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PubMed2005

Seroepidemiological study on human brucellosis in Assiut Governorate.

Brucellosis is the most important zoonotic disease constituting a public health problem in Assiut Governorate, hence this study was carried out to determine the prevalence of brucellosis among humans in Assiut Governorate. A total of 7154 peripheral blood samples were collected from patients with fever at Assiut Fever Hospital during the period from 2002-2003. A full detailed anamnestic and clinical assessment in the form of questionnaire was designed for each individual to determine the risk factors with specific emphasis to age, sex, residence and occupation. All serum samples were screened for Brucella antibodies by slide agglutination test. Positive sera were further analyzed by standared tube agglutination test. Enzyme linked immunosorbent assay (ELISA) was carried out to detect IgM and IgG Brucella antibodies. Statistical analysis was performed and correlation coefficient was done between all risk factors. Results declared that the prevalence of brucellosis was (1.29 +/- 0.004 %) and (1.22 +/- 0.002 %) as detected by agglutination and ELISA, respectively. IgM antibodies were estimated in 9.8 % of the examined patients, while IgG antibodies were found in 30.4 % of the examined patients, moreover both IgM and IgG antibodies were detected in 54.3 % of the examined patients. The prevalence of brucellosis was significantly (P < 0.05) affected by sex, where the rate of detection was higher among females (1.76 +/- 0.009 %) than males (1.05 +/- 0.004 %) as detected by agglutination test. On the other hand, the prevalence rate based on ELISA was (1.64 +/- 0.39 % and 1.01 +/- 0.89 %) for females and males, respectively. Prevalence of brucellosis was higher in rural areas (1.3 +/- 0.005 % & 1.25 +/- 0.009 %) than in urban areas (1.23 +/- 0.001% & 1.12 +/- 0.01 %) as detected by agglutination test and ELISA, respectively. The prevalence of brucellosis varied significanctly between different occupational and age groups. Public health impact of brucellosis is discussed and suggestive measures for control are explained.

Adolescent↗
PubMed2006

[Comparison of the diagnostic value of blood and bone marrow cultures in brucellosis].

The aim of this study was to compare the rates of brucellosis revealed by blood and bone marrow (BM) cultures obtained from patients followed up in our hospital, between 2002-2004 period. A total of 102 patients (62 male, 40 female; mean age: 39 +/- 5 years) were included to the study and 61 of them were in acute, 29 were in subacute, and 12 were in chronic stages of brucellosis. Blood and BM samples collected from all of the hospitalized patients were cultured by using the BACTEC 9050 system. The mean isolation period for BM cultures was 4.2 days, whereas it was 5.8 days for blood cultures. Overall the rate of positive blood cultures in brucellosis cases was found as 48% (n: 49), while the rate was was 34% (n: 35) for BM cultures, and the difference was statistically significant (p<0.05). Blood and BM culture positive results were detected in 40 (66%) and 28 (46%) of acute brucellosis cases, respectively. BM culture positive 23 samples yielded positive blood culture, while five were negative. These rates were found as 31% (n: 9), and 21% (n: 6) for subacute acute brucellosis cases, respectively. On the other hand Brucella spp. could not be isolated from blood cultures of 12 chronic cases, however, one (8%) was positive for BM culture. The patients were grouped according to their standard tube agglutination (STA) test results (group 1: 1/160-1/640, group 2: 1/1280-1/2560 STA titers), and when comparing these groups for their positive blood and BM culture results, the high rate in group 2 was found statistically significant (p<0.05). Nineteen (70%) of 27 patients who had previously received specific brucellosis therapy were positive for blood and/or BM cultures, indicating insufficient use of antibiotics, or the use of inappropriate antibiotic combinations. It was concluded that, since the rate of positive blood cultures were low in especially chronic brucellosis cases, bone marrow cultures should be obtained for the definite evaluation of these patients.

Acute Disease↗
PubMed1997

Spinal brucellosis in a southern California resident.

Dynamic changes in patient demography that are currently altering the regional epidemiology of brucellosis attest to the need for physicians to reacquaint themselves with a disease that has been largely forgotten in the United States. This is especially the case in California, which has a large immigrant population and where brucellosis clearly appears to have evolved from an occupational to a food-borne illness. In our recent clinical experiences with several cases of brucellosis, food-borne transmission of the organism is the presumptive cause of the disease, as no causes were associated with occupational risks for exposure to the organism. This suggests that given a clinical history consistent with brucellosis, physicians working with patient groups at risk for food-borne exposure must inquire about the ingestion of unpasteurized dairy products specifically and early during the patient visit. A history of travel to areas endemic for brucellosis may further aid diagnosis. Although a predominance of nonspecific clinical signs and symptoms (such as fevers or arthralgias) often makes the clinical diagnosis difficult, the frequency and characteristic patterns of localized disease should heighten clinicians' index of suspicion and lower the threshold for a serologic investigation. Prominent musculoskeletal complaints (especially back pain) accompanied by constitutional symptoms such as fever, malaise, and weight loss may be consistent with brucellosis and a history of unpasteurized dairy ingestion should be elicited. Radiographic evidence that localizes the source of back pain as caused by sacroiliitis or spondylitis is highly suggestive of brucellosis in appropriate patients. In such cases, serologic tests should be persuaded early if warranted by the clinical impression.

