title: The prevalence and impact of brucellosis in patients with hepatitis delta virus infection: inside theBrucellaoutbreak with cirrhosis.
abstract: BACKGROUND
  Hepatitis D virus (HDV) infection is a serious health problem leading to cirrhosis and hepatocellular carcinoma (HCC). Despite evidence that zoonotic infections are associated with end-stage liver disease, brucellosis in patients with delta hepatitis related to liver disease has not been well characterized. So, we examined this relationship using recent hospital-based data.
  
  
  METHODS
  We analyzed data from 96 delta hepatitis patients (mean age: 52.5 ±12.8 years; 50 male; 52 cirrhotics) and 117 (mean age: 50.4 ±7 years; 60 male) control subjects who were selected from patients with splenomegaly. TheBrucellaWright test in connection with blood culture was used to detect activeBrucellainfection. Demographic features, laboratory data, results of ultrasonographic examination of the abdomen and Wright agglutination titers were compared between groups.
  
  
  RESULTS
  There were 9 (9%) patients with active brucellosis in delta hepatitis patients. Compared to the control group, there was a statistically significant difference between groups in terms of having active brucellosis (9 vs. 2 patients;p< 0.001). Higher MELD scores were also associated with activeBrucellainfection (p< 0.005).
  
  
  CONCLUSIONS
  Patients with chronic hepatitis D related cirrhosis (CHD-C) were at risk of developing brucellosis requiring hospitalization. Higher Wright titers among patients with more advanced liver disease may reflect a unique phenomenon that requires further investigation to determine underlying causative factors.
authors.affiliation: Gastroenterology Department, Medical School, Yuzuncu Yıl University, Van, Turkey.
authors.forename: Burak
authors.initials: B
authors.lastname: Suvak
authors.affiliation: Gastroenterology Department, Medical School, Yuzuncu Yıl University, Van, Turkey.
authors.forename: Ahmet Cumhur
authors.initials: AC
authors.lastname: Dulger
authors.affiliation: Department of Family Medicine, Kecioren Family Medicine Center, Ankara, Turkey.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Suvak
authors.affiliation: Internal Medicine Department, Medical School, Yuzuncu Yıl University, Van, Turkey.
authors.forename: Aysun Özel
authors.initials: AÖ
authors.lastname: Yesilyurt
authors.affiliation: Microbiology Department, Vakıf Gureba Hospital, Istanbul, Turkey.
authors.forename: Bilge
authors.initials: B
authors.lastname: Gultepe
authors.affiliation: Microbiology Department, Yuzuncu Yıl University, Van, Turkey.
authors.forename: Huseyin
authors.initials: H
authors.lastname: Guducuoglu
keywords: brucellosis; cirrhosis; delta hepatitis