Bacteremic and nonbacteremic brucellosis: clinical and laboratory observations

Comparative Analysis of Pediatric Brucellosis Cases With and Without Bacteremia

Introduction: Brucellosis, which is among the endemic regions of Turkey, is a common zoonotic disease. The gold standard in diagnosing brucellosis is culture. We aimed to compare demographic characteristics, risk factors, and clinical and laboratory variables between cases with culture positivity and undetected in culture. Materials and Methods: This single-center study was conducted between January 2007 and April 2022. Clinical and laboratory data of patients with brucella growth in blood culture and patients without growth were compared. Results: A total of 150 patients were included in the study. The median age was 10 (1-18 years). Of the patients, 66 (44%) were female and 84 (56%) were male. Forty (26.7%) of the patients were bacteremic and 110 (73.3%) were nonbacteremic. In the bacteremic group, white blood cell count, platelet, and hemoglobin counts were lower, and aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values were higher. In clinical evaluation, fever, hepatomegaly, splenomegaly, and abdominal pain were more common in the bacteremic group. Conclusion: The distinction between bacteremic and nonbacteremic brucellosis can be predicted using laboratory values such as white blood cells, hemoglobin counts, platelet, ALT, and AST, and clinical findings such as fever, abdominal pain, hepatomegaly, and splenomegaly.

Comparison of the Characteristics of Brucella Patients Diagnosed With Blood Culture Positivity and/or Serology

PURPOSE

The aim of this study is to investigate and compare the clinical, laboratory, and treatment response characteristics of patients diagnosed with positive culture or serology. In this way, we wanted to assess the validity of serological diagnosis.

MATERIALS AND METHODS

The study was designed as a retrospective cross-sectional study between January 2010 and 2020. Patients with clinical and laboratory findings of acute/subacute brucellosis, patients with positive serological tests, and patients with growth of Brucella spp. in blood culture were included in the study. The patients were divided into three groups: Group 1 - Wright agglutination test result ≥ 1/160 and Brucella spp. growth in blood culture; Group 2 - Wright agglutination test result ≥ 1/160 and no growth in blood culture; and Group 3 - Brucella spp. growth in blood culture and negative serological test. These three groups were retrospectively evaluated for clinical features, laboratory parameters, areas of involvement, treatment options, and treatment response.

RESULTS

We identified 294 patients diagnosed with brucellosis. Blood cultures were obtained from all patients, and Brucella spp. was detected in 40 patients (13.6%). There were 35 patients in Group 1, 254 patients in Group 2, and five patients in Group 3. When examining patients with symptoms, only fever showed a difference between the groups, which was significantly higher in Group 1. Laboratory investigations of the C-reactive protein (CRP), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels of the patients showed significant differences between the groups; these parameters were significantly higher in Group 1.

CONCLUSION

No significant difference was found in terms of treatment response and prognosis between patients with and without blood culture growth who were clinically compatible with acute/subacute brucellosis as diagnosed by serological methods. Therefore, serological tests are reliable methods for the diagnosis of brucellosis in cases where blood culture is inconclusive.

Predicting Factors of Brucella melitensis Bacteremia in Children Admitted with Brucellosis

Objective Brucellosis is the most common zoonotic disease. Isolation of Brucella melitensis in blood culture is accepted as the gold standard for diagnosis. This study aims to determine the predictive factors of B. melitensis bacteremia in pediatric patients followed up with brucellosis.

Methods Two-hundred twenty pediatric brucellosis patients were included in the study. The epidemiological, clinical, and laboratory data were recorded.

Results The patients comprised 63.2% males and 36.8% females with a mean age of 10.45 ±  4.36 years (range, 1–18 years), and 70.5% were younger than 14 years old. B. melitensis was isolated in the blood culture in 33.6% of patients. In the epidemiological history of pediatric patients with bacteremic brucellosis, there was a history of dealing with, owning, or working with livestock. In patients with brucellosis, fever and weight loss, hepatomegaly, and arthritis were more common in patients with bacteremia than in those without bacteremia. Among laboratory findings, leukopenia, low albumin value, and high C-reactive protein were calculated as predictors of Brucella bacteremia in patients with brucellosis.

