061–7.
35. 35. Agalar C, Usubutun S, Turkyilmaz R. Ciprofloxacin and rifampicin versus doxycycline and rifampicin in the treatment of brucellosis. Eur J Clin Microbiol Infect Dis. 1999;18:535–8. doi: 10.1007/s100960050344.
36. 36. 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;45:727–33