Brucella Agglutination Test Research Articles

SAT609 Panhypopituitarism Secondary To Pituitary Abscess In A Patient With Neurobrucellosis

Abstract Disclosure: G. De la Peña Sosa: None. A. Cabello Hernández: None. M. Gómez Sámano: None. F. Gómez Pérez: None. Background: Pituitary abscess is a rare but potentially life-threatening disease that could lead to panhypopituitarism. It is important to suspect the diagnosis, especially in regions of the world with endemic infectious diseases. Clinical Case: A 55-year, farmer, with a history of consumption of unpasteurized dairy products, began in February 2023 with headache, impaired consciousness and fever. Initial tests were consistent with neuroinfection: lumbar puncture with cerebrospinal fluid (CSF) with elevated proteins (>200 mg/dL, n <45 mg/dL), decreased glucose (14 mg/dL with a serum glucose of 76 mg/dl), pleocytosis (800 mm3, n <5 mm3). Head CT-scan did not report alterations. Antibiotic treatment was started due to diagnosis of acute meningitis. Later Brain MRI was performed showing ventriculitis; the pituitary gland was heterogeneous with the presence of an 8x8mm abscess.Pituitary axis hormones were evaluated, showing results compatible with panhypopituitarism with central hypothyroidism (normal serum TSH 1.05 mIU/L (n 0.3-5 mIU/L), decreased free T4 0.57 ng/dL (n 0.63-1.34 nd/dL), decreased total T3 0.47 ng/mL (n 0.64-1.81 ng/mL)), central hypocortisolism (decreased morning cortisol levels 5.72 mcg/dL (n 6.7-22.6 mcg/dL) and ACTH 20 pg/mL (n 10-50 pg/ml)), central hypogonadism (decreased LH <0.20 mUI/mL (n 1.24-862 mUI/mL), decreased FSH 0.37 mUI/mL (n 1.27-19.26 mUI/mL), decreased testosterone 0.24 ng/mL (n 1.75-7.81 ng/mL)), growth hormone deficiency (decreased IGF-1 9.99 ng/mL (n 61-206 ng/mL)). Hormone replacement treatment with hydrocortisone and levothyroxine was started. Due to the epidemiological background, Rose Bengal test for Brucella spp. was performed, with positive results (n negative) and 2-mercaptoethanol Brucella agglutination test was also positive >1:20 (n <1:20). Diagnosis of neurobrucellosis was made and treatment with doxycycline, rifampin and ceftriaxone was started. Neurosurgery service suggested conservative management with antibiotics. Patient showed improvement in his neurological status and infectious symptoms disappeared. Subsequent pituitary MRI showed pituitary intraglandular abscess with a 15% decrease.The patient was discharged six weeks later with prednisone, levothyroxine, somatropin and testosterone, as well as doxycycline and rifampin for another 4 months. Conclusion: Pituitary abscess should be considered in a differential diagnosis of patients with neuro infection symptoms, panhypopituitarism and heterogenous image in the MRI. Opportune medical management may result in a lower mortality and a higher recovery of pituitary hormone function. Reference: Karagiannis, Apostolos K A et al. “Pituitary abscess: a case report and review of the literature.” Endocrinology, diabetes & metabolism case reports vol. 2016 (2016): 160014. doi:10.1530/EDM-16-0014 Presentation: Saturday, June 17, 2023

Brucella orchitis presenting as a testicular mass mimicking a testicular tumor: a rare case report

