A rare and atypic presentation of brusellosis: Acute abdomen

Öz

Acute abdominal surgery is an emergency. There are various diseases that are the etiology of acute abdomen. Rarely, infectious diseases can also cause acute abdomen. Brucellosis is a zoonotic disease, especially endemic to developing countries. This disease, which is also endemic in our country, is an important public health problem. This disease, which often causes prolonged fevers, can affect all kinds of organs. While bone-joint involvement is among the typical involvements, brucellosis can also have many different atypical clinical presentations. One of these presentations is gastrointestinal involvement. Although the liver and spleen, which are organs of the reticulo-endothelial system, are involved during the course of the disease, they do not cause severe abdominal pain. However, involvements such as hepatic abscess, acute cholecystitis, acute peritonitis, acute pancreatitis, and colitis may cause severe abdominal pain and even acute abdomen. Therefore, brucellosis should be considered in the differential diagnosis of abdominal pain, especially in cases where the diagnosis cannot be made in endemic regions. Necessary serological examinations should be done in these patients. In addition, it should not be forgotten that these patients require a multidisciplinary approach. In this review, we aimed to examine the role of brucellosis in acute abdomen.

Anahtar Kelimeler

• acute cholecystitis
• acute peritonitis
• acute pancreatitis
• colitis
• acute abdomen
• brucellosis

Brusellozun nadir ve atipik sunumu: Akut batın

Öz

Akut batın cerrahi acil bir durumdur. Akut batının etyolojisinde çok çeşitli hastalıklar yer almaktadır. Nadiren de olsa enfeksiyoz hastalıklar da akut batın tablosuna neden olabilir. Bruselloz zoonotik bir hastalık olup, özellikle gelişmekte olan ülkeler için endemiktir. Ülkemizde de endemik olan bu hastalık önemli bir halk sağlığı sorunudur. Sıklıkla uzamış ateş kliniğine neden olan bu hastalık her türlü organı tutabilir. Tipik tutulumlar arasında kemik eklem tutulumu mevcutken, brusellozun birçok farklı atipik klinik sunumları da olabilir. Bu sunumlardan birisi de gastrointestinal tutulumlardır. Hastalık seyri sırasında retikülo-endoteliyal sistem organı olan karaciğer ve dalak tutulumu olsa da bunlar şiddetli karın ağrısına neden olmaz. Ancak hepatik apse, akut kolesistit, akut peritonit, akut pankreatit, kolit gibi tutulumlar şiddetli karın ağrısına ve hatta akut batına neden olabilir. Bu nedenle karın ağrısı ayırıcı tanısında özellikle endemik bölgelerde tanı konulamayan olgularda bruselloz düşünülmelidir. Bu hastalardan gerekli serolojik tetkikler istenmelidir. Ayrıca bu hastalara multidisipliner yaklaşım gerektiği unutulmamalıdır. Bu derleme çalışmasında brusellozun akut batındaki rolünü incelemeyi amaçladık.

Anahtar Kelimeler

• Bruselloz
• akut kolesistit
• akut peritonit
• akut pankreatit
• kolit
• akut batın

Kaynakça

1. 1. Franco MP, Mulder M, Gilman RH, Smits HL. Human brucellosis. Lancet Infect Dis 2007;7(12):775-86.
2. 2. Harrison ER, Posada R. Brucellosis. Pediatr Rev 2018;39(4):222-4.
3. 3. Young EJ. Brucellosis. In: Feigin RD, Cherry JD, Demmler GJ, Kaplan SL, editors. Textbook of Pediatric Infectious Diseases, 5th ed. Philadelphia: Saunders; 2004. p.1852-1888.
4. 4. Öncel S. Brusella enfeksiyonları: Değerlendirme ve yönetim. KOU Sag Bil Derg 2016;2(3):25-30.
5. 5. Alp E, Doğanay M. Bruselloz. In: Willke Topçu A, Söyletir G, Doğanay M, eds. Enfeksiyon Hastalıkları ve Mikrobiyolojisi. 4. baskı. İstanbul: Nobel Tıp Kitabevleri, 2017: s. 863-7.
6. 6. Doganay M, Aygen B. Human brucellosis: An overview. Int J Infect Dis 2003;7(3):173–82.
7. 7. Al Anazi M, AlFayyad I, AlOtaibi R, Abu-Shaheen A. Epidemiology of brucellosis in Saudi Arabia. Saudi Med J 2019;40(10):981-8.
8. 8. al Faraj S. Acute abdomen as atypical presentation of brucellosis: Report of two cases and review of literature. J R Soc Med 1995;88(2):91-2.

