Brucellosis in the Arabian Peninsula: A Continued Saga That Could End with Optimistic Rewards

Abstract

Letters to the EditorBrucellosis in the Arabian Peninsula: A Continued Saga That Could End with Optimistic Rewards George F. ArajPhD, ABMM George F. Araj Associate Professor and Director, Clinical Microbiology, Department of Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon Search for more papers by this author Published Online::1 Nov 1993https://doi.org/10.5144/0256-4947.1993.571SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionTo the Editor: The editorial on brucellosis by Dr. Tabbara [1] is a timely call about this endemic disease, especially that the official annual incidence of cases reached 85 per 100,000 population in some Gulf countries, compared to 0.1 in the USA [2]. It is hoped that such a call inspires priority attention not only by the variety of Ministries and agencies that were noted, but also by the scientists and research institutes in the Kingdom to adopt brucellosis as a research theme.The available opportunity of abundant patient population, research funds and facilities should be seized upon in a coordinated, collaborative and consolidative team approach, not only towards control and preventive measures, but also to utilize the newer technologic tools (e.g. ELISA, molecular biology and PCR) to address unsettled clinical, diagnostic, follow-up, prognostic, therapeutic and vaccine issues as were embarked upon in Kuwait, but which were interrupted [3-7]. Examples of these include: 1) Defining specific diagnostic and prognostic markers to be used in serologic tests by determining purified and relevant antigenic epitopes, each of which could be associated with a certain stage of the disease course. Such markers could help in discriminating between infected humans and those treated and cured; 2) Conducting multicenter controlled clinical trials with newer antimicrobial agents that proved effective in vitro against brucella, and had good intracellular penetration, to find alternative therapies which are needed, especially in children and pregnant women. Besides, this will help to withhold rifampin and streptomycin to mycobacterial infections, particularly now that multi-drug-resistant mycobacteria are becoming a global problem; 3) Carrying out long-term (3-4 years) follow-up studies to correlate the course of the disease versus classes and subclasses of immunoglobulins using specific antigens (as in #1 above), to look for predictors of cure, relapse, and chronicity; 4) Designing nucleic acid probes and using polymerase chain reaction technology in the diagnosis of the disease, especially for chronic and complicated cases such as those with neurobrucellosis; and 5) Determining specific nucleic acid segments that can be utilized to differentiate between wild type strains and those used for vaccination.Such a qualitative investigative approach would not only be scientifically rewarding and internationally competitive, but would also make an impact on the world literature of brucella research. At this stage, the several publications from the Gulf region have covered a lot of fundamental aspects of brucellosis in adults and children, including epidemiologic characteristics [2,3], clinical features [3], various types of complications [3,4], laboratory features [3], diagnostic tests [5], susceptibility testing [6] and therapeutic trials [3,7]. These studies should be utilized as the foundation, rather than repeating them, to further explore the unknown or unsettled frontiers of the disease. Again, with consolidated efforts in the Kingdom, this is a realistic and optimistic goal to achieve in the scientific horizon of the Gulf brucellosis.ARTICLE REFERENCES:1. Tabbara KF. "Brucellosis: A model for eradication of endemic diseases from the Arabian Peninsula" . Ann Saudi Med. 1993; 13:1-2. Google Scholar2. Madkour MM, Gargani G. Epidemiological aspects. In: Brucellosis. Makour MM, ed. London, Butterworth1989;11-28. Google Scholar3. Lulu AR, Araj GF, Khateeb MI, et al.. "Human brucellosis in Kuwait: A prospective study of 400 cases" . Quart J Med. 1988; 66:39-54. Google Scholar4. Shakir AR, Al-Din ASN, Araj GF, et al.. "Clinical categories of neurobrucellosis: A report on 19 cases" . Brain. 1987; 110:213-23. Google Scholar5. Araj GF, Lulu AR, Khateeb MI, et al.. "ELISA versus routine tests in the diagonsis of patients with systemic and neurobrucellosis" . Acta Pathol Microbiol Immunol Scand. 1988; 96:171-6. Google Scholar6. Dhar R, Araj GF, Kisswani SM, Chugh TD. "In vitro activity of conventional and newer agents against Brucella melitensis isolates from Kuwait" . Med Principles Pract. 1990; 2:110-7. Google Scholar7. Lubani MM, Dudin KI, Sharda DC, et al.. "A multicenter therapeutic study of 1,100 children with brucellosis" . Pediatr Infect Dis J. 1989; 8:75-8. Google Scholar Previous article FiguresReferencesRelatedDetailsCited byAl-Attas R, Al-Khalifa M, Al-Qurashi A, Badawy M and Al-Gualy N (2000) Evaluation of PCR, Culture and Serology for the Diagnosis of Acute Human Brucellosis, Annals of Saudi Medicine, 20:3-4, (224-228), Online publication date: 1-May-2000. Volume 13, Issue 6November 1993 Metrics History Published online1 November 1993 InformationCopyright © 1993, Annals of Saudi MedicinePDF download