IntroductionBrucella epididymo-orchitis is a complication that occurs in 5.7% of patients with brucellosis and can rarely mimic a testicular tumor. We here report a case of a 25-year-old man with a testicular brucellosis that presented as a testicular mass that responded to conservative treatment using antibiotic therapy.Case reportA 25-year-old patient presented with left testicular pain, abdominal pain, easy fatiguability, and feeling unwell. Physical examinations were normal. A testicular tumor was suggested by a scrotal color Doppler US scan and testicular MRI. However, tumor markers were all within the normal range. A serum Brucella agglutination test (Rose Bengal test) was done, and it was positive. The patient received anti-brucella antibiotics. An ultrasound scan 3 months later revealed complete recovery after completing antibiotic treatments.DiscussionBrucella orchitis can be determined based on the triad of serology, ultrasonography, and the presence of the common symptoms like fever, testicular pain, redness, and enlargement. The early diagnosis of this phenomenon is crucial due to the morbidity and complications that may be encountered. Moreover, it has several differential diagnoses, such as testicular tumor, epididymitis, trauma, torsion of the testis, and hematocele. Failure to obtain an adequate diagnosis, particularly if a testicular tumor is suspected, may result in unnecessary intervention like orchiectomy.ConclusionBrucella orchitis is a complication of brucella infection that may mimic a testicular tumor. Several techniques of diagnosis are required for an accurate assessment.

One-stage posterior surgery combined with anti-Brucella therapy in the management of lumbosacral brucellosis spondylitis: a retrospective study

BackgroundThis study aimed to assess the clinical efficacy of one-stage posterior surgery combined with anti-Brucella therapy in the treatment of lumbosacral brucellosis spondylitis (LBS).MethodsFrom June 2010 to June 2020, the clinical and radiographic data of patients with LBS treated by one-stage posterior surgery combined with anti-Brucella therapy were retrospectively analyzed. The visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) and Oswestry Disability Index scores (ODI) were used to evaluate the clinical outcomes. Frankel’s classification system was employed to access the initial and final neurologic function. Fusion of the bone grafting was classified by Bridwell’s grading system.ResultsA total of 55 patients were included in this study with a mean postoperative follow-up time of 2.6 ± 0.8 years (range, 2 to 5). There were 40 males and 15 females with a mean age of 39.8 ± 14.7 years (range, 27 to 57). The Brucella agglutination test was ≥ 1:160 in all patients, but the blood culture was positive in 43 patients (78.1%). A statistical difference was observed in ESR, CRP, VAS, ODI, and JOA between preoperative and final follow-up (P < 0.05). Neurological function was significantly improved in 20 patients with preoperative neurological dysfunction after surgery. According to Bridwell’s grading system, the fusion of bone grafting in 48 cases (87.2%) was defined as grade I, and grade II in 7 cases (12.7%). None of the infestation recurrences was observed.ConclusionOne-stage posterior surgery combined with anti-Brucella therapy was a practical method in the treatment of LBS with severe neurological compression and spinal sagittal imbalance.

Brucellosis Serostatus Among Pregnant Women with Spontaneous Abortion and Stillbirth

Background: Brucellosis in pregnancy is associated with severe outcomes ranging from abortion to neonatal development problems. Objective: The aim of this study is to evaluate the seroprevalence of brucellosis antibodies among pregnant women presented with spontaneous abortion and stillbirth. Methods: In this cross-sectional study, 80 cases (stillbirth or spontaneous abortion) and 80 healthy pregnant women were serologically examined for brucellosis antibodies using Coombs, Wright and 2-mercaptoethanol (2ME) brucella agglutination tests. The questionnaire consisting of the following data was prepared for all the participants: gestational age, age, history of abortion, parity, source of dairy consumption, contact with livestock, urban or rural living setup, serological outcomes and education levels. Results: The two groups were not significantly different in terms of the brucellosis test. Patients in the case group with and without infection were not significant in terms of contact with livestock, place of residence, dairy consumption, and history of abortion. However, education level was significantly different in the two, seropositive and seronegative, groups. Conclusion: Our study did not find a significant number of seropositive brucellosis cases associated with stillbirth and spontaneous abortion. Further studies with greater samples are therefore recommended.

Brucellosis testing patterns at health facilities in Arusha region, northern Tanzania.

