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PubMed2000

The use of skin delayed-type hypersensitivity as an adjunct test to diagnose brucellosis in cattle: a review.

Brucellosis, caused by bacteria of the genus Brucella, is a contagious disease that causes economic loss to owners of domestic animals due to loss of progeny and milk yield. Because cattle, sheep, goats, and to a lesser extent pigs are considered to be the source of human brucellosis, serological tests have been used to screen domestic animals for antibodies against Brucella. Although the serological tests helped to eradicate brucellosis in many countries, serological tests are not always adequate to detect latent carriers of Brucella. Therefore, the use of the skin delayed-type hypersensitivity (SDTH) test, which is independent of circulating antibodies, might improve the diagnosis of brucellosis. In the literature, however, there are conflicting reports as to the value of the SDTH test for the diagnosis of brucellosis. Some studies consider the test unreliable, whereas others advocate its use because it detects brucellosis earlier than serological tests. The objectives of this study were therefore to assess the characteristics of the SDTH test, to select a Brucella strain that will yield a suitable brucellin for use in the field, and to determine whether the use of serological tests in combination with the SDTH test improves the detection of brucellosis. The results of this study clearly show that the SDTH test detects latent carriers of Brucella and confirms brucellosis in cattle with ambiguous serological test results. Brucellins prepared from smooth or mucoid strains of Brucella are better suited for use in the field than brucellins prepared from rough strains because they detect brucellosis in cattle with acute as well as chronic infection. The SDTH test is highly specific (99.3% specificity), and repeated testing of naive cattle or cattle infected with microorganisms that serologically cross-react with Brucella does not sensitize cattle to subsequent SDTH tests. However, it is possible that some naive cattle may serologically react to the injection of brucellin. The effect of these serological reactions on the sero-diagnosis of brucellosis is limited, because cattle may only now and then react serologically either with the serum agglutination test (SAT) or the complement fixation test (CFT). Nevertheless, cattle infected with microorganisms that serologically cross-react with Brucella may test seropositive for brucellosis 4 to 7 weeks after injection of brucellin, depending on the cross-reacting microorganism. The value of the SDTH test for the diagnosis of brucellosis was demonstrated after an outbreak of brucellosis. When the SDTH test was used in combination with SAT and CFT at diagnostic threshold > or =2 mm or > or =1 mm (increase in skinfold thickness), respectively, 39/44 (88%) or 42/44 (95%) of the infected cattle were detected compared with only 27/44 (61%) when SAT and CFT were used. When cattle in areas of low prevalence or in areas free from brucellosis are tested with the SDTH test an increase > or =2 mm in skinfold thickness should be considered indicative of infection. When the control and eradication of brucellosis is based on test-and-slaughter, an increase of > or =1 mm in skinfold thickness should be considered indicative of infection. Repeated serological testing complemented with the SDTH test in this programme will shorten the quarantine (movement control) period of a suspect herd, limiting the financial loss incurred during outbreaks of the disease. Consequently, since the SDTH test usually does not interfere with the serological diagnosis and can safely be used to establish the infection status of cattle in a suspect herd, it is opportune to consider adding the SDTH test to the procedure currently used to diagnose brucellosis in individual animals.

Animals↗
PubMed1986

Evaluation of ELISA in the diagnosis of acute and chronic brucellosis in human beings.

An enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of brucella-specific IgG, IgM and IgA in 173 patients with acute brucellosis, 22 patients with chronic brucellosis and in 281 controls consisting of 98 patients with other infectious etiologies, 20 patients with non-infectious diseases and 163 normal healthy adults. The ELISA results were compared with culture findings, the results of slide agglutination tests with Brucella melitensis (M), B. abortus (A) and Ross Bengal (RB) antigens, and of tube and microagglutination tests. Brucella cultures were positive in 53 and 5% of patients with acute and chronic brucellosis respectively. The slide agglutination tests with A, M, A plus M and RB antigens were positive in 42, 44, 51 and 98% of patients with acute brucellosis and in 23, 27, 27 and 64% of patients with chronic brucellosis. There was no significant difference in the results between the tube and microagglutination tests regardless of the type of antigen used. At a titre of greater than or equal to 80 or greater than or equal to 160 these tests were positive in 98% and 92% of patients with acute brucellosis and 60 and 40% of patients with chronic brucellosis. The brucella culture and agglutination tests were negative for all the controls. Brucella ELISA immunoglobulins (Ig) were detected in some individuals in the control groups but the majority of these had titres of less than or equal to 100 for IgG, IgM, and IgA. However, patients with brucellosis had significantly higher ELISA titres in all classes of Ig than controls but the sensitivity and specificity within each Ig class varied with the titre considered. At a titre of greater than or equal to 1600 the brucella IgG had a sensitivity and specificity of 98% for patients with acute or chronic brucellosis; this decreased with lower reciprocal titres. The brucella IgM titre of greater than or equal to 400 had a sensitivity of 98% and a specificity of 98% for patients with acute brucellosis. However, in patients with chronic brucellosis the brucella IgM was very low. The brucella IgA titre of greater than or equal to 200 showed a sensitivity of 98% and a specificity of 99% for patients with either acute or chronic brucellosis. This study indicates that brucella ELISA is a rapid, sensitive and specific assay, provides a profile of Ig classes in the diagnosis of acute and chronic brucellosis, is useful for mass screening and could be considered the method of choice for the serological diagnosis of brucellosis.

Acute Disease↗
PubMed2006

Risk factors for brucellosis--Leylek and Kadamjay districts, Batken Oblast, Kyrgyzstan, January-November, 2003.

INTRODUCTION: Brucellosis is a zoonotic disease that is associated with chronic serious sequelae in humans. During 1997-2002, the reported incidence of human brucellosis in Kyrgyzstan increased nearly twofold, from 20 to 36 per 100,000 population. In 2002, the highest incidence of brucellosis was reported in two rural districts of Batkan Oblast: Leylek (106 per 100,000 population) and Kadamjay (80 per 100,000 population). During January-November 2003, trainees from the Applied Epidemiology Training program in Central Asia conducted a matched, hospital-based, case-control study to identify risk factors for brucellosis and describe the epidemiology of disease in these two districts. METHODS: Brucellosis cases were defined on the basis of epidemiologic, clinical, and laboratory criteria. During January-November 2003, a total of 100 persons with confirmed brucellosis were identified in the infectious disease wards of the two district hospitals; these persons were matched by age and date of admission to 100 controls who were admitted to other hospital wards for unrelated conditions. Data on socioeconomic and occupational factors and history of exposure to animals and animal products were collected by using a structured questionnaire. Conditional logistic regression was used to study the association between exposure variables and brucellosis. RESULTS: Among the 100 persons with confirmed brucellosis during the study period, 86 (86%) owned farm animals, and 45 (45%) became ill during April-May, the birthing season for farm animals. Multivariate analysis indicated that brucellosis was associated with exposure to aborted farm animals in the household (odds ratio [OR] = 29.8; 95% confidence interval [CI] = 4.4-203.4) and consumption of home-made milk products obtained from bazaars or neighbors (OR = 11.4; CI = 1.6-83.9). Knowledge of the mode of brucellosis transmission appeared to be protective against disease transmission (OR = 0.2; CI = 0.03-0.8). DISCUSSION: Exposure to aborted home-owned animals and consumption of home-made milk products obtained from bazaars or neighbors were identified as probable sources of human brucellosis infections in the study districts. This finding suggests that brucellosis spreads among farm animals in the area and that home-made milk products are not adequately pasteurized. CONCLUSION: To reduce the burden of brucellosis in Batken Oblast, veterinary services should be improved, and health education programs should be increased. Implementing these measures should minimize exposure to farm animals and reduce the risk for infection from locally produced milk products.

Adolescent↗
PubMed2002

The Animal and Plant Health Inspection Service (APHIS) brucellosis eradication program in the United States.

