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Pulmonary brucellosis; Pathogenesis; Clinical presentations; Diagnosis; Challenges; Treatment

Introduction

Brucellosis, a zoonotic infection caused by bacteria of the genus Brucella, primarily affects animals such as cattle, goats, and sheep, but can also be transmitted to humans through direct contact with infected animals or consumption of contaminated dairy products. While brucellosis is commonly associated with fever, joint pain, and fatigue, its involvement in pulmonary manifestations is often overlooked. Pulmonary brucellosis, though relatively rare, presents unique challenges in diagnosis and treatment due to its diverse clinical presentations and potential to mimic other respiratory diseases [1].

Brucellosis is a worldwide re-emerging zoonosis caused by organisms belonging to the genus Brucella, which are Gram-negative, nonspore-forming, facultative intracellular bacteria. The incidence of the disease in Turkey is 0.59 per 100,000 persons per annum, and worldwide there are 500,000 new cases of brucellosis reported annually. The primary mode of transmission is through consumption of nonpasteurized milk or cheese from infected goats, sheep or cows, the consumption of contaminated meat or by direct contact with infected animals [2]. Characteristic symptoms such as undulant fever and malaise are seen in most patients. Focal manifestations are found in the joints and bones, in the respiratory tract, in the cardiovascular system, the nervous system, the urogenital system as well as in the liver, spleen and skin.

Pathogenesis of pulmonary brucellosis

The pathogenesis of pulmonary brucellosis involves the inhalation of infected aerosols or particles containing Brucella organisms. Once inhaled, the bacteria can localize in the respiratory tract, leading to a range of pulmonary manifestations. The bacteria's ability to evade host immune responses by residing within macrophages contributes to the chronicity and complexity of the disease [3].

Clinical presentations

Pulmonary brucellosis can present in various ways, making diagnosis challenging. Patients may exhibit non-specific symptoms such as cough, chest pain, and shortness of breath. Additionally, they might present with atypical symptoms, including night sweats, weight loss, and low-grade fever. These vague symptoms often lead to misdiagnosis or delayed diagnosis, as they overlap with other common respiratory infections.

Diagnostic approaches

Accurate and early diagnosis of pulmonary brucellosis is critical to prevent complications and initiate appropriate treatment. Diagnostic tests include blood cultures, serological tests, and molecular techniques like polymerase chain reaction (PCR). Radiological imaging, such as chest X-rays and computed tomography (CT) scans, plays a pivotal role in identifying pulmonary involvement, revealing patterns of nodules, consolidations, and pleural effusions [5, 4].

Challenges in diagnosis

Despite the availability of diagnostic methods, pulmonary brucellosis remains a diagnostic challenge due to its similarity to other respiratory diseases. The lack of awareness among healthcare professionals about the possibility of pulmonary brucellosis further contributes to delayed or missed diagnoses. Moreover, the disease's rarity in certain regions may lead to low clinical suspicion.

Clinical implications

Pulmonary brucellosis can lead to severe complications if not treated promptly and appropriately. Dissemination of the infection beyond the lungs can occur, involving other organs like the heart, liver, and spleen. Chronic respiratory symptoms can significantly affect patients' quality of life, and mismanagement of the disease can result in relapses [7, 6].

Treatment and management

The cornerstne of treating pulmonary brucellosis is a combination of antibiotics, typically involving doxycycline and rifampicin, sometimes supplemented with other antibiotics such as streptomycin or gentamicin in severe cases. The treatment duration varies, usually spanning several weeks to a few months. Close follow-up is essential to monitor treatment response and prevent relapse

. Prevention and future directions

Preventing pulmonary brucellosis involves both animal health measures to control the spread of the infection in livestock and public health education to reduce human exposure. Improved awareness among healthcare professionals about the potential for pulmonary involvement in brucellosis is crucial for timely diagnosis and management [9, 8].

Discussion

The discussion on pulmonary brucellosis highlights the importance of understanding its various aspects to improve diagnosis, management, and patient outcomes. Pulmonary involvement in brucellosis is a complex phenomenon, often leading to misdiagnosis due to its nonspecific symptoms and resemblance to other respiratory diseases. The challenge lies in raising clinical awareness among healthcare professionals regarding the possibility of pulmonary brucellosis, especially in regions where the disease is uncommon [10].

The diverse clinical presentations of pulmonary brucellosis, ranging from subtle respiratory symptoms to more severe manifestations, underline the need for a multidisciplinary approach to diagnosis. Radiological imaging plays a significant role in identifying pulmonary abnormalities, helping distinguish pulmonary brucellosis from other lung conditions. The radiological patterns, such as nodules, consolidations, and pleural effusions, can aid in early diagnosis and appropriate treatment initiation.

One of the critical issues in managing pulmonary brucellosis is the potential for complications if left untreated or if treatment is delayed. The bacteria's ability to disseminate beyond the lungs underscores the need for timely intervention to prevent systemic involvement and reduce the risk of relapse. The combination of antibiotics remains the mainstay of treatment, but the duration and choice of antibiotics should be tailored to the patient's condition, severity of the disease, and response to therapy. Close monitoring during treatment is essential to ensure compliance and assess treatment efficacy [11].

Conclusion

In conclusion, pulmonary brucellosis represents a challenging facet of a zoonotic infection that requires increased clinical awareness, early diagnosis, and appropriate management. This article has provided valuable insights into the pathogenesis, clinical presentations, diagnostic methods, challenges, treatment, and preventive measures related to pulmonary brucellosis. Enhancing healthcare professionals' understanding of this condition is pivotal in reducing misdiagnosis and improving patient outcomes. Radiological imaging, coupled with serological tests and microbiological cultures, aids in accurate diagnosis and guides treatment decisions.

With its ability to mimic other respiratory diseases and its potential to lead to severe complications, pulmonary brucellosis demands continued research to refine diagnostic techniques, optimize treatment regimens, and develop preventive strategies. Raising awareness among healthcare providers and the general public about the possibility of pulmonary involvement in brucellosis is crucial for early intervention and effective disease management. By advancing our understanding of pulmonary brucellosis and its implications, we can ensure better outcomes for individuals affected by this intriguing aspect of the disease.

Acknowledgement

None

Conflict of Interest

None

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