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УДК:616.98:579.841.93
NEW ASPECTS OF THE CLINICAL COURSE
OF CHRONIC BRUCELLOSIS
Maxtob Alimovna Farmanova
Bukhara Medical Institute Buxara, Uzbekistan
Resume
The purpose of this work was to study the clinical and diagnostic features of the
course of chronic forms of brucellosis.
Material and research methods. We conducted a clinical diagnostic examination
of 60 patients with chronic brucellosis who were hospitalized.
Results and its discussion. The issue of great theoretical and practical
importance is the study of the clinical status of the adult organism of patients with
brucellosis in the age aspect. Among the patients with chronic brucellosis examined
by us, in 54 (90.0%) patients, the disease began chronically (gradual onset in 10.0%)
with high fever in 56 (93.3%), accompanied by chills in 54 (90.0%) and sweating 56
(93.3%). 52 (86.6%) patients also had headaches and weakness.
When the infection was generalized against the background of high temperature,
the knee, ankle (35%) and relatively rarely hip (5%) joints, as well as the cervical
spine (1%) were more often affected.
Key words: Chronic brucellosis, clinic, symptoms, Wright-Hedelson.
КЛИНИКО-ЛАБОРАТОРНАЯ ХАРАКТЕРИСТИКА
БРЮЦЕЛЕЗНОЙ ИНФЕКЦИИ
Бухарский государственный медицинский институт.
Бухара, Узбекистан
Целью настоящей работы явилось изучение клинико-диагностических
особенностей течения хронических форм бруцеллеза.
Материал и методы исследование.
Нами было проведено клиническое-
диагностическое обследование 60 больных хроническим бруцеллезом,
находившихся на стационарном лечении.
Результаты и их обсуждение.
Среди обследованных нами больных
хроническим бруцеллезом у 54 (90,0%) больных заболевания началось
хронически (постепенное начало у 10,0%) с высокой температурой у 56
(93,3%), сопровождавшиеся ознобом 54 (90,0%) и потливостью 56 (93,3%). У
52 (86,6%) больных также отмечалась головные боли и слабость . При
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генерализации инфекции на фоне высокой температуры чаще поражались
коленные, голеностопные (35%) и сравнительно редко тазобедренные (5%)
суставы, а также шейный отдел позвоночника (1%).
Ключевые слова:
Хронический бруцеллез, клиника, симптомы, Райт-
Хедельсон.
BRUSELLA INFEKTSIONNING KLINIK-LABORATORIY
XARAKTERISTIKASI
Buxoro davlat tibbiyot instituti
Buxoro, O’zbekiston
Rezume
Ishning maqsadi brutsellyozning surunkali shakllarining kechishining klinik va
diagnostik xususiyatlarini o'rganish.
Materiallar va tadqiqot usullari. Surunkali brutsellyoz bilan kasalxonaga
yotqizilgan 60 nafar bemorni klinik diagnostik tekshiruvdan o‘tkazildi.
Natijalar va uning muhokamasi. Surunkali brutsellyoz bilan ko‘rikdan o‘tgan
bemorlarning 54 nafarida (90,0%) kasallik surunkali shaklda boshlangan (10,0 foizda
sekin-asta boshlangan), 56 nafarida (93,3 foiz) yuqori isitma, 54 nafarida (90,0 foiz)
sovuq qotish va terlash bilan kechgan. 56 (93,3%). 52 (86,6%) bemorda bosh og'rig'i
va umumiy holsizlik kuzatildi.
Tana harorati oshishi fonida generalizasiyalashgan bo'lsa, tizza, tovon (35%) va
nisbatan kamdan-kam hollarda son-chanoq (5%) bo'g'imlari, shuningdek, bo'yin
umurtqa pog'onasi (1%) zararlanadi.
Kalit so'zlar: Surunkali brutselloz, klinikasi, belgilari, Rayt-Xedelson.
Introduction. One of the most common zoonoses in the territory of the Republic
of Uzbekistan is brucellosis infection. The socio-economic significance of the
problem of brucellosis is determined by the peculiarities of the course of this infection
with the frequent development of chronic forms, often leading to long-term disability
and disability, and the working-age population is the main affected contingent, which
is associated with both professional factors and social reasons [1,2].
According to M. Avijgan et al. (2019), according to the WHO fact sheet,
although about half a million cases of brucellosis are registered annually, the true
incidence is always 10–25 times higher than the reported number of cases [4]. In the
book "Brucellosis. The current state of the problem”, published by Academician of
the Russian Academy of Sciences G.G. Onishchenko and corresponding member.
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RAS A.N. Kulichenko in 2019, presented a systematic analysis of the incidence of
brucellosis per 100 thousand population in individual countries [9,10,11].
Thus, the highest incidence is observed in Saudi Arabia - 6.0-149.5, in Jordan -
25.7-130.0, in Egypt - 0.28-70.0, in Turkey - from 11.9 to 49.5 . According to the
same authors, the incidence in China is increasing annually, averaging 4.3, and the
number of registered cases in 2015 increased to 60,000 [7,8]. Seven republics of the
former Soviet Union: Kyrgyzstan, Georgia, Azerbaijan, Kazakhstan, Uzbekistan,
Tajikistan, Turkmenistan are included in the list of 25 countries with the highest
incidence of brucellosis worldwide[12,13].