Efforts to eradicate brucellosis caused by Brucella abortus in the United States began in 1934 as part of an economic recovery program to reduce the cattle population because of the Great Depression and concurrent severe drought conditions. A number of states saw this as an opportunity to reduce the level of brucellosis, which was the most significant livestock disease problem in the US at the time. In 1934 and 1935, the reactor rate in adult cattle tested was 11.5%. In 1954, the magnitude of the brucellosis problem in the United States in terms of economics to the cattle industry and human health prompted Congress to appropriate funds for a comprehensive national effort to eradicate brucellosis. The brucellosis eradication program was designed as a cooperative effort between the federal government, the states, and livestock producers. As the science and technology of brucellosis has developed over the years through research and experience, the eradication program has been modified many times. As of 31 December 2000, there were no affected cattle herds in the United States. This was the first time in the history of the brucellosis program that the United States had no known brucellosis affected herds. However, brucellosis has a variable, sometimes quite lengthy incubation period, so it is expected that additional affected herds will be disclosed. It is likely that additional affected herds will be disclosed before brucellosis is finally eradicated from cattle. Animal health officials remain prepared to aggressively pursue any newly disclosed affected herds to eliminate the disease as quickly as possible. The State-Federal Brucellosis Eradication Program has made tremendous progress since its inception. In an eradication program, it is critically important to recognize that, despite all the tools that are available to eliminate the disease, an effective surveillance system is the critical first step that must be in place in order to be successful. It is imperative, not only to be able to find the disease and eliminate it, but to find it before it spreads to susceptible herds. When brucellosis can be identified, contained, and eliminated before spread occurs, eradication can be achieved.

Animal Welfare↗
PubMed2002

Brucellosis in the European Union and Norway at the turn of the twenty-first century.

Control and eradication programs of brucellosis in cattle, sheep, goats and pigs have been more or less successfully implemented within the Member States (MS) of the European Union (EU) and Norway after Word War II. As a result, the epidemiological situation of animal brucellosis is extremely diverse among different MS or regions within a MS and among the different animal species. Some MS, mainly North European countries, and Norway are declared "officially bovine brucellosis free" and/or "officially ovine and caprine (Brucella melitensis) free". The situation is less favorable in Southern European countries, particularly as far as sheep and goat brucellosis are concerned. This situation has important zoonotic consequences as reflected in the number of human brucellosis cases due to B. melitensis that are still encountered in those countries. Brucellosis in swine has re-emerged as a result of spillover from the wild boar brucellosis (Brucella suis biovar 2) reservoir, particularly in outdoor reared pigs. Besides the actual challenge to eradicate brucellosis, further issues have to be addressed: (1) the management of false positive serological results that occur in the course of brucellosis testing, particularly in cattle; (2) the impact of wildlife brucellosis, particularly wild boar brucellosis in domestic animals; and (3) the importance of B. melitensis infection in cattle that are in contact with infected sheep.

Animals↗
PubMed2005

In vitro nonspecific mitogenic response of T-cell subsets in acute and chronic brucellosis.

The aim of the present study was to determine the cellular immune response on the course of brucellosis by investigating the proliferation response of T-cell subsets to phytohemagglutinin (PHA), that is, nonspecific mitogen in the patients with acute and chronic brucellosis. The study was performed in 19 patients with untreated brucellosis (acute, n = 11; chronic, n = 8) and 19 healthy controls. Standard tube agglutination and Coombs tests for brucellosis were performed. CD4+ and CD8+ T cell were investigated by the flow cytometry and sorting methods in all of cases. After these cells were cultured and stimulated with PHA, [H3]-thymidine uptake and stimulation indices (SIs) were established. In all of the patients with brucellosis, CD4+ SIs and CD8+ SIs were found to be 1.40 +/- 0.63 and 1.45 +/- 0.42, respectively, and in the controls CD4+ SIs and CD8+ SIs were 1.59 +/- 0.36 and 1.64 +/- 0.37, respectively. In acute cases, CD4+ SIs were 1.71 +/- 0.64 and CD8+ SIs were 1.54 +/- 0.45. CD4+ SIs were 0.97 +/- 0.25 and CD8+ SIs were 1.32 +/- 0.37 in chronic cases. Although in acute cases CD4+ SIs and CD8+ SIs were not different from those in the control group, CD4+ SIs of chronic brucellosis cases were found to be significantly low as compared with those of acute brucellosis cases and the controls (P < 0.01). CD8+ SIs of acute and chronic brucellosis cases were not found to be different from those in the controls. Brucella agglutination titers of the patients with acute and chronic brucellosis were not found related with CD4 SIs and CD8 SIs. The findings of significantly low results of CD4+ T-cell proliferative responses of chronic brucellosis to PHA as compared with control and acute brucellosis cases remind that the development of chronic infection might be a result of T-helper proliferation defect.

