| Brucellosis, known as “undulant fever”,“Mediterranean fever” or “Malta fever”, is an acute and chronic zoonotic infections – an allergic diseases caused by Brucella.Brucella is a natural-focal disease, and it has been categorized as category B infectious diseaseby the Law of the People's Republic of China on Prevention and Treatment of Infectious Diseases. Brucellosis can occur through the skin and digestive tract mucosa to invade the body.The main sources of infection of human brucellosis are sick sheep, cattle, pigs, dogs and so on. Brucellosis belongs to multiple organ injury disease and it can cause multiple organ damage. The symptoms of Brucellosis induce inconstant fevers, muscular and bodily pain,sweating, weakness, liverspleen and lymph node enlargement.As a kind of global disease, it has widely spread, which has reached more than 170 countries and regions.It is a common occurrencebetween human and animals, and t around 500 to 600 million people in the world are suffering from brucellosis. The annual morbidity number is about 50 million which causes billions of dollars in economic losses.China reported two cases of brucellosis in Chongqing in 1905;from the middle of 1950 s,China began to conduct a survey of brucellosis and control on humans and animals in a planned and organized manner. But recently it shows that the incidence of brucellosis has increased and speeded to 28 provinces(cities, districts) in our country. In 1963, Liaoning Province first reported a case of human Brucellosis; But the overall morbidity rate is low and is under control; After 1994, the province's morbidity rate of brucellosis epidemic has increased and the scope is expanding gradually. In the 21 st century, the number of incidence gradually ranked among the top nationwide;Brucellosis is a serious threat to human health and influences the development of animal husbandry. Thus it has become the worldimportant public health problem, especially in developing countries. Objective:To investigate and analyze the epidemiological characteristics, the clinical characteristics, laboratory examination, we conducted our analysis based on the cases from Sixth People's Hospital of Shenyang.Brucellosis usually invades the spine. We also analyzed the imaging characteristics of Brucella spondylitis in order to improve level of the clinic diagnosis and provide the basis for early diagnosis and treatment. Methods:Based on 296 brucellosis cases in the Sixth People's Hospital of Shenyang, we conducted our analysis with the method of retrospective descriptive way(from January 2015 to December 2015). We collected, analyzed and summarized on the basis of its epidemiological characteristics, clinical manifestations, laboratory examination, imaging findings. Results:1. Among the 296 cases of brucellosis, 217 cases were male(73.31%) and 79 cases were female(26.69%).The gender ratio was 2.75:1;Age distribution was between 3 and 75 years,and it struckmost often between 46 and 65 years, with a total number of 177 cases(59.80%). Most patients were from Han Nationality(237 cases, 80.07%), followed by the Man Nationality, which was 41 cases(13.85%).2. Treatment time was concentrated in 6-8 months, a total of 106 cases( 35.8%). The peak of the disease was in June, with 41cases( 13.51%). Cases have been reported in all areas of Liaoning province,and the main high incidence cities were Shenyang and Jinzhou, which had 138(46.62%) and 40(13.51%) patients respectively. In the Shenyang area, the incidence in the front row were in Faku County with 35 people(25.36%), Liaozhong County with 20 people(14.49%) and Xinmin city with 16 people(11.60%).3. Most of the patients were farmers and herdsmen of 233 cases(78.72%) and following were cadres staff of 17 cases(5.74%)and workers of 11 cases(3.72%), all of whom had a clear epidemiology contact history. The largest proportion of patients had contacted with sheep in cases 253(85.47%).Most of the patients were feeding grazing personnel, slaughtering livestock personnel, veterinary, vaccination, edible uncooked, cooked meat contaminated food and dairy products and fur acquisition personnel.Among them, the disease were most obtained by feeding livestock in 256 cases(86.49%)4. The mainly symptoms in patients was arthralgia(87.84%), fever(80.74%), fatigue(76.01%),sweating(50.68%), some patient can have dizziness(9.46%), headache(13.85%), chills(23.31%), testicular swelling(10.14%);Acute phase accounted for 88.8%,which being main in clinical stages of composition;The main complications of brucellosis is Brucella spondylitis(196 cases,66.22%)5.Laboratory examination; SAT was positive in 290 cases(97.97%), blood cultures were positive in 155 cases(52.36%), procalcitonin(PTC) increased in 144 cases(48.65%), C- reactive protein(CRP) increased in 231 cases(78.04%), WBC increased in 23 cases(7.77%), alanine aminotransferase(ALT) increased in 89 cases(30.68%), aspartate aminotransferase(AST) increased in 77 cases(26.01%), alkaline phosphatase(ALP) increased in 78 cases(26.35%)6.133 cases of Brucellosis Spondylitis were diagnosed by imaging examination in our hospital, most of lumbar spine lesions(101 cases,75.94%), especially L4;thoracic vertebra lesions was 8 cases(6.02%);cervical vertebra lesions was 3 cases(2.26%), sacral vertebra lesions was 1 cases(0.75%); Lumbar and sacral vertebral lesions in 18 cases(13.53%);thoracic and lumbar spine lesions in 1 cases(0.75%); cervical and lumbar spine lesions in 1 cases(0.75%);Involvement paravertebral 62 cases(46.62%),vertebral canal involvement of 15 cases(11.28%), multiple vertebral bodies involved more than a single vertebral involvement, 2 incidence of vertebral bodies involved up to 74 cases(55.64%).7. CT showed bone destruction was minute and multiple, which confined to the vertebral body edge,and obvious proliferation hardening is around the lesions,Involvement para-vertebral showed the para-vertebral soft tissue swelling and abscess formation;MRI showed the bone destruction were hypointense change on T1, mixed signal or hyperintensity change on T2, paravertebral and spinal involvement can show the abnormal high signal of paravertebral or spinal canal, STIR showed high signal change, enhanced scanning lesions can be enhanced; CT and MRI diagnostic accuracy of brucellosis spondylitis had no statistical difference(P > 0.05), the diagnostic accuracy of brucellosis spondylitis with paravertebral abscess was statistically different(P < 0.05) Conclusion:1. The peak incidence of brucellosis patients in our hospital for 6-8 months,mainly in male adults, aged from 45-65 years old, in occupation crowd that the farmers and herdsmen had the more incidence of contact of sheep and cattle, Mostly infected by feeding;The highest incidence area is Shenyang city in liaoning province, the second is jinzhou city, shenyang regional distribution is more faku county and liaozhong and xinmin city.2. Most patients in the acute phase of treatment, bone and joint pain, fever, fatigue and sweating are the main symptoms of brucellosis in our hospital, at the same time may be accompanied by dizziness or headache, chills, testicular swelling, Swollen lymph nodes and other symptoms, in the meanwhile,there will be the corresponding complications and signs.3. Laboratory examination, RBPT test are positive, 97.97% patients with positive the SAT tests, pathogen isolation and culture as the gold standard, half of the patients with the positive blood culture, PCT?CRP is elevated to varying degrees,patients can appear liver and kidney dysfunction and electrolyte disorder,a small number of patients with anemia and(or)thrombocytopenia.4. Brucellosis Spondylitis were mainly located in the lumbar vertebrae and most of them was L4. Multiple vertebral lesions are higher than single vertebral body;CT scan and reconstruction techniques with higher density resolution is more intuitive to the display of bone destruction and repair;MRI withthe better tissue resolution, application of multiple scanning sequence can display the abnormal changes of vertebral body, paravertebral and spinal canal. MRI was more sensitive than CT scan in detecting the paravertebral abscess. |
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