Conclusion In regions where brucellosis is endemic, serum agglutination tests may be positive without clinical findings. Brucellosis can mimic many other diseases, so the definitive diagnosis is demonstrated by bacteremia. Blood cultures should be taken in patients with predictive factors suggestive of brucellosis.

The role of the serum tube agglutination test in the monitoring of human brucellosis: evaluation of post-treatment SAT titers

OBJECTIVE

Positive results of the serum tube agglutination test that persist after treatment may be interpreted by clinicians as treatment failures. Therefore, our study examined the value of serum tube agglutination test in demonstrating treatment success.

METHODS

In this retrospective study conducted at a single center, the pre- and post-treatment serum tube agglutination test titers of patients diagnosed with brucellosis were compared.

RESULTS

The end-of-treatment serum tube agglutination test titer was negative in 24 (18%) of 139 patients diagnosed with brucellosis. The most common complaints of the patients were fever (78.4%), chills (88.5%), sweating (84.9%), anorexia (79.1%), and arthralgia (63.3%). The rate of positive blood culture before the treatment was 68.3%. The absence of fever (p=0.005) and arthralgia (p=0.024) and the pretreatment serum tube agglutination test titer of <1/160 (p=0.014) were significant markers of serological cure.

CONCLUSION

Although serum tube agglutination test is an effective and very successful test in the diagnosis of brucellosis, our study shows that serum tube agglutination test is not useful in demonstrating the treatment success of human brucellosis in the early post-treatment period.

Laboratory and clinical predictors of focal involvement and bacteremia in brucellosis

Early diagnosis of organ involvement and bacteremia in brucellosis increases treatment success and may prevent poor clinical outcomes. This study aimed to investigate the predictors of focal involvement and bacteremia in patients with brucellosis. A total of 139 brucellosis patients aged 16 years and older were included in the study. Patients with and without organ involvement and bacteremic and non-bacteremic patients were compared separately. Low back pain, lymphadenomegaly, absence of fever on admission, ESR, AST, and neutrophil-lymphocyte ratio (NLR) were predictors of focal involvement (OR: 2.604; 3.167; 7.224; 1.039; 1.032; 1.738, respectively). The AUC value of ESR was 0.669 (0.573-0.765, p = 0.002) with the cutoff point > 30 mm/h (sensitivity 89.74% and specificity 37.00%) in predicting focal involvement in patients with brucellosis. Myalgia and headache (OR: 2.970; 2692) were defined as clinical predictors of Brucella bacteremia. Focal involvement should be considered in patients with brucellosis in the absence of myalgia and fever, presence of low back pain, and sedimentation > 30 mm/h. Brucella bacteremia should be considered regardless of fever, especially in patients with myalgia and headache in endemic areas.

Bacteremic and Nonbacteremic Brucellosis in Children in Turkey

INTRODUCTION

Human brucellosis is one of the most common zoonotic infections in the world. The definitive diagnosis of brucellosis is based on cultured Brucella organisms from blood or other tissue samples. We aimed to compare bacteremic and nonbacteremic brucellosis patients with demographical, epidemiological, clinical and laboratory features and determine the predictive factors affecting blood culture positivity.

MATERIALS AND METHODS

Children aged 1 month to 18 years who were followed up with the diagnosis of brucellosis between January 2005 and March 2021 were included in this retrospective study. According to the isolation of Brucella melitensis in blood culture, the patients were divided into two groups as bacteremic and nonbacteremic and compared in terms of demographic, clinical and laboratory characteristics.

