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Mixed infections or co-infections are not uncommon in dengue fever which can occur as a result of transient suppression of host immunity by unknown mechanisms or as a part of its complication. Brucellosis co infection or post dengue complication can occur due to the indigenous practice of consumption of raw unpasteurized cattle milk. Here is a case report of a 14-year-old girl who presented with dengue fever but then continued to have persistence of fever spikes with abdominal pain requiring administration of antibiotics as well as upgradation, on evaluation was found to have splenic abscess with prior history of ingestion of raw goat抯 milk with serology suggestive of Brucellosis. This case report was done to elucidate the likelihood of co infection of zoonoses like dengue and brucellosis and the importance of consideration of brucellosis as a differential in cases of unresolving pyrexia post dengue fever especially in countries with wide prevalence of this practice of consumption of unpasteurized cattle milk.
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Background According to the Classification and Catalogue of Occupational Diseases, brucellosis is one of the notifiable occupational infectious diseases, which occurs from time to time in the occupational population. Objective To compare the work-related injury appraisal process and results of 13 cases of brucellosis at both provincial and municipal levels, analyze and summarize the bias in the practical work of labor capacity identification for occupational diseases such as brucellosis by appraisal management departments and experts, and propose suggestions for optimizing appraisal work. Methods A comparative study was conducted on the objective examination results and labor capacity appraisal conclusions based on the occupational contact history, clinical diagnosis, occupational disease diagnosis staging, and labor capacity appraisal of 13 patients with brucellosis. The reasons for the inconsistency between the initial appraisal conclusion by institutions at the municipal level and the final appraisal conclusion by institutions at the provincial level were compared and analyzed. Results All of the 13 patients with brucellosis applied for municipal-level labor capacity identification after being identified as work-related injuries, 11 of which did not receive a disability level, and 2 were rated as level 10 disability. Four of those who did not receive the disability rate applied for provincial-level labor capacity identification. As a result, 2 cases were maintained original appraisal conclusions, while the other 2 changed the conclusions to level 9 disability and level 10 disability respectively. It was the first time in Shijiangzhuang municipal-level primary labor capacity appraisal and Hebei provincial-level labor capacity re-appraisal that the work-related injury caused by occupational brucellosis was rated as level 9 disability or level 10 disability. Hence, the lessons learned from this comparative analysis are that the degree of target organ damage and (or) organ dysfunction are the direct basis for work-related injury appraisal; an objective and scientific labor capacity identification for occupational brucellosis should base on the each case of disability evaluation, identify the relevant target organ damage and the degree of dysfunction, and rate the disability level after a comprehensive appraisal. Conclusion This analysis would be a guidance to the identification of labor capacity for occupational brucellosis in Hebei Province and the whole country. There is a hysteresis issue in the occupational disease provisions in the national standard GB/T 16180—2014 Standard for identify work ability—Gradation of disability caused by work-related injuries and occupatiaonal diseases. In current situation, appraisal experts should not only search for clauses that directly correspond to the occupational diseases and injuries, but also target conditions not covered in the clauses and conduct assessment based on the characteristics of occupational diseases, with scientific, accurate, and flexible application of the clauses in the standard and appendix, so as to make fair, just, and professional appraisal conclusions.
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Objective:To study the changes in serum small molecule metabolites after brucella infection in humans using untargeted metabolomics methods, and screening representative biomarkers. Methods:A total of 109 serum samples collected from January 2019 to December 2021 at the Brucellosis Clinic of the Baotou Center for Disease Control and Prevention were divided into acute phase group ( n = 40), chronic phase group ( n = 35) of brucellosis, and healthy group ( n = 34) based on clinical diagnosis. Ultra-high performance liquid chromatography quadrupole time-of-flight mass spectrometry technology was used to test serum samples and screen for differential metabolites. Receiver operating characteristic curve was used to evaluate the predictive ability of differential metabolites for brucellosis. Enriched pathways were screened using Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway to identify metabolic pathways significantly affected. Results:A total of 17 differential metabolites were screened between the acute phase group and the healthy group, and 12 differential metabolites were screened between the chronic phase group and the healthy group. There were a total of 5 differential metabolites (oleamide, linoleamide, stearamide, palmitoleic acid, α-linolenic acid) statistically significant among the three groups ( F = 16.84, 17.52, 14.31, 13.01, 20.76, P < 0.05). KEGG pathway analysis showed that the differential metabolites in the acute phase group were enriched in metabolic pathways such as ether lipid metabolism, glycerophosphate metabolism, sphingolipid signal and sphingolipid metabolism. The differential metabolites in the chronic phase group were enriched in metabolic pathways such as glycerophosphate metabolism, ether lipid metabolism, protein digestion and absorption metabolism. Conclusion:Untargeted metabolomics methods can screen out serum small molecule metabolites that undergo changes after brucella infection in the human body, including oleamide, linoleamide, stearamide, palmitoleic acid, α-linolenic acid can serve as potential biomarkers to distinguish brucellosis patients from healthy people.
