Liver involvement in patients with brucellosis: results of the Marmara study

Abstract

Brucellosis is a zoonotic disease that primarily affects the reticuloendothelial system. But, the extent of liver damage in due course of the disease is unclear. This study included 325 brucellosis patients with significant hepatobiliary involvement identified with microbiological analyses from 30 centers between 2000 and 2013. The patients with ≥5 times of the upper limit of normal for aminotransferases, total bilirubin level ≥2 mg/dl or local liver lesions were enrolled. Clinical hepatitis was detected in 284 patients (87.3 %) and cholestasis was detected in 215 (66.1 %) patients. Fatigue (91 %), fever (86 %), sweating (83 %), arthralgia (79 %), and lack of appetite (79 %) were the major symptoms. Laboratory tests showed anemia in 169 (52 %), thrombocytopenia in 117 (36 %), leukopenia in 81 (25 %), pancytopenia in 42 (13 %), and leukocytosis in 20 (6 %) patients. The most commonly used antibiotic combinations were doxycycline plus an aminoglycoside (n = 73), doxycycline plus rifampicin (n = 71), doxycycline plus rifampicin and an aminoglycoside (n = 27). The duration of ALT normalization differed significantly in three treatment groups (p < 0.001). The use of doxycycline and an aminoglycoside in clinical hepatitis showed better results compared to doxycycline and rifampicin or rifampicin, aminoglycoside, doxycycline regimens (p < 0.05). However, the length of hospital stay did not differ significantly between these three combinations (p > 0.05). During the follow-up, treatment failure occurred in four patients (1 %) and relapse was seen in three patients (0.9 %). Mortality was not observed. Hepatobiliary involvement in brucellosis has a benign course with suitable antibiotics and the use of doxycycline and an aminoglycoside regimen seems a better strategy in select patients.

An unusual presentation of brucellosis: hepatic microabscesses

“…Hepatic involvement in brucellosis has been reported in the literature in around 2–3% of the cases. Although B. abortus tends to establish a granulomatous form of hepatitis, B. melitensis may cause both diffuse and granulomatous lesions in the liver 1, 2, 3, 4. An abscess caused by Brucella spp usually represents the chronic form of disease, but it can occur in acute or subacute brucellosis.…”

“…Two‐thirds of patients had prolonged, slight pain in the right upper abdominal quadrant. Routine laboratory findings in brucellosis are not usually diagnostic that may include leukopenia, anemia, thrombocytopenia, pancytopenia, and mild‐to‐moderate elevation of liver function tests 2, 5, 6. Ultrasonography and computed tomography images are characteristic.…”

“…Hepatic involvement is frequent in both acute and chronic brucellosis. Usually, a slight increase in the liver function tests and mild hepatosplenomegaly occur, and sometimes, acute hepatitis develops, but hepatic abscess is a rare manifestation of that disease 1, 2, 3. This report describes a hepatic microabscesses probably due to brucellosis in a 33‐year‐old woman.…”

Evaluation of Hepatosplenomegaly and Liver Function Tests in 102 Brucellosis Cases

“…Olguların başvuru sırasında ölçülen en yüksek vücut sıcaklığı, aspartataminotransferaz (AST), alaninaminotransferaz (ALT), alkalenfosfataz (ALP), gama glutamiltransferaz (GGT), toplam/direkt/indirekt bilirubin, batın içi ultrasonografi (USG) değerlendirme sonucunda tespit edilen karaciğer ve dalak boyut anormallikleri ve tüm değerlendirmeler sonucunda karaciğer ile ilişkili herhangi bir bozukluğu olmayan hastalar kaydedildi. Batın USG ile granülomatöz hepatit, hepatik apse ve diffüz hepatit tanısı konuldu [6] . Klinik hepatit tanısı için karaciğer fonksiyon testlerinin normalin üst sınırı-nın beş kat üzerine çıkması kriter olarak belirlendi [6] .…”

“…Batın USG ile granülomatöz hepatit, hepatik apse ve diffüz hepatit tanısı konuldu [6] . Klinik hepatit tanısı için karaciğer fonksiyon testlerinin normalin üst sınırı-nın beş kat üzerine çıkması kriter olarak belirlendi [6] . Bu ölçümler için hastanemizdeki normal değerler Tablo 1'de verilmiştir.…”