Brucella Mellitensis Research Articles

Microorganisms involved in deep neck infection (DNIs) in Greece: detection, identification and susceptibility to antimicrobials

BackgroundTo determine, from October 2010 to October 2018, the epidemiology of Deep Neck Infections (DNIs), regarding the detection, the identification and the susceptibility to antimicrobials of causative microorganisms, in Thessaly-Central Greece.MethodsAn analysis of data from a prospective database was conducted on 610 consecutive patients with DNIs treated in the Otolaryngology / Head & Neck Surgery Department of University Hospital of Larissa. Demographics, clinical features and microbiological data were analyzed.ResultsAmong the 610 patients (1,9/1 male to female ratio, mean age: 39,24 ± 17,25) with DNIs, 579 had a single space (94,9%), while the remaining 31 had a multi-space (5,1%) DNI. The most common areas affected were the peritonsillar space (84,6%) followed by the submandibular space (6,5%). Clinical samples were obtained from 462 patients, and were tested by culture and by the application of 16S rRNA PCR. Two hundred fifty-five samples (55,2%) gave positive cultures, in which Streptococcus pyogenes and Staphylococcus aureus were predominant. The application of the 16S rRNA PCR revealed that 183 samples (39,6%) were positive for bacterial DNA; 22 of them, culture negative, were found to be positive for anaerobic (Fusobacterium necrophorum, Actinomyces israellii etc) and for fastidious microorganisms (Brucella mellitensis, Mycobacterium avium).ConclusionDNIs represent a medical and surgical emergency and evidence-guided empirical treatment with intravenous infusion of antibiotics at the time of diagnosis is mandatory, highlighting the importance of epidemiological studies regarding the causative microorganisms. Although, in our study, the predominant pathogens were S. pyogenes and S. aureus, the combination of culture and molecular assay revealed that anaerobic bacteria play also a significant role in the pathogenesis of DNIs. Based on the local epidemiology, we propose as empirical therapy the intravenous use of a beta-lactam /beta-lactamase inhibitor; metronidazole or clindamycin can be added only in specific cases such as in immunocompromised patients.

Combination of vial culture and broad-range PCR for the diagnosis of spontaneous bacterial peritonitis: experience in a Greek tertiary care hospital.

Spontaneous bacterial peritonitis (SBP) is often difficult to diagnose because bacteria in ascites cannot be detected accurately by conventional culture. In this study, we evaluated the use of broad-range 16S rRNA PCR, applied either directly to a total of 32 ascitic fluids (AFs) or to the AF vial cultures, after a long incubation of 14 days; the results were compared with those of AF vial cultures. Escherichia coli was isolated in four of 32 AF vial cultures (12.5%). The application of 16S rRNA PCR directly to AF detected only one of the four positive samples (sensitivity 25%, specificity 100%, positive predictive value (PPV) 100%, negative predictive value (NPV) 90.32%). However, the application of 16S rRNA PCR to AF vial cultures after 14 days of incubation correctly identified all the positive samples, including one more that was positive for Brucella mellitensis (sensitivity 100%, specificity 80%, PPV 80%, NPV 100%). The elongation of the incubation period of the AF vial cultures, combined with the use of 16S rRNA in negative vials, increases the possibility of identifying the causative agents of SBP and could be applied in the clinical laboratory.

Successful Management of Prosthetic Valve Brucella Endocarditis with Antibiotherapy Alone.

ObjectivesTo report a case of mechanical aortic prosthesis Brucella endocarditis successfully treated with antibiotics alone.Materials and methods: We describe a clinical case and present a review of the literature.ResultsA 60-year-old female farmer with a mechanical aortic prosthetic valve presented with low back pain and fever. She was diagnosed with prosthetic valve Brucella mellitensis endocarditis and was cured with antibiotic therapy alone. Few cases of successfully treated prosthetic valve Brucella endocarditis without surgery have been reported.ConclusionProsthetic valve Brucella endocarditis usually requires surgical valve replacement. However, selected patients may be successfully treated with antibiotic therapy alone.LEARNING POINTSBrucella endocarditis is responsible for most fatal cases of brucellosis.Brucellosis relapse after treatment in patients with a cardiac valve prosthesis should arouse suspicion for endocarditis.Long-term medical treatment alone can be successful in selected patients with Brucella endocarditis, even in those with prosthetic valve endocarditis..