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Objective:To investigate the epidemic distribution and characteristics of brucellosis in Heze City, and to provide a basis for formulating prevention and control measures in the future.Methods:The data of Heze City brucellosis reported from January 1, 2017 to December 31, 2021, were collected from the China Disease Prevention and Control Information System. The epidemiological case questionnaires of brucellosis in Heze City from January 1, 2017 to December 31, 2021 were collected from the centers for disease control and prevention of various cities, counties and districts. Retrospective analysis was used to conduct a descriptive analysis of the distributions, clinical manifestations and epidemiological history 3 weeks prior to the onset of the disease in Heze City from 2017 to 2021.Results:From 2017 to 2021, a total of 1 543 cases of brucellosis were reported in Heze City, with no death. The highest incidence was in 2018 (5.16/100 000). The peak period was from March to June each year (759 cases). There were cases reported in all counties (districts) of the city, and the counties (districts) with more cases were Mudan District (386 cases), Cao County (271 cases), Yuncheng County (251 cases), Shan County (138 cases) and Juye County (132 cases). The minimum age of onset was 11 months, and the maximum was 84 years old, mainly between the ages of 20 to 69 (1 381 cases). The gender ratio between males and females was 2.50 ∶ 1.00 (1 102 ∶ 441). Farmers had the highest incidence of the disease (1 329 cases). Main clinical manifestations were fever, hyperhidrosis, fatigue, muscle and joint soreness. Epidemiological history investigation within 3 weeks before the onset of the disease revealed 1 124 cases of close contact with animals, including 1 044 cases of contact with sheep.Conclusions:From 2017 to 2021, the incidence of brucellosis in Heze City shows a trend of first rising and then decreasing, and the epidemic affects all counties (districts) of the city, mainly middle-aged and elderly men. In the future, it is necessary to strictly control the flow of diseased animals, increase immunization and quarantine, and block the transmission route.
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Objective:To study the epidemic characteristics of human brucellosis in Yunnan Province, and to provide a reliable scientific basis for formulating accurate prevention and control strategies of brucellosis.Methods:The epidemic data of human brucellosis in Yunnan Province from January 2019 to December 2021 were collected from the information system of the China Center for Disease Control and Prevention, as well as annual monitoring data on brucellosis reported by various states (municipalities) in Yunnan Province. Descriptive epidemiological methods were adopted to analyze the epidemic situation, distribution characteristics (time, region, population), and serological and pathogenic monitoring results of brucellosis.Results:From 2019 to 2021, 1 408 cases of brucellosis were reported in Yunnan Province, with an average annual incidence of 1.00/100 000. The number of cases increased from 321 in 2019 to 701 in 2021, and the incidence increased from 0.68/100 000 in 2019 to 1.50/100 000 in 2021. The onset time was mainly from April to September (857 cases). The top 3 regions with the highest number of reported cases were Kunming City (483 cases), Qujing City (379 cases), and Honghe Hani and Yi Autonomous Prefecture (281 cases), accounting for 81.18% (1 143/1 408) of the total number of cases. The age of onset was mainly 20 - < 70 years old, accounting for 89.70% (1 263/1 408). There were 958 males and 450 females, with a sex ratio of 2.13 ∶ 1.00. Farmers were the main occupation, accounting for 84.02% (1 183/1 408). From 2019 to 2021, a total of 26 280 serum samples from key populations of brucellosis were monitored in Yunnan Province, with 572 positive serological tests and a positive rate of 2.18% (572/26 280). A total of 169 strains of Brucella were isolated from blood samples from hospitals throughout the province, including 155 strains of sheep type 3 and 14 strains of sheep type 1. Conclusions:From 2019 to 2021, the incidence of human brucellosis in Yunnan Province has been on the rise, with a high incidence in summer and autumn. The main population affected is young and middle-aged male farmers. Therefore, it is necessary to strengthen disease monitoring and health education for key populations during the high incidence season.
