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Konya P, Demirturk N, Gürbüz M, Colak G. Comparison of the Characteristics of Brucella Patients Diagnosed With Blood Culture Positivity and/or Serology. Cureus 2023; 15:e43758. [PMID: 37727170 PMCID: PMC10506729 DOI: 10.7759/cureus.43758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 09/21/2023] Open
Abstract
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.
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Affiliation(s)
- Petek Konya
- Infectious Diseases, Afyonkarahisar Health Sciences University, Afyonkarahisar, TUR
| | - Nese Demirturk
- Infectious Diseases, Afyonkarahisar Health Sciences University, Afyonkarahisar, TUR
| | - Melahat Gürbüz
- Clinical Microbiology, Afyonkarahisar Health Sciences University, Afyonkarahisar, TUR
| | - Gamze Colak
- Infectious Diseases, Afyonkarahisar Health Sciences University, Afyonkarahisar, TUR
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Ben-Shimol S, Farahvar S, Fruchtman Y, Justman N. Factors Associated With Single and Recurrent Bacteremia in Childhood Brucellosis. J Pediatric Infect Dis Soc 2020; 9:664-670. [PMID: 31840752 DOI: 10.1093/jpids/piz092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/05/2019] [Indexed: 11/14/2022]
Abstract
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.
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Affiliation(s)
- Shalom Ben-Shimol
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Salar Farahvar
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yariv Fruchtman
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Hemato-oncology Department, Soroka University Medical Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Naphtali Justman
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Agin M, Kayar Y. Demographic, Laboratory, and Clinical Comparison of Pediatric Brucella Cases With and Without Liver Involvement. Cureus 2020; 12:e10862. [PMID: 33178515 PMCID: PMC7652021 DOI: 10.7759/cureus.10862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction In this study, the purpose was to compare the demographic, clinical, and laboratory results of pediatric Brucella cases with and without liver involvement. Methods The data of 248 patients between 2 and 18 years of age at diagnosis with Brucellosis between July 2017 and August 2018 were analyzed retrospectively. Liver involvement was defined as elevated transaminase enzymes when compared to levels of the control group. Transaminases enzyme levels were taken as the control group. The two groups were compared in age, gender, complaints at admission, duration of symptoms, physical examination findings, laboratory values, blood culture reproduction, and relapse rates. Results There was no significant relationship between age and sex between groups with liver involvement (n = 92) and without liver involvement (n = 156). Loss of appetite, nausea, and sensitive stomach were higher in the patients who had hepatic involvement. In the patients who had hepatic involvement, the hemoglobin and platelet values were lower, and the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and blood culture growth were higher (p < 0.05). The relapse rates were lower in patients who had liver involvement (p < 0.05). Conclusions The correlation detected between blood culture positivity and elevated liver enzymes, CRP and ESR levels, low hemoglobin and platelet levels were considered to be consistent with the fact that brucellosis is a pathogen that involves the reticuloendothelial system.
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Affiliation(s)
- Mehmet Agin
- Pediatric Gastroenterology, Van Education and Research Hospital, Van, TUR
| | - Yusuf Kayar
- Gastroenterology, Van Education and Research Hospital, Van, TUR
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Hosseini SM, Farmany A, Arabestani MR. Effect of Doxycycline-Loaded Solid Lipid Nanoparticles on Serum Level of Trace Elements, Biochemical and Hematological Parameters in Acute and Chronic Brucellosis. Biol Trace Elem Res 2020; 194:463-471. [PMID: 31297737 DOI: 10.1007/s12011-019-01798-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/24/2019] [Indexed: 12/25/2022]
Abstract
Disease relapse is one of the most important challenges in treating brucellosis. The aim of this study was to investigate the effect of doxycycline-loaded solid nanoparticles (DOX-SLN) on acute and chronic brucellosis, serum levels of trace elements, and biochemical and hematological parameters in rats infected with Brucella melitensis. The treating effect of DOX-SLN was evaluated by investigating serum levels of trace elements such as zinc (Zn), copper (Cu), iron (Fe), magnesium (Mg), calcium (Ca), phosphorus (P), sodium (Na), and potassium (K); biochemical parameters such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and total bilirubin (TBil); and hematological parameters in rats suffering from acute and chronic brucellosis. The mean size, zeta potential, PDI, drug loading, and encapsulation efficiency of the synthesized nanoparticles were 299 ± 34 nm, - 28.7 ± 3.2 mV, 0.29 ± 0.027, 11.2 ± 1.3%, and 94.9 ± 3.2%, respectively. The serum level of trace elements (Zn, Cu, Fe), biochemical parameters (AST, ALT, ALP, TBil), and hematological parameters (white blood cell (WBC) and hemoglobin (HB)) were significantly different between healthy and infected rats. DOX-SLN had an appropriate treating effect on chronic brucellosis through modifying the serum level of mentioned factors. Assessing the serum level of trace elements, biochemical and hematological parameters can be useful in detecting brucellosis with other diagnostic tests and determining its acute or chronic phase. DOX-SLN had a better efficacy in treating chronic brucellosis than ordinary free drugs used routinely in this regard.
