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Pu Z, Liu Y, Bai M, Ling T, Pan J, Xu D, Dai P, Yan Y. Association Between Diagnostic Delays and Spinal Involvement in Human Brucellosis: A Retrospective Case-Control Study. Open Forum Infect Dis 2024; 11:ofae357. [PMID: 39035571 PMCID: PMC11259137 DOI: 10.1093/ofid/ofae357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 06/26/2024] [Indexed: 07/23/2024] Open
Abstract
Background Spinal involvement is a common but serious complication of human brucellosis. However, information on the risk factors associated with spinal involvement in individuals with brucellosis is limited. Methods This retrospective case-control study aimed to determine the potential risk factors associated with spinal complications in inpatients with brucellosis. Results During the study period, brucellosis was diagnosed in 377 patients, of whom 108 (28.64%) showed spinal involvement. Those with spinal involvement were significantly older than patients in the control group (mean age [standard deviation], 53.25 [10.48] vs 43.12 [13.84] years, respectively; P < .001). The diagnostic delays were significantly longer in patients with spinal involvement than in the control group (mean delay [standard deviation], 11.17 [13.55] vs 6.03 [8.02] weeks; P = .001). Age >40 years (odds ratio, 5.42 [95% confidence interval, 2.65-11.05]; P < .001) and diagnostic delay >4 weeks (2.94 [1.62-5.35]; P < .001) were independently associated with spinal involvement in brucellosis. The lumbar spine at the L3-5 level was the most affected (152 of 249 [61.04%]). Back pain (92 of 108 in case patients vs 21 of 108 in controls; P < .001) and splenomegaly (23 vs 42 of 108, respectively; P = .005) differed significantly between the 2 groups. Conclusions Age >40 years and diagnostic delay >4 weeks increased the risk of spinal involvement in brucellosis. Therefore, the time from symptom onset to diagnosis should be shortened, using effective measures to reduce spinal involvement risk.
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Affiliation(s)
- Zhongshu Pu
- Department of Infectious Diseases, 940th Hospital of Joint Logistics Support Force of the Chinese People's Liberation Army, Lanzhou, China
- Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, Xi’an, China
| | - Yiwen Liu
- Department of Immunization Program, Wuwei Municipal Center for Disease Control and Prevention, Wuwei, China
| | - Manling Bai
- Department of Infectious Diseases, Wuwei People's Hospital, Wuwei, China
| | - Tong Ling
- Department of Hygienic Logistics, 940th Hospital of Joint Logistic Support Force of the Chinese People's Liberation Army, Lanzhou, China
| | - Jing Pan
- Department of Hygienic Logistics, 940th Hospital of Joint Logistic Support Force of the Chinese People's Liberation Army, Lanzhou, China
| | - Dengrong Xu
- Department of Infectious Diseases, 940th Hospital of Joint Logistics Support Force of the Chinese People's Liberation Army, Lanzhou, China
| | - Peijun Dai
- Department of Infectious Diseases, 940th Hospital of Joint Logistics Support Force of the Chinese People's Liberation Army, Lanzhou, China
| | - Yongping Yan
- Department of Epidemiology, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical University, Xi’an, China
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Bai L, Ta N, Zhao A, Muren H, Li X, Wang BC, Bagen H, Wen Y. A follow-up study of 100 patients with acute brucellosis for its prognosis and prevention. Front Med (Lausanne) 2023; 10:1110907. [PMID: 38020155 PMCID: PMC10655092 DOI: 10.3389/fmed.2023.1110907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To prevent chronic brucellosis, this study analysed the changes in patient antibody titers, and the trajectories of biochemical indicators at different stages of brucellosis, identified relevant biomarkers, and explored risk factors affecting the prognosis of brucellosis patients. Methods A prospective cohort study was conducted to follow 100 patients with acute brucellosis. Laboratory serological test results [taken with a serum (tube) agglutination test (SAT)] and biochemical parameters (liver function, renal function, and hematological system) were measured repeatedly at four-time points: 0 weeks-baseline survey, 6 weeks after the first treatment, 12 weeks after the second treatment, and 3 months after the third treatment. The changes in the antibody titres and biochemical parameters at each time point were analysed for trend changes. Results One hundred patients with acute brucellosis were enrolled in this follow-up study, with 100% retention in follow-up. By the third follow-up, 21 patients had turned subacute and 11 had turned chronic. One-way repeated measures analysis of variance results showed statistically significant differences (p < 0.01) across the time points for the following five indicators: alanine aminotransferase, aspartate aminotransferase, total bilirubin, serum creatinine (SCr) and platelet count. The clinical symptoms of patients in the acute stage were mainly joint pain, fatigue, and fever, while those in the chronic stage complained primarily of joint pain and fatigue. The results of multivariate logistic analysis showed that joint pain [odds ratio (OR) = 3.652, 95% confidence interval (CI) =1.379-9.672], monoarticular pain (OR = 6.356, 95% CI = 4.660-8.669), elevated SCr (OR = 15.804, 95% CI = 1.644-151.966) and elevated haemoglobin (Hb) (OR = 1.219, 95% CI = 1.065-1.736) were risk factors for poor prognosis (not cured or chronic) in patients with brucellosis. Conclusion The trajectory of changes in patient SAT posirates and antibody titers can be used to distinguish patients with chronic brucellosis. The brucellosis is preventable and treatable, and the standard treatment can be effective in reducing the clinical symptoms of affected patients. If patients are not treated in a timely manner, joint pain, monoarticular pain, and elevated SCr are risk factors for patients who are not cured. Therefore, the treatment cycle for these patients should be extended.
