Background: A descriptive study of the characteristics of brucellosis patients in Jordan and antimicrobial therapy. Methods: In an outpatient study, records were reviewed between July 2016 and April 2024 and electronically saved. Brucella diagnosis was based on epidemiological factors, risk factors, the standard tube agglutination test (STA), and blood or tissue cultures. Records were uploaded into a spreadsheet and imported into the R-Program. A 2-sample Kruskal-Wallis rank sum tested the equality of proportions between two treatment regimens for all available and spondylodiscitis, P < 0.05 was considered significant. Results: Two hundred patients with Brucellosis were analyzed; males 106 (53%) with a mean age of 46.8 years, and females 94 (47%) with a mean age of 48.1 years. Patients from Jordan were 159 (79.9%), and the Arabian Peninsula 25 (12.6%). Brucellosis was a non-focal presentation in 121 (60.50%) patients, spondylodiscitis in 64 (32.0%), and sacroiliitis in 7 (3.5%). Spondylodiscitis involved lumbar 48 (75.0%), thoracic 11 (17.20%), and cervical 5 (7.8%). STA was a common diagnostic method (188, 94%). Risk factors included cheese 80 (47.3%), cattle, small ruminants, and she-camel milk 37 (21.89%), dairy products 28 (16.57%), meat 9 (05.33%), and working with cattle 10 (05.92%). ESR was highest in spondylodiscitis (mean of 54.5). Imaging studies commonly requested were MRI and Bone scans. Doxycycline/Rifampin were mostly prescribed antimicrobials. Conclusion: There is no clear guidance on brucella treatment. In endemic areas, brucella is still a concern. Population education must be a priority. Support for randomized trials addressing antimicrobials and durations is extremely needed.
References
[1]
Obaidat, M.M., Malania, L., Arner, R.J. and Roess, A.A. (2022) Seroprevalence and Risk Factors for Brucella Infections in Jordan. The American Journal of Tropical Medicine and Hygiene, 107, 576-580. https://doi.org/10.4269/ajtmh.21-0952
[2]
Taha, H., Smith, C., Durham, J. and Reid, S. (2023) Identification of a One Health Intervention for Brucellosis in Jordan Using System Dynamics Modelling. Systems, 11, Article 542. https://doi.org/10.3390/systems11110542
[3]
Pappas, G., Papadimitriou, P., Akritidis, N., Christou, L. and Tsianos, E.V. (2006) The New Global Map of Human Brucellosis. The Lancet Infectious Diseases, 6, 91-99. https://doi.org/10.1016/s1473-3099(06)70382-6
[4]
Abo Shehada, M.N. and Abu Halaweh, M. (2013) Risk Factors for Human Brucellosis in Northern Jordan. Eastern Mediterranean Health Journal, 19, 135-140. https://doi.org/10.26719/2013.19.2.135
[5]
EMPHNET (2021) Evaluating the Impact of Enhanced Laboratory Based Surveillance of Animal and Human Brucellosis in Jordan. Brucellosis Surveillance Jordan Newsletter.