Abscess↗
PubMed1999

Osteoarticular complications of brucellosis in an Atlantic area of Spain.

OBJECTIVE: To assess the frequency and clinical manifestations of osteoarticular brucellosis in an Atlantic area of Spain. METHODS: The case histories of all patients older than 14 years of age with active brucellosis diagnosed at the Hospital Xeral-Calde, Lugo, Spain, between October 1979 and October 1997 were reviewed. Diagnosis of brucellosis was by one of the following criteria: isolation of brucella species in blood or other fluids or tissue samples; or a clinical picture compatible with brucellosis in the presence of raised titers of specific antibodies by seroagglutination or Rose-Bengal plate agglutination tests. RESULTS: Forty-four patients (34 men, 10 women) of the 158 patients diagnosed with brucellosis (27.8%) had osteoarticular complications. Spondylitis (20/44; 45.5%) and sacroiliitis (15/44; 34.1%) were the most common complications. Patients with spondylitis were older and had a more chronic disease course than those with sacroiliitis or peripheral arthritis. Brucella abortus was the pathogenic strain responsible for human brucellosis in this region of Spain. CONCLUSION: In the Lugo region of Northwestern Spain osteoarticular brucellosis principally affects males and mainly involves spine and sacroiliac joints.

Adult↗
PubMed2005

[Brucellosis at the dawn of the 21st century].

Human brucellosis is now a rare disease in countries where eradication programs (especially vaccination) against brucellosis in cattle, sheep, and goats have been successfully implemented. In France, fewer than 50 brucellosis cases are annually notified to the National Institute for Infection Surveillance. Human brucellosis, however, remains endemic in the Mediterranean basin, Middle East, Western Asia, Africa, and South America. Shortcomings of standard diagnostic methods for brucellosis (variable sensitivity of culture, frequent serological cross reactions) have been only partially resolved by modern molecular biology techniques. There are now 3 new challenges to be faced by the medical and veterinarian community: the expanding wildlife reservoir of brucellosis, with a possible impact on domestic animals; the emergence of Brucella. melitensis infections in cattle, for which prophylactic efficacy of available vaccines has not been established; and recent recognition of a huge animal reservoir of Brucella species in marine mammals, for which the potential virulence in humans remains unknown.

Animals↗
PubMed2002

Brucellosis in Argentina.

Brucellosis has been recognized in Argentina since the 19th century. Several studies demonstrated the presence of the disease in most of the domestic species. Actually, the estimate of prevalence is that between 10 and 13% of the farm animals are infected with bovine brucellosis with an individual rate of 4-5%. The annual economical losses have been estimated at 60,000,000 US dollars. The control of bovine brucellosis began in 1932 and successive resolutions have been issued since then. The current resolution indicates that B. abortus S19 is mandatory in female calves between 3 and 8 months of age. The vaccine strain B. abortus RB51 was provisionally approved but only for cattle older than 10 months of age. The brucellosis control program consists principally of test and slaughter. This methodology has been successful mainly in the dairy farms that have the incentive due to increased pricing because of obtaining a low prevalence of the disease. Brucellosis has been found in porcine, caprine, ovine and canine species. All Brucella species have been found in the country. Human brucellosis is an important disease and a national coordinated diagnostic net has been formed to better control the disease in man.

Agriculture↗
PubMed2002

An epidemiological and surveillance overview of brucellosis in Romania.

This article reports epidemiological investigations on the occurrence of brucellosis in Romania. Like in other former communist countries, data concerning epidemiology of brucellosis and published articles are very few. The epidemiology and control of brucellosis in Romania was analyzed using data made available by the Office International des Epizooties and Veterinary Service of Romania. Romania, like many other developed countries, has eradicated Brucella abortus from cattle since 1969. Brucellosis caused by Brucella melitensis has never been reported. The incidence of brucellosis in swine and sheep is very rare but still there are a few outbreaks in some regions. In 2000, the number of cases was 47 in swine and 270 cases in sheep. Vaccination against brucellosis is prohibited in Romania.

