Clinical features, diagnosis, and treatment of 36 cases of brucellosis in non-epidemic areas
Objective:To explore the clinical characteristics of brucellosis patients and improve the diagnosis and treatment of this disease by clinicians.Methods:This is a retrospective study, in which the epidemiological characteristics, clinical manifestations, laboratory examinations, imaging data, and diagnosis and treatment of 36 cases of brucellosis admitted to Peking University First Hospital from January 2010 to December 2022 were collected and analyzed.Results:All the patients were from non-epidemic areas. The male to female ratio was 8∶1, and the median age was 47.5 (36.5, 57) years. Thirty-two cases (88.9%) came from rural areas, 28 (77.8%) had a history of contacting with cattle or sheep, and 27 (75.0%) developed symptoms in spring or summer. All the cases had fever, and 32 (88.9%) were admitted with “fever of unknown origin”. The other manifestations were joint pain (55.6%), splenomegaly (52.8%), lymph node enlargement (38.9%), hyperhidrosis (38.9%), myalgia (25.0%), testicular swelling/pain (19.4%), hepatomegaly (16.7%), and spondylitis (11.1%). Three cases (8.3%) developed pancytopenia, two of which were diagnosed as having secondary hemophagocytic syndrome. The median time from onset to diagnosis was 45 (30.5, 78.75) days. Twenty-six cases (72.2%) were confirmed by culture, and ten (27.8%) were revealed by the serum agglutination test. Participants received double or triple antibiotic therapy, including tetracycline, rifampicin, amikacin, quinolones, ceftriaxone, and cotrimoxazole. In 34 cases (94.4%), the body temperature returned to normal 2-3 days after treatment.Conclusion:In non-epidemic areas, missed diagnosis and misdiagnosis of brucellosis are common. When encountering patients with fever, joint pain, hyperhidrosis, myalgia, testicular swelling, hepatosplenomegaly, enlargement of lymph nodes, and spondylitis, clinicians should inquire about the history of contact with cattle and sheep, and be alert to the possibility of brucellosis.
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