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Affiliation(s)
- Long Bai
- Inner Mongolia Medical University College of Mongolian Medicine and Pharmacy, Hohhot, China
| | - Na Ta
- Inner Mongolia Agricultural University, Hohhot, China
- Inner Mongolia Center for Disease Control and Research, Hohhot, China
| | - Aoning Zhao
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Huhe Muren
- Inner Mongolia Agricultural University, Hohhot, China
| | - Xueyong Li
- Inner Mongolia Agricultural University, Hohhot, China
| | | | - Hurile Bagen
- Inner Mongolia Agricultural University, Hohhot, China
| | - Yongjun Wen
- Chi Feng Center for Disease Control and Research, Chifeng, China
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Akkoc G, Tekerek S. Osteoarticular Involvement in Childhood Brucellosis: Evaluation of Clinical, Laboratory and Radiologic Features of 185 Cases. Pediatr Infect Dis J 2023; 42:381-388. [PMID: 36795549 DOI: 10.1097/inf.0000000000003844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUNDS Brucellosis is a systemic zoonotic disease. Osteoarticular (OA) system involvement is a common complication and the predominant manifestation of brucellosis in children. We aimed to evaluate the epidemiologic, demographic, clinical characteristics, and laboratory and radiologic findings of children with brucellosis and how these related to OA involvement. METHODS This retrospective cohort study consisted of all consecutive children and adolescents diagnosed as having brucellosis who were admitted to the pediatric infectious disease department of University of Health Sciences Van Research and Training Hospital between August 1, 2017, and December 31, 2018, in Turkey. RESULTS A total of 185 patients diagnosed as having brucellosis were evaluated, 50.8% had OA involvement (n = 94). Seventy-two patients (76.6%) exhibited peripheral arthritis involvement, among of them, hip arthritis (63.9%; n = 46) was the most common manifestation, followed by arthritis of knee (30.6%; n = 22), shoulder (4.2%; n = 3) and elbow (4.2%; n = 3). A total of 31 patients (33.0%) had sacroiliac joint involvement. Seven patients (7.4%) had spinal brucellosis. Erythrocyte sedimentation rate level above 20 mm/h at admission and age were independent predictor of OA involvement (respectively odds ratio [OR] = 2.82; 95% confidential interval [CI] = 1.41-5.64, OR peryear = 1.10; 95% CI: 1.01-1.19). Increasing age was associated types of OA involvement. CONCLUSION A half of brucellosis cases had OA involvement. These results can help physicians to make early identification and diagnosis of childhood OA brucellosis who present with arthritis and arthralgia to enable the disease to be treated in time.
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Affiliation(s)
- Gulsen Akkoc
- From the Department of Pediatric Infectious Disease, University of Health Sciences Van Research and Training Hospital Van, Van, Turkey
- Department of Pediatric Infectious Disease, University of Health Sciences, Haseki Training and Research Hospital Istanbul, Istanbul, Turkey
| | - Serhat Tekerek
- Department of Radiology, University of Health Sciences Van Research and Training Hospital Van, Van, Turkey
- Department of Radiology, University of Health Sciences Antalya Research and Training Hospital Antalya, Antalya, Turkey
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Yan YY, Peh WCG. Mimics of Synovial Tumors Due to Chronic Infection. MEDICAL RADIOLOGY 2023:241-266. [DOI: 10.1007/174_2023_428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Celik N, Laloğlu E, Aslan H. Novel markers in predicting Brucella sacroiliitis: The platelet large cell ratio and basal immature reticulocyte fraction. ASIAN PAC J TROP MED 2023. [DOI: 10.4103/1995-7645.368022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Wu ZG, Song ZY, Wang WX, Xi WN, Jin D, Ai MX, Wu YC, Lan Y, Song SF, Zhang GC, Yao XB, Gao Z, Liu CY, Sun K, Yu DS, Xie BG, Sun SL. Human brucellosis and fever of unknown origin. BMC Infect Dis 2022; 22:868. [PMID: 36411430 PMCID: PMC9680120 DOI: 10.1186/s12879-022-07872-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 11/11/2022] [Indexed: 11/23/2022] Open
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.
