Comparative study of current diagnostic method with clinical based method for brucellosis: presentation of diagnostic clinical criteria in limited resource area

Introduction and objectives: According to National Program against Brucellosis (NPB), diagnosis is based on serological tests (Wright>1/80 and 2 ME>1/20) in the presence of clinical finding. Regarding the lack of laboratory facilities in rural areas, diagnosis of the disease is faced with some difficulties. We conducted this study in order to present clinical criteria for the diagnosis of illness in limited resource area.

Materials and methods: In a retrospective study, a total of 109 medical records of admitted brucellosis patients in three educational hospitals in Ahvaz south-west of Iran, from 2005 to 2007 were studied. By using the offered clinical criteria (OCC) (three major, or one major and three minor, or five minor) and NPB guidelines, patients were rediagnosed. Major criteria are animal close contact, fever and joint involvement. Minor criteria are sweating, headache, weight loss, chills and malaise. Finally the results of two diagnostic methods were compared in SPSS 16 software using chi-square and Fishers exact test. Differences with P<0.05 were considered significant.

Results: The most common findings were occupational exposure (75.22%), arthralgia (92.66%), fever (78.97%), sweating (65.13%), headache (56.8%), weight loss (51.37%), malaise (54.12%) and chills (45.8%). Of total 109 brucellosis, 84 (77.1%) were rediagnosed as brucellosis by NPB and 91(82.5%) by OCC. No significant difference (P=0.57) was observed between the two methods in diagnosis of brucellosis.

Conclusion: Our offered clinical criteria are as effective as the Iranian NPB guidelines in the diagnosis of brucellosis. These clinical criteria may be useful in rural and limited resource area of Iran.