[6]
Al-Sanouri, T., Khader, Y., Hailat, E., Iweir, S., Abu Khudair, M. and Al Nsour, M. (2023) Seroprevalence of Human Brucellosis among Syrian Refugees in Jordan, 2022. Journal of Pathogens, 2023, Article 5885316. https://doi.org/10.1155/2023/5885316
[7]
Lina, S.M.M., Kunasekaran, M.P. and Moa, A. (2021) Brucellosis Outbreak in China, 2019. Global Biosecurity, 3, 1-11. https://doi.org/10.31646/gbio.108
[8]
Pappas, G. (2022) The Lanzhou Brucella Leak: The Largest Laboratory Accident in the History of Infectious Diseases? Clinical Infectious Diseases, 75, 1845-1847. https://doi.org/10.1093/cid/ciac463
[9]
Li, N., Yu, F., Peng, F., Zhang, X. and Jia, B. (2020) Probable Sexual Transmission of Brucellosis. IDCases, 21, e00871. https://doi.org/10.1016/j.idcr.2020.e00871
[10]
Memish, Z.A. and Mah, M.W. (2001) Brucellosis in Laboratory Workers at a Saudi Arabian Hospital. American Journal of Infection Control, 29, 48-52. https://doi.org/10.1067/mic.2001.111374
[11]
Pan, S., Zhao, Y., Zhou, K., Chen, S., Maimaitiming, M., Wu, J., et al. (2024) Incidence and Outcomes of Brucella Endocarditis in a High-Prevalence Area: A Single-Center Study. Journal of Epidemiology and Global Health. https://doi.org/10.1007/s44197-024-00232-6
[12]
Yarmuhamedova, N.A., Djuraeva, K.S., Samibaeva, U.X., Bahrieva, Z.D. and Shodieva, D.A. (2020) Clinical and Epidemiological Aspects of Neurobrucellosis According to the Information of Samarkand Municipal Infectious Diseases Hospital. Інфекційні хвороби, 3, 60-65. https://doi.org/10.11603/1681-2727.2020.3.11554
[13]
Skenderi, E., Sulovari, A., Kuli-Lito, G., Shahini, N., Toci, G. and Pema, A. (2021) COVID-19 and EBV Co-Infection in a Child. Journal of Biosciences and Medicines, 9, 20-27. https://doi.org/10.4236/jbm.2021.95003
[14]
Alinaghian, M. and Avijgan, M. (2016) Brucellosis Presented as Thyroiditis: A Rare Case Report. Advances in Infectious Diseases, 6, 157-162. https://doi.org/10.4236/aid.2016.64019
[15]
Bouferraa, Y., Bou Zerdan, M., Hamouche, R., Azar, E., Afif, C. and Jabbour, R. (2021) Neurobrucellosis: Brief Review. The Neurologist, 26, 248-252. https://doi.org/10.1097/nrl.0000000000000348
[16]
Naderi, H., Sheybani, F., Parsa, A., Haddad, M. and Khoroushi, F. (2022) Neurobrucellosis: Report of 54 Cases. Tropical Medicine and Health, 50, Article No. 77. https://doi.org/10.1186/s41182-022-00472-x
[17]
Posit Team (2024) RStudio: Integrated Development Environment for R. Posit Software, PBC, Boston, MA. http://www.posit.co/
[18]
EMPHNET (2021) Brucellosis Surveillance Jordan Newsletter 2021. https://emphnet.net/media/etjp0osa/brucellosis-surveillance-newsletter-issue-4.pdf
[19]
Bosilkovski, M., Dimzova, M. and Grozdanovski, K. (2009) Natural History of Brucellosis in an Endemic Region in Different Time Periods. Acta Clinica Croatica, 48, 41-46.