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Objective:Clinical characteristics and diagnosis and treatment process was reported and analyzed of a patient with brucellosis complicated with thyroid abscess, providing reference for the clinical diagnosis of brucellosis complicated with thyroid abscess.Methods:Clinical medical records of a patient with brucellosis complicated with thyroid abscess who was treated at the General Surgery Department of Yanchi County People's Hospital in Wuzhong City, Ningxia Hui Autonomous Region in November 2021 were collected. The clinical manifestations, blood routine, brucella antibodies, thyroid function, bacterial culture, thyroid ultrasound and other examination results, as well as the diagnosis and treatment process, were comprehensively analyzed. Results:The patient was a male, 61 years old, who presented with a neck mass without typical clinical manifestations of brucellosis. Thyroid ultrasound revealed a space occupying lesion, and the preliminary diagnosis was thyroid cystadenoma. Thyroid right lobe and isthmus resection surgery was performed. During the operation, it was found that some of the thyroid glands were tightly adhered to the cervical blood vessels, so the resection surgery was changed to abscess drainage, and the drainage fluid was purulent and bloody. The bacterial culture result of thyroid purulent fluid (intraoperative puncture fluid and postoperative drainage fluid) was brucella lamblia, and the serum brucella test tube agglutination test titer was 1 ∶ 400 (+++). The patient improved and was discharged after local drainage and anti brucella treatment. Follow up for 4 months showed no abnormalities. Conclusions:Brucellosis which begins with a local infection of the thyroid gland is extremely rare, with no characteristic clinical manifestations, and is prone to misdiagnosis. Timely correction of the surgical plan during the treatment process avoids the removal of the patient's thyroid, which has a certain clinical reference value.
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Objective:To analyze the clinical symptoms and laboratory characteristics of patients with brucellosis combined with osteoarthritis.Methods:A retrospective analysis was conducted on the medical records of 168 patients with brucellosis who were hospitalized at the Jining Public Health Medical Center, Shandong Province from January 2021 to December 2022. Based on the imaging examination results, they were divided into combined osteoarthritis group and non combined osteoarthritis group. The demographic characteristics, clinical symptoms, and laboratory test results of the two groups of patients were compared and analyzed.Results:Among 168 patients with brucellosis, there were 83 patients with concurrent osteoarthritis, 85 patients without concurrent osteoarthritis, the males and females ratio was 2.73 ∶ 1.00 (123 ∶ 45), and the age was 56 (46, 64) years old. The median age of patients in combined osteoarthritis group was higher than that of patients in non combined osteoarthritis group (58 years vs 53 years, Z = - 2.89, P = 0.004). In clinical symptoms, the incidence of back pain, fatigue, and joint muscle pain in patients of combined osteoarthritis group was significantly higher than that in the non combined osteoarthritis group [75.9% (63/83) vs 56.5% (48/85), 30.1% (25/83) vs 15.3% (13/85), 47.0% (39/83) vs 17.6% (15/85), χ 2 = 7.07, 5.27, 16.58, P < 0.05]. In laboratory tests, the erythrocyte sedimentation rate (ESR) and hypersensitive C-reactive protein (hs-CRP) levels in patients of combined osteoarthritis group were higher than those in the non combined osteoarthritis group [27.0 (17.0, 34.0) mm/h vs 21.0 (10.5, 34.0) mm/h, 22.7 (14.3, 43.4) mg/L vs 17.9 (10.8, 34.2) mg/L, Z = - 2.51, - 2.00, P < 0.05]. Among patients with combined osteoarthritis, combined spondylitis accounted for the highest proportion (55.4%, 46/83), followed by peripheral arthritis (51.8%, 43/83). Conclusion:Osteoarthritis is a common complication of brucellosis, and patients of brucellosis with concurrent osteoarthritis have clinical features such as lower back pain, fatigue, and joint muscle pain, with significantly elevated of ESR and hs-CRP level.