RESULTS

One hundred eighty-nine (116 male, 61.4%) patients diagnosed with brucellosis were included in the study. There were 76 (40.2%) bacteremic and 113 (59.8%) nonbacteremic patients. Bacteremic patients were younger than nonbacteremic patients. Fever, arthralgia, hepatomegaly and splenomegaly were significantly higher in the culture positive group. High levels of C-reactive protein (CRP), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were found to be significant in the bacteremic group.

CONCLUSION

In our study, history of fever and arthralgia, hepatomegaly and splenomegaly in physical examination and high CRP, ALT and AST levels in the biochemical analysis were important factors determining blood culture positivity.

Epidemiological, Clinical and Laboratory Characteristics of Patients with Brucella Infection in Anhui Province, China

Background

Brucellosis is currently one of the most widespread zoonotic diseases caused by Brucella genus, and the Brucella melitensis is the major pathogen. The number of people infected with Brucella has gradually increased in Anhui Province.

Purpose

To retrospectively evaluate the epidemiological, clinical, and laboratory data of brucellosis patients in Anhui Province.

Patients and Methods

A total of 109 brucellosis patients were admitted to the First Affiliated Hospital of Anhui Medical University from January 2012 to March 2021. Data from all patients were retrieved from the hospital’s electronic medical system. The final results were grouped and compared according to the presence or absence of bacteremic brucellosis and three phases of brucellosis.

Results

The most common symptoms among all 109 brucellosis patients were fever (89.0%), followed by chills (52.3%), arthralgia (48.6%), and weight loss (30.3%), and laboratory results presented with anemia (65.1%), elevate of C-reactive protein (CRP) (91.7%), erythrocyte sedimentation rate (ESR) (86.2%), aspartate aminotransferase (AST) (40.4%), and lactate dehydrogenase (LDH) (43.1%). The percentage of fever (96.1%), arthralgia (58.8%), anorexia (35.3%), leukopenia (31.4%), and the AST (51.0%) were higher in bacteremic than nonbacteremic group. Additionally, the median level of LDH (332.0 mg/L, IQR, 209.0–553.0) was higher in bacteremic than nonbacteremic group. Nevertheless, the albumin (36.0 mg/L, IQR, 33.9–38.2) was lower in the bacteremic group. The percentage of fever (94.9%) and the median LDH level (316.0 U/L (IQR,218.0–517.5)) in the acute phase of brucellosis were higher than the percentage of fever (72.0%) and the median LDH level (209.0 U/L (IQR,162.0–276.0)) in the subacute phase of brucellosis.

Conclusion

Brucellosis has become an important public health issue in Anhui Province. Brucellosis is a disease with diverse clinical manifestations. Our data showed that unexplained fever, arthralgia, and elevated AST and LDH should be considered as a diagnosis of bacteremia brucellosis for early treatment intervention.

Epidemiological and clinical characteristics of bacteremic brucellosis

Objective

To retrospectively investigate the epidemiological features, clinical manifestations and laboratory characteristics of bacteremic brucellosis.

Methods

Brucellosis patients admitted to our clinic from January 2015 to December 2017 were included in the study. Patient electronic medical records were reviewed for epidemiological features, clinical manifestations, and laboratory findings.

Results

A total of 132 brucellosis patients were analyzed (64 cases with bacteremic brucellosis and 68 cases with nonbacteremic brucellosis). The median duration from exposure to onset of symptoms was 6.9 weeks (range: 1 day to 32 weeks) and 21.9 weeks (range: 1–76 weeks) in patients with bacteremic and nonbacteremic brucellosis, respectively. More bacteremic than nonbacteremic patients presented with fever and chills. Arthritis was observed in 34 (25.8%) patients, and was more commonly observed in nonbacteremic patients. Using C-reactive protein (CRP) and procalcitonin (PCT) as serological markers, the areas under the receiving operating characteristic curves were 0.64 [95% confidence interval (CI): 0.54–0.73] and 0.61 (95% CI: 0.51–0.70), respectively, for distinguishing bacteremic from non-bacteremic brucellosis.

