Hakan Erdem1, Asuman Inan2, Nazif Elaldi3, Recep Tekin4, Serda Gulsun5, Cigdem Ataman-Hatipoglu6, Nicholas Beeching7, Özcan Deveci4, Aysun Yalci8, Sibel Bolukcu2, Ozgur Dagli9. 1. Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey. Electronic address: hakanerdem1969@yahoo.com. 2. GATA Haydarpasa Training Hospital, and Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey. 3. Department of Infectious Diseases and Clinical Microbiology, Cumhuriyet University School of Medicine, Sivas, Turkey. 4. Department of Infectious Diseases and Clinical Microbiology, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey. 5. Dicle University School of Medicine, and Department of Infectious Diseases and Clinical Microbiology, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey. 6. Department of Infectious Diseases and Clinical Microbiology, Ankara University School of Medicine, Ankara, Turkey. 7. Liverpool School of Tropical Medicine, Liverpool, England. 8. Ankara Training and Research Hospital, and Department of Infectious Diseases and Clinical Microbiology, Ankara University School of Medicine, Ankara, Turkey. 9. Department of Infectious Diseases and Clinical Microbiology, Gaziantep State Hospital, Gaziantep, Turkey.
Abstract
BACKGROUND: Pulmonary involvement is a rare complication of brucellosis. We describe the largest series to date, to our knowledge, of patients with pulmonary brucellosis. METHODS: This 10-year, retrospective, descriptive study involved 27 centers in Turkey, including all patients with brucellosis with confirmed respiratory system involvement. RESULTS: Of 133 patients (67 men), 123 (92.5%) had acute infection (defined as < 2 months), with an overall mean ± SD duration of symptoms of 33.9 ± 8.5 days. The radiologic pattern of pulmonary disease was consolidation/lobar pneumonia in 91 patients (68.4%) and pleural effusion in 41 patients (30.8%), including 30 (22.5%) with both. Moreover, 23 patients (17.3%) had bronchitis (one with coexistent pneumonia), and 10 (7.5%) had nodular lung lesions (one with coexistent pneumonia and effusion). Blood culture results were positive in 56 of 119 patients, and all other cases were serologically confirmed. None of 60 sputum specimens and two of 19 pleural fluid samples (10.5%) yielded positive culture results for brucellosis. Other features of brucellosis, such as osteoarticular complications, were detected in 61 patients (45.9%); 59 (44.4%) had raised liver transaminase levels, and 59 (44.4%) had thrombocytopenia. Fifteen patients (11.3%) required management in an ICU for an average of 3.8 ± 2.2 days. All patients responded to standard combination antimicrobial therapy for brucellosis with no deaths, although treatment regimens required modification in seven patients. CONCLUSIONS: Brucellosis with pulmonary involvement is rare but has a good prognosis following treatment with appropriate antibiotics. Many clues in the exposure history, presenting clinical features, and baseline blood tests should alert the clinician to consider brucellosis.
BACKGROUND: Pulmonary involvement is a rare complication of brucellosis. We describe the largest series to date, to our knowledge, of patients with pulmonary brucellosis. METHODS: This 10-year, retrospective, descriptive study involved 27 centers in Turkey, including all patients with brucellosis with confirmed respiratory system involvement. RESULTS: Of 133 patients (67 men), 123 (92.5%) had acute infection (defined as < 2 months), with an overall mean ± SD duration of symptoms of 33.9 ± 8.5 days. The radiologic pattern of pulmonary disease was consolidation/lobar pneumonia in 91 patients (68.4%) and pleural effusion in 41 patients (30.8%), including 30 (22.5%) with both. Moreover, 23 patients (17.3%) had bronchitis (one with coexistent pneumonia), and 10 (7.5%) had nodular lung lesions (one with coexistent pneumonia and effusion). Blood culture results were positive in 56 of 119 patients, and all other cases were serologically confirmed. None of 60 sputum specimens and two of 19 pleural fluid samples (10.5%) yielded positive culture results for brucellosis. Other features of brucellosis, such as osteoarticular complications, were detected in 61 patients (45.9%); 59 (44.4%) had raised liver transaminase levels, and 59 (44.4%) had thrombocytopenia. Fifteen patients (11.3%) required management in an ICU for an average of 3.8 ± 2.2 days. All patients responded to standard combination antimicrobial therapy for brucellosis with no deaths, although treatment regimens required modification in seven patients. CONCLUSIONS:Brucellosis with pulmonary involvement is rare but has a good prognosis following treatment with appropriate antibiotics. Many clues in the exposure history, presenting clinical features, and baseline blood tests should alert the clinician to consider brucellosis.
Authors: D Ozturk-Engin; H Erdem; S Gencer; S Kaya; A I Baran; A Batirel; R Tekin; M K Celen; A Denk; S Guler; M Ulug; H Turan; A U Pekok; G Mermut; S Kaya; M Tasbakan; N Tulek; Y Cag; A Inan; A Yalci; C Ataman-Hatipoglu; I Gonen; A Dogan-Celik; F Bozkurt; S Gulsun; M Sunnetcioglu; T Guven; F Duygu; E Parlak; H Sozen; S Tosun; T Demirdal; E Guclu; O Karabay; N Uzun; O Gunal; H Diktas; A Haykir-Solay; A Erbay; C Kader; O Aydin; A Erdem; N Elaldi; A Kadanali; Z Yulugkural; L Gorenek; M Altındis; S Bolukcu; C Agalar; N Ormeci Journal: Eur J Clin Microbiol Infect Dis Date: 2014-02-21 Impact factor: 3.267
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