Clinical Features of Human Brucellosis and Risk Factors for Focal Complications: A Retrospective Analysis in a Tertiary-Care Hospital in Beijing, China

Zhang, Xin; Chen, Xue; Xiao, Changfa; Cai, Ming; Yang, Liu; Zhang, Yulin

doi:10.2147/ijgm.s380328

Cited by 9 publications

(10 citation statements)

References 27 publications

(39 reference statements)

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“…Therefore, brucellosis should be considered in the differential diagnosis of osteoarthropathy, orchitis, and other physiotherapy-related diseases in the rehabilitation department, especially in endemic regions. The spectrum of clinical symptoms and the distribution of focal involvement were found to be different from previous studies [16][17][18]. In our study, the complicated group showed a significantly higher incidence of arthralgia, inappetence, nausea, orchialgia, and eye bulging pain, while fatigue was significantly less frequent compared to the uncomplicated group.…”

Section: Discussioncontrasting

confidence: 99%

“…Specifically, osteoarticular complications were more commonly seen in large joints, such as the spine. Our results align with previous studies, which also identified arthralgia, absence of myalgias, and low back pain as associated factors for complications [ 16 , 19 – 21 ]. Notably, eye bulging pain, although not common in brucellosis patients, should be carefully considered during diagnosis and treatment.…”

Section: Discussionsupporting

confidence: 93%

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Incidence and warning signs for complications of human brucellosis: a multi-center observational study from China

Shi,

Qin,

et al. 2024

Infect Dis Poverty

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Background Brucellosis is a severe zoonotic disease that is often overlooked, particularly in impoverished countries. Timely identification of focal complications in brucellosis is crucial for improving treatment outcomes. However, there is currently a lack of established indicators or biomarkers for diagnosing these complications. Therefore, this study aimed to investigate potential warning signs of focal complications in human brucellosis, with the goal of providing practical parameters for clinicians to aid in the diagnosis and management of patients. Methods A multi-center cross-sectional study was conducted in China from December 2019 to August 2021. The study aimed to investigate the clinical characteristics and complications of patients with brucellosis using a questionnaire survey and medical record system. The presence of warning signs for complications was assessed using univariate and multivariate logistic regression models. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used for variable screening and model evaluation. Results A total of 880 participants diagnosed with human brucellosis were enrolled. The median age of the patients was 50 years [interquartile range (IQR): 41.5–58.0], and 54.8% had complications. The most common organ system affected by complications was the osteoarticular system (43.1%), with peripheral arthritis (30.0%), spondylitis (16.6%), paravertebral abscess (5.0%), and sacroiliitis (2.7%) being the most prevalent. Complications in other organ systems included the genitourinary system (4.7%), respiratory system (4.7%), and hematologic system (4.6%). Several factors were found to be associated with focal brucellosis. These factors included a long delay in diagnosis [odds ratio (OR) = 3.963, 95% confidence interval (CI) 1.906–8.238 for > 90 days], the presence of underlying disease (OR = 1.675, 95% CI 1.176–2.384), arthralgia (OR = 3.197, 95% CI 1.986–5.148), eye bulging pain (OR = 3.482, 95% CI 1.349–8.988), C-reactive protein (CRP) > 10 mg/L (OR = 1.910, 95% CI 1.310–2.784) and erythrocyte sedimentation rate (ESR) elevation (OR = 1.663, 95% CI 1.145–2.415). The optimal cutoff value in ROC analysis was > 5.4 mg/L for CRP (sensitivity 73.4% and specificity 51.9%) and > 25 mm/h for ESR (sensitivity 47.9% and specificity 71.1%). Conclusions More than 50% of patients with brucellosis experienced complications. Factors such as diagnostic delay, underlying disease, arthralgia, eye pain, and elevated levels of CRP and ESR were identified as significant markers for the development of complications. Therefore, patients presenting with these conditions should be closely monitored for potential complications, regardless of their culture results and standard tube agglutination test titers.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 93%

Incidence and warning signs for complications of human brucellosis: a multi-center observational study from China

Shi,

Qin,

et al. 2024

Infect Dis Poverty

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“…Additionally, cardiac and neurological manifestations might make the diagnosis more challenging. 15 Clinical manifestations of our case were insidious fever, generalized pain, weakness and lethargy, anorexia, and headache.…”

Section: Discussionmentioning

confidence: 61%

“…Patients with brucellosis typically experience non‐specific symptoms such fever, night sweats, arthralgia, headache, fatigue, anorexia, myalgia, and weight loss. Additionally, cardiac and neurological manifestations might make the diagnosis more challenging 15 . Clinical manifestations of our case were insidious fever, generalized pain, weakness and lethargy, anorexia, and headache.…”