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Affiliation(s)
- Zhi-guo Wu
- grid.412455.30000 0004 1756 5980Department of Infectious Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006 China
| | - Zhi-ying Song
- grid.412455.30000 0004 1756 5980Department of Infectious Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006 China
| | - Wei-xin Wang
- grid.449868.f0000 0000 9798 3808Department of Infectious Diseases, The Second Affiliated Hospital of Yichun University, Yichun, 336000 China
| | - Wen-na Xi
- grid.412455.30000 0004 1756 5980Department of Infectious Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006 China
| | - Di Jin
- grid.412455.30000 0004 1756 5980Department of Infectious Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006 China
| | - Mao-xing Ai
- grid.412455.30000 0004 1756 5980Department of Infectious Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006 China
| | - Yu-chan Wu
- grid.412455.30000 0004 1756 5980Department of Infectious Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006 China
| | - Yu Lan
- grid.412455.30000 0004 1756 5980Department of Infectious Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006 China
| | - Shu-fen Song
- grid.412455.30000 0004 1756 5980Department of Infectious Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006 China
| | - Gong-chang Zhang
- grid.412455.30000 0004 1756 5980Department of Infectious Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006 China
| | - Xue-bing Yao
- grid.412455.30000 0004 1756 5980Department of Infectious Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006 China
| | - Zhen Gao
- grid.412455.30000 0004 1756 5980Department of Infectious Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006 China
| | - Cui-yun Liu
- grid.412455.30000 0004 1756 5980Department of Infectious Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006 China
| | - Ke Sun
- grid.412455.30000 0004 1756 5980Department of Infectious Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006 China
| | - Dong-shan Yu
- grid.412455.30000 0004 1756 5980Department of Infectious Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006 China
| | - Bao-gang Xie
- grid.412455.30000 0004 1756 5980Department of Infectious Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006 China ,grid.411870.b0000 0001 0063 8301Department of Pharmaceutics, Medical College of Jiaxing University, Jiaxing, 314001 China
| | - Shui-lin Sun
- grid.412455.30000 0004 1756 5980Department of Infectious Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006 China
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Sebt MV, Jafari S, Khavaninzadeh M, Shavandi A. Diagnosis of brucellosis disease using data mining: A case study on patients of a hospital in Tehran. J Microbiol Methods 2022; 199:106530. [PMID: 35777597 DOI: 10.1016/j.mimet.2022.106530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Brucellosis is a common zoonotic infection of humans from livestock. This bacterial infection is acquired from infected animals and their products. The pathogen of this disease is a genus of bacilli called Brucella, and no effective vaccine has been discovered yet for the prevention of human brucellosis. OBJECTIVES The present study is mainly conducted to diagnose brucellosis accurately and timely, using Data Mining techniques. Based on the knowledge discovered with Data Mining and opinions of specialist physicians, this study aims to propose instructions for diagnosing brucellosis. MATERIALS AND METHODS The dataset used in this study contains 340 samples and is extracted from the files of patients at Tehran Imam Khomeini Hospital from the years 2010-2020. Attributes of this dataset have been determined based on domain expert opinions, namely specialist physicians. After initial analysis and data pre-processing, various Data Mining techniques have been employed to diagnose brucellosis, including neural networks, Bayesian networks, and decision trees. RESULTS According to the recorded data, 270 people (approximately 79% of samples) had brucellosis. Some clinical symptoms were more prominent among infected patients, including fever, arthritis, tremor, decreased appetite, and nightly perspiration. Among all employed Data Mining techniques in this study, the decision tree with C5.0 pruning algorithm possessed the highest accuracy in diagnosing patients with brucellosis (approximately 99% accuracy). Based on the obtained final model, the most important factors for diagnosing brucellosis are the Wright test, Coombs Wright test, blood culture test, and living place. DISCUSSION AND CONCLUSION According to the results of this study, brucellosis can be diagnosed with a high accuracy using Data Mining techniques. Furthermore, the most significant factors for diagnosing brucellosis disease can be identified by Data Mining. Among all investigated techniques in this study, the decision tree with C5.0 pruning algorithm has the most accuracy in diagnosing brucellosis. Given the decision tree created by the C5.0 algorithm and the opinions of specialist physicians, some instructions are proposed based on a decision-making framework to classify referents into patient and non-patient groups. These instructions can accelerate the diagnosis, reduce therapeutic costs, and decrease treatment period.
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Affiliation(s)
- Mohammad Vahid Sebt
- Department of Industrial Engineering, Faculty of Engineering, Kharazmi University, Tehran, Iran.
| | - Sirous Jafari
- Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| | - Milad Khavaninzadeh
- Department of Industrial Engineering, Faculty of Engineering, Kharazmi University, Tehran, Iran.
| | - Ali Shavandi
- Department of Industrial Engineering, Faculty of Engineering, Sharif University of Technology, Tehran, Iran.
