Undiagnosed Brucellosis in Psychiatric Patients: A Cross-Sectional Study

Abstract

Background: Brucellosis, also known as malt fever, poses significant health and economic challenges across various regions worldwide, particularly in Mediterranean and Middle Eastern countries. Objectives: This study aimed to identify cases of undiagnosed brucellosis among psychiatric patients. Methods: This descriptive cross-sectional study was conducted at Golestan Hospital in Ahvaz, Khozestan Province, Iran. The study aimed to investigate cases of undiagnosed brucellosis among psychiatric patients during the first six months of 2021. The diagnosis of brucellosis relied on standard tests, namely the Wright test, the Coombs-Wright test, and the two-mercaptoethanol test, which are widely recognized as reference techniques. In the endemic region of Iran, a positive titer of at least 1: 80 in the Wright test and titers of at least 1: 40 in the two-mercaptoethanol test are considered diagnostic criteria. The Coombs-Wright test is deemed positive when the titer is three dilutions higher than the Wright test titer in symptomatic patients. Results: A total of 225 patients admitted to psychiatric wards with psychiatric disorders underwent examination for brucellosis. The study revealed an undiagnosed brucellosis prevalence of 7.6% (n = 17). None of these patients had a recent or prior history of brucellosis, nor had they received any treatment for the disease. Among the seventeen patients, three reported experiencing typical and commonly observed symptoms of brucellosis, such as myalgia and arthralgia, during the clinical interviews. However, the remaining fourteen patients did not display any clinical symptoms typically associated with brucellosis, including myalgia, arthralgia, fever, and sweating. Instead, they solely exhibited psychiatric symptoms alongside their condition. Conclusions: Out of the 225 patients who were diagnosed with psychiatric disorders, 17 individuals were found to have brucellosis. Remarkably, 14 out of these 17 patients did not exhibit typical symptoms associated with brucellosis, but rather only showed psychiatric symptoms as manifestations of the disease.