Predictive value of clinical and laboratory findings in diagnosis of brucellosis
Bruselloz tanısında klinik ve laboratuvar bulgularının tahmini değerleri
Özgür Dağlı 1 * , Gül Durmuş 1
1 University of Health Sciences Bursa Yüksek İhtisas Research and Training Hospital Department of Infectious Diseases and Clinical Microbiology, Bursa, Turkey
* Corresponding Author
Ortadogu Tıp Derg, Volume 10, Issue 2, pp. 162-166
https://doi.org/10.21601/ortadogutipdergisi.315062
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Abstract
Aim: 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.
Öz
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.
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