Brucellosis in non-pasture area: a clinical analysis of 12 cases

Abstract

Objective To provide clinical evidence for early diagnosis and treatment of Brucellosis by analyzing the clinical characteristics of patient with brucellosis admitted in the Department of Emergency, Sun Yat-sun Memorial Hospital of Sun Yat-sen University. Methods Epidemiological, clinical, laboratory and treatment data, as well as outcomes of 12 patients diagnosed as brucellosis during December 2013 to April 2015 were retrospectively analyzed in this hospital. Results The majority of patients were the middle-aged; seven (58.3%) patients had a history of close contact with sheep or cows infected with brucellosis. All patients had a high fever (100%), accompanied with chilly, fatigue, sweating, rash, headache, ear pain, sore throat, cervicobrachialgia, lumbodorsal pain, myalgia and arthralgia, cough, and lymphadenectasis. White blood cell count were normal in 10 cases (83%), and decreased in 2 cases (17%). The percentage of neutrophilic granulocytes was normal in 7 cases (75%), decreased in 2 cases (17%) and increased in 1 case (8%). Platelet count decreased in 2 cases (17%). All patients had no anemia. 10 patients (83 %) had hepatic dysfunction, but without jaundice. Almost 92% patients had mild elevation of PCT level, and the CRP level was variably elevated in all patients (100%). All 12 patients were positive in serum agglutination test for Brucella, and 6 (50%) positive in blood and bone marrow culture for Brucella. All patients had effective prognosis after standard treatment, including doxycycline combined rifampicin, doxycycline combined streptomycin, doxycycline combined TMP-SMZ, doxycycline combined moxifloxacin or levofloxacin. Conclusions Due to the diversity of clinical manifestation, doctors often make a misdiagnosis or a missed diagnosis of Brucellosis in non-pasture area. Detailed history of exposure to infectious agents, as well as blood culture or brucella aggregation test, should be performed as early as possible for patients with long-term fever of unknown origin. Standard combined treatment has good clinical efficacy. Key words: Non-pasture area; Brucellosis; Clinical characteristics; Therapeutic effect