SAFETY AND EFFICACY OF INTRAVITREAL DEXAMETHASONE IMPLANTS IN THE MANAGEMENT OF MACULAR EDEMA SECONDARY TO INFECTIOUS UVEITIS

To assess the safety and efficacy of intravitreal dexamethasone implants in the treatment of macular edema secondary to infectious uveitis. We retrospectively reviewed clinical records from three uveitis referral units in Spain. The main outcome measures were rate of reactivation of infection, improvements in visual acuity and resolution of macular edema, as measured by optical coherence tomography. We included eight eyes from seven patients with a median age of 64 years (30-75). Etiologies of the infections were Herpes simplex virus-type 1, Varicela-Zoster virus, Treponema pallidum, Brucella mellitensis, Borrelia burgdorferi, Toxoplasma gondii, and cytomegalovirus. Median visual acuity was 20/160 (20/30-20/400) at baseline and 20/70 (20/25-20/200) at the last follow-up visit. Mean macular thickness was 516 μm (115) at baseline and 266.3 μm (40) at the last follow-up visit. Visual acuity improved in 100% of the eyes and none of the eyes showed macular edema at the last follow-up visit. Five patients required reinjections of the implant. Only one patient required antiglaucoma drops for a temporary increase in ocular pressure. There were no cases of reactivation of the infectious ocular disease. Median follow-up time was 18 months. In this small case series of eyes with macular edema secondary to infectious uveitis, treatment with dexamethasone intravitreal implants was not associated with reactivation of the infectious ocular disease. Furthermore, significant improvements in visual acuity and macular thickness were observed in our patients.

A Case of Brucellosis Admitting with Bleeding

During the course of an acute brucellosis infection, severe thrombocytopenia, ITP and bleeding are rarely seen and can be misleading for hematological diseases. Our case was a 20-year-old male patient. He had admitted to the Emergency Room with the complaints of gingival bleeding and bleeding of his pimples. His platelet count was 1.6 x 10³ /µL and he was hospitalized with the preliminary diagnoses of ITP or hematological malignancy. Despite steroids and IV immunoglobulin treatment, his thrombocytopenia did not improve and he further developed melena. A bone marrow biopsy was planned. No significant pathology was detected in the examination of bone marrow aspiration. Brucella tube agglutination test had been ordered to identify the etiology of thrombocytopenia. Its result was reported as 1/160 (+) leading to an hemoculture. The hemoculture resulted in the growth of Brucella mellitensis. Therefore the patient was diagnosed as Brucellosis. Steroid has stopped, with the administration of antimicrobial treatment, his platelet count started improving from second day onwards. All his hemotological findings improved with this treatment. The fact that the patient had findings of severe thrombocytopenia and bleeding resulted in considering a preliminary diagnosis of hematological malignancy. In our country which is endemic for Brucellosis, the differential diagnosis of several patients admitting with different hematological presentations should definitely include Brucella.

Pathological changes inducing by Brucella mellitensis in mice immunized with Culture Filtrate Brucella mellitensis Antigens (SCFAgs) and chitosan

