| BACKGROUND AND OBJECTIVE:Brucellosis is a common bacterial zoonosis and a common public health problem in many developing countries.This study reviewed the clinical data of 164 brucellosis patients in the First Hospital of Lanzhou University in recent 9 years.The purpose of this study is to explore the characteristics of brucellosis in Gansu Province,summarize the diagnosis and treatment experience of brucellosis,so as to deepen clinicians’ understanding of brucellosis and reduce the rate of misdiagnosis and missed diagnosis.METHODS:The medical records of patients with brucellosis from 2009 to 2017 in the First Hospital of Lanzhou University were retrospectively analyzed.These cases were mainly collected in the Department of Infectious Diseases and other internal medicine,Pediatrics,orthopedics and urology.It was done mainly through the following three aspects of analysis:① Statistical and descriptive analysis of epidemiological features,clinical features,complications,laboratory tests,and treatments;② Analysis of abnormal liver function in patients with brucellosis;③ Analysis of the correlation between the main clinical manifestations,complications,laboratory tests and the age or disease course in patients with brucellosis.RESULTS:1.(1)General Features: This article included 164 cases of brucellosis,the number of cases from 2009 to 2016 showed an increasing trend,and it was slightly lower than before in 2017.Brucellosis occured throughout the months of the year,and the epidemic peaks from March to September(122/164,74.39%).The incidence of male patients was mainly,the ratio of male to female was 2.9:1,The high incidence age groups were 25 to 54 years old of young adults(115/164,70.12%).The majority of the affected population were Han(152/164,92.68%),Baiyin,Jinchang and Lanzhou(78/164,47.56%)had the largest number of cases in Gansu Province.From a professional point of view,they were mainly farmers,herdsmen,animal fur processing personnel,veterinarians and epidemic prevention coordinators(133/164,81.1%).(2)Epidemiological characteristics: In 164 cases of brucellosis inpatients,121 cases had clear contact history with sheep or cattle(73.78%),12 cases(7.32%)had consumption history of rawmeat or unsterilized milk products,4 cases(2.44%)had family history of Brucellosis,27 cases(16.46%)of contact history were unknown.(3)Clinical features: The clinical stage was the most common in the acute phase,accounting for 71.95%,subacute and chronic periods accounted for 11.59% and 16.46%,respectively.The most common clinical symptoms included fever(72.56%),fatigue(68.29%),hyperhidrosis(54.27%),chills or shiver(45.12%),muscle and joint pain(43.29%),and loss of appetite(40.85%).The most common signs were splenomegaly(29.88%),followed by hepatomegaly(20.12%).(4)Complications: Bone and joint involvement in 58 cases(17.07%),were the most common complication of brucellosis.Respiratory system involvement in 8 cases(4.88%),7 cases involved genitourinary system(4.27%),cardiovascular system involvement in 2 cases(1.22%),highly suspected central nervous system involvement in 1 cases(0.61%),skin involvement in 2 cases(1.22%),hematological system and gastrointestinal system involvement were more common,30cases(18.29%)of liver damage were the most common gastrointestinal complications.(5)Laboratory and radiographic findings: The diagnosis of brucellosis depended on etiology and serological tests.Imaging examination mainly assists in the diagnosis of brucellosis complications,general laboratory tests lack specificity,some patients often appear anemia 46cases(28.05%),leukopenia 42 cases(25.61%),ALT increased in 66 cases(40.24%),AST increased in 65 cases(39.63%),GGT increased in 42 cases(25.61%),LDH increased in 82 cases(50%),and erythrocyte sedimentation rate increased in 100 cases(60.98%);C-reactive protein increased in 95 cases(57.93%).(6)Treatment regimen: doxycycline + rifampicin therapy for at least 6 weeks was the standard basic antimicrobial therapy regimen for brucellosis.One or two regimens of doxycycline+ rifampicin + quinolone or third-generation cephalosporins or aminoglycoside drugs were effective to treatment of patients with complications of brucellosis for at least 8 weeks.2.In 164 cases of brucellosis,66 cases(40.24%)had abnormal liver function,and the abnormal rates of ALT,AST,TBil,DBil,GGT and ALP in liver function before and after treatment were statistically significant(P <0.01).3.Fever in elderly patients over 60 years old is significantly lower than other age groups(p=0.001).The incidence of osteoarthritis increased significantly in the 13 to 34 age group(p=0.014).Fever,hyperhidrosis,and fatigue occured frequently in patients with less than 3 months of brucellosis(p=0.000).Muscle joint pain and complicated osteoarthritis were more common in patients with more than 3 months of brucellosis(p=0.000).The influence of different age groups and duration of symptoms on the parameters of laboratory tests was not statistically significant(P >0.05).CONCLUSIONS1.In recent years,the incidence of brucellosis in Gansu Province has been increasing year after year,and its epidemic has obvious seasonal,gender and age differences,and mainly related to the contact of animal production.Based on the complex and diverse clinical manifestations and complications of brucellosis,clinicians should strengthen the understanding and vigilance of the disease,broaden the diagnostic thinking,reduce the rate of misdiagnosis of the disease as much as possible,and adhere to standardized antibacterial treatment in order to reduce the occurrence of complications and avoid the development of chronic disease.2.Abnormal liver function in patients with brucellosis is more common in the clinical,usually mild to moderate injury.After given anti-brucellosis and liver preservation treatment,most of the indexes of liver function can be restored,and rarely develop to chronic or critical liver damage.3.In elderly or patients with a disease course of more than 3 months,fever may not be one of the main criteria for the diagnosis of brucellosis.Bone and joint involvement of brucellosis mostly occurs in young patients with disease progression to chronic phase. |
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