Risk factors for focal involvement in brucellosis

Demırdal, Tuna; Şen, Pınar

doi:10.1016/j.diagmicrobio.2020.115003

Cited by 9 publications

(15 citation statements)

References 8 publications

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“…In our study, arthralgia, loss of myalgia, and bulging pain were statistically signi cant warning factors for complicated patients and osteoarticular complications mainly involve large joints such as the spine. In agreement with our results, in similar studies, absence of myalgias and low back pain were associated factors for complications [19][20][21]. Bulging pain is not common in brucellosis patients and should be paid attention to in the course of diagnosis and treatment.…”

Section: Sampling and Participantssupporting

confidence: 91%

Incidence and Warning Signs for Complications of Human Brucellosis: A Multi-center Observational Study from China

Shi,

Qin,

et al. 2023

Preprint

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background Brucellosis is one of the most serious “ignored zoonoses” in the world and especially affects poverty-stricken nations. Early diagnosis of focal complications in brucellosis increases treatment success. However, up to now, no clear joint indicators of symptoms or biomarkers for the diagnosis of complications. Hence, we investigated the warning signs of focal complications in human brucellosis aimed to provide practical parameters for clinicians in patients diagnosis and management. Methods A multi‑center cross‑sectional study was conducted in China from December 2019 to August 2021. The clinical characteristics and complications of brucellosis patients were based on questionnaire survey and medical record system. Warning signs of complications were assessed by univariate and multivariate logistic regression models. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used for variable screening and model evaluation. Results A total of 880 participants of human brucellosis were enrolled. Of the patients, median age was 50 years [interquartile range (IQR):41.5,58.0] and 54.8% had complications. The complication involved any organ, common in osteoarticular system (43.1%), including peripheral arthritis (30.0%), spondylitis (16.6%), paravertebral abscess (5.0%) and sacroiliitis (2.7%); followed by genitourinary system (4.7%), respiratory system (4.7%), and hematologic system (4.6%). Long delay in diagnosis [odds ratio (OR):3.963, 95% confidence interval (CI):1.906–8.238 for > 90days], underlying disease(OR:1.675, 95%CI:1.176–2.384), arthralgia(OR:3.197, 95%CI:1.986–5.148), bulging pain(OR:3.482, 95%CI:1.349–8.988), C-reactive protein (CRP) > 10 mg/L (OR:1.910, 95%CI:1.310–2.784)and erythrocyte sedimentation rate (ESR) elevation (OR:1.663, 95%CI:1.145–2.415)were the relevant factors for focal brucellosis. The optimal cutoff value in ROC analysis was > 5.4 mg/L for CRP (sensitivity 73.4% and specificity 51.9%) and > 25 mm/h for ESR (sensitivity 47.9% and specificity 71.1%). Conclusions Over half of brucellosis patients suffered complications. Diagnostic delay, underlying disease, arthralgia, bulging pain, and high CRP and ESR were significant relevant markers of complications. Regardless of culture results and standard tube agglutination test (SAT) titers, patients with these conditions should be on the alert for complications.

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Section: Sampling and Participantssupporting

confidence: 91%

Incidence and Warning Signs for Complications of Human Brucellosis: A Multi-center Observational Study from China

Shi,

Qin,

et al. 2023

Preprint

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“…In addition to these factors, studies investigated the risk factors for focal brucellosis also reported that older age (OR 1.02, 95%Cl 1.00-1.04), lymphadenomegaly (OR 7.22, 95%Cl 1.07-48.71), AST (OR 1.03, 95%Cl 1.01-1.06), and neutrophil-lymphocyte ratio (OR 1.74, 95%Cl 1.07-2.83) were independent risk factors for predicting focal involvement. 11,28 Of note, most of these studies were data from Turkey, 11,21,28 and we first investigated the factors associated with focal complications in China. Therefore, it is of great help for Chinese clinicians to focus on the gender, the symptom of arthralgia and the count of platelet in making early diagnosis of focal infection.…”

Section: Discussionmentioning

confidence: 99%

“…9 Focal brucellosis was determined as any clear infection in anatomic regions, such as arthritis, spondylodiscitis, meningitis or infection in other sites other than hematogenous infection. 10,11 We assessed the clinical characteristics of patients with brucellosis, and then we explored the risk factors for focal brucellosis. A team of experienced infectious clinicians reviewed, abstracted and cross-checked the data.…”

Section: Data Collection and Definitionsmentioning

confidence: 99%

Clinical Features of Human Brucellosis and Risk Factors for Focal Complications: A Retrospective Analysis in a Tertiary-Care Hospital in Beijing, China

