Bruselloz tanısında klinik ve laboratuvar bulgularının tahmini değerleri

Amaç: Brusellozun kesin tanısı bakterinin izolasyonu ile konsa da çoğunlukla klinik ve laboratuvar bulgulara dayanır. Bu çalışmanın amacı bruselloz'un tanısında gereken parametreleri ve tahmin değerlerini araştırmaktır. Gereç ve Yöntem: Kültürde izole ederek tanı konan 50 bruselloz hastasının klinik ve laboratuvar bulguları ile klinikte ateş nedeni ile yatırılmış 50 hastanın bulguları retrospektif olarak taranarak karşılaştırıldı. Bu veriler lojistik regresyon analizi ile değerlendirildi. Sensitivite, spesifisite, pozitif ve negatif prediktif değerler hesaplandı.Sonuçlar: Brusellozun anlamlı klinik özellikleri; hepatomegali, splenomegali, artrit, RF pozitifliği, lökopeni, trombositopeni, anemi ve artmış ALT seviyeleri olarak saptandı. Bu özelliklerden ise splenomegali, artrit, RF pozitifliği, trombositopeni ve artmış ALT seviyelerinin Bruselloz'un tanısında anlamlı tahmin değerlerine sahip olduğu tespit edildi.Yorum: Bruselloz'un tanısında serum aglütinasyon testlerinin yeterli, yüksek düzeyde spesifisite ve sensitivite değerleri bulunmamakta, kültür sonuçlarının beklenmesi de tedaviyi geciktirebilmektedir. Bu nedenle endemik bölgelerde bruselloz tanısı için bu sonuçların tahmini tanısal değerleri göz önünde bulundurulmalıdır.

Anahtar Kelimeler:

Bruselloz, teşhis, tahmin

Predictive value of clinical and laboratory findings in diagnosis of brucellosis

Objectives: Although the definitive diagnosis of brucellosis requires isolation of the Brucella species, diagnosis is usually made based on both clinical and laboratory findings. The aim of this study was to determine the minimum required parameters that could be valuable in the diagnosis of brucellosis. Material and Method: A retrospective study was performed to compare the clinical and laboratory findings in 50 patients who were confirmed to have brucellosis by cultures with 50 patients with fever. Features independently predictive of brucellosis were assessed by multivariate logistic regression. Sensitivity, specificity and positive and negative predictive values were estimated.Results: Significant clinical features of brucellosis were hepatomegaly, splenomegaly, arthritis, RF positivity, leucopenia, thrombocytopenia, anemia, and elevated ALT levels. Five of these features were found to be predictive for the diagnosis of brucellosis; splenomegaly, arthritis, RF positivity, thrombocytopenia and elevated ALT levels. Conclusion: For the diagnosis of brucellosis, serum aglutination test does not have high specificity and sensitivity and waiting the results of cultures will delay the proper treatment. Predictive value of these results are worth taking into consideration in endemic regions.

Keywords:

Brucellosis, diagnosis, prediction,

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Dear Editor-in-Chief: Please find enclosed our manuscript entitled “Predictive value of clinical and laboratory findings in the diagnosis of Brucellosis,” which we request you to consider for publication as an Original Article. Brucellosis is a zoonotic infection caused by the genus Brucella, causing a plethora of debilitating diseases. Given the protean and often non-specific nature of symptoms, clinical diagnosis of brucellosis is difficult; confirmation of infection largely depends on obtaining samples promptly with consequent laboratory confirmation and initiation of immediate antibiotic treatment. In our study, we aimed to elucidate the minimum-required laboratory and clinical parameters that can be used in the prompt diagnosis of brucellosis. We conducted a retrospective study to compare the clinical and laboratory findings from 50 patients who were microbiologically confirmed as having Brucella spp. infection and 50 patients with fever. Using multivariate logistic regression, we were able to confirm that splenomegaly [odds ratio (OR) 8.13, 95% confidence interval (CI)], arthritis (OR 16.59, 95% CI), rheumatoid factor positivity (OR 4.86, 95% CI), thrombocytopenia (OR 7.87, 95% CI), and elevated ALT levels (OR 5.3, 95% CI) were independent predictors in brucellosis diagnosis. Although our study was small, these findings are of interest, considering the significant statistical differences. The predictive values of these clinical and laboratory markers are worth considering in countries where brucellosis remains endemic. This manuscript has not been published elsewhere and is not under consideration by another journal. There are no conflicts of interest to declare. I believe that the findings of this study are relevant to the scope of your journal and will be of interest to its readership. The manuscript has been carefully reviewed by an experienced editor whose first language is English and who specializes in editing papers written by scientists whose native language is not English. I look forward to hearing from you at your earliest convenience. Sincerely, Ozgur Dagli MD,