9. 9. Alkan Çeviker S, Elmaslar Mert HT, Gedik MA. Akut kolesistit ile başvuran atipik bruselloz olgusu. Sakarya Tıp Dergisi 2019; 9(4): 702-5.
10. 10. Koca YS, Barut I, Koca T, Kaya O, Aktas RA. Acute abdomen caused by brucellar hepatic abscess. Am J Trop Med Hyg 2016; 94(1):73-5.
11. 11. Barutta L, Ferrigno D, et al. Hepatic brucelloma. Lancet Infect Dis 2013;13:987-93.
12. 12. Ariza J, Pigrau C, Cañas C, Marrón A, Martınez F, Almirante B. Current understanding and management of chronic hepatosplenic suppurative brucellosis. Clin Infect Dis 2001:32;1024–33.
13. 13. Hakyemez İN, Tursun İ, Akkoyunlu Y. Kolesistit ve pansitopeniyle seyreden bruselloz: Bir olgu sunumu ve literatürün incelenmesi. Klimik Derg 2011;24(2): 129-31.
14. 14. White CS. Cholecystitis as a complication of brucellosis: Report of a case. Medicine Annals DC 1934;12:60-2.
15. 15. Ali BI. Acute a calcular cholecystitis in a patient with brucellosis. Ann Clin Case Rep 2016;1(1):1101.
16. 16. Fasquelle D, Charignon G, Rami M. Acute calcular cholecystitis in a patient with brucellosis. Eur J Clin Microbiol Infect Dis 1999;18(8):599-600.
17. 17. Morris SJ, Greenwald RA, Turner RL, Tedesco FJ. Brucella-induced cholecystitis. Am J Gastroenterol 1979;71(5):481-4.
18. 18. Yıldırım Ç, Akat EO, Taşbakan MI, Sipahi OR, Pul-lukçu H. Acute cholecystitis and granulomatous hepatitis caused by Brucella melitensis. Turkiye Klinikleri J Med Sci 2018;38(1):79-83.
19. 19. Mazlum A, Ceylan B, Ceylan Ş. Safra kesesi ampiyemi ile seyreden akut bruselloz olgusu. Göztepe Tıp Dergisi 2006;20:44-6.
20. 20. Andriopoulos P, Tsironi M, Asimakopoulos G. Acute abdomen due to Brucella melitensis. Scand J Infect Dis 2003;35:204- 5.
21. 21. Berbegal Serra JM, Rodriguez Alfaro JJ, Royo Garcia G. Brucellosis complicated by acute alithiasic cholecystitis. Rev Esp Enferm Apar Dig 1986;70:88.
22. 22. Ashley D, Vade A, Challapalli M. Brucellosis with acute acalculous cholecystitis. Pediatr Infect Dis J 2000;19:1112- 3.
23. 23. Ahbab S, Çavuşoğlu B, Ataoğlu H, Yenigün M. Bruselloza bağlı akut akalkuloz kolesistit. Causa Pedia 2015;4:1163.
24. 24. Ergün U. Brucellosis associated with acute cholecysitis. Izmir Democracy University Health Sciences Journal 2019; 2(2): 114-7.
25. 25. Köse H, Temoçin F, Temoçin S, Deveci M. Akut akalküloz kolesistit ile prezente olan bruselloz: Olgu sunumu ve literatür incelemesi. FLORA. 2017; 22(2):87-90.
26. 26. Gürsoy S, Baskol M, Ozbakir O, Güven K, Patiroğlu T, Yücesoy M. Spontaneous bacterial peritonitis due to Brucella infection. Turk J Gastroenterol 2003;14(2):145-7.
27. 27. Idígoras A, Ollero M, Caballero-Granado J, Calderón E. Peritonitis bacteriana espontánea por Brucella [Spontaneous bacterial peritonitis caused by Brucella]. Med Clin (Barc) 1997;109(12):478.
28. 28. Ozakyol AH, Sariçam T, Zubaroğlu I. Spontaneous bacterial peritonitis due to Brucella melitensis in a cirrhotic patient. Am J Gastroenterol. 1999;94(9):2572-3.
29. 29. Kantarçeken B, Harputluoğlu MM, Bayindir Y, Bay-raktar MR, Aladağ M, Hilmioğlu F. Spontaneous bacterial peritonitis due to Brucella melitensis in a cirrhotic patient. Turk J Gastroenterol 2005;16(1):38-40.
30. 30. Gençer S, Ozer S. Spontaneous bacterial peritonitis caused by Brucella melitensis. Scand J Infect Dis 2003;35(5):341-3.
31. 31. Erbay A, Bodur H, Akinci E, Colpan A, Cevik MA. Spontaneous bacterial peritonitis due to Brucella melitensis. Scand J Infect Dis. 2003;35(3):196-7.
32. 32. Dizbay M, Hizel K, Kilic S, Mutluay R, Ozkan Y, Karakan T. Brucella peritonitis and leucocytoclastic vasculitis due to Brucella melitensis. Braz J Infect Dis 2007;11(4):443-4.
33. 33. Ferreira AO, Martins LN, Marinho RT, Velosa J. Spontaneous bacterial peritonitis by Brucella in a cirrhotic patient. BMJ Case Rep 2013;2013:bcr2013008629.