Zhang¹,

Chen²,

Xiao³

et al. 2022

IJGM

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Brucellosis is an ongoing zoonotic disease in China, but there are few data in Beijing. This study was designed to illustrate clinical characteristics of patients with brucellosis in Beijing, China and explore the risk factors for focal brucellosis. Patients and Methods: Data of patients with brucellosis were retrospectively collected from the patients' electronic medical records in Beijing Youan Hospital during 2010 to 2021, including epidemiological, demographic and clinical features. Risk factors for focal brucellosis were identified by multivariable logistic regression models. Results: A total of 197 patients were included in the study, with 165 (83.8%) cases in acute phase and 32 (16.2%) cases in chronic phase. Patients in acute phase were more likely to have splenomegaly (24.2% vs 3.1%, p=0.007) than those in chronic phase, but had less arthralgia (62.4% vs 81.3%, p=0.040). The median level of alanine aminotransferase (36.9 vs 20.7, p=0.001) was higher in patients at acute stage than those at chronic stage. Of all the patients, 76 (38.6%) were reported with focal complications, including 16 (8.1%) peripheral arthritis, 36 (18.3%) spondylitis, 17 (8.6%) epididymoorchitis, 8 (4.1%) meningitis and 3 (1.3%) endocarditis. Additionally, male (OR 2.76, 95% CI 1.15-6.64, p = 0.023), arthralgia (OR 6.23, 95% CI 2.36-16.43, p < 0.001) and higher level of platelets (OR 1.01, 95% CI 1.00-1.01, p < 0.001) were the independent risk factors for focal brucellosis. Conclusion:The control of human brucellosis still cannot be ignored due to the re-emerging cases in Beijing, which are more likely to present splenomegaly and abnormal liver function in acute phase. Moreover, male, arthralgia and high level of platelets were the independent risk factors for focal brucellosis.

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“…Xu et al [ 12 ] found that positive blood cultures were indicative of complicated brucellosis, while Bircan et al [ 19 ] reported that negative blood cultures were statistically significant factors for complications. In other studies [ 20 – 22 ], the rates of blood culture and SAT positivity were similar in groups with and without focal involvement. The accuracy of blood culture results was greatly influenced by the conditions and techniques used [ 8 ].…”

Section: Discussionmentioning

confidence: 52%

Incidence and warning signs for complications of human brucellosis: a multi-center observational study from China

Shi,

Qin,

et al. 2024

Infect Dis Poverty

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Background Brucellosis is a severe zoonotic disease that is often overlooked, particularly in impoverished countries. Timely identification of focal complications in brucellosis is crucial for improving treatment outcomes. However, there is currently a lack of established indicators or biomarkers for diagnosing these complications. Therefore, this study aimed to investigate potential warning signs of focal complications in human brucellosis, with the goal of providing practical parameters for clinicians to aid in the diagnosis and management of patients. Methods A multi-center cross-sectional study was conducted in China from December 2019 to August 2021. The study aimed to investigate the clinical characteristics and complications of patients with brucellosis using a questionnaire survey and medical record system. The presence of warning signs for complications was assessed using univariate and multivariate logistic regression models. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used for variable screening and model evaluation. Results A total of 880 participants diagnosed with human brucellosis were enrolled. The median age of the patients was 50 years [interquartile range (IQR): 41.5–58.0], and 54.8% had complications. The most common organ system affected by complications was the osteoarticular system (43.1%), with peripheral arthritis (30.0%), spondylitis (16.6%), paravertebral abscess (5.0%), and sacroiliitis (2.7%) being the most prevalent. Complications in other organ systems included the genitourinary system (4.7%), respiratory system (4.7%), and hematologic system (4.6%). Several factors were found to be associated with focal brucellosis. These factors included a long delay in diagnosis [odds ratio (OR) = 3.963, 95% confidence interval (CI) 1.906–8.238 for > 90 days], the presence of underlying disease (OR = 1.675, 95% CI 1.176–2.384), arthralgia (OR = 3.197, 95% CI 1.986–5.148), eye bulging pain (OR = 3.482, 95% CI 1.349–8.988), C-reactive protein (CRP) > 10 mg/L (OR = 1.910, 95% CI 1.310–2.784) and erythrocyte sedimentation rate (ESR) elevation (OR = 1.663, 95% CI 1.145–2.415). The optimal cutoff value in ROC analysis was > 5.4 mg/L for CRP (sensitivity 73.4% and specificity 51.9%) and > 25 mm/h for ESR (sensitivity 47.9% and specificity 71.1%). Conclusions More than 50% of patients with brucellosis experienced complications. Factors such as diagnostic delay, underlying disease, arthralgia, eye pain, and elevated levels of CRP and ESR were identified as significant markers for the development of complications. Therefore, patients presenting with these conditions should be closely monitored for potential complications, regardless of their culture results and standard tube agglutination test titers.

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Risk factors for focal involvement in brucellosis

Cited by 9 publications

References 8 publications

Incidence and Warning Signs for Complications of Human Brucellosis: A Multi-center Observational Study from China

Incidence and Warning Signs for Complications of Human Brucellosis: A Multi-center Observational Study from China

Clinical Features of Human Brucellosis and Risk Factors for Focal Complications: A Retrospective Analysis in a Tertiary-Care Hospital in Beijing, China

Incidence and warning signs for complications of human brucellosis: a multi-center observational study from China

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