Brucellosis is listed as one of six priority zoonoses in Tanzania's One Health strategic plan which highlights gaps in data needed for the surveillance and estimation of human brucellosis burdens. This study collected data on current testing practices and test results for human brucellosis in Arusha region, northern Tanzania. Retrospective data were extracted from records at 24 health facilities in Arusha region for the period January 2012 to May 2018. Data were captured on: the test reagents used for brucellosis, procurement and testing protocols, the monthly number of patients tested for brucellosis and the monthly number testing positive. Generalised linear mixed models were used to evaluate relationships between health facility characteristics and the probability that brucellosis testing was conducted in a given month, and the proportion of individuals testing positive. Four febrile Brucella agglutination tests were used widely. The probability of testing for brucellosis in a given month was significantly associated with an interaction between year of testing and facility ownership. Test probability increased over time with more pronounced increases in privately owned as compared to government facilities. The proportion of individuals testing positive for brucellosis was significantly associated with facility type and district, with individuals tested in hospitals in Meru, Monduli and Ngorongoro districts more likely to test positive. Febrile Brucella agglutination tests, known for their poor performance, were the mainstay of brucellosis testing at health facilities in northern Tanzania. The study indicates that historical data on human brucellosis in Arusha and other regions are likely to provide an inaccurate measure of true disease burden due to poor performance of the tests used and variation in testing practices. Measures to address these identified shortcomings could greatly improve quality of testing and surveillance data on brucellosis and ultimately inform prevention and control of this priority disease.

Survey for Leptospira and Brucella in Amazonian manatees, Amazon river dolphins, and a tucuxi in the Brazilian Amazon.

Leptospirosis and brucellosis are zoonotic diseases with global distributions that represent severe hazards to humans and animals. We investigated exposure to Leptospira spp. and Brucella spp. in samples from Amazonian manatees Trichechus inunguis, Amazon river dolphins Inia geoffrensis, and a tucuxi Sotalia fluviatilis. The animals were free-ranging or undergoing in situ rehabilitation in the mid-Solimões River region, Brazilian Amazon. Serum samples from 19 Amazonian manatees were tested by microscopic agglutination test, Rose Bengal test, and 2-mercaptoethanol Brucella agglutination test. Antibodies against Leptospira spp. were detected in 63% of the manatees tested and serovar Patoc was considered the infecting serovar in all positive samples. Titers were generally low, indicating chronic exposure, but higher titers indicative of an active infection were detected in 3 animals. Anti-Brucella spp. antibodies were not detected. Tissue and/or body fluid samples from 12 Amazon river dolphins, a tucuxi, and 2 Amazonian manatees were investigated by multiplex PCR and bacteriology for Leptospira spp. and Brucella spp. All samples were negative. However, Enterococcus faecalis was isolated from uterine fluid, lymph node, and lung of 3 Amazon river dolphins. Bacillus spp. were isolated from milk and synovial fluid from 2 Amazon river dolphins and from a milk sample from 1 Amazonian manatee. Knowledge of the pathogens present in Amazonian manatees, Amazon river dolphins, and tucuxis is of great relevance to species conservation and environmental health. Although no clinical signs were noted, further research is needed to elucidate the clinical relevance of infection by Leptospira sp. serovar Patoc in Amazonian aquatic mammals.

Using a One Health Case-Based Investigation for Improved Control of Brucellosis in Isiolo, Kenya

Brucellais a highly pathogenic bacteria endemic in Kenya, and in spite of its severity in humans, the highly inadequate Febrile AntigenBrucellaAgglutination Test (FBAT) remains a primary tool for its diagnosis. Blood samples were collected from febrile patients in Kinna health center and screened by the local routine. Milk samples were purchased from local milk hawkers and analyzed forBrucellaantibodies using the milk ring test (MRT). The MRT-positive milk was traced to farms, and lactating cattle were sampled for milk and blood. Milk was MRT-tested and the serum was analyzed using the Rose Bengal test (RBT) and iELISA. Available patient and farm samples were stored on FTA cards for qPCR analyses. Despite a limited sample size, our study, in line with previous reports, shows a low diagnostic sensitivity (67%) and specificity (40%) of FBAT when compared to qPCR. As many as 48% of the raw bulk cattle milk samples were MRT-positive forBrucellaantibodies and 60% of cattle on three visited farms were IS711qPCR-positive. This case-based One Health investigation confirms the suspectedBrucellapresence, suggesting a targeted vaccination at high-prevalence farms, urgent interventions on milk safety, and a re-evaluation of the diagnostic and treatment regimen.