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Brucellosis is a zoonotic infectious disease caused by Brucella infection. So far, animal to animal Brucellosis has not been eradicated, and there is a lack of safe and effective human vaccine. Therefore, "early, combined, sufficient, and full course" drug treatment remains an important strategy in the management of human Brucellosis. The goal of treating brucellosis is to alleviate and shorten the symptom period, reduce complications, relapses, and chronicity. At present, although antibiotic treatment is effective for most patients, there are still some patients who experience treatment failure or later recurrence, so the treatment strategy for brucellosis urgently needs to be optimized. This article elaborates on the treatment principles, clinical treatment status, and future development trends of brucellosis, in order to provide references for optimizing drug treatment methods for brucellosis.
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Objective:To analyze the epidemic characteristics of brucellosis in China from 2004 to 2018, in order to understand the development trend of brucellosis.Methods:The surveillance data of brucellosis in China from 2004 to 2018 were collected from National Public Health Science Data Center. Joinpoint regression was used to analyze the trend of brucellosis incidence in China and various provinces. Overall trends were estimated by the average annual percentage change (AAPC). Seasonal and trend decomposition using loess (STL) was used to analyze the seasonal characteristics of brucellosis in China and various provinces. The age-related thermodynamic diagram of incidence rate was used to analyze the characteristics of age-onset changes.Results:From 2004 to 2018, a total of 524 980 brucellosis cases and 16 deaths were reported nationwide, with a incidence rate of 2.61/100 000 and a case fatality rate of (3.05 × 10 -3)%. The incidence of brucellosis in China was on the rise (AAPC = 11.58%, 95% CI: 7.91% - 15.25%, P < 0.001). There was no significant trend of change in Inner Mongolia Autonomous Region, Shanxi and Shaanxi provinces ( P > 0.05). Tibet Autonomous Region showed a downward trend (AAPC = - 55.19%, P < 0.001). All other provinces were showing an upward trend (AAPC > 0, P < 0.05). The peak incidence in China occurred from April to June. In terms of provinces, the peak incidence in Hainan, Sichuan, Guizhou, Fujian and Anhui provinces occurred from April to August, the peak incidence in Chongqing and Shanghai cities occurred from June to August, and the peak incidence in other provinces was generally from April to June. There were reports of brucellosis cases in all age groups nationwide, and the age distribution showed an inverted "V" shape. The peak incidence occurred in the 50 - 54 years old (5.43/100 000), followed by the 60 - 64 years old (4.94/100 000). From 2004 to 2018, the top 3 age groups of incidence rate changed from 40 - 44, 50 - 54 and 35 - 39 years old in 2004 to 50 - 54, 60 - 64 and 55 - 59 years old in 2018. Conclusions:The incidence of brucellosis is on the rise nationwide and in most provinces from 2004 to 2018. The high incidence age is gradually changing to the elderly population.
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ObjectiveTo explore the clinical characteristics of neurobrucellosis in Kashi， Xinjiang Uygur Autonomous Region， thus improve the diagnosis and treatment. MethodsA retrospective analysis was conducted on the clinical data of 18 cases of neurobrucellosis who were admitted to the First People's Hospital of Kashi Prefecture between December 2019 and January 2024. ResultsThe study included 9 males and 9 females， with a median age of 36 years （range： 17-54.5）. A clear epidemiological history was found in all the 18 brucllosis patients， 12 of whom presented with meningoencephalitis， 5 meningitis， and 1 encephalitis. Two comorbided with spinal meningitis， 2 osteoarthritis and 1 epididymitis. Most frequently reported clinical symptoms were headache， fever and fatigue. The prevalence rates of brucellosis by rose bengal plate agglutination test （RBPT） and serum agglutination test （SAT） were 11/12 and 8/9， respectively. Two of 10 patients had positive blood cultures， four of 16 had positive cerebrospinal fluid （CSF） cultures and five of five were detected to be positive by next-generation sequencing （NGS） for pathogens in CSF. CSF showed exudative changes and elevated number of leukocytes， with predominance of single nucleated cells. All patients were treated with the combined use of two to four from the drugs like doxycycline， rifampicin， ceftriaxone， cefixime， minocycline， levofloxacin and sulfanilamide. Most patients had a favorable prognosis. ConclusionsNeurobrucellosis should be considered in all patients with central nervous system manifestations from endemic areas. If there are exudative changes in CSF， differential diagnoses can be made by serological testing， blood culture， CSF culture and NGS. NGS could significantly increase the accuracy for neurobrucellosis diagnosis.
