Clinical Characteristics Of Brucellosis And Extrapulmonary Tuberculosis Admitted With Fever

Objective:Analyze the clinical characteristics of brucellosis and extrapulmonary tuberculosis(EPTB)admitted to hospital with fever,so as to enhance the understanding of these two diseases and improve the diagnostic rate.Method:Patients admitted to the First Affiliated Hospital of Guangxi Medical University due to fever from January 2013 to December 2019,who confirmed brucellosis or EPTB were enrolled in the study.They were divided into brucellosis group and EPTB group.The clinical symptoms and signs,onset time,inflammatory indexes,biochemical indexes and T lymphocyte subsets of the two groups were compared,and the differences between the two groups were analyzed.Result:A total of 140 patients were included in this study,including 59brucellosis and 81 EPTB.The patients in both groups were mainly young and middle-aged men aged from 30 to 59 years old,and most of them are rural population.There were 4 cases(6.8%)of brucellosis complicated with hypertension and 3 cases(5.1%)of diabetes,and 10 cases(12.3%)of EPTB complicated with hypertension and 5 cases(6.2%)of diabetes.Brucellosis smoking in 25 cases(42.4%)was higher than that in EPTB 17 cases(21.0%),brucellosis drinking in 16 cases(27.1%)was higher than EPTB 11 cases(13.6%),there was significant difference in smoking and drinking between the two groups(P<0.05).The number of cases of brucellosis and EPTB was the highest in 2017,in which the incidence of brucellosis had certain seasonality,mostly from March to May.Both groups had certain characteristics in occupational distribution.Brucellosis is mainly caused by slaughtering and breeding farmers,while EPTB is mainly by freelance and enterprises and institutions.The median time of the fever course of brucellosis was 40 days,the fever peak was 39.57±0.68℃,29 cases(49.2%)were mainly afternoon fever,the median time of the fever course of EPTB was 30 days,the fever peak was39.48±0.72℃,and 50 cases(61.7%)were mainly afternoon fever,there was no significant difference in fever time,fever peak and afternoon fever between the two groups(P>0.05).After the treatment of brucellosis,the median time for body temperature decreased to normal was 1 day,while the median time of EPTB temperature dropped to normal in 7 days,there was significant difference between the two groups(P<0.05).Brucellosis fever is often accompanied by cold fear,weight loss,fatigue,cough,sweating,joint pain,anorexia,hepatosplenomegaly.16.2%of male patients are accompanied by testicular pain.EPTB fever is often accompanied by headache,chills,fatigue,cough and enlarged lymph nodes,brucellosis were more prone to weight loss,hyperhidrosis,arthralgia,testicular pain,hepatosplenomegaly than EPTB,there was significant difference between the two groups(P<0.05).The blood routine test of brucellosis showed that the white blood cell count(WBC)was normal or decreased,the platelet count(PLT)and neutrophil percentage(NEU%)were in the normal range,and the lymphocyte percentage(LYM%)was normal or increased.The blood routine test of EPTB showed that WBC was normal or increased,and PLT and NEU%were often increased,while LYM%was mainly decreased.The inflammatory markers of brucellosis and EPTB were mild to moderate elevated.There were significant differences in WBC,PLT,NEU%and LYM%between the two groups(P<0.05).The levels of total bilirubin,alanine aminotransferase(ALT),aspartate aminotransferase(AST)and LD in brucellosis were significantly higher than EPTB(P<0.05).9 cases(20.9%)of brucellosis were positive or weakly positive for tuberculosis antibody,and 10cases(18.9%)of EPTB were positive or weakly positive for tuberculosis antibody,there was no significant difference between the two groups(P>0.05).The CD4~+T lymphocyte count in T lymphocyte subsets of brucellosis was mostly within the normal range,CD8~+T lymphocyte count was mainly normal or increased,CD4/CD8 was mostly decreased,while CD4~+T lymphocyte count and CD8~+T lymphocyte count in EPTB were often decreased.There was significant difference in CD8~+T lymphocyte count and CD4/CD8 between the two groups(P<0.05).Brucellosis is confirmed by blood culture or bone marrow culture,while EPTB is mainly based on clinical diagnosis,so it is difficult to isolate and culture Mycobacterium tuberculosis.Conclusion:The clinical symptoms and signs of brucellosis and EPTB are very similar,and they are lack of specificity.When it is difficult to distinguish them,it may be preliminarily identified by blood routine,ALT,AST,LD and T lymphocyte subsets detected on admission,and then further etiological examination to make a definite diagnosis.