The clinical features of 590 patients with brucellosis in Xinjiang, China with the emphasis on the treatment of complications

Background This study aims to analyze the clinical characteristics and treatment outcomes of 590 patients with brucellosis in Xinjiang, China. Methodology and principal findings The clinical characteristics, laboratory findings, complications and prognosis of 590 patients infected with brucellosis were retrospectively analyzed. These patients had a mean age of 44.24 ± 15.83 years with 60.5% having a history of close contacting with cattle and sheep. Of them, 53.6% (316 /590) were in acute phase and 21.5% were in chronic phase. Agglutination test showed 98.5% positive with 34% blood culture positive of Brucella. The major symptoms were fatigue (91%), hyperhidrosis(88.1%), fever(86.9%), and joint pain(81%) with 29.8% having enlarged liver, 26.1% having enlarged spleen and 23.2% having osteoarticular complications. Combination of doxycycline plus rifampicin for 12 weeks was an effective regimen for patients without complications. The 3-drug regimen (doxycycline+rifampicin+levofloxacin) for 12 weeks was recommended for these with complications. There were 6 patients died (1.02%) with overall relapse rate of 5.98%. Conclusions Brucellosis is mostly associated with contacting with domestic animal production in Xinjiang, China. Clinical symptoms include fever, fatigue, hyperhidrosis, and joint pain with common complication of osteoarticular involvement. Three-drug-regimen of doxycycline+rifampicin+levofloxacin for 12 weeks was effective for these patients with complications.
Author summary Brucellosis is a highly contagious zoonosis caused by bacteria of the genus Brucella and affecting mammals. Human Brucellosis is caused by ingestion of unpasteurized or undercooked food product from infected animals, or close contact with them. The infection with same bacteria even with same type can lead to manifestations varying from patient to patient. And there is no consensus for treating all types of brucellosis. In this paper, we retrospectively reviewed symptoms of Brucellosis in 590 patients living in Xinjiang area of China. We found that the percentage of chronic Brucellosis in Xinjiang from our study was 23.5%, which was higher than previous report. The reason for this increasing can be further explored. We also suggest that, despite the WHO recommended first-line 2-drug regimen is effective and preferred in most cases, the 3-drug regimen of doxycycline+rifampin+levofloxacin for 12 weeks should be recommended for patients with complications or experienced prolonged treatment. These findings are of clinical significance to improve Brucellosis management.