Adolescent↗
PubMed2002

Epidemiology and control of brucellosis in China.

The paper describes the history and evolvement of brucellosis in China. It presents the variation of epidemic situation, epidemiological characteristics, application of vaccines and control in brief. Before 1980s, human and animal brucellosis was quite severe; during 1980s, the incidence of human and animal brucellosis was relatively low, and seemed to decrease during the decade. During 1990s, there were no obvious changes in the incidence of animal brucellosis, but the incidence of human brucellosis increased, especially from 1995 to 2001. There are not only some common characteristics but also some differences in brucellosis epidemiology relative to that reported in the rest of the world. For the entire country, B. melitensis was the predominant strain associated with outbreaks, and the epidemic peak is from February to June. Several Brucella vaccines have been used in China for prevention and control of brucellosis. such as B. abortus 104 M in humans, B. suis S2 in animals. The introduction of comprehensive measures has allowed great progress in the prevention and control of brucellosis in China. Surveillance points were set-up countrywide to estimate the epidemic situation. In addition, we discussed the new characteristics of brucellosis in China, the influence of the El Nino phenomenon on brucellosis epidemic situation, the phenomenon of antigenic interference between Brucella species and some disadvantages of live Brucella vaccines.

Animals↗
PubMed2006

Association between the Phe206Leu polymorphism of L-selectin and brucellosis.

Brucellosis remains a major zoonosis worldwide; therefore, better understanding of its immunology is a priority for the development of new therapeutic and vaccination strategies. Genetic factors appear to have an important role in the pathogenesis of infectious diseases such as brucellosis. Adhesion molecules, such as members of the selectin family, participate in the interaction between leukocytes and the endothelium, as well as in inflammatory cell recruitment. The impact of L-selectin polymorphisms on brucellosis has not so far been investigated. The aim of this study was to assess an L-selectin Phe206Leu (F206L) polymorphism in patients with active brucellosis, and to analyse its possible relationship with disease progression. A case-control association study was carried out on 619 subjects, including 374 patients with brucellosis and 245 age- and sex-matched healthy controls. Genomic DNA was isolated, and amplification of L-selectin genomic regions was performed by PCR incorporating sequence-specific primers (PCR-SSP) to distinguish the genotypes. The frequencies of the F206L polymorphism were studied. A significant difference in F206L polymorphism was found between patients with brucellosis and controls. The 206Leu allele was more frequent in patients than in healthy individuals (36.6 versus 28 %, P=0.003). In addition, there was an association between the presence of the 206Leu allele and a relapse of brucellosis (odds ratio 6.53, 95 % confidence interval 1.5-28.8, P=0.005). The higher frequency of L-selectin genotypes in patients with brucellosis than in control individuals, as well as the association between the 206Leu allele and the occurrence of brucellosis relapse, suggest that the F206L polymorphism could make individuals more vulnerable to brucellosis.

Adult↗
PubMed1984

[Treatment of human brucellosis with rifampicin].

