Original Article

Predictive Significance of Laboratory Tests in Bacteremic Brucellosis

Abstract

Background: Brucellosis is one of the most common zoonotic infections. Although culture is the gold standard diagnostic method, bacterial growth in blood cultures may not always occur due to various factors. We aimed to investigate demographic, clinical, and laboratory findings that may have predictive significance for bacteremia in brucellosis.

Methods: Patients older than 18 years of age followed up with a diagnosis of brucellosis between 2012 and 2022 were included in this retrospective multicenter study. They were divided into two main subgroups according to their Brucella species reproductive status as bacteremic and non-bacteremic.

Results: A total of 743 patients, 370 (49.80%) bacteremic and 373 (50.20%) non-bacteremic brucellosis patients, were enrolled. The mean age of the bacteremic group (36.74 years) was lower than the non-bacteremic group (43.18 yr). High fever, chills/cold, sweating, nausea, vomiting, and weight loss were more common in the bacteremic group. In the bacteremic group, white blood cell count, platelet count, hemoglobin level, mean platelet volume, eosinophil, and neutrophil counts were lower, and lymphocyte, erythrocyte sedimentation rate, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and ferritin levels were higher. According to the receiver operating characteristic (ROC) analysis, when the cut-off value of ferritin was considered 67, it was the parameter with the strongest predictive significance in Brucella bacteremia.

Conclusion: High ferritin level, low eosinophil count, and increased erythrocyte sedimentation rate were determined as the most critical laboratory findings in predicting bacteremia in brucellosis.

1. Özdem S, Tanır G, Öz FN, et al (2022). Bac-teremic and Nonbacteremic Brucellosis in Children in Turkey. J Trop Pediatr, 68(1): fmab114.
2. Qie C, Cui J, Liu Y, et al (2020). Epidemio-logical and clinical characteristics of bac-teremic brucellosis. J Int Med Res, 48(7): 0300060520936829.
3. Ozturk-Engin D, Erdem H, Gencer S, et al (2014). Liver involvement in patients with brucellosis: results of the Marmara study. Eur J Clin Microbiol Infect Dis, 33(7): 1253-1262.
4. Parlak E, Alay H, Can FK, et al (2019). Eval-uation of knowledge and behaviors of students in faculty of medicine towards rational drug use. Turk J Clin Lab, 10(3): 294 - 300.
5. Al Dahouk S, Nöckler K (2011). Implica-tions of laboratory diagnosis on brucello-sis therapy. Expert Rev Anti Infect Ther, 9(7): 833-845.
6. Copur B, Sayili U (2022). Laboratory and clinical predictors of focal involvement and bacteremia in brucellosis. Eur J Clin Microbiol Infect Dis, 41(5): 793–801.
7. Zheng R, Xie S, Lu X, et al (2018). A sys-tematic review and meta-analysis of epi-demiology and clinical manifestations of human brucellosis in China. Biomed Res Int, 2018:5712920.
8. Ulug M, Ulug NC, Selek S (2010). Patients with acute brucellosis level of acute phase reactants. Klimik J, 23: 48–50.
9. Di Bonaventura G, Angeletti S, Ianni A, et al (2021). Microbiological Laboratory Diag-nosis of Human Brucellosis: An Over-view. Pathogens, 10(12): 1623.
10. Pappas G, Papadimitriou P (2007). Chal-lenges in Brucella bacteraemia. Int J Anti-microb Agents, 30 Suppl 1:S29-31.
11. Erdem H, Elaldi N, Ak O, et al (2014). Genitourinary brucellosis: results of a multicentric study. Clin Microbiol Infect, 20(11): O847-853.
12. Abdi-Liae Z, Soudbakhsh A, Jafari S, et al (2007). Haematological manifestations of Brucellosis. Acta Med Iran, 45(2): 145-148.
13. Fruchtman Y, Segev RW, Golan AA, et al (2015). Epidemiological, diagnostic, clini-cal, and therapeutic aspects of Brucella bacteremia in children in southern Israel: A 7-year retrospective study (2005–2011). Vector Borne Zoonotic Dis, 15(3): 195-201.
14. Buzgan T, Karahocagil MK, Irmak H, et al (2010). Clinical manifestations and com-plications in 1028 cases of brucellosis: a retrospective evaluation and review of the literature. Int J Infect Dis, 14(6): e469-478.
15. Kadanali A, Ozden K, Altoparlak U, et al (2009). Bacteremic and nonbacteremic brucellosis: clinical and laboratory obser-vations. Infection, 37(1): 67-69.
16. Qie C, Cui J, Liu Y, et al (2020). Epidemio-logical and clinical characteristics of bac-teremic brucellosis. J Int Med Res, 48(7): 300060520936829.
17. Memish Z, Mah MW, Al Mahmoud S, et al (2000). Brucella bacteraemia: clinical and laboratory observations in 160 patients. J Infect, 40(1): 59-63.
18. Kara SS, Cayir Y (2019). Predictors of blood culture positivity in pediatric brucellosis. J Coll Physicians Surg Pak, 29(7): 665-70.
19. Shi C, Wang L, Lv D, et al (2021). Epidemi-ological, clinical and laboratory character-istics of patients with brucella infection in Anhui Province, China. Infect Drug Resist, 14:2741-2752.
20. Amjadi O, Rafiei A, Mardani M, et al (2019). A review of the immunopathogenesis of Brucellosis. Infect Dis (Lond), 51(5):321-333.
21. Apa H, Devrim I, Memur Ş, et al (2013). Factors affecting Brucella spp. blood cul-tures positivity in children. Vector Borne Zoonotic Dis, 13(3): 176-180.
22. Özlü C (2022). Brucellosis from Hematology Perspective. Dent Med J, 4(1): 72-78.
23. Hirosawa T, Harada Y, Morinaga K (2020). Eosinopenia as a diagnostic marker of bloodstream infection in a general inter-nal medicine setting: a cohort study. BMC Infect Dis, 20(1): 85.
24. Jiao PF, Chu WL, Ren GF, et al (2015). Ex-pression of eosinophils be beneficial to early clinical diagnosis of brucellosis. Int J Clin Exp Med, 8(10): 19491-5.
25. Mubaraki MA, Sharahili AI, Elshanat S, et al (2022). Biochemical and hematological markers as brucellosis indicators in the Najran region of Saudi Arabia. J King Saud Univ Sci, 34(6): 102138.
26. Almirón MA, Ugalde RA (2010). Iron homeostasis in Brucella abortus: The role of bacterioferritin. J Microbiol, 48(5): 668-73.
27. Bayraktar M, Bayraktar N, Bayindir Y, et al (2005). Serum C-reactive protein in pa-tients with brucellosis, iron and ferritin levels in the diagnosis and follow-up value. Ankem J, 19: 61-3.
Files
IssueVol 53 No 4 (2024) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v53i4.15556
Keywords
Brucellosis Eosinophil Ferritin Bacteremic

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Çelik M, Çiçek Y, Atalay E, Altındağ D, Akgül F, Ürkmez F, Gürbüz E, Şahin A, Özdemir Al S, Bilgiç Atlı S, Alkan S, İpek D, Oğuz Mızrakçı S, Reşat Ceylan M, Yürük Atasoy P, Kasım Karahocagil M. Predictive Significance of Laboratory Tests in Bacteremic Brucellosis. Iran J Public Health. 2024;53(4):799-808.