34. 34. Niu Q, Zhao H, Chen M, et al. Brucella peritonitis in a patient on peritoneal dialysis: Case report and literature review. Perit Dial Int 2018;38(Suppl 2):64-8.
35. 35. Ozisik L, Akman B, Huddam B, et al. Isolated Brucella peritonitis in a CAPD patient. Am J Kidney Dis 2006;47(5):e65-6.
36. 36. Taskapan H, Oymak O, Sümerkan B, Tokgoz B, Utas C. Brucella peritonitis in a patient on continuous ambulatory peritoneal dialysis with acute brucellosis. Nephron 2002;91(1):156-8.
37. 37. Al Zabali S M, Rubaihan A K, Alnetaifat M F, Alshahrani S, Alhammadi M. Brucella peritonitis in a patient on peritoneal dialysis: A case report and review of literature. Cureus 2021;13(12): e20679.
38. 38. Madkour Monir M. Gastrointestinal brucellosis. In: Madkour’s Brucellosis. Madkour Monir M, Ed. 2nd ed. Springer-Verlag, Berlin, Germany, 2001: p.150-158.
39. 39. Al-Awadhi NZ, Ashkenani F, Khalaf ES. Acute pancreatitis associated with brucellosis. Am J Gastroenterol 1989; 84: 1570-4.
40. 40. Rombola F, Bertuccio SN. Acute pancreatitis after early termination of brucellosis antibiotic therapy. J Gastrointestin Liver Dis 2008;17:234.
41. 41. Aleman MC, Alegre J, Marques A, Surinach JM, Fernadez de Sevilla T. Acute pancreatitis in the course of brucellosis. An Med Interna 1994;11:311.
42. 42. Odeh M, Oliven A. Acute pancreatitis associated with brucellosis. J Gastroenterol Hepatol 1995;10: 691-2.
43. 43. Papaioannides D, Korantzopoulos P, Sinapidis D, Charalabopoulos K, Akritidis N. Acute pancreatitis associated with brucellosis. JOP 2006;7(1):62-5.
44. 44. Berber I, Erkurt MA, Yetkin F, et al. A rare disease in the differential diagnosis of acute pancreatitis: Acute brucellosis. Intern Med 2014;53(20):2401-4. doi: 10.2169/internalmedicine.53.2510.
45. 45. Wu BU, Banks PA. Clinical management of patients with acute pancreatitis. Gastroenterology 2013; 144: 1272-81.
46. 46. Caballeria F, Masso RM, Arago JV, Sanchis A. Ascites as the first manifestation of Brucella Granulomatous hepatitis. J Hepatol 1992; 15: 415-6.
47. 47. Jorens PG, Michielsen PP, Van den Enden EJ, et al. A rare cause of colitis-Brucella melitensis. Report of a case. Dis Colon Rectum 1991;34(2):194-6.
48. 48. Oguz MM, Oztek-Celebi FZ. Brucellar terminal ileitis and epididymo-orchitis in an adolescent: Case report and review of the literature. J Infect Dev Ctries 2018;12(10):919-21.
49. 49. Petrella R, Young EJ. Acute brucella ileitis. Am J Gastroenterol 1988; 83: 80-2.
50. 50. Mazokopakis EE, Giannakopoulos TG, Christias EG. Acute brucellosis as a cause of infective colitis. Mil Med 2008;173(11):1145-7.
51. 51. Rodrigues Dos Santos J, Silva R, Nejo P, Vassalo T, Coimbra A, Peixoto L. A case of brucellosis with possible ileal involvement. GE Port J Gastroenterol 2020 ;27(4):269-73.
52. 52. Ho H, Zuckerman MJ, Schaeffer L, Polly SM Brucellosis: Atypical presentation with abdominal pain. Am J Gastroenterol 1986; 81: 375–7.
53. 53. Labrune P, Jabir B, Magny JF, Guibert M, Damay M, Odievre M. Recurrent enterocolitis-like symptoms as the possible presenting manifestations of neonatal Brucella melitensis infection. Acta Paediatr Scand 1990;79(6-7):707-9.
54. 54. Stermer E, Levy N, Potasman I, Jaffe M, Boss J. Brucellosis as a cause of severe colitis. Am J Gastroenterol 1991;86(7):917-9.
55. 55. Jorens PG, Michielsen PP, Van den Enden EJ, et al. A rare cause of colitis-Brucella melitensis. Report of a case. Dis Colon Rectum 1991;34(2):194-6.
56. 56. Ablin J, Mevorach D, Eliakim R. Brucellosis and the gastrointestinal tract: The odd couple. J Clin Gastroenterol 1997; 24: 25-9.
57. 57. Kaufman N, Reichman N, Flatau E. Brucellosis presenting as acute abdomen. Harefuah 1999;136(4):276-8.
58. 58. Mousa AR, Elhag KM, Khogali M, Marafie AA. The nature of human brucellosis in Kuwait: study of 379 cases. Rev Infect Dis 1988;10(1):211-7.