THE IMPORTANCE OF INFLAMMATION MARKERS IN ACUTE BRUCELLOSIS: DIAGNOSTIC, PROGNOSTIC, MONITORING, DIFFERENTIAL DIAGNOSIS, AND TREATMENT CONSIDERATIONS

Abstract

Acute brucellosis, a zoonotic bacterial infection caused by “Brucella” species, presents with systemic symptoms including fever, arthralgia, malaise, and potential focal complications, particularly osteoarticular involvement in 10–85% of cases (most commonly 20–40% in many series). Inflammation is central to its pathogenesis, with “Brucella” persisting intracellularly in macrophages and eliciting variable acute-phase responses. Traditional markers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, and neutrophils, alongside derived ratios like neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI), provide accessible, cost-effective tools for preliminary diagnosis, severity assessment, complication prediction (e.g., osteoarticular in up to 30–70% of complicated cases), and treatment monitoring in endemic regions. These markers also aid in differential diagnosis from mimics like malaria, typhoid, tuberculosis, or viral fevers, where patterns differ (e.g., marked leukocytosis in pyogenic infections vs. normal/low WBC in brucellosis). Global incidence estimates range from 2.1 million annual cases, with high endemicity in Asia and Africa (e.g., rates >35/100,000 in some areas like Ningxia, China). Emerging biomarkers like irisin and cytokines further enhance utility. Treatment considerations involve prolonged dual-antibiotic regimens (e.g., doxycycline + rifampin for 6 weeks; relapse rates 4.8–10%), with markers guiding response and detecting relapses. These tools facilitate early intervention in resource-limited settings, reducing chronicity and morbidity.

This review integrates etiopathogenetic insights with statistical evidence from recent studies to underscore their multifaceted clinical value. Besides explains synthesizes etiopathogenetic mechanisms, clinical features, and systemic complications, incorporating updated insights from recent consensus guidelines and studies to enhance understanding and optimize patient outcomes.