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      Hepatobiliary Brucellosis: Brucella Bacteremia Presenting with Refractory Hepatobiliary Infection

      case-report
      1 , , 1 , , 2
      Case Reports in Critical Care
      Hindawi

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          Abstract

          Brucellosis often presents with common and nonspecific symptoms such as fever, malaise, and arthralgia but can also involve primary organs. Intra-abdominal involvement is rare. We report a case of hepatobiliary brucellosis presenting as a refractory hepatobiliary infection in a healthy young adult with no underlying rheumatologic disease or history of exposure to risk factors. Detection of Brucella in the blood led to a shift in the patient's management and consequently her recovery.

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          Most cited references16

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          Human brucellosis.

          Human brucellosis still presents scientists and clinicians with several challenges, such as the understanding of pathogenic mechanisms of Brucella spp, the identification of markers for disease severity, progression, and treatment response, and the development of improved treatment regimens. Molecular studies have shed new light on the pathogenesis of Brucella spp, and new technologies have permitted the development of diagnostic tools that will be useful in developing countries, where brucellosis is still a very common but often neglected disease. However, further studies are needed to establish optimum treatment regimens and local and international control programmes. This Review summarises current knowledge of the pathogenic mechanisms, new diagnostic advances, therapeutic options, and the situation of developing countries in regard to human brucellosis.
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            Brucellosis.

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              Complications associated with Brucella melitensis infection: a study of 530 cases.

              We carried out a prospective study of 530 patients older than 14 years of age with brucellosis. We describe the incidence and clinical features of the focal forms of the disease, analyzing some of the possible factors associated with their appearance. One hundred sixty-nine patients (31.9%) had a focal form or complication. Osteoarticular complications were the most frequent, totaling 113 cases (66%), followed by genitourinary with 18 cases (5.1% of males), hepatic (2.5%), neurologic (1.7%), and heart (1.5%). Nine patients (1.7%) had more than 1 complication. In a multivariate analysis, diagnostic delay greater than 30 days (OR 2.0), ESR > 40 mm/hr (OR 1.9), and levels of alpha-2 globulin > 7.5 g/L (OR 6.8) were statistically significant independent variables associated with the presence of focal forms. Twenty-five patients with complications (14.8%) required surgical treatment. The relapse rate was 3.6% for those patients without complications and 4.1% for patients with focal forms (p > 0.05). However, when therapeutic failure, relapses, and mortality were considered together, the risk of an unfavorable evolution was significantly greater in patients with focal forms (10.6% versus 3.6% in patients without complications; OR 1.9, 95% CI 1.4-7.1, p < 0.005). Given the worse prognosis, knowledge and early diagnosis of the focal forms of B. melitensis infection is especially important.
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                Author and article information

                Contributors
                Journal
                Case Rep Crit Care
                Case Rep Crit Care
                CRICC
                Case Reports in Critical Care
                Hindawi
                2090-6420
                2090-6439
                2023
                11 November 2023
                : 2023
                : 5513052
                Affiliations
                1Beirut Arab University, Beirut, Lebanon
                2Lebanese University, Lebanon
                Author notes

                Academic Editor: Mehmet Doganay

                Author information
                https://orcid.org/0009-0001-7501-3063
                https://orcid.org/0009-0000-4493-9499
                https://orcid.org/0000-0002-4261-6474
                Article
                10.1155/2023/5513052
                10657239
                76a7b611-d68e-47ea-9d2a-026b0923680b
                Copyright © 2023 Dania El Hallak et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 12 July 2023
                : 23 October 2023
                : 3 November 2023
                Categories
                Case Report

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