In order to determine the influence of Culture Filtrate Brucella mellitensis Antigens (CFAgs) on B. mellitensis infection in chatosan immunostimulater mice, sixty for white mice, both sex,7-8 weeks age were divided randomly into for groups.1st group(n=16 ) was immunized with 0.4ml of CFSAgs B. mellitensis (concentration of protein( 4.2mg/ml) ,i/p two doses, 2 weeks intervals. 2nd group(n=16) was feed on diet supplement with chitosan ,(1mg/kg B.W) 4 weeks. group. 3ed group(n=1) was inoculated with (0.4ml) I/P with1X109 CFU/ML of viable virulent B. mellitensis and was served as control positive group. 4th group (n=16) was inoculated with 0.5ml sterile normal saline. Cellular and humoral immune response were recorded at 28-30 day post immunization, skin test and passive heam agglutination test respectively, then all animals of immunized and feed chatosan groups were challenge with B. mellitensis as control positive group. The results explained that dead for animals in cotral positive during 15 days post inoculation with virulent viable B. mellitensi with very heavy bacterial isolation, from animal of control positive group post infection The results revealed that immunization with CFSAgs elicited both humoral and cellular immune responses, the level values of both arms of immune response also result reveald that immunization with CFSAgs + chatosan elicited both humoral and cellular immune responses higher than other group , Severe pathological lesions were seen in examined organs of control positive group but these lesions are mild or few in animal immunization with CFSAgs + chatosan. The main lesions in examined organs of these animals are suppurative inflammation ,small grnulomma .. We conclusion that immunization with CFSAgs + chatosan can improve the immune responses in the animals that are suffering from Brucella mellitensis infection

A rare case of seronegative neurobrucellosis

Neurobrucellosis is one of the complications of brucellosis. We report a rare case of a 17-year-old girl with seronegative neurobrucellosis and depression and diplopia. Results of agglutination tests for Brucella both in serum and CSF were negative. Diagnosis was made only by positive culture of Brucella mellitensis with inoculation of the patient’s cerebrospinal fluid in a BACTEC 9050 System. The patient was successfully treated using ceftriaxone, doxycycline and rifampicin therapy for six months.

Clinical Features, Complications and Treatment Outcome of Brucella infection: Ten Years' Experience in an Endemic Area

Purpose: Brucellosis is a multi-systemic infection that is endemic in some parts of the world. The purpose of this study was to examine the epidemiology as well as the clinical and haematological characteristics, complications, and treatment outcome of patients with brucellosis at the King Fahd Hospital of the University Alkhobar, Saudi Arabia.Methods: A descriptive case assessment of all adult patients (aged 13 years and above) with brucellosis over a period of 10 years between 1998 and 2007 was undertaken.Results: The diagnosis of brucellosis in 84 patients was made by clinical findings, positive agglutination titre, and/or the isolation of Brucella species. The number of patients with brucellosis presenting at ourhospital reduced over the study period, with a much smaller proportion of cases occurring after the year 2000. Most of the patients had fever (73%) and musculoskeletal symptoms (64%). Splenomegaly was recorded in 13% and hepatomegaly in 11% of patients. Seven patients (8%) had epididymo-orchitis.Two patients presented with fever of unknown origin with negative serology and only bone marrow culture was positive for Brucella mellitensis. Two patients presented with menstrual associated recurrent fever. One previously healthy patient presented with jaundice and spontaneous peritonitis. No therapeutic failure was observed but relapse occurred in six patients (7%). None of the patients who received streptomycin or ciprofloxacin as part of their antibiotic regimen had a relapse.Conclusion: Brucellosis has a wide range of clinical manifestations. Although the number of patients with brucellosis presenting at our hospital has reduced, continuous organized effort is necessary for brucellosis control.

Can brucella endocarditis be treated successfully with medical therapy alone?

Human brucellosis is caused by one of the three species of Brucella: Brucella mellitensis, B. abortus, and B. suis. Worldwide, the incidence of human brucellosis ranges from <0.01 to >200 per 100,000 population. Cardiovascular complications occur in <2%, but accounts for most of the mortality. Brucella endocarditis usually involves normal native aortic valves in 75% of cases. A combination of antibiotics and valve replacement is the most acceptable treatment. So far only 15 adult cases have been reported as having been cured with medical therapy alone. We report another case treated successfully with antibiotics alone.

