Clinical Characteristics And Related Factors Of Patients With Brucellosis And Respiratory Diseases

Objective:This study described the general demographic characteristics,clinical manifestations,comorbidities,and auxiliary examination results of patients combined with respiratory diseases,and compared the differences between the patients with and without the respiratory diseases.The purpose of this study was to provide scientific basis for the diagnosis and identification of clinicians by exploring the clinical characteristics and related factors of this disease.Methods:The clinical data of all hospitalized patients with brucellosis in the First Affiliated Hospital of Jilin University from January 1,2014 to December 31,2018 were collected for retrospective study.The research content included general demographic characteristics,epidemiological contact history,clinical manifestations,comorbidities,laboratory test results,imaging test results,etc.Epidata3.1 software was used to establish the database,and data statistics and analysis used SPSS 24.0software.The description of measured data was expressed by mean±standard deviation or median(interquartile range)and the count data was described by the constituent ratios and rates.And the comparison between count data groups was compared by Chi-square test.Multivariate analysis was performed using non-conditional Logistic regression model.When P < 0.05,the difference was considered statistically significant.Results:In this study,424 cases of effective hospitalized brucellosis patients were collected,including 187 cases(44.10%)with respiratory diseases and 237cases(55.90%)without respiratory diseases.1.Clinical features of patients with brucellosis and respiratory diseases(1)Types of combined respiratory diseases: the number of patients withpneumonia was 177(94.65%),followed by bronchitis,24 cases,accounting for12.83%,while the rest were pleural effusion(5,2.67%),emphysema(5,2.67%),pulmonary abscess(3,1.67%),upper respiratory tract infection(2,1.07%),bronchiectasis(1,0.53%).(2)The gender ratio of patients was 2.02: 1.The youngest was 2 years old and the oldest was 85 years old.The median age(interquartile range)was 49(40,59)years old.And 41~60 group had the largest number of patients,99 cases,accounting for 52.94%.The patients were mainly farmers and herdsmen,with a total of 140 cases,accounting for 74.87%.(3)162 patients(86.63%)had a clear epidemiological contact history,and 25patients(13.37%)had unknown contact history.There were 89 cases(54.94%)who had contact with cattle and sheep at the same time,followed by 53 cases(32.72%)who had contact with sheep alone and 16 cases(9.87%)who had contact with cattle alone.The main contact methods were feeding or grazing,65 cases(40.12%),followed by living in a place with cattle and sheep(22.22%),eating uncooked meat and contaminated food(14.81%).(4)184 patients were in the acute stage of brucellosis,accounting for 98.40%;only 3 patients were in the chronic stage,accounting for 1.60%.The shortest hospital stay was only 2 days,and the longest was 50 days.Among them,?10 days had the largest number,142 cases,accounting for 75.94%.Before discharge,182 cases improved,accounting for 97.33%,and only 4 cases remained unrecovered,accounting for 2.14%.(5)Clinical diagnosis results:(1)Clinical manifestations: 176 cases of fever(94.12%),61 cases of chills(32.62%),54 cases of cough(28.88%),41 cases of fatigue(21.93%),12 cases of rash(6.42%),10 cases of lymphadenectasis(5.35%).(2)Comorbidities: 56 cases of hyponatremia(29.95%),48 cases of hypocalcemia(25.67%),46 cases of hypoproteinemia(24.60%),40 cases of hypochloremia(21.39%),37 cases hypokalemia(19.79%),26 cases(13.90%)of cholecystitis,25 cases of fatty liver(13.37%),24 cases of hyperlipidemia(12.83%),17 cases of urinary system infection(9.09%),and 17 cases of anemia(9.09%).(3)Laboratory test results: 134 cases(71.66%)of hematocrit decreased,118 cases(63.10%)of hemoglobin decreased,175 cases(93.58%)of albumin decreased,140 cases(74.87%)of total protein decreased,leukocyte enzyme activity was positive in 57cases(30.48%),urine protein was positive in 44 cases(23.53%),120 cases of calcium ions decreased(64.17%),169 cases of CRP increased(90.37%),and 73 cases of PCT increased(39.04%).170 patients received PAT,of which 169(99.41%)were positive.147 patients received SAT,of which 135(91.84%)were positive.And a total of 178 patients received blood culture tests,Brucella was isolated from 77patients(43.26%).(4)Imaging findings: of the 128 patients who underwent ultrasonography,30 had splenomegaly(23.44%),20 had mitral or tricuspid regurgitation(15.63%),15 had cholecystitis(11.72%).2.Analysis of factors related to brucellosis and respiratory diseases(1)The univariate analysis results of the combined respiratory disease group and the uncombined group showed: age,occupation,clinical stage,fever,cough,sputum,pharyngeal hyperemia and pain,hyponatremia,hypocalcemia,hypoproteinemia,hypochloremia,red blood cells,hemoglobin,hematocrit,platelets,aspartate aminotransferase,cholinesterase,total protein,albumin,albumin/globulin,urine occult blood,urine protein,leukocyte enzyme activity,calcium ions in the combined and uncombined groups were statistically significant(P<0.05).(2)Multivariate analysis of the combined respiratory disease group and the uncombined group showed that the age was 65 years or older(OR=2.010;95%CI:1.027~3.931);the occupation was farmers and herdsmen(OR=2.081;95%CI:1.011~4.282);clinical symptoms of cough(OR=2.685;95%CI: 1.592~4.527);combined with hypocalcemia(OR=2.198;95%CI: 1.273~3.795);positive urine protein(OR=2.138,95%CI: 1.239~3.689),had increased risk of brucellosis patients combined with respiratory diseases.Conclusions:1.Pneumonia is the most common type of brucellosis combined with respiratory diseases.2.There are more males than females in the population of brucellosis combined with respiratory diseases and those without,mainly middle-aged and older.And the main occupation is farmers and herdsmen.3.The vast majority of patients with brucellosis and respiratory diseases have aclear history of animal contact.Cattle and sheep are the main contact animals.Feeding and grazing are the main contact methods.4.The clinical stages of brucellosis combined with respiratory diseases are mostly in the acute stage.The main clinical manifestations are fever,chills,cough,and fatigue.The main comorbidities are electrolyte disorders such as hyponatremia,hypocalcemia,hypochloremia,and hypoproteinemia.97.33% of patients improved when discharged.5.Brucellosis patients who are 65 years old or older,farmers and herdsmen,have cough,have hypocalcemia,and are positive for urinary protein may increase risk for respiratory diseases.