Detection of brucellosis in cattle and evaluation of risk factors associated with the disease in workers slaughterhouse

Brucellosis is anthropozoonosis caused by Brucella spp. Among the zoonotic species, B. abortus is the main species affecting cattle and can easily be transmitted to humans. The purpose of this study was to investigate, through epidemiological inquiry and serological analysis, animal and human health as related to smooth strain Brucella spp. in a slaughterhouse located in the southern region of the state of Bahia. For this purpose, blood samples were collected from workers and animals at a slaughterhouse together with the State Inspection Service. Then, the Buffered Acidified Plate Antigen test was performed for animals and humans, the Slow Agglutination Test was performed for humans only; and the Complement Fixation Test and the 2-Mercaptoethanol Brucella Agglutination test (2ME) were performed for animals only. In addition, an epidemiological inquiry was applied to workers in order to assess risk factors for the disease. After data analysis, it was concluded that infection by smooth strains of Brucella spp. was detected in 14.0% of the cattle. Additionally, one worker out 41 tested reactive to the disease.

Hospital-based evidence on cost-effectiveness of brucellosis diagnostic tests and treatment in Kenyan hospitals

Hospitals in Kenya continue to use the Febrile Antigen Brucella Agglutination Test (FBAT) to diagnose brucellosis, despite reports showing its inadequacy. This study generated hospital-based evidence on the performance and cost-effectiveness of the FBAT, compared to the Rose Bengal Test (RBT).Twelve hospitals in western Kenya stored patient serum samples that were tested for brucellosis using the FBAT, and these were later re-tested using the RBT. Data on the running time and cost of the FBAT, and the treatment prescribed for brucellosis, were collected. The cost-effectiveness of the two tests, defined as the cost in US Dollars ($) per Disability Adjusted Life Year (DALY) averted, was determined, and a basic sensitivity analysis was run to identify the most influential parameters. Over a 6-month period, 180 patient serum samples that were tested with FBAT at the hospitals were later re-tested with RBT at the field laboratory. Of these 24 (13.3%) and 3 (1.7%) tested positive with FBAT and RBT, respectively. The agreement between the FBAT and RBT was slight (Kappa = 0.12). Treatment prescribed following FBAT positivity varied between hospitals, and only one hospital prescribed a standardized therapy regimen. The mean $/DALY averted when using the FBAT and RBT were $2,065 (95% CI $481-$6,736) and $304 (95% CI $126-$604), respectively. Brucellosis prevalence was the most influential parameter in the cost-effectiveness of both tests. Extrapolation to the national level suggested that an estimated $338,891 (95% CI $47,000-$1,149,000) per year is currently spent unnecessarily treating those falsely testing positive by FBAT. These findings highlight the potential for misdiagnosis using the FBAT. Furthermore, the RBT is cost-effective, and could be considered as the mainstay screening test for human brucellosis in this setting. Lastly, the treatment regimens must be harmonized to ensure the appropriate use of antibiotics for treatment.