Rifampin, which exhibits good intracellular diffusion and in vitro bactericidal activity on brucella, is effective in experimental brucellosis in mice, without selection of resistant strains. It was therefore legitimate to use rifampin in man since conventional treatment of acute brucellosis is followed by recurrence in 15% (tetracycline alone) or 3.7% (streptomycin-tetracycline combination) of cases. Rifampin was given to 13 patients with brucellosis (acute brucellosis in 8, osteoarticular brucellosis in 3 and chronic brucellosis in 2). Rifampin was given as sole therapy in a daily dosage of 600 to 1 200 mg. A tetracycline was subsequently needed in three cases, in combination with rifampin in two, and as replacement therapy in one. Treatment lasted 20 to 60 days in acute brucellosis and 2 to 15 months in other forms. Only one failure was recorded among the 11 cases of acute or localized brucellosis. Conversely, effectiveness of rifampin proved incomplete (1 case) or null (1 case) in chronic forms. The satisfactory effectiveness of rifampin is confirmed by a review of the literature which found 17 reports addressing the subject. These include 324 cases of brucellosis treated by rifampin, as sole therapy in 255 patients, with only 24 failures ascribable to faulty dosage. Indeed, rifampin must be given for at least 30 days, in a minimal daily dosage of 600 mg or 10 mg per kg, in a single dose. Cotrimoxazole is an antagonist and should not be associated with rifampin. Conversely, tetracyclines are synergistic and their association, which is useless in acute brucellosis, is helpful in localized and chronic forms.

Acute Disease↗
PubMed2002

Brucellosis in sub-Saharan Africa: epidemiology, control and impact.

Brucellosis is an important disease among livestock and people in sub-Saharan Africa. In general, the incidence is the highest in pastoral production systems and decreases as herd size and size of landholding decreases. The prevalence of risk factors for infections are best understood for bovine brucellosis and to a lesser extent for ovine and caprine brucellosis. The occurrence and epidemiology of brucellosis in pigs is poorly understood. This species bias is also reflected in control activities. As with other public-sector animal health services, the surveillance and control of brucellosis in sub-Saharan Africa is rarely implemented outside southern Africa. Brucellosis is even more ignored in humans and most cases go undiagnosed and untreated, leading to considerable suffering for those affected. Decision-making to determine the importance of brucellosis control relative to other public concerns and what brucellosis control strategies should be applied is urgently required. A strategy for how brucellosis decision-making might be considered and applied in future is outlined.

Africa South of the Sahara↗
PubMed1976

[Clinical and epizootiological aspects of bovine, caprine, and ovine brucellosis in Greece].

The author reports on an investigation, in Greece, of the clinical and epizootiological aspects of bovine, caprine and ovine brucellosis. These three types of brucellosis are found in the abortive and latent forms. The abortive form is revealed by contagious abortions whose frequency depends principally on the composition of the animal population of the farm; during its evolution, numerous very high positive serological reactions are observed. It involves many complications, causes heavy economic losses and is passed on to a great number of breeders. The latent form is accompanied by chronic manifestations, but passes unnoticed for the most part and is discovered only by serological tests during a period of suspect abortions of human cases of brucellosis. There are fewer of these cases then when the disease evolves in the region in the abortive form. The latent form contributes to the multiplication of centres of infection (1) when apparently uninfected female animals coming from farms contaminated with the latent form are introduced into healthy herds, (2) when the latent form changes into the abortive form after the introduction of healthy female animals into farms contaminated with this form. Furthermore, because of its inapparent evolution, it is a constant danger to rural populations. Bovine brucellosis has been observed in 16 of the 52 departments in the country, and caprine and ovine brucellosis in 21. The proportion of infection throughout the bovine, caprine and ovine herds of the 38 departments in which the investigation was made is approximately 4.70, 1.29, and 0.33 per thousand, respectively. The usual pathogenic agent of bovine brucellosis is Br. abortus; Br. abortus resistant to thionin is found less frequently and Br. melitensis only occasionally. The usual pathogenic agent of caprine and ovine brucellosis is Br. melitensis; Br. intermedia is less frequent and Br. abortus is found only rarely. Four Tables show the clinical investigation of 150 bovine abortions of brucellic origin and observations on the sanitary conditions of 22 cattle-sheds and herds infected with abortive or latent brucellosis. The author concludes in favour of the necessity of medical prophylactic measures and the strict application of sanitary prophylactic measures. In general, new animals should not be introduced into farms but when this is necessary the animal should not be considered free from brucellosis simply because of negative serological reactions. The best policy, in this case, is to repopulate entire farms negative to serological tests by seronegative animals coming also from entirely negative farms.