Thus, in Kazakhstan, the incidence rate per 100 thousand population was 10.0
[6], in Kyrgyzstan 20.5–25.0, in – 42.7–76.4) [5], in Tajikistan for 2000–2014. in
some disadvantaged areas of the country, more than a thousand cases of the disease
have been registered [3]. In the Republic of Uzbekistan in 2001-2017. the incidence
of brucellosis in people varied from 1.8 to 2.8 per 100 thousand population, mainly
Surkhandarya - 9.6, Jizzakh - 8.0, Navoi - 7.9, Bukhara - 5.6, Syrdarya - 4.5 and
Kashkadarya - 4.3 regions of the republic [2].
The purpose of this work was to study the clinical and diagnostic features of the
course of chronic forms of brucellosis.
Material and research methods. We conducted a clinical diagnostic examination
of 60 patients with chronic brucellosis who were hospitalized. The diagnosis was
established on the basis of clinical and diagnostic data, confirmed by serological tests
of Wright, Hedelson and TPHA and bacteriological method. To characterize the
patients, we used the classification of N.I. Ragoza, supplemented by V.M. Majidov.
Results and its discussion. The issue of great theoretical and practical importance is
the study of the clinical status of the adult organism of patients with brucellosis in the
age aspect. According to the age structure of patients, we found that in most cases
infection with chronic brucellosis is observed among the working age. So the peak
incidence falls on the age period from 18 to 30 years and is 40%.
During the primary epidemiological diagnosis of chronic brucellosis in 46.6%
of patients, the professional nature of the disease with a contact route of infection was
established: 20% - farmers who did not receive specific prophylaxis did not always
use meat raw materials; 26.6% - housewives (milkmaids) during care
behind cattle, in contact with sick animals, their secretions. In 8.3% of patients,
the alimentary route of infection:
consumption of unboiled milk and raw dairy products (feta cheese, cream, sour
cream, etc.). It should be noted that the proportion of patients (54.1%) among the
owners of the individual sector remains high.
The main sources of chronic brucellosis among the surveyed were cattle and
small cattle. However, the prevailing role in this case belongs to small cattle, which
are more sensitive to brucella.
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In all patients, the diagnosis was established on the basis of serological studies.
The results of the serological reaction.
Wright's reaction in 100% of patients with chronic brucellosis was positive in
various diagnostic titers, but dilutions in titers of 1:200 (46.7%) and 1:400 (43.3%)
were more common. Heddelson's reaction was positive. Out of 60 patients in 12
(20.0%) patients, the diagnosis was established by bacteriological method. At the
same time, growth of Brucella melitensis was found in 8 patients, and Brucella
abortus was isolated in 4 patients.
In the course of the work, we revealed a large percentage of unrecognized
chronic brucellosis: out of 60 patients under our supervision with an incorrect
diagnosis, 35 (58.3%) received treatment. The most commonly misdiagnosed
diseases of the respiratory system (ARVI, bronchitis) - 11 (31.4%), lymphadenopathy
of unknown etiology - 4 (11.4%), rheumatism - 4 (11.4%) diseases of the liver and
biliary system (chronic cholecystitis , cholecystopancreatitis) - 10 (25.5%) Arthritis,
sciatica - 6 (17.2%). Misdiagnosis led 58% of cases to late hospitalizations.
As a result of a clinical examination, taking into account the timing of infection
and epidemiological history, we found chronic brucellosis with a combined lesion of
the osteoarticular and nervous systems in 39 (65%) patients, and with a predominant
lesion of the osteoarticular system in 21 (35%) patients. Assessing the severity of the
condition of the examined patients, we noted that in patients in most cases chronic
brucellosis proceeded in a moderate form (28.3% and 71.7%, respectively). The
general well-being of patients with chronic brucellosis, as a rule, did not suffer much,
even during a period of high fever, which is a characteristic sign of the chronic
brucellosis period of infection.
Complaints at the onset of the disease were varied, such as a feeling of general
weakness (89.0%), chills (up to 90%), sweating (up to 91%), various pain sensations
(up to 35.0%). Up to 35.0% of patients complained of mild joint pain without
objective changes in the joints. For pain in the lumbar spine - 3%, for neuromuscular
pain - 1.0% of patients.
Among the patients examined by us with chronic brucellosis, in 54 (90.0%)
patients, the disease began chronically (gradual onset in 10.0%) with high fever in 56
(93.3%), accompanied by chills in 54 (90.0%) and sweating 56 (93.3%). 52 (86.6%)
patients also had headaches and weakness. The nature of the temperature curves was
different. Wavelike (53.0%), febrile (35.0%) and subfebrile (6.6%) types of fever
were observed. As our data show, after the start of antibiotic therapy in 57 (95.0%)
patients, the fever subsided on the 4th - 5th day, and in the remaining 5.0% of patients
it lasted up to 6 - 7 days. Following the disappearance of the fever, the chill also
disappeared. However, sweating in 90.0% of patients with chronic brucellosis
persisted longer up to 20 days.