Abattoirs↗
PubMed2002

Epidemiology, zoonotic aspects, vaccination and control/eradication of brucellosis in India.

In India, brucellosis was first recognised in 1942 and is now endemic throughout the country. The disease is reported in cattle, buffalo, sheep, goats, pigs, dogs and humans. B. abortus biotype-1 in cattle and buffaloes and B. melitensis biotype-1 in sheep, goats and man are the predominant infective biotypes. The long-term serological studies have indicated that 5% of cattle and 3% of buffaloes are infected with brucellosis. Economic losses due to brucellosis in livestock are considerable in an agrarian country like India. There is no organised and effective brucellosis control programme in the country. With the indigenous development of serum and milk based ELISA kits, the population survey of the disease has been undertaken on a large scale in several states and plans for the control of the disease through calf-hood vaccination are being worked out. An innovative approach--Bovine Brucellosis Progressive Control Programme (BBPCP) is targeted to overcome the basic problems of ban on cow slaughter, distress sale of animals following the positive serological diagnosis of brucellosis and absence of a disease control strategy. The work plan for the implementation of BBPCP is presented.

Animals↗
PubMed2003

A method of accelerated eradication of bovine brucellosis in the Czech Republic.

A method of accelerated eradication of bovine brucellosis was developed and applied in the Czech Republic, where livestock was reared primarily in large-scale units. Before this method was adopted, annual economic losses were about US dollars 20 million and thousands of people were estimated to suffer from brucellosis (e.g. 32.4% of tested veterinarians were positive). Initial mass serological testing confirmed 654 outbreaks with 99,787 intrafocal bovines distributed in half of the regions of the Republic. Disease incidence was 213 with a prevalence of 676 per 100,000 bovines. Systematic investigations detected all affected herds, including 91 new outbreaks. A depopulation policy was applied on farms and ranches with brucellosis-infected cattle, with the aim of totally eradicating the disease by a fixed deadline. Breeding on diseased ranches was temporarily discontinued and affected herds were replaced by healthy cattle from brucellosis-free regions. Since then, the incidence of the disease in cattle and humans has been maintained at level zero. Eradication without recurrence was achieved within five years, without reducing the cattle population, the rate of cattle production, or the income of farmers. Ten years after the eradication of the disease, the cumulative benefit/eradication cost ratio reached 7:1. Post-eradication surveillance has confirmed a brucellosis-free status. The eradication of bovine brucellosis has resulted in an increase in cattle production and trade. By 2000, eradication had averted losses of approximately US dollars 700 million and saved more than two thousand people from becoming affected with this zoonosis.

Animals↗
PubMed1998

Brucellosis in patients infected with the human immunodeficiency virus.

Brucellosis has been described rarely in patients infected with HIV, despite the fact that eradication of intracellular brucellae is largely dependent on cell-mediated immunity. The characteristics of all patients with HIV infection and brucellosis seen in seven Spanish hospitals are reported. Since the beginning of the AIDS epidemic, 12 HIV-infected patients were diagnosed with brucellosis (8 with cultures positive for Brucella spp., 4 with high anti-Brucella antibody titers). Most patients were male and intravenous drug users. Eleven patients had no symptoms of HIV infection when first diagnosed with brucellosis and had relatively preserved cellular immunity (median CD4 + cell count 588, range 136-1006). There was a clear epidemiologic antecedent for acquisition of brucellosis in 11 patients. Clinical symptoms included fever, arthromyalgia, and sweating in all patients; four patients presented with focal disease. All patients had high agglutinin titers, and eight of nine had cultures positive for Brucella. Therapy with doxycycline and streptomycin was curative in all cases. Two patients experienced a recurrence of symptoms after initial treatment, although no microbiological relapses were documented after a median follow-up period of 18 months. HIV infection does not seem to increase the incidence of brucellosis. Since most cases occur in asymptomatic patients with relatively preserved immunity, the epidemiology, clinical presentation, diagnosis, response to therapy, and outcome are similar to those observed in non-HIV infected patients.

Adult↗
PubMed2005

Acute brucellosis in Saudi families: relationship between brucella serology and clinical symptoms.

