Epidemiological And Clinical Features Of Brucellosis In Northeastern Sichuan

Objective: To analyze the epidemiological and clinical features of Brucellosis in northeastern Sichuan,and summarize the diagnosis and treatment experience of brucellosis,so as to reduce the rate of misdiagnosis and missed diagnosis,provide assistance for the diagnosis,treatment and prevention of brucellosis in northeastern Sichuan.Methods: The data of brucellosis cases in northeastern Sichuan from January 2014 to December 2017 were retrospectively analyzed,including Nanchong City,Guangyuan City,Guangan City,Dazhou City and Bazhongv City.The data were collected by contacting local hospitals to collect clinical data,by contacting local centers for disease control and prevention(CDC)to collect epidemiological data,and by telephone follow-up.Results:1 Epidemiological data: A total of 37 confirmed cases of brucellosis were collected from five cities in northeastern Sichuan in the past four years.The number of cases from 2014 to 2017 showed an increasing trend;the average age of onset of brucellosis was 46.97 years,the ratio of male to female was 1.78:1,and the occupation was mainly farmer and herdsman(64.9%);brucellosis occured throughout the months of the year,and the epidemic peaks from April to July;29 cases(78.4%)had clear contact history with diseased animals,3 cases(8.1%)had consumed their beef,mutton and dairy products;5 cases(13.5%)had no clear contact history.2 clinical data:(1)Clinical manifestation: The most common clinical symptoms were fever(32 cases,86.5%),mostly moderate to high fever,other symptoms were fatigue(23 cases,62.2%),hyperhidrosis(22 cases,59.5%),joint soreness(21 cases,56.8%),muscle soreness(20 cases,54.1%),nervous system symptoms(13 cases,35.1%),respiratory system symptoms(8 cases,21.6%),digestive system symptoms(8 cases,21.6%)and urinary system symptoms(2 cases,5.4%)and skin symptoms(1 case,2.7%).The common signs included lymphadenopathy(8 cases,21.6%),splenomegaly(8 cases,21.6%),serous effusion(4 cases,10.8%)and testicular swelling(3 cases,8.1%).There were 9 departments in which patients first visited,26 cases(70.3%)were definitely diagnosed after one hospitalization,5 cases(13.5%)after two hospitalizations,3 cases(8.1%)after three hospitalizations,1 cases(2.7%)after four hospitalizations and 2 cases(5.4%)after more than four hospitalizations.(2)aboratory examination: Routine laboratory examinations: In this study,22 patients were collected for routine laboratory examinations,including 15 patients(55.6%)with abnormal blood routine examinations,main manifestation was mild cytopenia involving one or more cell lineage,but Only 3 patients had mild leukocyte elevation(?13.0 c10^ 9/L).8 patients(29.6%)with abnormal liver function examinations,normal renal function examinations and 4 patients(14.8%)with hypokalemia by electrolyte examinations.Serological and Pathogenic examination of Brucellosis: Of the 37 patients in this study,23 patients were only cultured for etiology and the results were all positive;4 patients were only had serological tests and the results were all positive;10 patients had both serological and pathogenic cultures,two of the patients had positive serological tests but the pathogenic cultures were negative,the other eight patients were positive for both tests.(3)Treatment regimen: A total of 37 patients were collected in this study.Four of them collected epidemiological data and diagnostic information through CDC,but the treatment plan and prognosis were unknown,therefore,a total of 33 patients were collected,of which 17 were cured and 16 were not cured(improved).19 out of 33 patients received detailed treatment options as follows:(1)13 patients were cured,the course of treatment was at least 6 weeks,but the course of treatment for patients with testicular epididymitis was 24 weeks.Drug selection scheme: Two patients were treated with rifampicin alone and fever abated after 4 days of treatment.Ten patients were treated with combination of two drugs: Rifampicin + doxycycline treatment was the most common treatment(7 cases in total)and fever abated after 3 days of treatment;Two patients were treated with rifampicin + streptomycin and fever abated after 4.5 days of treatment;One patient were treated with rifampicin + levofloxacin and fever abated after 3 days of treatment.One patient was treated with a triple regimen consisting of streptomycin + doxycycline + levofloxacin and fever abated after 2 days of treatment.(2)A total of 6 patients were not cured(improved): Two patients were treated with cefoperazone sulbactam alone for one week;Two patients were treated with cefoperazone sulbactam + levofloxacin for 1-2 weeks;One patient with testicular epididymitis was treated with rifampicin + levofloxacin + moxalactam for 8 weeks;One patient was treated with rifampicin + levofloxacin + cefoperazone tazobactam for 9 weeks without any other complications.Conclusion:1 Overall,most of the patients were young and middle-aged males,the occupation was mainly farmer and herdsman;The epidemic peaks from April to July;The main route of transmission of brucellosis is direct or indirect exposure to infected sheep and their contaminants;2 The clinical manifestations of brucellosis are diverse and lack of specificity.Fever is the most prominent and often comes to the doctor because of it.It is suggested that the possibility of brucellosis should be taken into account when the fever and hyperhidrosis are found in patients in northeastern Sichuan without obvious chills,shiver and elevated or slightly elevated white blood cells.3 At present,bacterial culture is the main method of diagnosis of brucellosis in northeastern Sichuan.Serological examination of brucellosis should be strengthened according to the recommendation of the guidelines so as to diagnose brucellosis quickly and conveniently.4 The majority of patients with brucellosis in northeastern Sichuan can get satisfactory results by choosing a reasonable plan according to the guidelines and giving standardized foot therapy.The most convincing treatment was rifampicin combined with doxycycline for 6 weeks,aminoglycosides or third-generation cephalosporins or quinolones can be added to patients with complications,and the course of treatment can be prolonged appropriately.