Total spinal involvement due to delayed diagnosis and treatment of noncontiguous brucellar spondylitis

Rational: Brucellosis is a globally prevalent zoonotic disease. Any part of the body can be affected by active brucellosis but osteoarticular involvement are the most common symptoms which was reported to vary from 10% to 85%. The spine is the most common site of brucellosis in the bones. However, noncontiguous brucellar spondylitis is rare, only few cases have been reported in the literature. Patient concerns: A 62-year-old woman with brucellar spondylitis presented with lower back pain and pain in the right lower extremity for six months. Diagnosis: Brucella agglutination test (1:320) and the result of polymerase chain reaction (PCR) confirmed the diagnosis of noncontiguous brucellar spondylitis. Intervention: During hospital stay, the women received intravenous treatment for brucellosis (A combination of doxycycline 200 mg/d, rifampicin 900 mg/d, levofloxacin 0.5 g/QD, and ceftriaxone 2 g/QD was administered for 1 week), The L4-S1 vertebral body was fixed by posterior lumbar debridement. Outcome: Six months after discharge, the follow-up radiographic images showed stable vertebral height and good lumbar stability. She complained no discomfort. Lessons: Multi-level involvement is an exceptional form of brucellar spondylitis. To the best of our knowledge, only few similar cases have been reported. PCR and bacterial culture is necessary for confirmed diagnosis.

Clinical and imaging characteristics of 110 patients with infectious sacroiliitis

Objective: To investigate the clinical and imaging characteristics of infectious sacroiliitis. Methods: A total of 110 patients diagnosed with infectious sacroiliitis were retrospectively analyzed between 2008 and 2017.Clinical manifestations and therapeutic responses, laboratory tests such as HLA-B(27), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), T cell spot test for tuberculosis infection(TB-SPOT), Brucella agglutination test ect., blood culture of pathogens, pathological findings as well as magnetic resonance imaging were all recorded and analyzed. Results: Among the 110 patients, the male to female ratio was 44 to 66 with an average age 15-58(29.4±10.8) years and the course of disease 0.3-60 (5.7±13.2) months. As to the pathogens, 71 cases were pyogenic, 24 cases with tuberculous sacroiliitis, and 15 cases were brucellosis infections. The majority of patients (97.3%) had unilateral sacroiliac joint involvement. Ten (9.1%) patients suffered infectious sacroiliac arthritis after delivery. Hip pain was the main clinical manifestation (83/110,75.5%) and fever as the second (77/110,70.0%). HLA-B(27) was positive in 11 patients (10.0%). Both ESR and CRP were elevated in the majority. There were 103 patients receiving sacroiliac joint puncture biopsy. Seven patients were diagnosed through blood culture or brucellosis agglutination test. Bone marrow edema and osteolytic lesions in magnetic resonance imaging (MRI) were more common in pyogenic or tuberculous sacroiliitis than in brucellosis infections. Conclusion: Infectious sacroiliitis should be differentiated from spondyloarthritis, which develops more in female patients, with short disease duration and fever, mostlynegative HLA-B(27). The majority patients present unilateral sacroiliitis. Active inflammatory lesions are usually beyond sacroiliac joints with osteolytic changes in MRI examinations.

Differentiation Between Brucellar and Tuberculous Spondylodiscitis in the Acute and Subacute Stages by MRI: A Retrospective Observational Study

The aim of this study was to reveal the distinctive features of magnetic resonance imaging (MRI) for distinguishing brucellar spondylodiscitis (BSD) from tuberculous spondylodiscitis (TSD) in the acute and subacute stages. This study involved 14 patients with BSD and 18 patients with TSD from May 2011 to January 2015. BSD was diagnosed based on ≥1/160 titers of a Brucella agglutination test or isolation of Brucella spp. TSD was diagnosed based on the isolation of tuberculosis bacteria. All patients underwent T1- and T2-weight imaging (T1WI and T2WI) and fat suppression T2WI (FS T2WI). The height and the signal intensity (SI) of the vertebra and intervertebral disc were assessed. The distinctive MRI features were compared using the chi-square test. The SI of the vertebra between BSD and TSD was observed in terms of histogram characteristics of kurtosis, skewness, and percentile (75%-25%) on FS T2WI. Twenty-nine (76.3%) vertebrae of BSD were infected throughout the whole vertebra, and 49 (90.7%) vertebrae of TSD were infected near the osseous end plate (P <.001). Compared to TSD, the vertebral height of BSD was nearly intact (P <.001), owing to the new bone formation in the end plate without vertebral collapse. Furthermore, significant differences in the SI of the vertebra were observed between patients with BSD and TSD in terms of homogeneous characteristics on FS T2WI, that is, kurtosis (BSD vs TSD, 0.107 vs -0.250, P = .023), skewness (BSD vs TSD, -0.021 vs 0.266, P = .017), and percentile (75%-25%) (BSD vs TSD, 54.498 vs 79.399, P = .00049). The nearly intact vertebra with homogeneous high signal on FS T2WI was an important MRI feature for distinguishing BSD from TSD in the acute and subacute stages.

