key: cord-0977970-6b35xamt
authors: Tsagkaris, Christos; Laskaratou, Emmanouela Dionysia; Alexiou, Athanasios
title: COVID-19 can delay the timely diagnosis of musculoskeletal brucellosis: A summary of evidence and recommendations for healthcare practitioners and health bodies
date: 2021-11-24
journal: Ethics Med Public Health
DOI: 10.1016/j.jemep.2021.100743
sha: d0e553e780abd95e828c1df9602c00ec7fbaa681
doc_id: 977970
cord_uid: 6b35xamt

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Brucellosis is a bacterial zoonotic infection with an incidence reaching up to 200 in 100.000 in endemic regions. The disease is prevalent in rural and remote areas of the Mediterranean and the Arabic peninsula, where residents are in close contact with bovine, cattle, dogs, sheep and camels [1] . The emergence of the COVID-19 pandemic has further restricted the -already limited -access of these populations to healthcare since Spring 2020. It is quite likely that a considerable number of brucellosis cases received no or delayed diagnosis or were treated as potential COVID-19 cases, given the similarities in clinical presentation (fatigue, fever, musculoskeletal pain, respiratory symptoms).

Although brucellosis is rarely lethal, it can cause long-lasting symptoms such as recurrent fevers, heart inflammation, orchitis, joint pain, and fatigue. Chronic musculoskeletal sequalae of brucellosis occur in up to 50% of those with chronic disease [2] , resulting in occupational impairment, decreased income and deteriorated personal and family health. While relevant evidence is limited, the potential burden of nonproperly treated brucellosis can evolve in a considerable public health issue in the near future. The authors provide a summary of the existing knowledge and outline a strategy for the prevention and early diagnosis of brucellosis in rural and remote areas during the COVID-19 pandemic.

A quick literature search in Pubmed / Medline reveals the lack of epidemiological studies concerning the impact of COVID-19 on the timely diagnosis of brucellosis. To date, the existing knowledge boils down to a retrospective epidemiological study, two case reports and a letter to the editor. Cheng et al [3] (2021) investigated the incidence of natural focal diseases including Brucella in Jiangu, China during the course of the pandemic in 2020. They compared the output of a validated prediction model with the reported incidence of these diseases during these months and further juxtaposed the monthly incidence in 2020 with data from the same period between 2015-2019. The reported cases in 2020 were less than the expected ones, a finding which can be partially attributed to the restricted access of patients to the healthcare facilities for diagnosis and treatment. The same concern was expressed by Bareto-Argilagos and Rodriquez-Torrens [4] Finally, yet importantly, the public, especially those working with livestock in or from endemic areas, needs also education, so as to decrease the risk of disease transmission or early recognize the symptoms and seek appropriate care. In the context of the One Health approach, veterinarians can be involved in frequently screening animal -reservoirs for brucellosis and spreading awareness to their communities.

Overall, the COVID-19 pandemic has a negative effect on brucella diagnosis and treatment.

Zoonotic diseases do not belong to the past; they exist at the present and remind us that we must take the appropriate precautions to limit their spread. As symptoms of brucellosis can mimic that of covid-19 infection, physicians should bear in mind that they are called to make the right differential diagnosis in endemic regions. Certainly, this cause also belongs to and needs to be supported by allied healthcare professionals, healthcare administrations, stakeholders and the public.

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