Clinical characteristics and outcome of Brucella endocarditis

Brucella endocarditis, a rare complication of brucellosis, is the main cause of death attributable to this disease. There are difficulties in the diagnosis and uncertainty regarding many aspects of the treatment of Brucella endocarditis. We retrospectively examined the clinical characteristics and outcome of patients diagnosed with Brucella endocarditis. Of the six patients diagnosed as having Brucella endocarditis, four had valvular disease, one had aortic and mitral mechanic valve prosthesis (AVR+MVR) and one had secundum type atrial septal defect. Transesophageal echocardiography showed vegetations in four patients. Blood culture grew Brucella mellitensis only in two patients. Standard agglutination tests were elevated in all patients (range 1/320-1/10240). Four patients were managed with combined antibiotherapy and surgery. One refused further treatment and one refused an operation and follow-up was lost for that patient. Two patients died during follow-up; one having had a previous AVR+MVR operation refused further treatment and the other suffering renal failure. Due to the fulminant course of the disease, treatment should be initiated when there is a clinical suspicion, even if the culture results are unknown or negative. Agglutination titres aid in the diagnosis. A combination of antibiotherapy and surgery seems to be preferable treatment modality.

Spondilodyscitis: five years of experience in a department of rehabilitation

Spondylodiscitis is a rare cause of spinal cord lesion. Although this kind of infection is known to have a low incidence; it reflects cases of major clinical interest, since early diagnosis and treatment are determinant reducing morbi-mortality and in improving functional prognosis. To analyse demographic and clinical data; the diagnostic investigations, the rehabilitation programme and the outcome in hospitalised patients. The authors performed a retrospective, descriptive study. They reviewed the medical records of all hospitalised patients in Centro Hospitalar de Coimbra (CHC), between January 2002 and April 2007, with the diagnosis of spondylodiscitis and for which the cooperation of Physical Medicine and Rehabilitation was required. Of the 28 hospitalised patients found, the mean age was 63.5 years (DP +/-15,6); 71% come from a rural environment. The average days of hospitalisation time was 76.6 days (DP +/- 34,2). The most frequent involved agents were Mycobacterium tuberculosis (21%), Staphylococcus aureus (14%) and Brucella mellitensis (14%). In 39% of the cases no agent was identified. The most common clinical manifestations were pain (92%) and neurological sings/symptoms (35%). Of the diagnostic investigations undertaken, MRI (85%), CT scan (67%), increased ESR (60%) and CRP (71%) were the most used. The lumbar spine was the region most frequently involved (67%). In 42% of the cases para-spinal soft-tissue and/or spinal canal were affected. The preferable treatment was the conservative one; there was a need for surgical approach only in two patients. The rising up of the patients constituted the main reason, why the cooperation of Physical Medicine and Rehabilitation was required. In 67% of de cases, the patients were advised to use orthosis and 64% started a rehabilitation programme. Of the 21 patients with a known outcome, 62% recovered completely. The most frequent causative agent was Mycobacterium tuberculosis, having a significant role in spondylodiscitis in our country, attending to its high prevalence. As there is almost always a late diagnosis, a long pharmacological treatment and a slow rehabilitation, there has to be a high rate of suspicion and an early rehabilitation in order to diminish mortality and its economic costs. Physical Medicine and Rehabilitation has a prevailing role in the improvement of the functional prognosis in this disease.

Rapid Diagnosis of Brucella Epididymo-Orchitis by Real-Time Polymerase Chain Reaction Assay in Urine Samples