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Objective To explore the application of seasonal autoregressive integrated moving average (ARIMA) model in the prediction of brucellosis in Urumqi, and to use this model to predict the incidence trend of brucellosis in Urumqi. Methods The monthly incidence data of brucellosis in Urumqi from January 2010 to December 2021 were selected to construct the ARIMA prediction model. The prediction effect of the model was evaluated by mean standard deviation (RMSE) and mean absolute error (MAE). The monthly incidence of brucellosis in Urumqi in 2022 was predicted by the constructed model. Results The incidence of brucellosis in Urumqi had obvious seasonal distribution, and the cases were concentrated from May to July. ARIMA(1,1,1)(1,0,1)12 was the optimal prediction model, with RMSE=0.883 and MAE=5.24. The monthly incidence of brucellosis in Urumqi in 2022 was predicted to be 7, 4, 4, 6, 9, 9, 10, 7, 7, 5, 5, and 5 cases, respectively. Conclusion ARIMA model can well fit and predict the monthly incidence of brucellosis in Urumqi and provide a basis for the monitoring and prevention of brucellosis.
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RESUMEN Objetivo. Determinar la seroprevalencia de brucelosis y leptospirosis en cerdos de granjas de pequeña escala en áreas rurales del partido de Tandil, Argentina; analizar los factores de riesgo asociados; describir los serogrupos de Leptospira spp. prevalentes y determinar la distribución espacial de ambas enfermedades. Materiales y métodos. Se obtuvieron 340 muestras de suero. Se utilizaron la prueba de aglutinación en placa, la prueba de Rosa de Bengala y el Test de Polarización de la Fluorescencia para detectar anticuerpos contra Brucella spp. Se aplicó la Prueba de Aglutinación Microscópica para el diagnóstico de leptospirosis. Se utilizaron métodos estadísticos para evaluar los factores asociados a las infecciones. Resultados. Se observaron seroprevalencias de 0 y 22,6% para brucelosis y leptospirosis, respectivamente. Los serogrupos de Leptospira más prevalentes fueron: Canicola, Ballum, Icterohaemorrhagiae y Pomona. Los principales factores de riesgo asociados a la infección por leptospirosis fueron el mayor número de cerdos, la presencia de equinos y la presencia de jabalíes cerca o dentro de las granjas. Se asoció el uso de subproductos de cereal como alimento para los animales y el uso de cajón para el destete. Se detectó un agrupamiento espacial significativo de seropositividad a Leptospira spp. en un área de baja altitud. Conclusiones. La brucelosis probablemente esté controlada, pero Leptospira spp. se encuentra presente en estas producciones. El conocimiento de la seroprevalencia de la brucelosis y la leptospirosis, su distribución espacial y los factores de riesgo asociados puede ser útil para la prevención y el control de enfermedades zoonóticas endémicas en la región.
ABSTRACT Objectives. To determine the seroprevalence of brucellosis and leptospirosis in pigs reared on small-scale farms in rural areas of the district of Tandil, Buenos Aires Province, Argentina; to analyse the associated risk factors; to describe the prevalent Leptospira spp. serogroups; and to determine the spatial distribution of both diseases. Materials and methods. A total of 340 serum samples were obtained. Buffer Plate Agglutination Test, Rose Bengal Test, and Fluorescence Polarisation Assay were used to detect antibodies against Brucella spp. Microscopic Agglutination Test was applied for serological diagnosis of leptospirosis. Statistical methods were used to evaluate the factors associated with the infections. Results. Seroprevalence of 0% and 22.6% was observed for brucellosis and leptospirosis, respectively. The most prevalent Leptospira serogroups identified were Canicola, Ballum, Icterohaemorrhagiae and Pomona. The main risk factors associated with leptospirosis infection were farms with a higher number of pigs and the presence of horses and wild boars near or within the farms. The use of milling by-products of cereal grains as animal feed and the presence of weaning cages were also associated. A relevant spatial cluster of seropositivity to Leptospira spp. was identified in a low-altitude area. Conclusions. Our results suggest that brucellosis is probably controlled, but Leptospira spp. are present in the farming systems under study. Knowledge of brucellosis and leptospirosis seroprevalence, spatial distribution and associated risk factors can be useful for the prevention and control of endemic zoonotic diseases in the region.
