Brucellosis in cases of end-stage renal disease

Patients with brucellosis frequently present with joint and bone pain. However, brucellosis may be overlooked in patients with end-stage renal disease (ESRD) who undergo dialysis since amyloidosis due to renal osteodystrophy and beta-2 microglobulinaemia may cause bone pain as well. Only four cases of end-stage renal failure accompanied by brucellosis have been reported in the literature. We evaluated clinical and laboratory characteristics and organ involvement of seven brucellosis patients with end-stage renal failure and compared them with brucellosis cases without any renal diseases.

This is a prospective study and involved 158 patients diagnosed with brucellosis. All the patients were divided into two groups: brucellosis patients with ESRD (Group 1) and brucellosis patients without any renal disease (Group 2).

Group 1 included 7 patients (5 males and 2 females with the mean age 52.1 +/- 14 years) and Group 2 included 151 patients (62 males and 89 females with the mean age 45.4 +/- 16 years). Out of seven patients in Group 1, one had neurobrucellosis, one had paravertebral abscess, one had epidural abscess and one had peripheral arthritis. In addition, one patient in Group 1 with accompanying sickle cell anaemia presented with pain crisis and was diagnosed with brucellosis on admission. Serological tests were negative for brucellosis, but Brucella melitensis was isolated in blood cultures in another patient with accompanying continuous ambulatory peritoneal dialysis. Group 1 more frequently had joint pain and malaise. B. melitensis was isolated in blood cultures in blood taken in the absence of fever in half of the cases in Group 1 positive for B. melitensis in blood cultures on admission.

B. melitensis can be isolated in blood cultures even in the absence of high fever. In fact, in the present study, B. melitensis was isolated in most of the cases without high fever. For this reason, blood cultures should be performed in cases of end-stage renal diseases suspected of having brucellosis although fever is not present. In addition, brucellosis can present various clinical forms in endemic areas, mimics several diseases and can be characterized with severe complications.