Brucella Olgularında Ağrı Prevalansı ve Yaşam Kalitesinin Değerlendirilmesi

Amaç: Geniş bir klinik spektruma neden olan Brusellozda ağrı kaçınılmaz bir semptomdur. Bu çalışmada Bruselloz tanılı hastalarda ağrının varlığı, şiddeti, lokalizasyonu, ağrı kesici kullanımı ve yaşam kalitesi üzerine etkisini inceledik. Gereç ve Yöntemler: Klinik ve laboratuvar bulgularına göre Bruselloz tanısı alan hastalar çalışmaya dahil edildi. Hastaların yaş, cinsiyet, Brusellozun klinik evresi, organ tutulumu, serum C-reaktif protein (CRP) düzeyleri ve standart tüp aglütinasyon testi (STA) titresi kaydedildi. Skorlar, Kısa Ağrı Envanteri (BPI) ve Dünya Sağlık Örgütü Yaşam Kalitesi Ölçeği Kısa Form Türkçe Versiyonu (WHOQOL-BREF-TR) ile hastalarla yüz yüze seanslarda elde edildi. Bulgular: Çalışmaya dahil edilen 92 Brusella hastasının medyan yaşı 40.5 idi. Hastaların %54.3'ü erkek, %45.7'si kadındı. Başvuru sırasında %57,6'sı akut, %31.5'i subakut ve %10,9'u kronik Bruselloz idi. Hastaların %31.5'inde organ tutulumu mevcuttu. Tanı anında hastaların %89,1'inde ağrı şikayeti vardı. Ağrı lokalizasyonu en sık sırasıyla diz, sırt, kalça ve omuzdaydı. Hastaların %51.1'i günde en az bir kez nonsteroid antiinflamatuar ilaç kullanıyordu. Yaş, hastalık evresi, organ tutulumu, serum CRP düzeyi ve STA titresi ile WHOQOL-BREF ve VAS ölçümü değerleri arasında istatistiksel olarak anlamlı ilişki bulunmadı. WHOQOL-BREF Psikolojik (p=0.003) ve WHOQOL-BREF Sosyal (p=0.008) ölçümü değerleri kadınlarda erkeklere göre daha yüksek bulundu Sonuç: Ağrı Bruselloz hastalarında sık görülen bir semptomdur. Laboratuvar parametreleri ve organ tutulumu ne olursa olsun Bruselloz hastalarının ağrıları hastalığın tüm evrelerinde değerlendirilmelidir. Ağrı semptomları bu hasta grubunda yaşam kalitesini etkiler ve sık ağrı kesici kullanımına neden olarak istenmeyen yan etkilere neden olabilir.

Anahtar Kelimeler:

Bruselloz, ağrı, organ tutulumu, klinik evre, laboratuvar parametreleri

EVALUATION OF PAIN PREVALENCE AND QUALITY OF LIFE IN BRUCELLA CASES

Objective: Pain is an inevitable symptom in Brucellosis, which causes a wide clinical spectrum. In this study, we aimed to examine the effect of pain on presence, severity, localization, analgesic intake and quality of life in patients diagnosed with Brucella. Materail and Methods: Patients diagnosed with Brucella based on clinical and laboratory findings were included in the study. Age, gender, clinical stage of Brucella, organ involvement, serum C-reactive protein (CRP) level and standard tube agglutination test (STA) titer of the patients were recorded. The Brief Pain Inventory (BPI) and the Turkish Version of the World Health Organization Quality of Life Scale Short Form (WHOQOL-BREF-TR) were administered face-to-face to the patients. Results: The median age of 92 Brucella patients included in the study was 40.5 years. 54.3% of the patients were male and 45.7% were female. At admission, 57.6% were acute, 31.5% subacute, and 10.9% chronic. Organ involvement was present in 31.5% of the patients. At the time of diagnosis, 89.1% of the patients had pain complaints. Pain localization was most frequently in the knee, back, hip and shoulder, respectively. 51.1% of the patients were using nonsteroidal anti-inflammatory drugs (NSAIDs) at least once a day. There was no statistically significant correlation between age, disease stage, organ involvement, serum CRP level and STA titer and WHOQOL-BREF and VAS measurement values. WHOQOL-BREF Psychological (p=0.003) and WHOQOL-BREF Social (p=0.008) measurement values were found to be higher in women than men. Discussion and Conclusion : Pain is a common symptom in Brucella patients. Regardless of age, laboratory parameters and organ involvement, pain in Brucella patients should be questioned at all clinical stages. It affects the quality of life and may cause undesirable side effects by causing frequent painkiller intake.