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Objective To perform a visual bibliometric analysis of hot spots as well as areas of Brucella disease research by searching brucellosis related literature. Methods A thematic search was conducted in the web of science core set database using Brucella disease or brucellosis as keywords to retrieve literature between January 1985 and December 2021. CiteSpace was used to visualize the countries, institutions, authors, and keywords in the retrieved relevant literatures. Results A total of 4 495 eligible articles studies were included, with the United States being the most populous country and the University of Sao Paulo being the most influential. Jilin University and Shihezi University in Xinjiang, China were relatively influential in this field. For the key words analysis, the top 3 of high-frequency words were infection, diagnosis, abortion, and in the 12 clusters formed, the clusters formed by #1, #4 were larger and the research hotspot continued. Keywords in the last five years including human brucellosis, immunity, zoonotic disease, were highlighted. Conclusion Study analysis suggested that human brucellosis with zoonosis was a research hotspot, more scholars focused on the infectious route and other exposure risks of cattle as intermediate hosts, epidemiological studies on brucellosis or will be new trends.
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@#Abstract: Objective To investigate the clinical characteristics and incidence of Brucella encephalitis and meningitis in children. Methods We report the clinical data of a child with Brucella melitensis meningitis in children, and summarize the incidence, diagnosis methods and treatment of Brucella encephalitis or meningitis in children, taking into account the relevant domestic and foreign literature from January 2014 to December 2020. Results A 4-year-old girl was admitted to the hospital with status epilepticus on March 15, 2021 because of interrupted right limb numbness for 16 hours and convulsions for 2 hours. She had 2 non-febrile convulsions three months before admission and was diagnosed with epilepsy. This incident was acute, accompanied by low fever, with epilepsy as the main manifestation. Cerebrospinal fluid test suggested central nervous system infection, but the nature of infection could not be determined by routine and biochemistry of cerebrospinal fluid.The cerebrospinal fluid next generation sequencing confirmed that the pathogen of the infection was B. melitensis, which was further verified by the peripheral blood antibody test. After effective antibiotics combined with a full course of treatment, the patient recovered after six months of treatment. A total of 60 articles were retrieved in the database, including 29 in Chinese. During this period, a total of 7 cases of brucellosis in children with nervous system involvement were reported, one of which was a case report, and the other 6 cases were mentioned in the comprehensive analysis of children with brucellosis. Conclusions Brucella encephalitis or meningitis in children has a low incidence and various clinical features, which are easy to be misdiagnosed or missed.
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ObjectiveTo describe the serological surveillance results of human brucellosis in Ganzhou City， Jiangxi Province from 2018 to 2021， characterize the epidemic and current situation of brucellosis， and to provide scientific evidence for effective prevention and control of brucellosis. MethodsSurveillance data of human brucellosis serological testing was collected in Ganzhou City from 2018 to 2021. Spatial， temporal， and demographic distribution was further determined. ResultsFrom 2018 to 2021， a total of 42 humans serologically positive for brucellosis were reported from 18 counties （cities and districts） in Ganzhou City， including 26 males and 16 females with a gender ratio of 1.6∶1. The number of serologically positive cases showed a decreasing trend， with the positive rate decreasing from 46.43% in 2018 to 33.33% in 2021. Majority of the cases （54.00%） aged 40‒ years old. Furthermore， the number of serologically positive cases varied by month； majority of the cases （80.95%） was from April to August. Additionally， a total of 10 counties （cities and districts） reported serologically positive cases of brucellosis， among which the top 3 counties （cities and districts） by cumulative number of positive cases were Zhanggong District （18 cases）， Dayu County（5 cases）， and Longnan City（4 cases）. ConclusionSerologically positive cases of human brucellosis decrease in Ganzhou， in which the incidence of male cases is generally higher than female cases. The seasonality of human brucellosis is in spring and summer. At-risk population is 40‒ years old. Additionally， at-risk areas are southwest and central areas of Ganzhou.