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Salman H, Akçam FZ, Arslan M, Atar M, Keskin M, Akçam M. Childhood Brucellosis: A Single-Center Experience from the Central Mediterranean Region of Turkey. J PEDIAT INF DIS-GER 2022. [DOI: 10.1055/s-0042-1745837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Abstract
Objective Brucellosis is an important zoonotic disease in developing countries, which can occur with varying clinical findings and cause complications. The aim of this study was to evaluate cases diagnosed with brucellosis that were followed up in our clinic over the last 10 years.
Methods A retrospective evaluation was made of cases diagnosed with brucellosis and then followed up and treated as inpatients or outpatients in our clinic between January 2011 and 2021. Patient data were obtained from the hospital automated records system.
Results This study included 81 cases comprising 43 (53.1%) males and 38 (46.9%) females with a mean age of 10.7 ± 4.5 years (range, 13 months–18 years). There was a history of consuming unpasteurized milk and/or dairy products in 69 (85.2%) patients, living in a rural location in 66 (81.3%), and the family keeping livestock in 49 (60.5%) cases; there was a family history of brucellosis in 31 (38.3%) cases. The most common complaint at presentation was joint pain in 71.6%, the most common finding on physical examination was fever (59.3%), and the most common laboratory finding was elevated C-reactive protein (71.6% of cases). Brucella spp. were isolated from 12 of 43 patients who had blood cultures performed. Complications occurred in 33 (40.7%) cases, most commonly involving the osteoarticular system.
Conclusion Priority should be given to family education about not consuming raw animal products. Animals should be checked, vaccinated, and treated with a multidisciplinary approach. Until the clinical condition in endemic areas is proven to be due to a different cause, patients should be examined with the suspicion that any clinical finding may be due to brucellosis.
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Affiliation(s)
- Hakan Salman
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Füsun Zeynep Akçam
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Müjgan Arslan
- Division of Pediatric Neurology, Department of Pediatrics, School of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Müge Atar
- Division of Pediatric Endocrinology, Department of Pediatrics, School of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Mahmut Keskin
- Division of Pediatric Cardiology, Department of Pediatrics, School of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Mustafa Akçam
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Suleyman Demirel University, Isparta, Turkey
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Lukambagire AS, Mendes ÂJ, Bodenham RF, McGiven JA, Mkenda NA, Mathew C, Rubach MP, Sakasaka P, Shayo DD, Maro VP, Shirima GM, Thomas KM, Kasanga CJ, Kazwala RR, Halliday JEB, Mmbaga BT. Performance characteristics and costs of serological tests for brucellosis in a pastoralist community of northern Tanzania. Sci Rep 2021; 11:5480. [PMID: 33750848 PMCID: PMC7943594 DOI: 10.1038/s41598-021-82906-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/21/2021] [Indexed: 01/31/2023] Open
Abstract
The control of brucellosis across sub-Saharan Africa is hampered by the lack of standardized testing and the use of tests with poor performance. This study evaluated the performance and costs of serological assays for human brucellosis in a pastoralist community in northern Tanzania. Serum collected from 218 febrile hospital patients was used to evaluate the performance of seven index tests, selected based on international recommendation or current use. We evaluated the Rose Bengal test (RBT) using two protocols, four commercial agglutination tests and a competitive enzyme-linked immunosorbent assay (cELISA). The sensitivity, specificity, positive predictive value, negative predictive value, Youden's index, diagnostic accuracy, and per-sample cost of each index test were estimated. The diagnostic accuracy estimates ranged from 95.9 to 97.7% for the RBT, 55.0 to 72.0% for the commercial plate tests, and 89.4% for the cELISA. The per-sample cost range was $0.69-$0.79 for the RBT, $1.03-$1.14 for the commercial plate tests, and $2.51 for the cELISA. The widely used commercial plate tests performed poorly and cost more than the RBT. These findings provide evidence for the public health value of discontinuing the use of commercial agglutination tests for human brucellosis in Tanzania.
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Affiliation(s)
- AbdulHamid S Lukambagire
- College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro, Tanzania.
