Human brucellosis and fever of unknown origin

Abstract

Background Human brucellosis has become one of the major public health problems in China, and increases atypical manifestations, such as fever of unknown origin (FUO), and misdiagnosis rates has complicated the diagnosis of brucellosis. To date, no relevant study on the relationship between brucellosis and FUO has been conducted. Methods We retrospectively reviewed the medical charts of 35 patients with confirmed human brucellosis and prospectively recorded their outcomes by telephone interview. The patients were admitted to the Second Affiliated Hospital of Nanchang University between January 01, 2013 and October 31, 2019. Patient data were collected from hospital medical records. Results The percentage of males was significantly higher than that of female in FUO (78.95% vs. 21.05%, P < 0.05), and 80% of the patients had a clear history of exposure to cattle and sheep. Moreover, 19 (54%) cases were hospitalized with FUO, among which the patients with epidemiological histories were significantly more than those without (P < 0.05). The incidence of toxic hepatitis in FUO patients was higher than that in non-FUO patients (89% vs. 50%, P < 0.05). Meanwhile, the misdiagnosis rate was considerably higher in the FUO group than in the non-FUO group (100% vs. 63%; P < 0.05). Conclusion Brucellosis is predominantly FUO admission in a non-endemic area of China, accompanied by irregular fever and toxic hepatitis. Careful examination of the epidemiological history and timely improvement of blood and bone marrow cultures can facilitate early diagnosis and prevent misdiagnosis.

Brucella pleuritis misdiagnosed as tuberculous pleuritis: a case report

“… 3 Treatment is often delayed because of misdiagnosis. 5 There are approximately half a million new infections reported worldwide each year, 6 with a large number of livestock infections, which has a large economic impact. A main route of Brucella infection in the respiratory system is aerosol transmission, 7 , 8 and subsequent blood transmission may be the most important route of lung infection.…”

Brucella Spondylitis: Current Knowledge and Recent Advances

“…Other symptoms and signs are abdominal pain, splenomegaly, and hepatomegaly [54]. Apart from all the aforementioned symptoms, brucellosis should also be considered in the differential diagnosis of a fever of unknown origin, especially in non-endemic areas [55]. Complicated forms of the disease include osteoarticular, genitourinary, neurologic, cardiovascular, and pulmonary involvement [56,57].…”

Case report: A case of brucellosis misdiagnosed as coronavirus disease 2019/influenza in China

“…Human-to-human transmission takes place through blood transfusion, bone marrow transplantation, and mother-to-fetus transmission ( 3 ). The signs and symptoms of brucellosis are not specific, fever, sweat, fatigue, and joint ache are the most common manifestation of human brucellosis, these are similar to influenza, severe colds, coronavirus disease 2019 (COVID-19), malaria, and other infectious diseases, so clinical diagnosis is difficult in place of lack of health facility and specific and rapid diagnostic methods ( 4 , 5 ). An epidemiological survey based on 2060 cases collected from brucellosis clinics in China showed that 57.62% of patients were misdiagnosed or suspected of having other diseases with similar clinical symptoms ( 6 ).…”