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Objective:To study the clinical characteristics and prognosis of Brucella and other pathogens infections complicated with anti-myelin oligodendrocyte glycoprotein-IgG associated disorders (MOGAD). Methods:The clinical data of a patient with brucellosis complicated with MOGAD diagnosed in the Department of Neurology of the First Affiliated Hospital of Zhengzhou University in April 2022 were reported, and related case reports of infection coexisting with MOGAD were reviewed and summarized.Results:This case was a 44-year-old male, with recurrent fever and anorexia, followed by sudden weakness, numbness, pain in both lower limbs and dysuria, and then pain in the right neck. Magnetic resonance imaging showed lesions in the spine and spinal cord. Due to the positive myelin oligodendrocyte glycoprotein antibodies in cerebrospinal fluid and serum, and the growth of Brucella in blood culture, he was diagnosed as brucellosis complicated with MOGAD. After anti-brucellosis and glucocorticoid therapy, his symptoms improved. The literature on infection coexisting with MOGAD was reviewed and 22 cases were included. The infection sources included COVID-19, Borrelia burgdorferi, etc. No case of Brucella infection complicated with MOGAD had been reported. The main clinical manifestations of the 22 cases included myelitis (63.6%, 14/22), optic neuritis (40.9%, 9/22), acute disseminated encephalomyelitis (18.2%, 4/22), multiphasic disseminated encephalomyelitis (4.5%, 1/22) and meningoencephalitis (4.5%, 1/22). Magnetic resonance imaging was performed in 20 cases, showing spinal cord lesions in 12 cases (60.0%, 12/20), intracranial lesions in 10 cases (50.0%, 10/20) and optic nerve lesions in 6 cases (30.0%, 6/20). Cerebrospinal fluid examination was performed in 19 patients, of whom 13 (13/19) had increased cerebrospinal fluid cell count and 10 (10/18) had increased cerebrospinal fluid protein. Twenty-two patients received glucocorticoid therapy, of which 95.5% (21/22) responded well and 95.5% (21/22) had a good prognosis. Conclusions:Brucella and other pathogens infection may complicate with MOGAD, with similar clinical manifestations, and glucocorticoid therapy is effective.
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Objective:To investigate the clinical characteristics of atypical neurobrucellosis.Methods:Retrospective analysis was made on the epidemiological characteristics, clinical manifestations, laboratory and imaging findings of five cases of atypical neurobrucellosis admitted to the People's Hospital of Inner Mongolia Autonomous Region from December 2020 to June 2021.Results:The age of the five cases ranged from four to sixty-nine years old, including three females and two males. Four cases had a clear history of sheep contact. Serum F1 antibody against brucellosis was positive in all five cases, serum tube agglutination test (SAT) was positive in three cases, lumbar puncture cerebrospinal fluid (CSF) examination showed increased intracranial pressure in four cases, and bacterial smear and tuberculosis culture were negative in all of the five cases. After magnetic resonance imaging (MRI), two cases were found to have abnormal intracranial high signals, of which one case was abnormal in bilateral frontal parietal lobe and right temporal occipital lobe, showing long T1 and T2 signals and increased fluid-attenuated inversion recovery sequence(FLAIR) signal; and another case was abnormal in bilateral corona radiata, posterior limbs of internal capsule and bilateral cerebral peduncles, it showed continuous T2 and FLAIR slightly high signal intensity. One case had abnormal signal in the spinal cord, showing a small patch like long T2 signal on the right side of the spinal cord at the level of C2-3 discs. Electromyography was abnormal in one case. Among the five cases, two cases presented with brucellosis encephalitis, one case with brucellosis myelitis, one case with glossopharyngeal nerve damage caused by brucellosis, and one case with brucellosis cerebrospinal neuropathy. All five patients were treated with a combination of doxycycline, rifampicin and ceftriaxone, and three patients had a good prognosis.Conclusions:The clinical manifestations of atypical neurobrucellosis are various. Clinicians should strengthen their understanding of the disease and reduce the chance of missed diagnosis and misdiagnosis.
