Brucellosis in patients with malignancies: A systematic review

Abstract

Objective To explore the epidemiological trends and clinical presentations of brucellosis in patients diagnosed with different types of cancer.

Methods A systematic review was performed utilizing PubMed, Embase, Scopus, Web of Science, and Google Scholar following PRISMA guidelines until September 2022. An update in December 2023 was conducted to ensure thorough coverage of the literature.

Results A total of 28 articles met the eligibility criteria, reporting 38 cases of brucellosis in patients with cancer. Among these cases, hematological cancers were the most common, comprising 66% of the cases, and B. melitensis was identified as the predominant species. The primary clinical manifestations of brucellosis infection included constitutional symptoms in a notable 60.5% of cases and febrile neutropenia in 21%. Additionally, six cases (15.8%) experienced relapse or recurrence of brucellosis, all of which were managed using a combination therapy of rifampin and doxycycline. While 28 patients successfully achieved remission from both brucellosis and their underlying neoplastic conditions, unfortunately, nine cases resulted in mortality attributed to septic shock, progressive liver failure, and massive embolism; no deaths directly related to brucellosis were reported. Among the non-surviving cases, hematologic malignancies were the most prevalent neoplastic conditions (77.7%).

Conclusions Brucellosis-cancer co-occurrence is rare but is not related to increasing mortality. The risk of relapse is higher in cancer patients, especially with hematologic malignancies. Screening, monitoring, and judicious antibiotic use can mitigate brucellosis risks in neoplastic patients.

Keywords

Brucellosis / Immunocompromised / Cancer / Malignancy / Opportunistic infection

Conflict of interest statment

The authors declare that they have no competing interests.

Funding

The authors received no extramural funding for the study.

Authors' contributions

S.A. and I.A.D. contributed to the conception. M.G., K.M., S.A., and F.I. wrote the original draft. I.A.D., HAN, and H.E. contributed to the manuscript revision and editing. M.G. contributed to the figure conceptualization and designing.

Publisher’s note

The Publisher of the Journal remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

5 Acknowledgments

The authors would like to thank the Clinical Research Development Unit (CRDU) of Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran for their help and support in conducting this study.

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