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At the height of the febrile period in our patients, we observed a decrease in
appetite (in 35%), and occasionally nausea (2%). The tongue is usually moist, slightly
coated, the abdomen is soft, painless. 3 patients had constipation.
We noted an increase in the liver to varying degrees in 65.0% (39.0) of patients,
of which (20.0%) (8) - the liver was located at the edge of the costal arch by 1-2 cm,
in 17.9% (7 ) - by 2.1 - 3.0 cm. In most patients, the liver was soft or medium density,
painless, only in 17.9% (7) of patients, the liver was dense and sensitive to palpation.
Among the examined 60 patients with chronic brucellosis, 43.3% (26) showed
an increase in the spleen, arch by 0.5 - 1.0 cm. Moderate splenomegaly was detected
in 3.7%) (4). In our patients, we did not observe any particular changes in the kidneys
and urinary tract. However, at the height of the febrile period, 8.3% of patients had
mild albuminuria (traces). As the temperature dropped, the changes in the urine
disappeared. When the infection was generalized against the background of high
temperature, the knee, ankle (35%) and relatively rarely hip (5%) joints, as well as
the cervical spine (1%) were more often affected.
Clinically, these lesions were manifested as volatile and mild soreness and
redness. The pains were short-term, unstable and quickly disappeared, because of
which the patients did not pay attention to their localization.
Conclusion: 1. Clinical and epidemiological analysis of chronic brucellosis
showed that the clinical picture of chronic brucellosis remains seasonal, men are more
likely to get sick, and the level of bacteriological analysis is low (10%). 2. In the
clinical course of chronic brucellosis, a chronic moderate course of the disease is
noted, arthritis prevails and is transient. Mono- (60%) and polyarthritis (40%) are
relatively common.
LITERATURE:
1.
Атаходжаева Д.Р., Касимов И.А., Способности повышение эффективности
лечения бруцеллеза 2018. - С 5-18.
2.
Бруцеллёз. Современное состояние проблемы / под ред. Г.Г. Онищенко,
А.Н. Куличенко. – Ставрополь: ООО «Губерния», 2019. – 336 c.
3.
М.А.Фарманова, М.Зайниддинова Клинико-эпидемиологические аспекти
хронического бруцеллеза // CENTRAL ASIAN JOURNAL OF MEDICAL
AND NATURAL SCIENCES – 2021. С. 70-75
4.
С.Г. Худойдодова Features of the course and treatment of laryngitis in measles
in young children. // Новый день в медицине, - 2020. №1. - С. 450-452.
5.
Расулов С.А., Мирзоев Д.М., Давлатов Х.О., Ахматбекова С.Ш. Динамика
заболеваемости бруцеллёзом мелкого рогатого скота и людей в районах
Республики Таджикистан с высокими показателями инфицированности //
Российский ветеринарный журнал.- 2016.- №1.
World scientific research journal
https://scientific-jl.com/wsrj
Volume-40_Issue-1_June-2025
262
6.
Avijgan M., Rostamnezhad M., Jahanbani-Ardakani H. Clinical and serological
approach to patients with brucellosis: A common diagnostic dilemma and a
worldwide perspective // Microbial Pathogenesis.-2019.-Vol.129.-P .125-130.
7.
Kasymbekov J., Imanseitov J., Ballif J. and antibiotic susceptibility of livestock
Brucella melitensis isolates from Naryn Oblast, Kyrgyzstan // PLoS Negl. Trop.
Dis.- 2013.- Vol.7.– P.2047.
8.
М.А. Фарманова, И.А. Касимов, Д.Р. Атажаджаева Бруцеллез
касаллигининг клинико-эпидемиологик хусусиятлари // Тиббиётда янги
кун. – 2020. №1. – С 29.
9.
Shevtsov A., Syzdykov M., Kuznetsov A, et al. Antimicrobial susceptibility of
Brucella melitensis in Kazakhstan. // Antimicrob Resist Infect Control.- 2017.-
Vol.6.- P.130.
10.
И.А.Касимов,
М.С.Шаджалилова,
М.А.Фарманова.
Бруцеллез
инфекциясининг клиник-эпидемиологик хусусиятлари ва иктисодий
жихатларини бахолаш // Тиббиётда янги кун. 2020. -№2. Б. 30.
11.
Ахмедова М.Д., Арашова Г.А., Облокулов А.А. Иммунологические
показатели при остром бруцеллёзе // Российская научно-практическая
конференция с международным участием. 2009. - №1. Часть 1. С. 33-34.
12.
Ниязова Т. А., Облокулов А.Р., Магзумов Х. Б., Тохтамуродов Х. Д.,
Бобожонов Ш.Ж. Резидуал бруцеллёзни даволаш самарадорлигини
ошириш // Тиббиётда янги кун. 2020. №2 (30). Б. 473-476.
13.
Облокулов А.Р., Ниязова Т.А., Мирзажанова Д.Б., Нуруллаев
Р.Р. Клиническая эффективность применения экдистена при первично
хроническом бруцеллезе // Инфекция иммунитет и фармакология. 2014. №
3-2. С. 32.