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Affiliation(s)
- Seyed Mostafa Hosseini
- Department of Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abbas Farmany
- Dental Research Center, School of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Reza Arabestani
- Department of Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
- Brucellosis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
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Abstract
Objectives Childhood brucellosis is a common public health problem in developing countries. The diagnosis of brucellosis based on nonspecific symptoms is an ongoing problem for physicians, especially in endemic areas. In this study, it is aimed to discuss the efficacy of frequently used test methods in the differential diagnosis of brucellosis. Methods The records of 332 patients admitted to pediatric clinic on suspicion of brucellosis were retrospectively analyzed. Patients with brucellosis were included in the positive group (n = 262) and those without brucellosis were included in the negative group (n = 70). Results As a result of biochemical analysis of the cases, median alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), erythrocyte sedimentation rate (ESR), and C reactive protein (CRP) values were significantly higher in the positive group than that in the negative group (p<0.05). There was no significant difference between median white blood cell, neutrophil, lymphocyte, neutrophil to lymphocyte ratio, hemoglobin, and platelet values between groups (p>0.05). Receiver operating curves were plotted to compare predictive values of CRP (area under curve (AUC): 0.635, p= 0.001), ESR(AUC:0.701, p<0.001), AST(AUC: 0.595, p=0.015), ALT(AUC:0.604, p=0.007), and GGT(AUC:0.593, p=0.016) in 332 patients with suspected brucellosis. Conclusions Increased levels of AST, ALT, GGT, CRP, and ESR may have a complementary role in the differential diagnosis of childhood brucellosis. However, all of these markers should be evaluated with clinical findings due to their low specificity and sensitivity.
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Affiliation(s)
| | - Süleyman Geter
- Pediatrics, Sanliurfa Training and Research Hospital, Sanliurfa, TUR
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Abstract
Brucellosis, caused by the intracellular pathogens Brucella, is one of the major zoonotic infections. Considering the economic burden, its prevalence has been a health concern especially in endemic regions. Brucella is able to survive and replicate within host cells by expressing different virulence factors and using various strategies to avoid the host's immune response. This leads to progression of the disease from an acute phase to chronic brucellosis. Exploration of genetic variations has confirmed the expected influence of gene polymorphisms on susceptibility and resistance to brucellosis of humans. Since there is no approved human vaccine and treatment is uncertain with risk of relapse, it is important to increase knowledge about pathogenesis, diagnosis and treatment of brucellosis in order to manage and control this infection, especially in endemic regions.
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Affiliation(s)
- Omolbanin Amjadi
- a Student Research Committee, Department of Immunology, School of Medicine , Mazandaran University of Medical Sciences , Sari , Iran
| | - Alireza Rafiei
- b Department of Immunology, School of Medicine , Mazandaran University of Medical Sciences , Sari , Iran
| | - Masoud Mardani
- c Infectious Diseases and Tropical Medicine Research Center , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Parisa Zafari
- a Student Research Committee, Department of Immunology, School of Medicine , Mazandaran University of Medical Sciences , Sari , Iran.,b Department of Immunology, School of Medicine , Mazandaran University of Medical Sciences , Sari , Iran
| | - Ahmadreza Zarifian
- d Infectious Disease Research Group, Student Research Committee, Medical School , Mashhad University of Medical Sciences , Mashhad , Iran
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