The Clinical Characteristics Of Brucellosis Patients With Osteoarthrotype And Non-osteoarthrotype

Objective:To compare the clinical characteristics of brucellosis patients with osteoarthrotype and non-osteoarthrotype,so as to provide the basis for the diagnosis and treatment of brucellosis.Methods:The case data of inpatients diagnosed with brucellosis in the Department of Infectious Diseases,First Hospital of Shanxi Medical University from January 2018 to January 2020 were collected.Patients were divided into osteoarthrotype group and non-osteoarthrotype group according to whether they were had osteoarthropathy.To compare the general data(age,sex,occupation,history epidemiological),course of disease,clinical symptoms,WBC,RBC,PLT,LY,ALT,AST,ESR,CRP,SAT and blood clture between the two groups.Results:Clinical data of 116 patients with brucellosis were collected,including 89 males(76.7%)and 27 females(23.3%),the male to female ratio is 3.30:1.The age is from 12 to82 years,with an average age of(50.51±16.01)years.Among them,5 cases(4.3%)under18 years,35 cases(30.2%)in 18-44 years,35 cases(30.2%)in 45-59 years,and 41 cases(35.3%)aged more than 60 years.Brucellosis patients have various occupational types,there were 68 cases(58.6%)of farmers,15 cases(12.9%)of staff,9 cases(7.8%)of retirements,7 cases(6.1%)of students,2 cases(1.7%)of workers and 15 cases(12.9%)of others.85 patients(73.3%)had clear epidemiological history,and 59 patients(69.4%)had direct contact,followed by 19 patients(22.4%)who had food-source contact and 7patients(8.2%)who had respiratory contact.The acute stage was 108 cases(93.1%)and chronic stage was only 8 cases(6.9%).The clinical symptoms included 104(89.7%)cases of fever,72(62.1%)cases of muscle and joint pain,62(53.4%)cases of splenomegaly,52(44.8%)cases of fatigue,45(38.8%)cases of hyperhidrosis,44(37.9%)cases of lymphadenectasis,and 12(10.3%)cases of hepatomegaly.In addition,16 cases(13.8%)of digestive system,13 cases(11.2%)of nervous system and 1 case(0.9%)of reproductive system were involved,and corresponding symptoms of organ injury appeared.Of the 116 patients with brucellosis,72(62.1%)were in the osteoarthrotype group and 44(37.9%)were in the non-osteoarthrotype group.In the osteoarthrotype group,there were 1 cases under 18 years(1.4%),16 cases in 18-44 years(22.2%),25 cases in45-59 years(34.7%)and 30 caess aged more than 60 years(41.7%).In the non-osteoarthrotype group,there were 4 cases under 18 years(9.1%),19 aged more than60 years(43.2%),10 cases in 18-44 years(22.7%)and 11 caess aged more than 60years(25.0%).The age difference between the two groups was statistically significant(P<0.05).The symptoms of fatigue were more common in the osteoarticular group than in the non-osteoarticular group.Fever and hyperhidrosis,hepatomegaly and splenomegaly lymph node enlargement was more common in non-osteoarticular group than in osteoarticular group.There was no statistically significant difference in these symptoms between the two groups(P>0.05).The two groups were no statistically significant difference(P>0.05)in sex,history of epidemiology,clinical course,clinical symptoms(fever,fatigue,hyperhidrosis,hepatomegaly,splenomegaly,lymphadenectasis,symptoms of digestive system,nervous system,reproductive system symptoms),laboratory tests(WBC,RBC,LY,ESR,CRP,AST,SAT,blood culture).There were statistically significant differences in age,occupation and laboratory test(ALT,PLT)between the two groups(P<0.05).In the osteoarticular group,the osteoarticular CT manifestations showed bone destruction and abscess formation.And the osteoarticular MRI manifestations showed spondylitis,arthritis,osteonecrosis abscess formation and etc.Logistic regression analysis of age,occupation,PLT and ALT between the two groups showed that PLT decreased(OR=0.172;95%CI: 0.041～0.727)and ALT increased(OR=0.369;95%CI: 0.149～0.913)were the related factors of brucellosis patients whether bone and joint ingury occur.Conclusion:Brucellosis can occur in all ages and occupations,most of them are male.Mainly through direct contact with sick animals,but also through respiratory tract contact and food source contact transmission.The clinical manifestations of fever,muscle and joint pain,splenomegaly and fatigue are more common.Brucellosis with osteoarthropathy was more common in the aged more than 60 years.Brucellosis without osteoarthropathy was more common in the young.And fatigue was more common in patients with osteoarthropathy than in patients without osteoarthropathy.Brucellosis with osteoarthropathy imaging manifestations may include spondylitis,arthritis,bone destruction,abscess formation and etc.The possibility of brucellosis should be noted for these patients.