| | - Ângelo J Mendes
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Rebecca F Bodenham
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - John A McGiven
- OIE/FAO Brucellosis Reference Laboratory, Department of Bacteriology, Animal and Plant Health Agency, Surrey, UK
| | | | - Coletha Mathew
- College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Matthew P Rubach
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Duke Global Health Institute, Durham, NC, USA
| | - Philoteus Sakasaka
- Duke Global Health Institute, Durham, NC, USA
- Kilimanjaro Clinical Research Institute-Biotechnology Laboratory, Moshi, Tanzania
| | | | - Venance P Maro
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Gabriel M Shirima
- The Nelson Mandela African Institution for Science and Technology, Arusha, Tanzania
| | - Kate M Thomas
- Kilimanjaro Clinical Research Institute-Biotechnology Laboratory, Moshi, Tanzania
- Centre for International Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Christopher J Kasanga
- College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Rudovick R Kazwala
- College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Jo E B Halliday
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Duke Global Health Institute, Durham, NC, USA
- Kilimanjaro Clinical Research Institute-Biotechnology Laboratory, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Hassouneh L, Quadri S, Pichilingue-Reto P, Chaisavaneeyakorn S, Cutrell JB, Wetzel DM, Nijhawan AE. An Outbreak of Brucellosis: An Adult and Pediatric Case Series. Open Forum Infect Dis 2019; 6:ofz384. [PMID: 31660348 PMCID: PMC6790400 DOI: 10.1093/ofid/ofz384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/27/2019] [Indexed: 11/20/2022] Open
Abstract
Background Brucellosis is recognized as a neglected zoonotic disease and a major public health threat. The purpose of this study was to characterize epidemiological risk factors and healthcare utilization and compare clinical aspects of disease among adult and pediatric cases in North Texas. Methods A retrospective chart review of electronic medical records was completed at 3 large tertiary centers—Parkland Health and Hospital System, Clements University Hospital, and Children’s Medical Center—between January 1, 2007 and June 1, 2017. Demographic, clinical, and laboratory variables were collected. Cases were defined as confirmed or probable. Results Twenty-eight cases of brucellosis were identified: 26 confirmed (9 children, 17 adults) and 2 probable cases (1 child, 1 adult). Half (n = 14) were diagnosed in 2016 during an outbreak in Dallas County. Risk factors associated with infection were consumption of unpasteurized cheese (71%), recent travel (54%), close contact to a confirmed human brucellosis case (36%), and exposure to animals (11%). Median days of symptoms was 10 and 16 for children and adults, respectively. The majority (79%) of patients visited the emergency department before diagnosis and 93% were hospitalized. Fever was the most common symptom in children (80%) and adults (100%). Hepatitis (75% of children) and anemia (82% of adults) were the most common laboratory abnormalities. The most common complication in children was splenic lesions (40%), and the most common complication in adults was hepato/splenomegaly (39%). Conclusions The diagnosis of Brucella infection requires a high index of suspicion and should be considered in patients presenting with a febrile illness and a compatible exposure history.
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Affiliation(s)
- Linda Hassouneh
- Department of Pediatrics, Division of Pediatric Infectious Diseases UT Southwestern, Dallas, Texas.,Warren Alpert Medical Brown University, Providence, Rhode Island
| | - Syeda Quadri
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, UT Southwestern, Dallas, Texas.,Franciscan Physician Network, Hammond, Indiana
| | | | - Sujittra Chaisavaneeyakorn
- Department of Pediatrics, Division of Pediatric Infectious Diseases UT Southwestern, Dallas, Texas.,St. Jude Children's Research Hospital, Memphis, Tennessee
| | - James B Cutrell
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, UT Southwestern, Dallas, Texas.,VA North Texas Healthcare System, Dallas
| | - Dawn M Wetzel
- Department of Pediatrics, Division of Pediatric Infectious Diseases UT Southwestern, Dallas, Texas
| | - Ank E Nijhawan
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, UT Southwestern, Dallas, Texas
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PECULIARITIES OF TLR-2 (ARG753GLN) AND TLR-4 (ASP299GLY) POLYMORPHISM PREVALENCE IN PATIENTS WITH ACUTE BRUCELLEIS AND CARDIOVASCULAR SYSTEM DISEASES. EUREKA: HEALTH SCIENCES 2019. [DOI: 10.21303/2504-5679.2019.00923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Currently, there are single data on the relationship between TLR-2 polymorphisms (Arg753Gln) and TLR-4 (Asp299Gly) polymorphisms and susceptibility to brucellosis. Therefore, the aim of the study was to determine the frequency of TLR-2 (Arg753Gln) and TLR-4 (Asp299Gly) polymorphisms in patients with acute brucellosis with cardiovascular lesions in the Republic of Azerbaijan.
Materials and methods: 178 patients with a brucellosis clinic were examined. According to the criteria for inclusion in the study, only 120 people fully met all the criteria, which made up the main group. The control group consisted of 30 healthy individuals. TLR-2 (Arg753Gln) and TLR-4 (Asp299Gly) polymorphisms were also determined for all patients in both groups. In order to assess the state of the cardiovascular system, an electrocardiogram was recorded, blood pressure was measured, and an ultrasound scan of the heart was performed for all patients.
