Analysis Of Clinical Characteristics Of 35 Cases Of Brucellosis In Jiangxi

ObjectiveThe clinical features of brucellosis are not typical and the misdiagnosis rate is high.The clinical characteristics of patients with brucellosis in Jiangxi were analyzed to provide some references for early diagnosis and clinical treatment of brucellosis in Jiangxi.MethodologyThe clinical data of 35 patients with brucellosis diagnosed in the second affiliated Hospital of Nanchang University from January 2013 to October 2019 were collected and analyzed retrospectively.According to the clinical characteristics and diagnosis and treatment of patients with brucellosis,35 patients with brucellosis were further divided into the group of Fever of unknown origin(FUO,n = 19)and the group of Fever of non-unknown origin(non-FUO,n = 16).The epidemiological and clinical characteristics of the two groups were analyzed.Results(1)Patients with brucellosis in Jiangxi are mainly young(18-40 years old,28.57%)and middle-aged(41-65 years old,57.14%).The prevalence rates of farmers and workers in occupation were 62.86% and 28.57% respectively,the proportion of workers in FUO was 10.53%,and that in non-FUO was 50.00%,the difference was significant(P<0.05).80% have a clear history of contact with sheep and cattle,and the history of contact with sheep and cattle is 62.86% and 17.14%,respectively.The time of onset was mainly in April-June(62.86%),and the place of residence was mainly distributed in Fuzhou(28.57%),Yichun(17.14%),Nanchang(14.29%)and so on.There were 34 patients(97.14%)in acute stage and 1 case(2.86%)in subacute stage.The main clinical manifestations were fever(97.14%),fatigue(85.71%),muscle and joint pain(68.57%),chills(48.57%),hyperhidrosis(40.00%)and low back pain(34.29%).The heat type is mainly characterized by irregular fever and long-term low fever(88.57%),and rarely shows typical wavy fever(8.57%).Complications included toxic hepatitis(80.00%),joint synovitis(22.86%),pneumonia(20.00%),spondylitis(14.28%)and bilateral pleurisy(2.86%).Among the laboratory examination indexes,leukocyte(WBC)was normal in 29 cases(82.86%),eosinophil percentage(EO%)decreased significantly in 26 cases(74.29%),hemoglobin(HGB)decreased in 23 cases(65.71%),and liver function was abnormal in 28 cases(80.00%).C-reactive protein(CRP)increased in 33 cases(94.29%),erythrocyte sedimentation rate(ESR)increased in 23 cases(85.19%),and procalcitonin(PCT)increased in 2 cases(6.45%).Blood culture was performed in 34 cases,positive in 31 cases,bone marrow culture in 17 cases,positive in 15 cases,bone marrow culture and blood culture in 16 cases,including 14 cases(87.50%)in bone marrow culture and 13 cases(81.25%)in blood culture.11 cases(68.75%)were both positive.Among the 35 patients with confirmed brucellosis,19(54.29%)were admitted to the hospital with FUO,and all had misdiagnosis before admission(100%);16(45.71%)were admitted to the hospital with non-FUO,and 10(62.50%)were misdiagnosed before admission;the misdiagnosis rate between the two groups was significantly different(P<0.05).The proportion of toxic hepatitis in FUO and non-FUO was 94.74% and 62.50% respectively,the difference was significant(P < 0.05).(2)the regimens of doxycycline combined with levofloxacin and doxycycline combined with rifampicin were 45.71% and 34.29% respectively.The course of treatment was 6 weeks and all were cured.There was no difference in the curative effect between the two groups(P=1.00>0.05).Conclusion(1)The clinical symptoms of 35 cases of brucellosis in Jiangxi were irregular fever,long-term low fever,fatigue,muscle and joint pain,etc.Most of the laboratory tests showed that WBC and PCT were normal,the percentage of EO decreased obviously,HGB decreased,CRP and ESR increased,the rate of liver damage and the positive rate of etiological culture were high.(2)35 cases of brucellosis were mainly admitted to hospital with FUO,and the misdiagnosis rate was high.Patients admitted to the hospital with irregular fever,fatigue,muscle and joint pain and toxic hepatitis in non-epidemic areas need to exclude the possibility of brucellosis.The combination of epidemiological characteristics,blood routine characteristics,liver function examination and etiological results can help to make an early diagnosis.(3)35 cases of brucellosis were treated with different combination regimens based on doxycycline,which can be selected according to the specific conditions.