Brucellosis mimic SLE

Brucellosis is an infectious disease with articular involvement. Brucellosis and rheumatologic disorders are difficult to discriminate between them in regions endemic to brucellosis. The autoantibody level in patients with brucellosis has been discussed in a few studies. In one study showed autoimmune processes in the pathogenesis of brucellosis . The purpose of this paper is to report a case of brucellosis that presented with positive autoimmune markers while negative Brucella agglutination test. Also the effectiveness of prednisolone in an acute phase.

Seroprevalence of Brucellosis in Human Immunodeficiency Virus Infected Patients in Hamadan, Iran.

ObjectivesBrucellosis is a systemic disease with a wide spectrum of clinical manifestations. This study aimed to determine the seroprevalence of brucellosis in human immunodeficiency virus (HIV) infected patients in Hamadan Province in the west of Iran.MethodsA total of 157 HIV-infected patients were screened through standard serological tests, including Wright’s test, Coombs’ Wright test, and 2-mercaptoethanol Brucella agglutination test (2ME test), blood cultures in Castaneda media, and CD4 counting. Data were analyzed using Stata version 11.ResultsWright and Coombs’ Wright tests were carried out, and only 5 (3.2%) patients had positive serological results. However, all patients had negative 2ME results, and blood cultures were negative for Brucella spp. Moreover, patients with positive serology and a mean CD4 count of 355.8 ± 203.11 cells/μL had no clinical manifestations of brucellosis, and, and the other patients had a mean CD4 count of 335.55 ± 261.71 cells/μL.ConclusionResults of this study showed that HIV infection is not a predisposing factor of acquiring brucellosis.

Concurrent Presentation of Neurobrucellosis and Spinal Cyst Hydatid: A Case Report

Introduction: Brucellosis and cyst hydatid are highly endemic to Turkey. Although these diseases are mostly seen separately, it is also possible to see them together in the same patient. In this case report, we present a patient diagnosed with neurobrucellosis and vertebral cyst hydatid at the same time. Case report: A thirty-five-year-old woman presented with progressive weakness, and numbness in both the legs, headache and fever. The patient came from a province where brucellosis was endemic and her Brucella agglutination tests were positive. The abscess formation encountered in her spinal MRI and milimetric hyperintense lesions on T2-weighted images in white matter in her cranial MRI are interpreted as different presentations of brucellosis. After antibiotic therapy for brucellosis, cranial symptoms dramatically improved. Since the vertebral lesion persisted despite of the medical therapy, it was operated and the pathology of the lesion was reported as hydatid cyst. Discussion: Spinal cyst hydatid is the most common bone involvement of cyst hydatid and it is usually difficult to distinguish from other infectious diseases such as tuberculosis, brucellosis and chronic osteomyelitis. Although very rare, spinal cyst hydatid might be accompanied by a secondary infection and present like an abscess, making the differential diagnosis almost impossible. In such cases histopathological evaluation is extremely important. Brucellosis is another disease commonly encountered in Turkey and the other Mediterranean countries. Inflammation, vascular insult and white matter changes are the imaging abnormalities encountered in neurobrucellosis. After appropriate therapy, complete clinical and radiologic improvement is possible. Brucellosis and cyst hydatid might be encountered in the same patient, especially in endemic areas. In our case, neurobrucellosis and spinal hydatid cyst presented at the same time, making the differential diagnosis highly difficult. Conclusion: Hydatid cyst and brucellosis may present at the same time but in different ways. In diagnosis process, if we try to explain all symptoms and lesions with the diagnosis of hydatid cyst or brucellosis solely, we may end up missing one of them.

