RESUMO
A study was conducted to characterise the articular manifestation of Brucella melitensis within a family in Peru. From January 1981 to June 1986, 39 families with 232 individuals were evaluated. Brucellosis was diagnosed in 118 family members (attack rate of 50.9%). A lower attack rate was observed in children less than 10 years' old compared with other age groups (p less than 0.02). Complete clinical data were available in 92 of the 118 affected members. Moderate and severe forms of the diseases were more prevalent in women than in men (41.8% v 13.5%; p less than 0.001). Twenty eight of the 92 patients developed some brucellar complications; the articular involvement was the most prevalent (23.9%). Arthritis was also more common in women than in men (34.5% v 8.1%; p less than 0.01). Children appeared to have less articular involvement. Overall, the following pattern was observed: peripheral arthritis (54.5%); unilateral sacroiliitis (23.0%); mixed arthritis (4.5%), and spondylitis (9.1%). Spondylitis was seen only in the elderly with chronic brucellosis. Four patients developed extra-articular rheumatism. Within members of family groups, brucellar arthritis occurred less frequently than in individual patients from the same hospital. This suggests that many family cases were diagnosed in the early stages.
Assuntos
Artrite Infecciosa/genética , Brucelose/genética , Adolescente , Adulto , Fatores Etários , Artrite Infecciosa/complicações , Brucelose/complicações , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Estudos Prospectivos , Espondilite/etiologiaRESUMO
Brucellosis is a zoonosis which in humans is caused by one of four species of the Brucella genus: B. melitensis, B. abortus, B. suis and B. canis. B. abortus is the species prevalent in North America and Europe and B. melitensis in most developing countries. Differences in disease manifestations may be accounted for either by differences in the species or by differences in the host. Articular involvement in brucellosis, although recognized since 1904, has been variably emphasized. Three hundred and four cases of human Brucellosis caused by B. melitensis, the prevalent species in Perú, were seen during a 12-yr period in one Lima hospital. Fever, malaise and hepatomegaly were the most frequent findings. Diagnosis was greatly improved when cultures were done in the biphasic Ruiz-Castañeda medium, rather than in trypticase soy broth. Serologic diagnosis is still important, and it should include standard tube testing, detection of IgG blocking antibodies and fractionation with 2-ME in chronic cases. The disease may take one of three courses: acute, (< 8 wk), chronic (> 8 wk) or undulant (periods of remissions and exacerbations). Four syndromes were recognized in a total of 33.8% of patients with Brucellosis. The most frequent pattern (in approximately 46.6% of patients with arthritis) was sacroiliitis, usually non-destructive and either uni- or bilateral. The second most frequent articular syndrome was peripheral arthritis (38.8%), manifested either as a single large lower extremity joint or as an asymmetric pauciarthritis. Rarely patients presented with a rheumatoid-like arthritis. Mixed arthritis (7.8%) was a combination of the first two. The above forms occurred in patients with an acute or undulant course. Spondylitis was the least common form of arthritis (6.8%), and differed significantly from the other forms of arthritis in the duration of symptoms (chronic course), age of patients (older individuals) and the paucity of fever and malaise. It also tended to be destructive. The arthritis usually resolved with the combined regimen of tetracycline (2 g p.o. for 21 days) and streptomycin (1 g i.m. for 21 days) without sequelae. Illustrative cases of these syndromes are presented. The relatively benign nature of most of the patients with bruccellar arthritis lead us to postulate that they are for the most part reactive arthritides. Host factors are thought to be important in determining the response to the infection, but they are yet to be identified. Our own genetic studies have failed to identify an increased frequency of B27 or CREG antigens in the patients with sacroiliitis.(ABSTRACT TRUNCATED AT 400 WORDS)