Section: Discussionmentioning

confidence: 80%

Massive cardiac vegetation and cardiomyopathy in a 23‐year‐old rancher with brucellosis

Mirhosseini,

Bagheri,

Lak

et al. 2023

Clinical Case Reports

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Key clinical massageA 23‐year‐old rancher was admitted with the diagnosis of brucellosis. In evaluations, a massive vegetation in the aortic valve was seen. A combination of antibiotic therapy and cardiac surgery were performed, it seems this approach reduces mortality and complications.AbstractBrucellosis (also known as “undulant fever,” “Mediterranean fever,” or “Malta fever”) is a zoonotic infection transmitted to humans from infected animals (cattle, sheep, goats, camels, pigs, or other animals) by ingestion of food products (such as unpasteurized dairy products) or by contact with tissue or fluids. It is the most frequent zoonosis globally and a major public health issue in many resource‐poor nations. Endocarditis is one of the rarest and most dangerous consequences of brucellosis. Additionally, the combination of endocarditis with cardiomyopathy increases its rarity. This condition is usually treated with a high level of suspicion Serological, clinical, and epidemiological data can all be used to make a diagnosis. The use of echocardiography aids in the early diagnosis. Due to the high risk of recurrence and the extent of tissue destruction brought on by Brucella, the majority of experts advise an early surgical intervention; nevertheless, other writers assert that low‐risk patients also require cautious therapy. In this article, we discuss the situation of a patient who underwent surgery and had Brucella endocarditis and heart failure. In conclusion, a combination of antibiotic therapy and cardiac surgery, reduces mortality and complications associated with Brucella endocarditis and improves patient quality of life.

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“…Following uptake by local tissue lymphocytes, Brucella can disseminate throughout the body via the lymphoreticular system or bloodstream, leading to potential damage to various organs or body systems. 2,12,13 Traditional culture methods for brucellosis typically require one to four weeks for detection. 14 Clinical manifestations of brucellosis are characterized by undulant fever, malaise, arthralgias, hepatomegaly, splenomegaly, lymphadenopathy, or focal involvement of specific organs such as the epididymis, joints, cardiovascular system, and central nervous system.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Metagenomic Next-Generation Sequencing Confirmed a Case of Spine Infection with Brucella melitensis in Non-Endemic Area

Du,

Tao,

Yang

et al. 2023

IDR

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Brucellosis is a zoonotic disease caused by Brucella spp., with the highest prevalence found in the northern cities of China. In this case report, we present an occurrence of spinal infection caused by B. melitensis in a 67-year-old man residing in a non-endemic area of southern China. The patient initially presented with chest and back pain, which was not accurately diagnosed and treated at a local hospital. Subsequently, due to worsening pain, he was admitted to our hospital. To determine the cause of the infection, we performed CT-guided aspiration biopsy and collected biopsy tissue for metagenomic next-generation sequencing (mNGS) on the second day of hospitalization. Imaging investigations revealed involvement of the thoracic vertebrae, specifically thoracic 4-7 with the main focus on 5-6, accompanied by stenosis of the intervertebral space. The mNGS results indicated that the spine infection was caused by B. melitensis. The patient's history as a shepherd and a positive Rose Bengal plate test (RBPT) further supported the diagnosis of brucella spondylitis. In order to alleviate pain and restore spinal function, the patient underwent posterior internal fixation of the thoracic spine. Treatment was initiated with cefoperazone/sulbactam, followed by doxycycline. Subsequently, the patient was switched to a combination therapy of rifampicin and doxycycline for a duration of six weeks. The patient responded well to treatment, and his condition remained stable. In conclusion, brucellosis is a common disease that can be easily misdiagnosed. This case report highlights the potential value of mNGS in early and rapid diagnosis. We believe that mNGS can serve as an effective tool to improve the diagnosis of spine infections caused by this pathogen.

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Clinical Features of Human Brucellosis and Risk Factors for Focal Complications: A Retrospective Analysis in a Tertiary-Care Hospital in Beijing, China

Cited by 9 publications

References 27 publications

Incidence and warning signs for complications of human brucellosis: a multi-center observational study from China

Incidence and warning signs for complications of human brucellosis: a multi-center observational study from China

Massive cardiac vegetation and cardiomyopathy in a 23‐year‐old rancher with brucellosis

Case Report: Metagenomic Next-Generation Sequencing Confirmed a Case of Spine Infection with Brucella melitensis in Non-Endemic Area

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