| Objective Summarize and analysize the clinical features,laboratory fingdings,treatment and prognosis of human brucellosis,explore the influence factors for adverse prognosis,and provide scientific evidence for diagnosis,treatment and case management of human brucellosis.Methods A total of 2041 cases with laboratory-confirmed brucellosis,admitted to the hospital from January 1st to December 31st of 2014,were included in this retrospective study.The patient files were investigated by a standardized form for their demographic data,history,clinical and laboratory findings,antibiotic treatment,as well as clinical outcomes and complications.The outcome of treatment was investigated by telephone interview and the influence factors of adverse prognosis were analyzed by logistic regression analysis.Results1.Demographic characteristics2041 laboratory confirmed cases were included in this study.Based on the systemic disease duration before admission to hospital,1520(74%)cases were evaluated as acute,446(22%)cases as subacute and 75(4%)as chronic.The median age of the 2041 cases was 43 years(IQR 31-52)and 77%were male.Most(56%)cases were aged 25-49 years.84%were farmers or herders,and 97%had a history of animals exposure.The median day of hospitalization duration is 12 days(IQR 9-14).2.Symptoms and signsThe most common symptoms and signs on presentation were fatigue(67%),fever(64%),arthralgia(63%),sweating(54%),back pain(37%),lack of appetite(25%),headache(24%)and weight loss(19%).In a comparison of different clinical groups,fever,weight loss,cough and lack of appetite were more common in acute cases than in subacute and chronic cases,P<0.05,while fatigue and spinal tendness were more frequent in subacute cases,P<0.01.Chronic cases showed significantly more often arthralgia,back pain,activity limitation and joints tenderness than subacute and acute cases,P<0.01.3.Laboratory findingsThe most common laboratory findings were anemia(24%),increased CRP(39%)and ESR(69%),elevated ALT(33%),AST(20%)and bilirubin(14%).These abnormal findings were more frequent in acute cases than in subacute and chronic cases,P<0.05.The positive rate of blood culture in acute brucellosis cases(54%)is significantly higher than in subacute(31%)and chronic groups(19%),P<0.001.63%cases showed SAT titer ?1:400.After discharge from hospital,the laboratory findings of acute cases gotten improved gradually over time.4.ComplicationsComplication was present in 1827 cases(89.5%).The most frequent involvement was osteoarticular complication with 1380 cases(68%).Other complications include:splenomegaly(853 cases,42%),hepatomegaly(481 cases,24%),hematological complications(627 cases,31%),genitourinary complications(409 cases,20%),respiratory complications(122 cases,6%),cardiovascular complications(13 cases,0.6%),cutaneous complications(10 cases,0.5%),central nervous system complications(5 cases,0.3%)and 1 case of uveitis.Osteoarticular complication was found to be more frequent and statistically significant in chronic cases(87%)as compared to acute(64%)and subacute(77%)cases(P<0.0001).5.Telephone follow-up1321 cases(65%of 2041 cases)responded our telephone interview and 720 cases lost.The recovery rate of 1001 acute cases was 65.2%,higher than subacute(49.5%)and chronic cases(51.2%).10 cases died after discharge,in which only one case died from endocarditis caused by Brucella,while others died from other diseases.6.Prognostic influence factorsThe multi-factors logistic analysis showed that the high risk factors key to adverse prognosis were as follows:age?45 years(OR=1.75,95%CI:1.36-2.24,P<0.001),back pain(OR=1.50,95%CI:1.16-1.94,P=0.002)and joints tenderness(OR=1.73,95%CI:1.13-2.65,P=0.011).While cases who had abnormal haematologic findings at admission had a significantly better clinical outcome comparing with those had no haematologic complication(OR =0.60,95%CI:0.45-0.79,P=0.0003).The longer the duration of illness is,the more likely to have higher risk of poor prognosis:there was no significant difference between the prognosis of cases who got treatment within one week after onset and those within one month.While compared with patients who got treatment within 1 week after onset,those within 1 to 3 months were 1.65 times(P=0.015)likelier to have poor prognosis;those within 3-6 months were 1.75 times(P=0.029)likelier to have poor prognosis;and those longer than 6 months were 2.99 times(P<0.001)likelier to have poor prognosis.Conclusions1.The overall outcome of brucellosis cases was not good.Acute cases had a high rate of chronicity.The longer the duration of illness is,the more likely to have higher risk of poor prognosis.To reduce chronicity;early diagnosis and treatment has high priority of human brucellosis prevention and control.Age?45 years,back pain,and joints tenderness were risk factors of adverse prognosis of brucellosis.Older cases or patients with osteoarticular complication were suggested to have longer course of treatment.2.The positive rate of blood culture and SAT showed decreasing tendency gradually along with the condition progress,which suggested that diagnostic method with high sensitivity should be used to identify chronic brucellosis cases to avoid missed diagnosis.3.Brucellosis patients showed different characteristics in different clinical stages:abnormal laboratory findings were more frequent in acute cases,and chronic cases were inclined to have osteoarticular complication.Respiratory involvement was more common in acute cases. |
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