The Evaluation of the Clinical, Laboratory, and Radiological Findings of 16 Cases of Brucellar Spondylitis.

Objective. To evaluate the clinical, laboratory, and radiological presentation of 16 cases of brucellar spondylitis. Methods. The clinical manifestations, laboratory tests, and imaging findings of 16 patients (aged from 24 to 66 years) with brucellar spondylitis treated between September 2012 and September 2014 at the Second Affiliated Hospital of Xi'an Jiaotong University (Xi'an, China) were retrospectively analyzed. Results. Clinical manifestations included high fever, severe pain, sweating, and fatigue. One patient had epididymitis, and two showed clear signs of spinal nerve damage. Laboratory tests showed elevated erythrocyte sedimentation rate (ESR) and C-reactive protein content. Serum brucella agglutination tests were positive, and 11 brucella blood cultures were positive. Imaging manifestations mainly consisted of abnormal signals in the intervertebral space or abnormal signals in the adjacent vertebral bodies (16/16, 100%) in magnetic resonance imaging (MRI), disc space narrowing (14/16, 88%) in X-ray and MRI, or bone destruction and sclerosis around the damaged zone (13/16, 81%) in computed tomography, with rare cases of psoas abscess (2/16, 13%) and sequestrum (1/16, 6%). Conclusion. Since brucellar spondylitis exhibited characteristic clinical and imaging manifestations, it could be diagnosed with specific laboratory tests. Early MRI examination of suspected cases could improve rapid diagnosis.

A cross-sectional study of the seroprevalence and flock-level factors associated with ovine and caprine brucellosis in southeastern Iran.

This cross-sectional study was conducted to estimate seroprevalence and to identify flock-level factors associated with seropositivity to brucellosis in small ruminants in Kerman province, southeastern Iran. In October-November 2011, serum samples were randomly collected from 1767 sheep and 1233 goats, older than 18 months, from 300 flocks. The sera were initially screened for the presence of anti-Brucella antibodies using the Rose-Bengal test; those found to be positive were then examined by Wright and 2-mercaptoethanol Brucella agglutination tests. A questionnaire was used to collect data on flock-level factors likely associated with the within flock seroprevalence of brucellosis. The associations were statistically evaluated for significance in multivariable logistic models. Sixty three flocks (21.00%; 95% CI: 16.80-26.60) had at least one seropositive animal. The mean within-flock seroprevalence was 3.10% (95% CI: 2.60-3.90). The presence of newly purchased animals (OR=3.42; 95% CI: 1.35-8.65) was significantly associated with seropositivity. Our findings highlight the role of animal movement among flocks in the epidemiology of brucellosis in this region. Thus, a control program for brucellosis in the region is suggested to impose appropriate restrictions on animal trade and improve knowledge of livestock owners about quarantine principles for newly purchased animals.