Abortion, Veterinary↗
PubMed2006

Spinal brucellosis: Turkish experience based on 452 cases published during the last century.

BACKGROUND: Spinal brucellosis continues to be the leading cause of morbidity from infectious disease in the infested regions of the world, particularly in the rural areas including Turkey. The purpose of this review was to present the Turkish experience by analyzing the literature on the management of spinal brucellosis during the last century. MATERIALS AND METHOD: To establish new guidelines for the diagnosis and treatment of this disabling health problem, publications reported from Turkey in national (n = 27) and international (n = 37) journals during the last century and databases containing medical literature were analysed. RESULTS: It was observed that the number of articles produced by Turkish authors regarding spinal brucellosis has tremendously increased throughout the study period. Although the total number of reported cases with spinal brucellosis from a total of 34 secondary or tertiary referral centers in Turkey was 452, only cases having detailed information were evaluated for further analysis according to inclusion/exclusion criteria. Despite the inherent limitations, this type of study clearly indicates that the incidence of brucellosis has not decreased in Turkey over recent years. The clinical and radiological findings of brucellosis involving the spine were mostly atypical and it was difficult to diagnose this infectious disease owing to its nonspecific and variable clinical picture. Therefore, it may easily lead to a misdiagnosis of lumbar disc herniation or other spinal infections and a high index of suspicion is required to diagnose this condition in endemic parts of the world. In addition to serological tests, CT and/or MRI techniques were found to be sensitive for diagnosis and follow-up because they provide early diagnosis of lesions involving the spine and more accurate localization of intraspinal and paraspinal infestation by means of multiplanar images. Histologically, noncaseating granulomatous tissue and chronic inflammation were characteristic features of cases of brucellosis with spinal involvement. CONCLUSIONS: Based on this critical review of literature from Turkey, it is concluded that early diagnosis and correct management are important to prevent the harmful effects of brucellosis and its complications, and that the treatment of choice is antibiotic therapy alone in most cases of brucellosis involving the spine.

Adolescent↗
PubMed2005

Rose Bengal test: diagnostic yield and use for the rapid diagnosis of human brucellosis in emergency departments in endemic areas.

The aim of the present study was to analyse the diagnostic yield of the rose Bengal test for the rapid diagnosis of human brucellosis in an emergency department in an area where the disease is endemic. The study included 711 patients diagnosed initially with brucellosis and 270 controls. Brucellosis patients were divided into three groups: group I, individuals with no regular exposure to or history of brucellosis; group II, individuals exposed repeatedly to Brucella infection; and group III, individuals infected with Brucella who had received appropriate treatment during the previous 12 months. Blood cultures were positive for 445 (62.6%) brucellosis patients, while the remaining 266 (37.4%) patients were diagnosed according to clinical and serological criteria. The overall sensitivity of the rose Bengal test was 92.9%. The specificities for groups I, II and III were 94.3%, 91.7% and 76.9%, respectively, with positive likelihood ratios of 16.5, 10.4 and 4.2, respectively. The diagnostic gain after the performance of the rose Bengal test was good or very good in patients with no previous exposure to Brucella or history of brucellosis, but poor in patients who were exposed repeatedly to Brucella or had a history of brucellosis and a low pre-test probability. Use of the rose Bengal test as the sole technique for the diagnosis of brucellosis in endemic areas should be considered very carefully in the context of patients who are exposed repeatedly to Brucella or have a history of brucellosis.

Adolescent↗