Results: it was found that 93 patients (77.50±3.13 %) with acute brucellosis had some or other signs of impairment in the work of the cardiovascular system, identified clinically or as a result of functional examination. Among carriers of the Asp / Gly genotype of the TLR-4 gene, an increased risk of brucellosis with CVS diseases was determined (χ2=30.19; p <0.0001; OR=24.29; 95 % CI [5.45 – 108.37]), while the carriage of the homozygous genotype Asp / Asp, by contrast, had a protective effect on the development of brucellosis (OR=0.06, 95 % CI [0.02 – 0.20]). Among the carriers of the Arg / Gln genotype and the Gln / Gln genotype of the TLR-2 gene, a significantly increased risk of brucellosis with CVS diseases was determined (χ2=5.68; p=0.02; OR=3.10; 95 % CI [0.99 – 9.67]) and (OR=2.48; 95 % CI [0.53 – 11.61]), respectively. While the carriage of the homozygous Arg / Arg genotype, by contrast, was rarely seen in patients with brucellosis (OR=0.28, 95 % CI [0.10 – 0.74]).
Conclusions: The Asp / Gly genotype of the TLR-4 gene was 12.7 times more frequently detected in patients with acute brucellosis with CVS diseases than in healthy individuals and 9.5 times more often than in patients without CVS diseases (p<0.05). The Arg / Gln genotype of the TLR-2 gene was 2.4 times more frequently detected in patients with acute brucellosis with CVS diseases than in healthy individuals (p<0.05).
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Jiang W, Chen J, Li Q, Jiang L, Huang Y, Lan Y, Li Y. Epidemiological characteristics, clinical manifestations and laboratory findings in 850 patients with brucellosis in Heilongjiang Province, China. BMC Infect Dis 2019; 19:439. [PMID: 31109292 PMCID: PMC6528215 DOI: 10.1186/s12879-019-4081-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 05/13/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Brucellosis has extensive clinical spectrum, clinicians have insufficient understanding of the disease, and the misdiagnosis rate is still high. By collecting and analyzing the clinical characteristics of patients with brucellosis in Heilongjiang Province to provide guidance and reference for clinicians to make timely diagnosis and treatment. METHODS The demographic and epidemiological characteristics, clinical features, complications, laboratory findings were retrospectively evaluated in 850 brucellosis patients admitted in the Department of Infectious Diseases of the First Affiliated Hospital of Harbin Medical University and the Second Hospital of Daqing from 2012 to 2017. RESULTS Of the 850 patients, the most common clinical manifestations were fever (93.3%), joint pain (69.8%), sweating (45.2%), fatigue (38.6%), and splenomegaly (34.0%). Peripheral arthritis, spondylitis and epididymal-orchitis were the common complications. Of the 398 patients who were followed up and completed treatment, 22 (5.5%) had relapse. CONCLUSIONS Brucellosis is a multisystem disease with diverse clinical manifestations. In areas where brucellosis is endemic, the possibility of the disease should be considered in patients with unexplained fever and joints pain. In addition, the high rate of relapse is mainly due to the misdiagnosis of complications, so local CT or MRI examination is necessary for patients with joint pain and low back pain. Timely diagnosis, early detection of complications are essential to improve the prognosis and reduce relapse.
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Affiliation(s)
- Wenhui Jiang
- Department of Infection Diseases, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001 Heilongjiang China
| | - Jiwang Chen
- The Second Hospital of Daqing, Daqing, 163000 Heilongjiang China
| | - Qian Li
- Department of Infection Diseases, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001 Heilongjiang China
| | - Lisheng Jiang
- Department of Infection Diseases, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001 Heilongjiang China
| | - Yanxin Huang
- Department of Infection Diseases, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001 Heilongjiang China
| | - Yinghua Lan
- Department of Infection Diseases, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001 Heilongjiang China
| | - Yongguo Li
- Department of Infection Diseases, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001 Heilongjiang China
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When brucellosis met the Assessment of SpondyloArthritis international Society classification criteria for spondyloarthritis: a comparative study. Clin Rheumatol 2019; 38:1873-1880. [PMID: 30806857 DOI: 10.1007/s10067-019-04481-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/04/2019] [Accepted: 02/14/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To distinguish brucellosis patients fulfilling the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for spondyloarthritis (SpA) from SpA patients. METHODS Brucellosis patients diagnosed from September 2012 to December 2017 who met the ASAS classification criteria for SpA were analyzed with clinical characteristics and laboratory and imaging examinations. Axial or peripheral SpA patients were respectively included into the comparative analysis with a 4:1 ratio. RESULTS Twenty-two brucellosis (10 axial and 12 peripheral) patients (male, 16 cases; 72.72%; mean (S.D.) age, 40.23 (16.49) years) and 88 SpA patients were included. All brucellosis patients had been misdiagnosed or considered as SpA before admission to our center. The brucellosis patients had shorter disease duration (axial, P = 0.001; peripheral, P = 0.108). More than half (59.09%) of the patients had contact history with livestock. The low back pain (LBP) of brucellosis patients was generally less improved with exercise (axial, P = 0.001; peripheral, P = 0.008). More brucellosis patients had myalgia (axial, P < 0.001; peripheral, P = 0.071) or fever (axial, P < 0.001; peripheral, P = 0.107). None of them had positive HLA-B27. Blood culture tests were performed in all brucellosis patients and only 4 (18.18%) were positive. Twenty (90.91%) brucellosis patients were gold-immunochromatographic assay (GICA) positive. Bone marrow edema and bone erosion in sacroiliac joints were respectively detected in 100% (10/10) and 90% (9/10) axial brucellosis patients by MRI. Adjacent muscle involvement was found in 80% (8/10) of the patients. CONCLUSIONS Indicators including disease duration, contact history of livestock, features of LBP, myalgia, fever, and HLA-B27 can help the differential diagnosis of brucellosis and SpA. GICA test and sacroiliac joints MRI can furtherly confirm the diagnosis of brucellosis.
