Recently years, little research has been reported on the incidence and influence of hypocalcemia in brucellosis. Findings from our study suggested that there was a certain proportion of hypocalcemia in brucellosis patients and around 17.8% patients were found with it.
Brucellosis is a multi-system disease with diverse clinical manifestations, which may present some atypical symptoms and prompt patients to seek treatment, such as nervous systems (headache, mental symptoms, etc.)[15], consistent with previous reports.In this study, headache,anorexia, knee pain and mental symptoms in hypocalcemia group were significantly higher than those in normal corrected calcium group.Among the subjects surveyed, most of the mental symptoms of brucellosis patients are insomnia.According to research, it has been shown that calcium is the brain neuron metabolism indispensable important substances.Sufficient calcium can inhibit the abnormal excitement of brain nerves, making people remain calm.Lack of calcium makes people fidgety and unstable[16].Therefore, it can be speculated that the study object with poor sleep may be lacking of calcium in the body, resulting in emotional ups and downs and inability to sleep peacefully, which further suggests that when brucellosis patients suffer from insomnia, they should pay attention to calcium supplement.
As with complex clinical complications[17], multiple organ damage can be caused by brucellosis,such as Brucellosis spondylitis.The incidence of meningitis and ion disorder (hyponatremia, hypokalemia and hypocalcemia) in hypocalcemia group was higher than that in normal corrected calcium group, indicating that hypocalcemia affected the occurrence of various systemic diseases, including blood system, nervous system, etc.[18], suggesting that hypocalcemia may be associated with systemic disease in brucella patients.It has been described that CKD can cause nervous system complications through metabolic disorders (such as acidosis, hypocalcemia, hyperphosphatemia)[19]. Moreover, associated with the recurrence of hypocalcemia. Hypokalemia was occasionally described in literature[20]. Related to syndrome of inappropriate antidiuretic hormone among patients with brucellosis[21], hyponatremia was also occasionally reported.
In our research, the correlation between medication history and brucellosis patients with hypocalcemia was also analyzed.After multivariate Logistic regression analysis ,we found that rifampicin antibiotic medication history before the brucellosis confirmed is a risk factor for hypocalcemia, which showed the significant correlation between the application of antibiotic rifampicin class and merger of brucellosis with hypocalcemia, and bolstered the point previously put forward that rifampicin may play a role in the occurrence of hypocalcemia[22].According to literature reports, rifampicin is an enzyme inducer that can increase liver metabolism of 25-hydroxyvitamin D and reduce circulating level by up to 70%[23]. In people who already have the risk of vitamin D deficiency, rifampicin may cause symptomatic hypocalcemia in the treatment of active tuberculosis[24].Clinicians believe that anti-tuberculosis chimerism uses a standard entrainer, an exhausted vitamin D reserve, and this may be important for a osteomalacia and bone tumor[25] .It is speculated that rifampicin may induce hypocalcemia in brucellosis patients by reducing the circulating level of 25-hydroxyvitamin D, which in turn may lead to some bone-related diseases.It is further suggested that clinicians should pay attention to reminding brucellosis patients to bask in the sun and supplement calcium to prevent bone-related diseases.In addition, the history of rifampicin use is a risk factor for hypocalcemia in brucellosis patients, which may further reveal the abuse of antibiotics before diagnosis, which often delays and aggravates the disease. Then secondary complications occur, such as spondylitis, orchitis affecting fertility and life-threatening pleural effusions, which complicates the treatment of brucellosis. From this,we remind the patients to accept medical treatment timely when they feel uncomfortable, obey the doctor's instruction, and standardize the use of medicine.
In conclusion, a retrospective analysis of 572 cases was conducted, in order to better understand clinical features and epidemiological characteristics of brucellosis, and the changes of clinical parameters of brucellosis with hypocalcemia. Meanwhile, we are aimed to provide more scientific evidence on the importance of hypocalcemia in brucellosis.The indicative role of hypocalcemia on rare complications, symptoms and the severity of brucellosis need further evaluation in randomized clinical trials. In addition, primary health care physicians should be alerted when hypocalcemia was checked out in brucellosis patients and the choice of antibiotics should be paid attention to in clinical treatment of brucellosis and remind brucellosis patients to bask in the sun and supplement calcium to prevent some bone-related diseases.Finally,we remind the patients to seek medical treatment in time and standardize the use of drugs.