Total Knee Arthroplasty Infected by Brucella Melitensis

Objectives:Brucella infection associated with arthroplasty is a rare event. We present the long-term results of two-stage revision knee arthroplasty due to TKA infection by Brucella melitensis.Methods:A 62-year-old man presented with a 4-month history of night sweats, high body temperature, and right knee pain in 2003. Two years previously, he had undergone a right TKA for treatment of gonarthrosis. Upon examination, the knee appeared swollen, warm, and sore, and a sinus tract formation had developed at the incision area. Bacteriologic cultures taken from the sinus tract discharge revealed B. melitensis. The patient’s erythrocyte sedimentation rate (ESR) was 83 mm/h, C-reactive protein (CRP) level was 12.38 mg/L, and blood leukocyte concentration was 9425/mm3. Plain radiography confirmed septic loosening. A two-stage revision TKA was planned. The first stage involved removal of the infected prosthesis and debridement of the remaining cement and necrotic tissue. Removal of the prosthetic components and cement and application of an antibiotic-loaded spacer (teicoplanin-impregnated) was also performed in the first stage. Oral rifampicin (900 mg) and doxycycline (300 mg) were administered daily for 12 weeks postoperatively. At the end of the antibiotic therapy, the patient was seen as an outpatient, and his ESR, CRP level, and antibody titer had decreased to normal values. Finally, prosthetic revision was performed in the second stage of the TKA.Results:Ten years following surgery, the patient had returned to full activities of daily living, described no knee pain, and was very satisfied with the outcome. No abnormalities associated with the femoral, tibial, or patellar components were observed on plain radiography 10 years following surgery. The results of a Brucella agglutination test at that time were negative.Conclusion:Osteoarticular disease related to Brucella remains a problem in endemic regions. Brucellosis should be kept in mind in the differential diagnosis of prosthetic joint infections, especially in patients with a history of brucellosis and exposure to possible sources of the bacteria. We believe that two-stage revision arthroplasty is the first-line treatment of a loose TKA infected with B. melitensis. In addition, if a systemic Brucella infection is identified, the patient should be managed with two-stage revision surgery.

Value of magnetic resonance imaging in brucellar spondylodiscitis.

The aim of this retrospective study was to evaluate magnetic resonance (MR) imaging in patients with brucellar spondylodiscitis. Sixty-three patients with spondylodiscitis were diagnosed based on positive clinical findings, ≥1/160titres of brucella agglutination tests and/or positive blood cultures. MR imaging was performed in all of the patients with spondylodiscitis. Signal changes and enhancement of vertebral bodies, involvement of paravertebral soft tissues and epidural spaces, nerve root and cord compression and abscess formation were assessed. Of 63 patients with spinal brucellosis, eight had thoracic, 35 had lumbar, ten had cervical vertebral, seven had both thoracic and lumbar, and three had both lumbar and sacral vertebral involvement. Thirteen patients had cord compression and six had root compression. Four patients had facet-joint involvement, and one had erector spinae muscle involvement. Twenty-four had intervertebral disc narrowing. Seventeen patients were in the acute stage, 32 in the subacute stage and 14 in the chronic stage. Vertebral bodies, vertebral end plates and intervertebral disc spaces were hypointense and hyperintense in the acute stage, whereas they were hypointense and heterogeneous in the subacute and chronic stages on T1- and T2-weighted images, respectively. Brucella is still a public health problem in endemic areas. MR imaging is a highly sensitive and noninvasive imaging technique which should be first choice of imaging in the early diagnosis of spondylodiscitis.

Magnetic resonance imaging findings of musculoskeletal brucellosis

ObjectiveThe aim of this retrospective study was to determine the magnetic resonance imaging (MRI) findings of patients with musculoskeletal brucellosis. Materials and methodsSixty-eight among 304 patients with musculoskeletal brucellosis, aged 12–82 years (average, 50.2years), were included in the study. Patients were diagnosed based on clinical findings, Brucella agglutination tests, and MRI findings. MRI was performed to all of the patients with sacroiliitis, spondylitis-spondylodiscitis, and peripheral arthritis. ResultsBrucella serum agglutination test was >1/160 in all cases and blood cultures were positive in twelve cases. The most commonly affected site was the spine (57.3%), wherein lumbar vertebrae were found to be most commonly affected. The second most common affected site was sacroiliac joint (26.4%), whereas peripheral joints were affected in 11 cases (16.1%). ConclusionBrucellosis may affect various sites in musculoskeletal system. The spine was the most frequently affected site in our study. Sacroiliac joints and the other peripheral joints were less commonly involved sites. Brucellosis should be included in the differential diagnosis of a patient with arthralgia or symptoms of musculoskeletal system disorders especially in endemic areas.