Prospectively were studied clinical characteristics, diagnostic tools and outcome in 33 patients with hip arthritis during brucellosis that were treated at the clinic for infectious diseases in Skopje, Republic of Macedonia (FYROM). Thirty-six hip involvements were noted. The patient's age was mean (SD) 23.7 (19.9) years, 18 were male. Twenty-one of them acquired the disease through direct contact with infected animals. In five patients, hip arthritis was the unique manifestation of the disease. Concomitant affection of other osteoarticular localisation was found in 18 patients. The diagnosis of hip arthritis was achieved using radionuclide bone scan and ultrasound examination in 17 and 16 cases, respectively. During the follow-up period, six relapses, three therapeutic failures and one sequela were noted. Brucellar aetiology should be considered in all patients from endemic areas, who have manifest symptoms of hip joint involvement.

Aim To present our 10-year clinical experience with brucellosis patients at the University Clinic for Infectious Diseases and Febrile Conditions in Skopje, Republic of Macedonia.Methods A total of 550 patients with brucellosis treated between 1998 and 2007 were retrospectively assessed for their demographic, epidemiological, and clinical characteristics and outcomes.Results Of the 550 patients, 395 (72%) were male. The median age was 34.5 years (range, 1-82). Direct contact with infected animals was recorded in 333 (61%) patients and positive family history in 310 (56%). The most frequently seen symptoms were arthralgia (438, 80%), fever (419, 76%), and sweating (394, 72%). The most common signs were fever and hepatomegaly, which were verified in 357 (65%) and 273 (50%) patients, respectively. Focal brucellosis was found in 362 patients (66%) and osteoarticular in 299 (54%). Therapeutic failures were registered in 37 (6.7%) patients. Of the 453 (82%) patients who completed a follow-up period of at least 6 months, relapses occurred in 60 (13%). ConclusionDue to non-specific clinical manifestation and laboratory parameters, brucellosis should be considered one of the differential diagnoses of any patient suffering from obscure involvement of various organs in a brucellosis-endemic region. High percentage of relapses and therapeutic failures in spite of the use of currently recommended therapeutic regimens indicates the seriousness of this zoonosis and the need to control it.

Human brucellosis is a serious problem in the Republic of Macedonia presenting with a high percentage of localized forms, relapses and therapeutic failures. The risk factor for acquiring the disease had no influence on the outcome.

In the Republic of Macedonia infections are the leading cause of FUO, predominately visceral leishmaniasis. In the future in patients with prolonged fever, physicians should think more often of this disease, as well as of the possibility of atypical presentation of the common classical causes of FUO.

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