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Objective:To learn about the epidemic dynamics and spatial epidemic characteristics of human brucellosis in Gansu Province.Methods:Data on human brucellosis in Gansu Province reported by China Disease Control and Prevention Information System from January 2016 to December 2020 were collected and analyzed by descriptive epidemiology and spatial clustering analysis.Results:A total of 10 025 cases of human brucellosis were reported in Gansu Province from 2016 to 2020, with a statistically significant difference in incidence rate between years (χ 2 = 242.86, P = 0.001). The incidence was the lowest in 2018 (6.03/100 000), and the highest in 2020 (11.39/100 000). The reported cases were concentrated in 45 - 55 years old, accounting for 34.52% (3 461/10 025); the male to female ratio was 2.91 ∶ 1.00 (7 458/2 567); farmers were the main occupation, accounting for 82.11% (8 232/10 025). Among the 86 counties (cities, districts) in Gansu Province, Yongchang County had the highest number of reported cases in 2020 (339 cases), and Sunan Yugur Autonomous County had the highest incidence in 2020 (190.89/100 000). Spatial autocorrelation analysis showed that there was significant spatial positive correlation between the incidence rate of human brucellosis in Gansu Province from 2016 to 2020 (global Moran's I > 0, Z > 1.96, P < 0.05), showing a spatial clustering distribution. The high-high clustering areas were concentrated in Yongchang County and Sunan Yugur Autonomous County. Conclusion:In Gansu Province, the main population of human brucellosis is middle-aged male farmers, and the incidence of brucellosis is spatially clustered.
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Objective:To investigate the diagnostic value of 99mTc-methylenediphosphonate(MDP) whole body bone scintigraphy in early brucellosis patients with bone and joint injuries. Methods:According to the Diagnosis for Brucellosis (WS 269-2019), combined with epidemiological history, clinical manifestations and serological tests, from November 2020 to April 2021, 15 early brucellosis patients (the course of disease was within 6 months) who had not received any drug treatment diagnosed at the Department for Brucellosis Prevention and Control, Qinghai Institute for Endemic Disease Prevention and Control were selected as the research subjects, and 99mTc-MDP whole body bone scintigraphy was performed on the patients to evaluate the images and analyze the pathological changes. Results:The 99mTc-MDP whole body bone scintigraphy of 15 patients with early brucellosis showed abnormalities, and the abnormal concentration of radionuclides mainly occurred in the 8th to 12th thoracic vertebrae (T8-12), the 1st to 2nd lumbar vertebrae (L1-2) and L4-5. Among them, the thoracic vertebrae abnormalities were T8, T9, T10, T11 and T12 in 1 case each; lumbar vertebrae abnormalities were 1 case of L1, 1 case of L2, 4 cases of L4, and 5 cases of L5. Conclusions:The 99mTc-MDP whole body bone scintigraphy is abnormal in patients with early brucellosis. Bone scintigraphy has certain value in the diagnosis of bone and joint injuries in patients with early brucellosis.
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Objective:To construct a follow-up evaluation index system for "Diagnosis of Brucellosis" (WS 269-2019), and provide a reference basis for the next revision and improvement of the standard.Methods:The evaluation index system for "Diagnosis of Brucellosis" (WS 269-2019) was preliminarily established by consulting relevant references and materials. The experts in the field of diagnosis, treatment, prevention and control of brucellosis were selected, and two rounds of expert consultation were carried out in the form of questionnaires using the Delphi method. The necessity and availability of evaluation indicators were scored, and suggestions for modifying and adding indicators were put forward. Based on this, a standard follow-up evaluation index system was established. At the same time, a judgment matrix was constructed combined with the Saaty scale, and the analytic hierarchy process was used to calculate the weight of each index in the system.Results:After 2 rounds of expert ( n = 10) consultation, a standard follow-up evaluation index system for "Diagnosis of Brucellosis" (WS 269-2019) was constructed with 3 first-level indexes, 8 second-level indexes and 21 third-level indexes. The positive coefficients of experts in 2 rounds of questionnaires were both 100%; the coefficient of authority of experts was 0.82; the Kendall's coefficients of concordance of first-level, second-level and third-level indexes were 0.722, 0.260, and 0.181, respectively, with P < 0.05. Among the first-level indexes, the weight of standard quality evaluation was the highest (0.364), and the weight of standard implementation status was the lowest (0.278); among the second-level indexes, the combined weight of social benefits was the highest (0.186), and the combined weight of advanced nature was the lowest (0.043); among the third-level indexes, the combined weight of timely diagnosis rate was the highest (0.096), and the combined weight of consistency with technical data was the lowest (0.009). Conclusions:The constructed follow-up evaluation index system for "Diagnosis of Brucellosis" (WS 269-2019) is scientific and reliable, which evaluated qualitatively and quantitatively, reduces the defects of a single evaluation, and provides a basis for subsequent revision and improvement of the standard.