We studied the diagnostic yield of a real-time polymerase chain reaction assay in urine samples for the rapid diagnosis of brucella epididymo-orchitis compared to that of conventional microbiological techniques. We used an SYBR Green I LightCycler based real-time polymerase chain reaction to retrospectively study 10 urine samples from patients with Brucella epididymo-orchitis. The assay amplifies a 223 bp sequence of a gene that codes for the synthesis of an immunogenetic membrane protein specific for Brucella genus (BCSP31). After amplifying this 223 bp sequence we performed melting curve analysis to verify the specificity of polymerase chain reaction products. Brucella melitensis was isolated from blood cultures in 9 cases (90%). Wright's seroagglutination was negative or inconclusive in 30% of cases. Brucella was isolated from urine in only 1 case, whereas real-time polymerase chain reaction assay in urine was positive in 9 (90%). Also, results were available in 4 hours, whereas mean time to availability of the final blood culture results was 5.8 days (range 4.5 to 7). SYBR Green I LightCycler based real-time polymerase chain reaction assay in urine samples is highly sensitive and specific, and easy to perform. It could provide the clinician with results in less than 5 hours. The technique could be a practical and useful tool for the rapid diagnosis of genitourinary complications of human brucellosis.

P45 Prosthetic knee infection by rev. 1 brucella mellitensis vaccinal strain

P45 Prosthetic knee infection by rev. 1 brucella mellitensis vaccinal strain

Successful management of Brucella mellitensis endocarditis with combined medical and surgical approach.

Brucella endocarditis is an underdiagnosed complication of human brucellosis, associated with high morbidity and mortality. We report the successful management of a number of cases of Brucella mellitensis endocarditis. Seven consecutive cases of Brucella mellitensis endocarditis were treated over the last 20 years, based on high suspicion of the disease at first place. The early suspicion of Brucella endocarditis relied on medical history and a standard tube agglutination titer > or =20. Blood and/or cardiac tissue cultures were positive in all patients, but available late following surgery. All patients were successfully treated with a combination of aggressive medical and early surgical therapy. All affected valves were replaced within 1 week from admission (five aortic and three mitrals). Medical treatment included co-trimoxazole, tetracyclines and streptomycin, before surgery, followed by co-trimoxazole and tetracyclines for a median of 12 months (range: 3-15 months) after surgery until the titers returned to a level < or =1:160. There were neither operative deaths nor recurrence of infection. One patient died two years after the operation due to massive cerebrovascular accident. Ten-year survival was 85.7+/-13.2%. Although Brucella mellitensis endocarditis is a rare entity, its optimum management should be a combination of aggressive medical treatment and early surgical intervention, based on high degree of suspicion in areas with high incidence of the disease.

Detección de Brucella melitensis por el sistema BACTEC 9050

To evaluate BACTEC 9050 system capacity for detection of bacteremia due to Brucella spp. 16 febrile patients were studied during an epidemic infection for Brucella spp. Suspicious of brucellosis was serologically confirmed with Rose Bengal test and agglutination tube test. Only one blood culture was processed per patient. Ten millilitres of blood were inoculated in a Bactec Plus aerobic/F bottle and incubated in BACTEC 9050 automatic system. The bottles were kept in incubation during 21 days, and they were subcultured when the machine detected its growth; if not, a blind subculture was performed after 21 days. 13 of 16 patients showed bacteriemia (81.2%): 11 patients were detected by BACTEC 9050 system and 2 patients by blind subculture after 21 days. A positive result appeared in 149.8 hours (6.2 days) as a mean. Earlier detections were seen in 83 hours (3.4 days) and the latest ones at 245 hours (10.2 days). The aetiology agent of the epidemic infection was Brucella mellitensis biotype 1. We found significative differences comparing the BACTEC 9050 with BACTEC 9120/9240 systems (p<0.03). Incubation protocols of 5 days are not useful for BACTEC 9050 system in the case brucellosis suspicious. Protocols of 7 would detect only 69.2% of the cases.

Brucella mellitensis Endocarditis on a Porcine Heterograft Bioprosthesis

A Brucella mellitensis endocarditis on a Hancock valve bioprosthesis is reported. The patient was successfully treated by a combination of valve replacement, wide surgical debridement of the aortic annulus and medical treatment with trimethoprim and sulfamethoxazole. To the best of our knowledge, this is the first case of Brucella endocarditis on a bioprosthesis.

Serological evidence of Brucella mellitensis infection in goats and eland in Zambia.

Serological evidence of Brucella mellitensis infection in goats and eland in Zambia.