[20]
Spernovasilis, N., Karantanas, A., Markaki, I., Konsoula, A., Ntontis, Z., Koutserimpas, C., et al. (2024) Brucella Spondylitis: Current Knowledge and Recent Advances. Journal of Clinical Medicine, 13, Article 595. https://doi.org/10.3390/jcm13020595
[21]
Turgut, M., Turgut, A.T. and Koşar, U. (2006) Spinal Brucellosis: Turkish Experience Based on 452 Cases Published during the Last Century. Acta Neurochirurgica, 148, 1033-1044. https://doi.org/10.1007/s00701-006-0877-3
[22]
Lim, K., Kwak, Y., Kim, D., Kim, Y. and Kim, J. (2012) Back Pain Secondary to Brucella Spondylitis in the Lumbar Region. Annals of Rehabilitation Medicine, 36, 282-286. https://doi.org/10.5535/arm.2012.36.2.282
[23]
Ariza, J., Pujol, M., Valverde, J., Nolla, J.M., Rufi, G., Viladrich, P.F., et al. (1993) Brucellar Sacroiliitis: Findings in 63 Episodes and Current Relevance. Clinical Infectious Diseases, 16, 761-765. https://doi.org/10.1093/clind/16.6.761
[24]
Slobodin, G., Rimar, D., Boulman, N., Kaly, L., Rozenbaum, M., Rosner, I., et al. (2016) Acute Sacroiliitis. Clinical Rheumatology, 35, 851-856. https://doi.org/10.1007/s10067-016-3200-6
[25]
Dayan, L., Deyev, S., Palma, L. and Rozen, N. (2009) Long-Standing, Neglected Sacroiliitis with Remarked Sacro-Iliac Degenerative Changes as a Result of Brucella spp. Infection. The Spine Journal, 9, E1-E4. https://doi.org/10.1016/j.spinee.2008.03.011
[26]
Shi, Y., Gao, H., Pappas, G., Chen, Q., Li, M., Xu, J., et al. (2018) Clinical Features of 2041 Human Brucellosis Cases in China. PLOS ONE, 13, e0205500. https://doi.org/10.1371/journal.pone.0205500
[27]
Morovati, S., Bozorgomid, A., Mohammadi, A., Ahmadi, F., Arghand, L., Khosravi Shadmani, F., et al. (2024) Brucellar Arthritis and Sacroiliitis: An 8-Year Retrospective Comparative Analysis of Demographic, Clinical, and Paraclinical Features. Therapeutic Advances in Infectious Disease, 11. https://doi.org/10.1177/20499361241246937
[28]
Bagheri Nejad, R., Krecek, R.C., Khalaf, O.H., Hailat, N. and Arenas-Gamboa, A.M. (2020) Brucellosis in the Middle East: Current Situation and a Pathway Forward. PLOS Neglected Tropical Diseases, 14, e0008071. https://doi.org/10.1371/journal.pntd.0008071
[29]
Al-Amr, M., Abasi, L., Khasawneh, R., Almharat, S., Al-Smadi, R., Abbasi, N., et al. (2022) Epidemiology of Human Brucellosis in Military Hospitals in Jordan: A Five-Year Study. The Journal of Infection in Developing Countries, 16, 1870-1876. https://doi.org/10.3855/jidc.16861
[30]
Pal, M., Kerorsa, G.B., Desalegn, C. and Kandi, V. (2020) Human and Animal Brucellosis: A Comprehensive Review of Biology, Pathogenesis, Epidemiology, Risk Factors, Clinical Signs, Laboratory Diagnosis. American Journal of Infectious Diseases, 8, 118-126.
[31]
Bush, L.M. and Vazquez-Pertejo, M.T. (2024) Brucellosis (Undulant Fever; Malta Fever; Mediterranean Fever; Gibraltar Fever; Bang Disease). https://www.msdmanuals.com/professional/infectious-diseases/gram-negative-bacilli/brucellosis
[32]
Ozturk-Engin, D., Erdem, H., Gencer, S., Kaya, S., Baran, A.I., Batirel, A., et al. (2014) Liver Involvement in Patients with Brucellosis: Results of the Marmara Study. European Journal of Clinical Microbiology & Infectious Diseases, 33, 1253-1262. https://doi.org/10.1007/s10096-014-2064-4
[33]
Uysal, S., Dana, F., Işikgöz, M., Kismali, E., Sipahi, O.R., Pullukçu, H., et al. (2014) Evaluation of Hepatosplenomegaly and Liver Function Tests in 102 Brucellosis Cases. Mediterranean Journal of Infection Microbes and Antimicrobials, 3, 1-3.