OBJECTIVE: To determine if screening family members of patients with acute brucellosis will enhance the detection rate of brucellosis and also to determine the relationship between symptoms and brucella serology. MATERIALS AND METHODS: Family members from patients with acute brucellosis were interviewed and serologically screened. All seropositive family members were clinically and serologically followed for six months. RESULTS: Twenty-five acute brucellosis patients and their 178 family members were enrolled from January 2001 to February 2002. Of the 178 family members, 40 (23%) manifested various symptoms, 138 (77%) were asymptomatic, with an overall seroprevalence rate of 34 (19%). The rate of seropositivity among the symptomatic family members was 23 (58%) and for the asymptomatic was 11 (8%) (P<0.001). The majority of the symptomatic family members (13 (57%)) had a high Brucella titer in comparison to one (9%) of the asymptomatic group (P<0.001). Acute brucellosis was diagnosed and treated in 18 (78%) of the symptomatic seropositive family members and in four (36%), of the asymptomatic seropositive family members with an acute brucellosis prevalence rate of 22 (12%). All family members with acute infection recovered without sequelae; one patient relapsed (5%). CONCLUSION: Symptomatic family members are more likely to be seropositive with a high titer in comparison to the asymptomatic members.

Acute Disease↗
PubMed2005

Serum copper and zinc concentrations in patients with brucellosis.

The aim of this study was to measure the alterations in serum trace element concentrations, including zinc (Zn) and copper (Cu) in patients with brucellosis and to compare them with the results of healthy individuals. Seventy-five subjects, 60 patients with brucellosis and 15 healthy individuals were included in this study. The serum Zn and Cu concentrations were measured by using atomic absorbtion spectrophotometer in sera of patients with brucellosis and statistically compared with those of healthy individuals. Serum Cu concentration was found to be significantly higher in patients with brucellosis than that of healthy individual (130.5+/-24.7, 96+/-8.65 microg/dl, respectively) (p < 0.01). Serum Zn concentration was lower in patients with brucellosis than those of healthy subjects (79.5 +/-13.5 and 83+/-5.59 microg/dl, respectively) (p < 0.01). Serum trace element concentrations showed significant alterations in patients with brucellosis compared with healthy subjects.

Adult↗
PubMed2003

Epidemiology of ovine brucellosis in Awassi sheep in Northern Jordan.

We used a combined cross-sectional and longitudinal design to estimate seroprevalence of Brucella antibodies in Awassi sheep and the incidence of abortion due to brucellosis during one lambing season, and to test risk factors. The Brucella organisms isolated from aborted fetuses and vaginal swabs were characterized as Brucella melitensis biotype 3. Seventy Awassi sheep flocks were selected randomly from Northern Jordan. Sixty two of the 70 flocks were used in the cross-sectional study and 8 flocks were monitored for three consecutive months to estimate the incidence of abortion. Questionnaire data and 602 serum samples were collected and analyzed. Thirty five flocks (56%) were brucellosis-seropositive by the Rose Bengal plate-agglutination test (RBT) and 28 (45%) by enzyme-linked immunosorbent assay (ELISA). The crude seroprevalence of brucellosis at the individual-animal level was 14.3% by RBT, 7.2% by ELISA and 2.2% using both tests in series. The flock-specific, animal-level abortion risk ranged between 2.5 and 50% (median=22.6%). The flock brucellosis-status was used as the outcome variable in a multivariable logistic regression. Grazing at communal pasture increased odds, but usage of disinfectants, previous vaccination for brucellosis, and tap water were protective. The animal-level incidence of abortion was 20% and the specific incidence risk of abortion due to brucellosis was 13%.

Abortion, Veterinary↗
PubMed2001

[Can the Brucellacapt test be substituted for the Coombs test in the diagnosis of human brucellosis?].

BACKGROUND: Throughout this work we have studied the capacity of Brucellacapt test to replace Coombs test in the serological diagnosis of human brucellosis. METHODS: A total of 66 initial sera from patients with diagnostic of brucellosis were studied. The patients were divided in two groups: 42 patients showing a primo-infection (group1), and 24 patients with a previous case of brucellosis (group 2). As a controls, for the group 1 we have used 100 sera from healthy donors, and for group 2, 28 sera from people that have had clinical brucellosis but actually are in good health. All serum samples were tested in either Coombs and Brucellacapt tests. The diagnostic yield was calculated using ROC (receiver-operating characteristic) plots.Moreover, the results obtained in Coombs and Brucellacapt tests with 397 serum samples from 66 patients with brucellosis were compare with a non-parametric method. RESULTS: The sensibility and specificity for group1 were respectively 1 and 0.98 for Coombs and, 1 and 0.95 for Brucellacapt tests. For group 2, the results in Coombs test were 1 and 0.80, and in Brucellacapt test 0.95 and 0.74. In this second group, the area under the ROC plot was 0.950 for Coombs and 0.904 for Brucellacapt tests. Non statistical differences were observed comparing both serological tests using the Wilcoxon method (Z= -0.213; p=0.8). CONCLUSIONS: Brucellacapt and Coombs tests yield similar diagnostic results in the follow-up of serological samples from patients with brucellosis, and its should consider as interchangeables.