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Esmaeilnejad-Ganji SM, Esmaeilnejad-Ganji SMR. Osteoarticular manifestations of human brucellosis: A review. World J Orthop 2019; 10:54-62. [PMID: 30788222 PMCID: PMC6379739 DOI: 10.5312/wjo.v10.i2.54] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 11/29/2018] [Accepted: 12/17/2018] [Indexed: 02/06/2023] Open
Abstract
Brucellosis is a common global zoonotic disease, which is responsible for a range of clinical manifestations. Fever, sweating and musculoskeletal pains are observed in most patients. The most frequent complication of brucellosis is osteoarticular involvement, with 10% to 85% of patients affected. The sacroiliac (up to 80%) and spinal joints (up to 54%) are the most common affected sites. Spondylitis and spondylodiscitis are the most frequent complications of brucellar spinal involvement. Peripheral arthritis, osteomyelitis, discitis, bursitis and tenosynovitis are other osteoarticular manifestations, but with a lower prevalence. Spinal brucellosis has two forms: focal and diffuse. Epidural abscess is a rare complication of spinal brucellosis but can lead to permanent neurological deficits or even death if not treated promptly. Spondylodiscitis is the most severe form of osteoarticular involvement by brucellosis, and can have single- or multi-focal involvement. Early and appropriate diagnosis and treatment of the disease is important in order to have a successful management of the patients with osteoarticular brucellosis. Brucellosis should be considered as a differential diagnosis for sciatic and back pain, especially in endemic regions. Patients with septic arthritis living in endemic areas also need to be evaluated in terms of brucellosis. Physical examination, laboratory tests and imaging techniques are needed to diagnose the disease. Radiography, computed tomography, magnetic resonance imaging (MRI) and bone scintigraphy are imaging techniques for the diagnosis of osteoarticular brucellosis. MRI is helpful to differentiate between pyogenic spondylitis and brucellar spondylitis. Drug medications (antibiotics) and surgery are the only two options for the treatment and cure of osteoarticular brucellosis.
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Affiliation(s)
- Seyed Mokhtar Esmaeilnejad-Ganji
- Clinical Research Development Center, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol 47176-47745, Iran
- Department of Orthopedics, Babol University of Medical Sciences, Babol 47176-47745, Iran
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol 47176-47745, Iran
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Lolika PO, Modnak C, Mushayabasa S. On the dynamics of brucellosis infection in bison population with vertical transmission and culling. Math Biosci 2018; 305:42-54. [PMID: 30138637 DOI: 10.1016/j.mbs.2018.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 08/10/2018] [Accepted: 08/18/2018] [Indexed: 11/17/2022]
Abstract
We introduce a new mathematical modeling framework that seek to improve our quantitative understanding of the influence of chronic brucellosis and culling control on brucellosis dynamics in periodic and non-periodic environments. We conduct both epidemic and endemic analysis, with a focus on the threshold dynamics characterized by the basic reproduction numbers. In addition, we also perform an optimal control study to explore optimal culling strategy in periodic and non-periodic environment.
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Affiliation(s)
- Paride O Lolika
- Department of Mathematics, University of Zimbabwe, P.O. Box MP 167, Harare, Zimbabwe; Department of Mathematics, University of Juba, P.O. Box 82 Juba, Central Equatoria, South Sudan
| | - Chairat Modnak
- Department of Mathematics, Faculty of Science, Naresuan University, Phitsanulok 65000, Thailand
| | - Steady Mushayabasa
- Department of Mathematics, University of Zimbabwe, P.O. Box MP 167, Harare, Zimbabwe.