Keywords:

Brucellosis, pain, organ involvement, clinical stage, laboratory parameters,

PDF

___

Pappas G, Papadimitriou P, Akritidis N, Christou L, Tsianos EV. The new global map of human brucellosis. Lancet Infect Dis. 2006;6(2):91-9.
Dadar M, Shahali Y, Whatmore AM. Human brucellosis caused by raw dairy products: A review on the occurrence, major risk factors and prevention. Int J Food Microbiol. 2019 Mar 2;292:39-47.
TR Ministry of Health General Directorate of Primary Health Care Work Yearbook 2016 https://dosyasb.saglik.gov.tr/Eklenti/13183,sy2016turkcepdf.pdf.Accessed on: January 2019
Dadar M, Shahali Y, Fakhri Y, Godfroid J. The global epidemiology of Brucella infections in terrestrial wildlife: A meta-analysis. Transbound Emerg Dis. 2021; 68(2):715-729.
Głowacka P, Żakowska D, Naylor K, Niemcewicz M, Bielawska-Drózd A. Brucella - Virulence Factors, Pathogenesis and Treatment. Pol J Microbiol. 2018; 67(2):151-161.
Al-Tawfiq JA, Memish ZA. Antibiotic susceptibility and treatment of brucellosis. Recent Pat Antiinfect Drug Discov. 2013;8(1):51-4.
Yagupsky P, Morata P, Colmenero JD. Laboratory Diagnosis of Human Brucellosis. Clin Microbiol Rev. 2019;33(1):e00073-19.
Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singap. 1994;23(2):129-38.
Eser SY, Fidaner H, Fidaner C, Elbi H ve ark. Measure of quality of life WHOQOL-100 and WHOQOL-Bref. 3P 1999;7(2 Suppl.):5-13.
Nematollahi S, Ayubi E, Karami M, Khazaei S, Shojaeian M, Zamani R, Mansori K, Gholamaliee B. Epidemiological characteristics of human brucellosis in Hamadan Province during 2009-2015: results from the National Notifiable Diseases Surveillance System. Int J Infect Dis. 2017;61:56-61.
Ma L, Ma J, Chen X, Dong L. A 10-year retrospective comparative analysis of the clinical features of brucellosis in children and adults. J Infect Dev Ctries. 2021;15(8):1147-1154.
Malik GM. A clinical study of brucellosis in adults in the Asir region of southern Saudi Arabia. Am J Trop Med Hyg. 1997;56(4):375-7.
Lifeso RM, Harder E, McCorkell SJ. Spinal brucellosis. J Bone Joint Surg Br. 1985 May;67(3):345-51.
Young EJ. Brucella species. In: Mandell GL, Bennet JE, Dolin R, editors. Principles and practice of infectious diseases. 7th edn. Philadelphia: Churchill Livingstone; 2010. p. 2921–5
Kayaaslan B, Bastug A, Aydin E, Akinci E, But A, Aslaner H, Yetkin MA, Bodur H. A long-term survey of brucellosis: Is there any marker to predict the complicated cases? Infect Dis (Lond). 2016;48(3):215-21.
Balın ŞÖ, Tartar AS, Akbulut A. The predictive role of haematological parameters in the diagnosis of osteoarticular brucellosis. Afr Health Sci. 2018;18(4):988-94.
Yardımcı C , Sarı D, Ceylan B, Ulutürk R, Fincancı M. The evaluation of the relationship between the duration of symptoms with STA titers, growth on blood culture and locomotor system involvement. Göztepe Tıp Dergisi 24(2):69-72, 2009.
Aygen B, Doğanay M, Sümerkan B, Yildiz O, Kayabaş U. Clinical manisfestations, complications and treatment of brucellosis: A retrospective evaluation of 480 patients. Med Mal Infect 2002;32(9):485-93.
Taamallah K, Hammami F, Gharsallah H, Koubaa M, Ben Jemaa M, Fehri W. Brucella Prosthetic Valve Endocarditis: A Systematic Review. J Saudi Heart Assoc. 2021;33(3):198-212.
Cesur S, Çapar Y, Demir P, ve ark. Brusellozlu 104 olgunun retrospektif olarak incelenmesi. İnfeksiyon Dergisi. 2004;18 (2):169–73.
Demirdağ K, Özden M, Kalkan A, Çelik İ, Kılıç SS. Bruselloz: 146 olgunun retrospektif değerlendirilmesi. Flora Dergisi. 2002;7 (2):120–25.
Shaalan MA, Memish ZA, Mahmoud SA, Alomari A, Khan MY, Almuneef M, Alalola S. Brucellosis in children: clinical observations in 115 cases. Int J Infect Dis. 2002;6(3):182-6.
Pappas G, Akritidis N, Bosilkovski M, Tsianos E. Brucellosis. N Engl J Med. 2005 ;352(22):2325-36.
Tali ET. Spinal infections. Eur J Radiol. 2004;50(2):120-33.
Vardar İ, Türker N, Cebelli İ, Kölgeli O, Uçdu M, Ayaydın A. Bruselloz: 120 erişkin olgunun klinik, laboratuar ve tedavi özelliklerinin değerlendirilmesi. İzmir Atatürk Eğitim Hastanesi Tıp Dergisi. 2002;40(1):67–70.
Turan H, Serefhanoglu K, Karadeli E, Togan T, Arslan H. Osteoarticular involvement among 202 brucellosis cases identified in Central Anatolia region of Turkey. Intern Med. 2011;50(5):421-8.