Conclusion

Fever and chills were frequently observed in bacteremic brucellosis patients, whereas arthritis was more common in nonbacteremic brucellosis patients. Serum CRP and PCT can be used as potential serological markers for diagnosing bacteremic brucellosis.

Factors Associated With Single and Recurrent Bacteremia in Childhood Brucellosis

BACKGROUND

Data regarding risk factors of bacteremic brucellosis, and specifically recurrent bacteremia, are scarce. We assessed patients with childhood brucellosis, differentiating between those having culture-negative, single-bacteremic, and recurrent-bacteremic episodes.

METHODS

The medical files of pediatric brucellosis patients, from 2005 through 2014, were reviewed retrospectively. Univariate and multivariate analyses were performed to compare demographic and clinical characteristics of culture-negative, single-bacteremic, and recurrent-bacteremic (≥30 days between positive cultures) episodes.

RESULTS

Of all 436 brucellosis cases, 22% were culture-negative, 72% were single-bacteremic, and 6% were recurrent-bacteremic. In a univariate analysis, single-bacteremic episodes were associated with fever (90% vs 65% and 40% in culture-negative and recurrent bacteremia, respectively) and elevated glutamic oxaloacetic transaminase (GOT) levels. Recurrent-bacteremic episodes were associated with anemia (26% vs 14% and 9% in single bacteremia and culture negative, respectively), elevated GOT, low immunoglobulin M (IgM) titers (56% vs 89% and 99%, respectively), and lower levels of adequate treatment (74% vs 94% and 86%, respectively). In multivariate analyses, single bacteremia was associated with fever (odds ratio [OR], 3.595, compared with culture negative), while recurrent bacteremia was inversely associated with IgM titers ≥1:160 (OR, 0.022 and 0.226 compared with culture negative and single bacteremia, respectively) and fever (OR, 0.108 compared with single bacteremia).

CONCLUSIONS

Brucellosis episodes are commonly complicated with bacteremia. Single-bacteremic episodes were associated with high-grade fever and elevated liver enzymes, possibly indicating high bacterial virulence. Recurrent-bacteremic episodes were associated with poor treatment at initial diagnosis, along with low rates of fever, low IgM titers, and high anemia rates, possibly indicating impaired host response. Physicians should consider treatment modifications for suspected recurrent-bacteremic brucellosis, including monitoring treatment adherence, and possibly administering prolonged treatment.

Cervical Epidural Abscess due to Brucella Treated with Decompression and Instrumentation: A Case Report and Review of Literature

Brucella is caused by a Gram-negative bacillus and is a common disease in endemic areas where people are in close contact with animals and dairy products, but brucellar cervical epidural abscess is rare. We describe a rare case of a C5–6 brucellar epidural abscess in a veterinary doctor who was treated with decompression and instrumentation. We also review the cases of cervical brucellar epidural abscess treated with instrumentation in the literature.

Epidemiological, diagnostic, clinical, and therapeutic aspects of Brucella bacteremia in children in southern Israel: a 7-year retrospective study (2005-2011)

BACKGROUND

Data on the various aspects of brucellosis in children living in southern Israel are missing.

OBJECTIVES

Our aim was to study the epidemiological, microbiological, diagnostic, clinical, therapeutic and outcome features of brucellosis in children <19 years of age in southern Israel during 2005-2011.

PATIENTS AND METHODS

The study population included all patients hospitalized with a diagnosis of brucellosis, established according to a clinical presentation compatible with brucellosis+presence of Brucella bacteremia (BB).

