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Volume 38, Issue 2

Original Article

Diagnostic Dilemma Between Two Mimicking Zoonoses: A Comparative Analysis of Acute Brucellosis And Crimean-Congo Hemorrhagic Fever

Mustafa Arslan
Affiliations
  • Amasya Üniversitesi Tıp Fakültesi, İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Amasya, Türkiye
https://orcid.org/0000-0002-3362-1044
,
Şirin Çetin
Affiliations
  • Amasya Üniversitesi Tıp Fakültesi, Biyoistatistik Anabilim Dalı, Amasya, Türkiye
https://orcid.org/0000-0001-9878-2554
  • acute brucellosis
  • akut bruselloz
  • Crimean-Congo hemorrhagic fever
  • differential diagnosis
  • Kırım-Kongo kanamalı ateşi
  • leukopenia
  • lökopeni
  • thrombocytopenia

Abstract

Objective: In regions where Crimean-Congo hemorrhagic fever (CCHF) and acute brucellosis are endemic, a diagnostic dilemma arises in patients who present to the emergency department with high fever and are diagnosed with leukopenia and thrombocytopenia. This study aimed to compare the clinical, epidemiological, and laboratory features of CCHF and acute brucellosis cases, revealing their similarities and differences, thereby guiding clinicians, especially those performing initial evaluations, in the differential diagnosis process.

Methods: Crimean-Congo hemorrhagic fever and acute brucellosis cases diagnosed in our center between June 2013 and June 2023 were evaluated retrospectively. Crimean-Congo hemorrhagic fever diagnosis was confirmed by RT-PCR test, while acute brucellosis diagnosis was made by blood culture and/or serological tests. Only the first application of each patient was included in the study. Demographic information and clinical and laboratory findings of the cases were obtained from patient files.

Results: A total of 88 patients with CCHF and 95 patients with acute brucellosis were included in the study. No statistically significant differences were found between the groups in terms of age, gender, rural residence, or occupation (p>0.05). In CCHF patients, leukopenia, thrombocytopenia, and elevated levels of creatine phosphokinase (CPK), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) were significantly more common (p<0.001). In cases of acute brucellosis, anemia, erythrocyte sedimentation rate, and C-reactive protein (CRP) levels were significantly higher (p<0.001). Measurements above the threshold value of 277 U/L determined for CPK provided 88.64% sensitivity and 90.53% specificity in predicting the diagnosis of CCHF (AUC=0.953). Conjunctival hyperemia, nausea, vomiting, and diarrhea were more common in CCHF patients, while back pain, hip pain, and widespread joint pain were more prominent in acute brucellosis patients.

Conclusion: Certain clinical and laboratory findings obtained at the initial presentation of patients with CCHF and acute brucellosis may aid the clinician in making a diagnostic distinction. In particular, it has been observed that the CPK level has high diagnostic value in distinguishing between these two diseases. Multicenter studies with larger samples that will represent the whole country are needed.

Show References

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  • 112-9
  • Mustafa Arslan
  • [email protected]
  • 10.36519/kd.2025.5137
  • October 20, 2024
  • April 3, 2025
  • June 28, 2025

  • Arslan M, Çetin Ş. [Diagnostic dilemma between two mimicking zoonoses: A comparative analysis of acute brucellosis and Crimean-Congo hemorrhagic fever]. Klimik Derg. 2025;38(2):112-9. Turkish.
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