Incidence and warning signs for complications of human brucellosis: a multi-center observational study from China.

IF 8.1 1区 医学 Infectious Diseases of Poverty Pub Date : 2024-02-20 DOI:10.1186/s40249-024-01186-4
Qing-Nan Shi, Hui-Jie Qin, Qiao-Shan Lu, Shu Li, Zhong-Fa Tao, Meng-Guang Fan, Mu-Heta Aishan, Zeng-Qiang Kou, Qiu-Lan Chen, Wen-Wu Yin, Yan-Ping Zhang
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Abstract

Background: Brucellosis is a severe zoonotic disease that is often overlooked, particularly in impoverished countries. Timely identification of focal complications in brucellosis is crucial for improving treatment outcomes. However, there is currently a lack of established indicators or biomarkers for diagnosing these complications. Therefore, this study aimed to investigate potential warning signs of focal complications in human brucellosis, with the goal of providing practical parameters for clinicians to aid in the diagnosis and management of patients.

Methods: A multi-center cross-sectional study was conducted in China from December 2019 to August 2021. The study aimed to investigate the clinical characteristics and complications of patients with brucellosis using a questionnaire survey and medical record system. The presence of warning signs for complications was assessed using univariate and multivariate logistic regression models. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used for variable screening and model evaluation.

Results: A total of 880 participants diagnosed with human brucellosis were enrolled. The median age of the patients was 50 years [interquartile range (IQR): 41.5-58.0], and 54.8% had complications. The most common organ system affected by complications was the osteoarticular system (43.1%), with peripheral arthritis (30.0%), spondylitis (16.6%), paravertebral abscess (5.0%), and sacroiliitis (2.7%) being the most prevalent. Complications in other organ systems included the genitourinary system (4.7%), respiratory system (4.7%), and hematologic system (4.6%). Several factors were found to be associated with focal brucellosis. These factors included a long delay in diagnosis [odds ratio (OR) = 3.963, 95% confidence interval (CI) 1.906-8.238 for > 90 days], the presence of underlying disease (OR = 1.675, 95% CI 1.176-2.384), arthralgia (OR = 3.197, 95% CI 1.986-5.148), eye bulging pain (OR = 3.482, 95% CI 1.349-8.988), C-reactive protein (CRP) > 10 mg/L (OR = 1.910, 95% CI 1.310-2.784) and erythrocyte sedimentation rate (ESR) elevation (OR = 1.663, 95% CI 1.145-2.415). The optimal cutoff value in ROC analysis was > 5.4 mg/L for CRP (sensitivity 73.4% and specificity 51.9%) and > 25 mm/h for ESR (sensitivity 47.9% and specificity 71.1%).

Conclusions: More than 50% of patients with brucellosis experienced complications. Factors such as diagnostic delay, underlying disease, arthralgia, eye pain, and elevated levels of CRP and ESR were identified as significant markers for the development of complications. Therefore, patients presenting with these conditions should be closely monitored for potential complications, regardless of their culture results and standard tube agglutination test titers.

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人类布鲁氏菌病并发症的发病率和预警信号:一项来自中国的多中心观察研究。
背景:布鲁氏菌病是一种严重的人畜共患病,常常被忽视,尤其是在贫困国家。及时发现布鲁氏菌病的病灶并发症对于提高治疗效果至关重要。然而,目前缺乏诊断这些并发症的既定指标或生物标志物。因此,本研究旨在调查人类布鲁氏菌病局灶性并发症的潜在预警信号,目的是为临床医生提供实用参数,帮助诊断和管理患者:2019年12月至2021年8月在中国开展了一项多中心横断面研究。研究旨在通过问卷调查和病历系统调查布鲁氏菌病患者的临床特征和并发症。采用单变量和多变量逻辑回归模型评估了并发症预警信号的存在情况。接收者操作特征曲线(ROC)和曲线下面积(AUC)用于变量筛选和模型评估:结果:共招募了 880 名确诊为人类布鲁氏菌病的患者。患者的中位年龄为 50 岁[四分位距(IQR):41.5-58.0],54.8% 的患者有并发症。受并发症影响最常见的器官系统是骨关节系统(43.1%),其中外周关节炎(30.0%)、脊柱炎(16.6%)、椎旁脓肿(5.0%)和骶髂关节炎(2.7%)最为常见。其他器官系统的并发症包括泌尿生殖系统(4.7%)、呼吸系统(4.7%)和血液系统(4.6%)。研究发现,有几个因素与病灶性布鲁氏菌病有关。这些因素包括诊断延迟时间过长[大于 90 天的几率比(OR)= 3.963,95% 置信区间(CI)1.906-8.238]、存在潜在疾病(OR = 1.675,95% CI 1.176-2.384)、关节痛(OR = 3.197,95% CI 1.986-5.148)、眼球突出痛(OR = 3.482,95% CI 1.349-8.988)、C 反应蛋白(CRP)> 10 mg/L(OR = 1.910,95% CI 1.310-2.784)和红细胞沉降率(ESR)升高(OR = 1.663,95% CI 1.145-2.415)。ROC分析的最佳临界值为:CRP > 5.4 mg/L(灵敏度为73.4%,特异度为51.9%),ESR > 25 mm/h(灵敏度为47.9%,特异度为71.1%):超过50%的布鲁氏菌病患者出现了并发症。诊断延误、潜在疾病、关节痛、眼痛以及 CRP 和 ESR 水平升高等因素被认为是并发症发生的重要标志。因此,无论患者的培养结果和标准试管凝集试验滴度如何,都应密切监测患者是否出现潜在并发症。
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来源期刊
Infectious Diseases of Poverty
Infectious Diseases of Poverty INFECTIOUS DISEASES-
自引率
1.20%
发文量
368
期刊介绍: Infectious Diseases of Poverty is an open access, peer-reviewed journal that focuses on addressing essential public health questions related to infectious diseases of poverty. The journal covers a wide range of topics including the biology of pathogens and vectors, diagnosis and detection, treatment and case management, epidemiology and modeling, zoonotic hosts and animal reservoirs, control strategies and implementation, new technologies and application. It also considers the transdisciplinary or multisectoral effects on health systems, ecohealth, environmental management, and innovative technology. The journal aims to identify and assess research and information gaps that hinder progress towards new interventions for public health problems in the developing world. Additionally, it provides a platform for discussing these issues to advance research and evidence building for improved public health interventions in poor settings.
期刊最新文献
Global burden of zoonotic infectious diseases of poverty, 1990-2021. Out-of-pocket payment and catastrophic health expenditure of tuberculosis patients in accessing care at public-private mix clinics in Myanmar, 2022. Point-of-care test of blood Plasmodium RNA within a Pasteur pipette using a novel isothermal amplification without nucleic acid purification. Molecular characterisation of human rabies in Tanzania and Kenya: a case series report and phylogenetic investigation. Spatial and temporal characterization of Aedes albopictus oviposition activity in candidate urban settings for sterile insect technique testing in La Reunion Island.
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