RESULTS

A total of 128 (50.8%) of 252 patients admitted with a diagnosis of brucellosis had BB (all with Brucella melitensis). All patients were of Muslim Bedouin ethnicity. The mean incidence of BB in southern Israel was 16 cases/100,000 Bedouin, with no significant changes during the study period. Overall duration of symptoms before diagnosis was 10.1±10.9 days. Fever at diagnosis was recorded in <20% of the patients. The most frequent symptoms were arthralgia (61.7%), weakness (32.8%), gastrointestinal disturbances (27.3%), myalgia (25%), and headache (18.8%). The main clinical findings included monoarthritis (36.7%), hepatosplenomegaly (25%), lymphadenopathy (17.2%), heart murmur (11.7%), and skin rash (9.4%), respectively. Anemia, leukopenia, thrombocytopenia, and pancytopenia were reported in 17.6%, 29.6%, 12.8%, and 2.3% of the patients, respectively. Twenty-nine (30.5%) patients with BB had serum agglutinin titers ≤1/160 (13, 13.7%%, had titers <1/160). Twenty-seven (93%) of the 29 patients aged 0-4 years were treated with gentamicin and trimethoprim-sulfamethoxazole; a total of 77 (60.2%) patients received gentamicin and doxycycline.

CONCLUSIONS

Childhood brucellosis remains an important public health problem in southern Israel. BB was diagnosed in >50% of the children with brucellosis, and B. melitensis was identified in all cases. Arthralgia, weakness, and gastrointestinal complaints were the most common symptoms, and monoarthritis, hepatosplenomegaly, and lymphadenopathy were the most common clinical findings. A considerable number of patients with BB had undetectable/low serum agglutinin titers, suggesting insufficient reliability on serology alone in diagnosis of brucellosis.

Factors affecting Brucella spp. blood cultures positivity in children

Brucella infections have a wide spectrum of symptoms especially in children, making the diagnosis a complicated process. The gold standard for the final diagnosis for brucellosis is to identify the Brucella spp. isolated from blood or bone marrow cultures. The main purpose of this work was to evaluate the factors affecting the isolation of Brucella spp. from blood cultures. In our study, the ratio of fever, presence of hepatomegaly, and splenomegaly were found to be higher in the bacteremic group. In addition, C-reactive protein levels and liver function enzymes were found to be higher in the bacteremic group. In our opinion, while evaluating the febrile child with suspected Brucella infection, we highly recommend sampling blood cultures regardless of the history of previous antimicrobial therapy and duration of the symptoms.

Detection of orchitis and sacroiliitis due to brucellosis by 99mTc polyclonal human immunoglobulin scintigraphy

Here, we report 1 case of Brucella orchitis detected by 99mTc human immunoglobulin scintigraphy and confirmed by testicular ultrasound. A 29-year-old farmer was admitted to our hospital with fever, fatigue, arthralgia, and painful scrotal swelling that had appeared 12 days before admission. Clinically, right sacroiliitis was recorded through the Fabere test Unilateral sacroiliitis and orchitis were detected by 99mTc human immunoglobulin scintigraphy. Hypoechoic left testicular lesions and swelling of the concurrent epididymis were seen on a testicular ultrasound examination. Wright agglutination test and blood specimen culture for Brucella species were positive.

Implications of laboratory diagnosis on brucellosis therapy

Brucellosis is a worldwide zoonosis with a huge economic impact on animal husbandry and public health. The diagnosis of human brucellosis can be protracted because the disease primarily presents as fever of unknown origin with unspecific clinical signs and symptoms. The isolation rate of the fastidious etiologic agent from blood cultures is low, and therefore laboratory diagnosis is mainly based on serologic and molecular testing. However, seronegative brucellosis patients have been described, and antibody titers of diagnostic significance are difficult to define. Whether the molecular detection of Brucella DNA in clinical samples should be followed by long-term antibiotic treatment or not is also a matter of debate. The aim of this article is to review and discuss the implications of laboratory test results in the diagnosis of human brucellosis on disease therapy.

Ribosomal RNA sequence analysis of Brucella infection misidentified as Ochrobactrum anthropi infection

A Brucella isolate was identified from purulent material collected during a hip surgery. Two previous blood cultures from the same patient yielded Ochrobactrum anthropi. After rRNA sequencing, all the isolates were identified as Brucella species and subsequently serotyped as Brucella suis. Misidentification of Brucella species remains a problem with bacterial identification systems.