Challenges in case management of brucellosis: a retrospective study from an endemic region

Abstract

Human brucellosis remains a significant public health concern in northeastern Türkiye and is among the leading causes of visits to infectious disease clinics. In this study, we aimed to describe the clinical characteristics and laboratory findings of patients with brucellosis in high-burden regions, with a particular focus on identifying diagnostic indicators of complicated disease. METHODS: We conducted a retrospective study of patients with positive serology for brucellosis who were admitted to Harakani State Hospital in Kars between September 2022 and December 2023. Patients were grouped based on whether they had complicated or uncomplicated brucellosis. Potential diagnostic indicators of complicated brucellosis were identified using univariate and multivariate logistic regression. RESULTS: The study included 97 patients with a median age of 42 years; 41.2% were female. Rose Bengal and Brucellacapt/Coombs Wright (BC/CW) tests were positive in 94.8% and 98.9% of patients, respectively. Cases were classified as acute (55.7%), subacute (28.9%), and chronic (15.5%). Complicated brucellosis was identified in 33 patients (34%). In univariate analyses, complicated brucellosis was associated with thrombocytopenia (OR: 5.53; 95% CI: 1.01-30.29), elevated C-reactive protein (CRP) (OR: 5.9; 95% CI: 2.31-15.15), elevated erythrocyte sedimentation rate (ESR) (OR: 3.23; 95% CI: 1.14-9.18), and a BC/CW titer >1:320 (OR: 2.76; 95% CI: 1.13-6.72). Elevated CRP levels were observed in 43.3% of patients and remained independently associated with complicated brucellosis in multivariable analysis (adjusted OR: 4.36; 95% CI: 1.60-11.87). Relapse occurred in 13 patients (13.4%) within six months. CONCLUSIONS: The presence of thrombocytopenia, high CRP and ESR levels, and high BC/CW titers was a diagnostic indicator of complicated brucellosis. Early identification of high-risk patients using combined clinical and laboratory parameters may improve follow-up strategies and clinical outcomes.