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High index of suspicion for brucellosis in a highly cosmopolitan city in southern China
Kwok-Yung Yuen
Corresponding Author
ORCiD: https://orcid.org/0000-0003-3750-7932
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Infectious Diseases.
Background: Brucellosis is one of the most widespread zoonosis in the world. In China, 90% of human brucellosis occurs in six northern agricultural provinces. However, there is a recent increase in the trend of human brucellosis in southern provinces with limited cases reported in the literature. Our study aims to describe the clinical features and epidemiology of brucellosis in a tertiary hospital in southern China.
Methods: A retrospective case series of brucellosis was conducted between January 1, 2014 and October 31. 2018. Cases were identified based on positive Brucella serology by tube agglutination test, or positive culture from clinical specimen identified by Vitek 2 and MALDL-TOF MS. Clinical details of brucellosis including patients’ occupation, risk factors, and complications were analyzed. Clinical characteristics between patients from Guangdong and other provinces were also compared.
Results: A total of 13 cases of laboratory-confirmed brucellosis were identified. 7 (53.8%) of the patients were male, 6 (46.2%) were female, with age ranging from 29 to 73 years old (median age: 51 years). 5 patients (38.5%) were from Guangdong province, while the remaining patients (61.5%) were from other provinces. The commonest risk factors of acquisition were consumption of undercooked meat and goat placenta. Patients from Guangdong province were found to be more likely to have prior placenta consumption. The commonest clinical presentations were fever, osteoarticular pain, urinary symptoms, splenomegaly, and lymphadenopathy. Spondylodiscitis/ peripheral joint arthritis (5 patients, 38.5%) was the most prevalent complication, while extra-osteoarticular complications including abdominal aortitis, hepatosplenic abscess, chest wall abscess, and epididymo-orchitis were observed in 4 other patients. Furthermore, it was demonstrated that MALDI-TOF MS is reliable in Brucella identification after additional of reference spectra with standard Brucella strain.
Conclusions: Brucellosis, previously thought to be only found in northern China, is now increasingly seen in highly cosmopolitan part of southern China. MALDI-TOF MS in hospitals in China should include reference spectra with standard Brucella strain to aid bacterial identification in routine clinical practice. In addition to tuberculosis, typhoid fever and typhus, brucellosis should be considered in patients with fever of unknown origin in this locality.
Keywords
brucellosis, China, Clinical finding, Laboratory finding, Complication
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CURRENT STATUS: Published
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Posted 30 Dec, 2019
Published
On 08 Jan, 2020
No community comments so far
Editorial decision: Accept
On 27 Dec, 2019
Editor assigned
On 26 Dec, 2019
Submission checks complete
On 25 Dec, 2019
Editor invited
On 25 Dec, 2019
No comments provided
Editorial decision: Minor revision
On 11 Dec, 2019
Reviewer #1 agreed
On 05 Nov, 2019
Review #1 received
Received 05 Nov, 2019
Editor assigned
On 31 Oct, 2019
Reviewers invited
Invitations sent on 31 Oct, 2019
Submission checks complete
On 30 Oct, 2019
Editor invited
On 30 Oct, 2019
No comments provided
Editorial decision: Major revision
On 02 Oct, 2019
Review #2 received
Received 29 Sep, 2019
Reviewer #2 agreed
On 15 Sep, 2019
Review #1 received
Received 07 Sep, 2019
Reviewer #1 agreed
On 25 Aug, 2019
Reviewers invited
Invitations sent on 24 Jul, 2019
Editor assigned
On 01 Jul, 2019
Submission checks complete
On 30 Jun, 2019
Editor invited
On 19 Jun, 2019
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Subject Areas
Infectious Diseases
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This preprint is under consideration at BMC Infectious Diseases. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
High index of suspicion for brucellosis in a highly cosmopolitan city in southern China
Kwok-Yung Yuen
Corresponding Author
ORCiD: https://orcid.org/0000-0003-3750-7932
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 3
Posted 30 Dec, 2019
Published
On 08 Jan, 2020
No community comments so far
Editorial decision: Accept
On 27 Dec, 2019
Editor assigned
On 26 Dec, 2019
Submission checks complete
On 25 Dec, 2019
Editor invited
On 25 Dec, 2019
No comments provided
Editorial decision: Minor revision
On 11 Dec, 2019
Reviewer #1 agreed
On 05 Nov, 2019
Review #1 received
Received 05 Nov, 2019
Editor assigned
On 31 Oct, 2019
Reviewers invited
Invitations sent on 31 Oct, 2019
Submission checks complete
On 30 Oct, 2019
Editor invited
On 30 Oct, 2019
No comments provided
Editorial decision: Major revision
On 02 Oct, 2019
Review #2 received
Received 29 Sep, 2019
Reviewer #2 agreed
On 15 Sep, 2019
Review #1 received
Received 07 Sep, 2019
Reviewer #1 agreed
On 25 Aug, 2019
Reviewers invited
Invitations sent on 24 Jul, 2019
Editor assigned
On 01 Jul, 2019
Submission checks complete
On 30 Jun, 2019
Editor invited
On 19 Jun, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Infectious Diseases.
Background: Brucellosis is one of the most widespread zoonosis in the world. In China, 90% of human brucellosis occurs in six northern agricultural provinces. However, there is a recent increase in the trend of human brucellosis in southern provinces with limited cases reported in the literature. Our study aims to describe the clinical features and epidemiology of brucellosis in a tertiary hospital in southern China.
Methods: A retrospective case series of brucellosis was conducted between January 1, 2014 and October 31. 2018. Cases were identified based on positive Brucella serology by tube agglutination test, or positive culture from clinical specimen identified by Vitek 2 and MALDL-TOF MS. Clinical details of brucellosis including patients’ occupation, risk factors, and complications were analyzed. Clinical characteristics between patients from Guangdong and other provinces were also compared.
Results: A total of 13 cases of laboratory-confirmed brucellosis were identified. 7 (53.8%) of the patients were male, 6 (46.2%) were female, with age ranging from 29 to 73 years old (median age: 51 years). 5 patients (38.5%) were from Guangdong province, while the remaining patients (61.5%) were from other provinces. The commonest risk factors of acquisition were consumption of undercooked meat and goat placenta. Patients from Guangdong province were found to be more likely to have prior placenta consumption. The commonest clinical presentations were fever, osteoarticular pain, urinary symptoms, splenomegaly, and lymphadenopathy. Spondylodiscitis/ peripheral joint arthritis (5 patients, 38.5%) was the most prevalent complication, while extra-osteoarticular complications including abdominal aortitis, hepatosplenic abscess, chest wall abscess, and epididymo-orchitis were observed in 4 other patients. Furthermore, it was demonstrated that MALDI-TOF MS is reliable in Brucella identification after additional of reference spectra with standard Brucella strain.
Conclusions: Brucellosis, previously thought to be only found in northern China, is now increasingly seen in highly cosmopolitan part of southern China. MALDI-TOF MS in hospitals in China should include reference spectra with standard Brucella strain to aid bacterial identification in routine clinical practice. In addition to tuberculosis, typhoid fever and typhus, brucellosis should be considered in patients with fever of unknown origin in this locality.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5