Brucellosis↗
PubMed2002

Evaluation of Brucella dipstick assay for the diagnosis of acute brucellosis.

The diagnostic value of the dipstick assay was evaluated by comparison with Rose Bengal (RB), serum aglutination tests (SAT) and 2 mercaptoethanol test (2-ME) on consecutive serum samples submitted because of suspicion of brucellosis. Serum samples of 232 patients with suspected brucellosis that were submitted for laboratory confirmation were included in the study. Twelve out of 232 serum samples were detected as positive with the dipstick assay. All of these 12 patients had positive RB and SAT results. In 16 RB positive samples dipstick test was negative. Fifteen of these samples had insignificant (titer<1/160) or borderline (titer 1/160) SAT results and the clinical symptoms of these patients were consistent with chronic brucellosis rather than acute or recent-onset brucellosis. Dipstick assay is an easy-to-perform assay that can be used for the diagnosis of acute brucellosis especially in rural areas where brucellosis is widespread and in settings where well-equipped laboratories are not available.

Acute Disease↗
PubMed2003

Serum cytokine levels in patients with acute brucellosis and their relation to the traditional inflammatory markers.

The number of clinical studies on gamma interferon (IFN-gamma), tumor necrosis factor-alpha (TNF-alpha) and interleukin-4 (IL-4) in human brucellosis is limited. The present study was focused on IFN-gamma, TNF-alpha and IL-4 levels in acute brucellosis cases, in the acute phase and at the end of the treatment. The relation of these cytokines to traditional inflammation markers was also investigated. The study included 27 cases of acute brucellosis and 20 healthy volunteers who had no complaints. It was found that mean IFN-gamma and TNF-alpha levels, CRP (C-reactive protein) levels and ESR (erythrocyte sedimentation rate) values were significantly higher in acute brucellosis cases as compared to post-treatment values and values measured in the control group. In addition, IFN-gamma and TNF-alpha levels measured in the acute phase correlated with the increase in CRP levels and ESR values. Our results confirmed that IFN-gamma and TNF-alpha are involved in the pathophysiology of brucellosis and are closely related to the inflammatory activation of the disease. In view of the present findings, it is suggested that IFN-gamma and TNFalpha may be used for monitoring brucellosis.

Acute Disease↗
PubMed2001

[Osteoarticular brucellosis and signs of autoimmunity].

UNLABELLED: We report two cases of osteoarticular brucellosis in childhood, which illustrate the diagnostic difficulties in non-endemic areas. CASE REPORT: A 12-year-old boy was admitted for a unilateral sacroiliitis for which the brucellosis origin was established by serological and blood cultures (without fever). Autoimmunity was detected and disappeared following the treatment of the affection. A six-year-old girl was admitted for a monoarthritis of the left ankle (with fever) for which the brucellosis origin was also established by serology and blood cultures. COMMENTS: The above cases underline the importance of knowing the atypical varieties of brucellosis. The brucellosis serologies need to take part in the etiological workup of an infectious osteoarthritis when a classic infectious cause cannot be proved. Blood cultures on a specific medium are essential to carry out, even in the case of apyrexia. Finally, the possibility of autoimmunity signs for the brucellosis has to be known to avoid orientating the diagnosis towards an autoimmune systemic disease.

Ankle↗
PubMed1996

Defective interferon-gamma production by T-lymphocytes from patients with acute brucellosis.

The authors investigated the production of interleukin-2 (IL-2) and interferon-gamma (IFN-gamma) by phytohaemagglutinin (PHA)-stimulated T-lymphocytes from 21 untreated patients with acute brucellosis. PHA-stimulated T-lymphocytes from acute brucellosis patients showed normal IL-2 production but defective IFN-gamma production (brucellosis patients 531 +/- 103 pg mL-1 vs. healthy controls 1024 +/- 212 pg mL-1) after 72 h of culture. This altered pattern of IL-2 and IFN-gamma production by T-lymphocytes was observed in seven brucellosis patients whose T-lymphocytes exhibited a normal proliferative response to PHA (61 612 +/- 18 422 cpm) as well as in the 14 patients with a defective T-lymphocyte proliferative response to the PHA after 5 days of culture (19 479 +/- 4409 cpm). After antibiotic therapy, production of the two lymphokines by the PHA-stimulated T-lymphocytes from acute brucellosis patients was similar to that of T-lymphocytes from healthy control subjects. The authors conclude that PHA-stimulated T-lymphocytes from untreated patients with acute brucellosis have defective INF-gamma production but normal IL-2 production.

Acute Disease↗