[34]
Deniz, S., Baykam, N., Celikbas, A., Yilmaz, S.M., Guzel, T.C., Dokuzoguz, B., et al. (2015) Screening Household Members of Acute Brucellosis Cases in Endemic Areas and Risk Factors for Brucellosis. Vector-Borne and Zoonotic Diseases, 15, 468-472. https://doi.org/10.1089/vbz.2014.1723
[35]
Özcanaslan, F.Ç., Çay, Ü., Özgür Gündeşlioğlu, Ö., Ünal, İ. and Kocabaş, E. (2021) Retrospective Evalution of Pediatric Brucella Patients Followed and Family Screening with Household Members for Brucella Infection. Journal of Pediatric Infection, 15, 73-78. https://doi.org/10.5578/ced.202119801
[36]
Solera, J., Geijo, P., Largo, J., Rodriguez-Zapata, M., Gijon, J., Martinez-Alfaro, E., et al. (2004) A Randomized, Double-Blind Study to Assess the Optimal Duration of Doxycycline Treatment for Human Brucellosis. Clinical Infectious Diseases, 39, 1776-1782. https://doi.org/10.1086/426024
[37]
Al-Derzi, N.A. (2007) The Value of 2-Mercaptoethanol Test in Diagnosing Recurrent Active Brucellosis. Dohuk Medical Journal, 1, 23-31.
[38]
Roushan, M.R.H., Amiri, M.J.S., Laly, A., Mostafazadeh, A. and Bijani, A. (2010) Follow-up Standard Agglutination and 2-Mercaptoethanol Tests in 175 Clinically Cured Cases of Human Brucellosis. International Journal of Infectious Diseases, 14, e250-e253. https://doi.org/10.1016/j.ijid.2009.05.008
[39]
Mansoori, N. and Pourmand, M.R. (2016) Vaccines and Vaccine Candidates against Brucellosis. Infection, Epidemiology and Medicine, 2, 32-36. https://doi.org/10.18869/modares.iem.2.4.32
[40]
Heidary, M., Dashtbin, S., Ghanavati, R., Mahdizade Ari, M., Bostanghadiri, N., Darbandi, A., et al. (2022) Evaluation of Brucellosis Vaccines: A Comprehensive Review. Frontiers in Veterinary Science, 9, Article 925773. https://doi.org/10.3389/fvets.2022.925773
[41]
Elbehiry, A., Aldubaib, M., Marzouk, E., Abalkhail, A., Almuzaini, A.M., Rawway, M., et al. (2023) The Development of Diagnostic and Vaccine Strategies for Early Detection and Control of Human Brucellosis, Particularly in Endemic Areas. Vaccines, 11, Article 654. https://doi.org/10.3390/vaccines11030654
[42]
WHO (2020) Brucellosis. https://www.who.int/news-room/fact-sheets/detail/brucellosis#:~:text=The%20incubation%20period%20of%20the,g%20daily%20for%2015%20days.Last
[43]
Brucellosis CDC Yellow Book 2024. https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/brucellosis#:~:text=A%20combined%20regimen%20of%20doxycycline,the%20treatment%20of%20uncomplicated%20infection
[44]
Ariza, J., Gudiol, F., Pallarés, R., Rufí, G. and Fernández-Viladrich, P. (1985) Comparative Trial of Rifampin-Doxycycline versus Tetracycline-Streptomycin in the Therapy of Human Brucellosis. Antimicrobial Agents and Chemotherapy, 28, 548-551. https://doi.org/10.1128/aac.28.4.548
[45]
Ariza, J., Gudiol, F., Pallares, R., Viladrich, P.F., Rufi, G., Corredoira, J., et al. (1992) Treatment of Human Brucellosis with Doxycycline Plus Rifampin or Doxycycline Plus Streptomycin. Annals of Internal Medicine, 117, 25-30. https://doi.org/10.7326/0003-4819-117-1-25
[46]
Soares, C.N., Angelim, A.I.M., Brandão, C.O., Santos, R.Q., Mehta, R. and da Silva, M.T.T. (2022) Neurobrucellosis: The Great Mimicker. Revista da Sociedade Brasileira de Medicina Tropical, 55, e0567-2021. https://doi.org/10.1590/0037-8682-0567-2021