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Human brucellosis in Kuwait: a prospective study of 400 cases
A R Lulu1, G F Araj, M I Khateeb
1Medical Department, Jahra Hospital, Ministry of Public Health, Kuwait.
Abstract:
The clinical pattern of 400 cases of brucellosis in Kuwait is presented. The disease was acute in 77 per cent, sub-acute in 12.5 per cent and chronic in 10.5 per cent of cases. Raw milk was the major source of infection. The major features on presentation, irrespective of the course of the disease, were fever, sweating, headache, rigors, arthralgia, myalgia, and low back pain. Hepatosplenomegaly was present in 41 per cent of cases and in 32 per cent neither liver nor spleen were palpable. The haematologic findings were not specific and hepatic dysfunction (shown by liver enzyme abnormalities) was common. Skeletal (26 per cent) and genital (8.5 per cent) changes and neurobrucellosis (7 per cent) were the major complications. The ELISA was the most sensitive and reliable diagnostic test especially in relation to chronic brucellosis and neurobrucellosis. ELISA allowed the determination of brucella-specific immunoglobulins (Ig)G, IgM and IgA in the CSF, and provided profiles of Ig, in sera, which were different in patients with chronic (elevated IgG and IgA) from those with acute (elevated IgM alone or IgG, IgM and IgA) brucellosis. Treatment with tetracycline, doxycycline or rifampicin gave a cure rate of over 91 per cent in acute and subacute brucellosis. Co-trimoxazole was associated with a relapse rate of 50 per cent. Two drug combinations of streptomycin and tetracycline, streptomycin and rifampicin or streptomycin and doxycycline were effective, but one of five patients with chronic brucellosis relapsed. A combination of streptomycin, tetracycline and rifampicin with or without steroids was used successfully in neurobrucellosis, septicaemic shock and subacute bacterial endocarditis.
Insights
Brucellosis in Kuwait predominantly presents acutely, with raw milk as the main infection source. Effective treatments include tetracycline, doxycycline, or rifampicin, with ELISA proving a reliable diagnostic tool.
Area of Science:
- Infectious Diseases
- Bacteriology
- Public Health
Background:
- Brucellosis is a significant zoonotic disease with diverse clinical manifestations.
- Understanding the epidemiology and clinical spectrum is crucial for effective management.
Purpose of the Study:
- To describe the clinical patterns, diagnostic approaches, and treatment outcomes of brucellosis in Kuwait.
- To evaluate the efficacy of different diagnostic tests and therapeutic regimens.
Main Methods:
- Retrospective analysis of 400 brucellosis cases in Kuwait.
- Clinical data collection, including symptoms, physical findings, laboratory results, and complications.
- Evaluation of diagnostic tests, primarily ELISA, for immunoglobulin profiling.
- Assessment of treatment regimens and relapse rates.
Main Results:
- Brucellosis was acute in 77%, sub-acute in 12.5%, and chronic in 10.5% of cases, with raw milk as the primary source.
- Common symptoms included fever, sweating, headache, and arthralgia. Hepatosplenomegaly occurred in 41%.
- ELISA demonstrated high sensitivity and reliability, differentiating immunoglobulin profiles in acute versus chronic brucellosis. Skeletal and neurobrucellosis were significant complications.
- High cure rates (>91%) were achieved with tetracycline, doxycycline, or rifampicin in acute/subacute cases. Combination therapies showed effectiveness, particularly for complicated cases.
Conclusions:
- Brucellosis in Kuwait presents with a predominantly acute clinical pattern, linked to raw milk consumption.
- ELISA is a valuable diagnostic tool, aiding in distinguishing disease phases.
- Standard antibiotic regimens are highly effective, but careful monitoring is needed for chronic cases and complications like neurobrucellosis.