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Olsen SC, Boggiatto P, White DM, McNunn T. Biosafety Concerns Related toBrucellaand Its Potential Use as a Bioweapon. APPLIED BIOSAFETY 2018. [DOI: 10.1177/1535676018771983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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García Casallas JC, Villalobos Monsalve W, Arias Villate SC, Fino Solano IM. Acute liver failure complication of brucellosis infection: a case report and review of the literature. J Med Case Rep 2018. [PMID: 29519244 PMCID: PMC5844122 DOI: 10.1186/s13256-018-1576-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background Brucellosis is one of the most widespread zoonoses worldwide. It can affect any organ system, particularly the gastrointestinal system, but there is no report of acute liver failure as a brucellosis complication. Case presentation We present a case of acute liver failure secondary to brucellosis infection. A 75-year-old Hispanic man presented to a University Hospital in Chía, Colombia, with a complaint of 15 days of fatigue, weakness, decreased appetite, epigastric abdominal pain, jaundice, and 10 kg weight loss. On examination in an emergency room, abdomen palpation was normal with hepatosplenomegaly and the results of a liver function test were elevated. The diagnosis of brucellosis was confirmed by epidemiological contact and positive Rose Bengal agglutination with negative enzyme-linked immunosorbent assay immunoglobulin M for Brucella. He was then treated with doxycycline plus trimethoprim/sulfamethoxazole, with a favorable clinical outcome. Conclusions The clinical presentation of brucellosis can be very imprecise because it can affect any organ system; however, there is no report of acute liver failure as a brucellosis complication. This is the first reported case in the Colombian literature of acute liver failure due to brucellosis. We found this case to be of interest because it could be taken into account for diagnosis in future appearances and we described adequate treatment and actions to be taken at presentation.
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Affiliation(s)
- Julio César García Casallas
- Internal Medicine and Clinical Pharmacology, Department of Clinical Pharmacology and Therapeutics, Clínica Universidad de La Sabana, Chía, Colombia. .,Pharmacology Department, University of La Sabana, Chía, Colombia. .,Universidad El Bosque, Chía, Colombia. .,Research Group Therapeutic Evidence, University of La Sabana, Chía, Colombia.
| | | | | | - Ingrid Marisol Fino Solano
- Clinical Pharmacology Resident, Clinical Pharmacology Department, University of La Sabana, Chía, Colombia
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Bosilkovski M, Stojanov A, Stevanovic M, Karadzovski Z, Krstevski K. Impact of measures to control brucellosis on disease characteristics in humans: experience from an endemic region in the Balkans. Infect Dis (Lond) 2017; 50:340-345. [PMID: 29192529 DOI: 10.1080/23744235.2017.1407037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AIM To analyze the impact of measures undertaken to control brucellosis in the Republic of Macedonia on demographic, epidemiological and clinical characteristics of the disease in humans. METHODS Demographic, epidemiological and clinical characteristics of 340 patients with brucellosis were retrospectively analyzed. Patients were treated at the University Clinic of Infectious Diseases in Skopje during three time periods: 1989-1990 when no national strategy for disease control existed, 2000-2001 when some activities for control were performed and 2011-2014 when an organized and financially supported strategy was accomplished. RESULTS A drastic decrease of the number of cases of human brucellosis during the last period when compared to the first two ones (3.9 and 3.3 times lower, respectively) was evident. Patients from the third period were significantly older, with median age 41 years (range 4-73) vs. 31 years (3-77) and 34 years (1-74), respectively (p = .013). There were more males (86.6 vs. 73.6% and 63.2%, respectively, p = .002) and the disease was more often acquired professionally (80.6 vs. 60.1% and 59.2%, respectively, p = .006). Fewer patients from the third period had elevated body temperature either as a symptom (50.7 vs. 73.6% and 69.6%, respectively, p = .003), or as a sign (35.8 vs. 55.4% and 56.8%, respectively, p = .011) and less often exhibited focal forms (40.3 vs. 56.8% and 64.0%, respectively, p = .007). CONCLUSION The national strategy for brucellosis control, which included vaccination of small ruminants, resulted in a decrease of human brucellosis cases in the Republic of Macedonia and there was a tendency to milder disease manifestations.
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Affiliation(s)
- Mile Bosilkovski
- a University clinic for infectious diseases and febrile conditions, Medical Faculty , Ss. Cyril and Methodius University , Skopje , Republic of Macedonia
| | | | - Milena Stevanovic
- a University clinic for infectious diseases and febrile conditions, Medical Faculty , Ss. Cyril and Methodius University , Skopje , Republic of Macedonia
| | | | - Kiril Krstevski
- d Faculty of Veterinary Medicine , Ss. Cyril and Methodius University , Skopje , Republic of Macedonia
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Cytokine Profiles in Acute Brucellosis, Compared with Those in Other Febrile Illnesses. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2017. [DOI: 10.5812/archcid.66077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Shen L, Jiang C, Jiang R, Fang W, Feng Q, Wang L, Wu C, Ma Z. Diagnosis and classification in MRI of brucellar spondylitis. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.jrid.2017.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Alinaghian M, Avijgan M. Brucellosis Presented as Thyroiditis: A Rare Case Report. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/aid.2016.64019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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