Consumption Of Unpasteurized Milk Research Articles

Campylobacteriosis associated with the consumption of unpasteurised milk: findings from a sentinel surveillance site.

Campylobacteriosis is the most common notifiable disease in New Zealand. While the risk of campylobacteriosis has been found to be strongly associated with the consumption of undercooked poultry, other risk factors include rainwater-sourced drinking water, contact with animals and consumption of raw dairy products. Despite this, there has been little investigation of raw milk as a risk factor for campylobacteriosis. Recent increases in demand for untreated or 'raw' milk have also raised concerns that this exposure may become a more important source of disease in the future. This study describes the cases of notified campylobacteriosis from a sentinel surveillance site. Previously collected data from notified cases of raw milk-associated campylobacteriosis were examined and compared with campylobacteriosis cases who did not report raw milk consumption. Raw milk campylobacteriosis cases differed from non-raw milk cases on comparison of age and occupation demographics, with raw milk cases more likely to be younger and categorised as children or students for occupation. Raw milk cases were more likely to be associated with outbreaks than non-raw milk cases. Study-suggested motivations for raw milk consumption (health reasons, natural product, produced on farm, inexpensive or to support locals) were not strongly supported by cases. More information about the raw milk consumption habits of New Zealanders would be helpful to better understand the risks of this disease, especially with respect to increased disease risk observed in younger people. Further discussion with raw milk consumers around their motivations may also be useful to find common ground between public health concerns and consumer preferences as efforts continue to manage this ongoing public health issue.

Relationship Between Mental Disorder and Chronic Toxoplasmosis in Iranian Soldiers

Background: Toxoplasmosis, with worldwide distribution, may have tissue cyst in a different organ such the brain. The mental disorder associated with toxoplasmosis among soldiers has been poorly studied. Objectives: The purpose of this study was to investigate mental disorders among soldiers with chronic toxoplasmosis. Methods: A total of 239 soldier’s blood samples from one of the garrison in Tehran, Iran, were collected and sera were detected for IgG against T. gondii using the ELISA technique. Results: Of all examined, sera 69 (28.87%) were positive, who were interpreted as the chronic toxoplasmosis. There was no significant association between mental disorders and chronic toxoplasmosis. The positive chronic toxoplasmosis was significantly higher in the consumption of unpasteurized milk, undercooked meat, and juicy and soil-related occupations. Conclusions: It seems that the immune system may control the parasite completely and prevalence of chronic toxoplasmosis was high in the region.

Seroprevalence of Toxoplasma gondii among pregnant women attending antenatal clinics at Hawassa University comprehensive specialized and Yirgalem General Hospitals, in Southern Ethiopia

BackgroundToxoplasmosis is caused by infection with the protozoan parasite Toxoplasma gondii. It is acquired by consumption of raw or undercooked meat containing tissue cyst, food or water contaminated with oocyst and congenital infection through the placenta leading to serious congenital abnormalities in the fetus like miscarriage, stillbirth, intrauterine death and neurologic defects. Therefore; this study was aimed to determine the prevalence of toxoplasmosis infection and its possible risk factors associated with pregnant women attending antenatal clinics in Hawassa and Yiregalem Hospitals, Southern Ethiopia.MethodsA hospital-based cross-sectional study was conducted from December 2016 to May 2017. The study was done in antenatal care clinics of Hawassa and Yiregalem Hospitals in Southern, Ethiopia. Five hundred pregnant women were interviewed with a pretested structured questionnaire to collect risk factors and socio-demographic data. Blood samples were collected and serum was separated and tested for anti- Toxoplasma gondii antibodies using ELISA (Enzyme-linked Immunosorbent Assay). Data were analyzed using SPSS version 20 statistical software. The risk factors were tested for significance using Bivariate and multivariate analysis. P-value < 0.05 was considered statistically significant.ResultsThe weighted prevalence of this study was 81.8% for the anti- Toxoplasma gondii antibody. Almost all participants (99.6%) had no information about the disease. A significant association was observed between seroprevalence and contact with domestic cats (OR = 1.206, 95% CI (1.627–2.206, P = 0.043), consumption of raw meat (OR = 0.848, 95% CI: 1.517–2.941, P = 0.019) and unpasteurized milk (OR = 0.871, 95% CI 1.531–2.221, P = 0.032). A significant association was not observed between seroprevalence and age, history of abortion, and blood transfusion.ConclusionsThe findings of this study demonstrated a relatively higher prevalence of seropositivity than studies reported from other countries. Existence of domestic cats at home, consumption of undercooked meat and unpasteurized milk were identified as risk factors for T. gondii infection. Therefore, a health education program to increase the mother’s knowledge about toxoplasmosis towards avoiding eating undercooked meat, contact with cats and consumption of unpasteurized milk during pregnancy is recommended. Furthermore, our results suggested that the implementation of newborn screening and follow-up testing can lead to reducing of toxoplasmosis associated complications.

Cat-to-Human Transmission of Mycobacterium bovis, United Kingdom.

Human infection with Mycobacterium bovis is reported infrequently in the United Kingdom. Most cases involve previous consumption of unpasteurized milk. We report a rare occurrence of 2 incidents of cat-to-human transmission of M. bovis during a cluster of infection in cats.

Knowledge of pastoralists on livestock diseases and exposure assessment to brucellosis within rural and peri-urban areas in Kajiado, Kenya.

Background: Livestock diseases impact the livelihoods of pastoralists. Brucellosis, a neglected zoonotic disease is highly prevalent in this system with an estimated 16% of livestock population in sub-Saharan Africa infected with the disease. The objective of this study was to assess knowledge of livestock diseases and the risk of exposure to brucellosis among pastoralists living in Kajiado County of Kenya. Methods: The study sites included pastoralist communities living in rural and peri-urban areas within the County. Both primary and secondary data were collected using participatory methods including pairwise ranking, proportional piling and probing and a review of the published literature. Exposure risk assessment was conducted according to the CODEX Alimentarius framework: Hazard identification, hazard characterization, exposure assessment and risk estimation. Results: According to pastoralists, livestock diseases that frequently occurred in their flocks and herds were contagious caprine pleuropneumonia, lumpy skin disease and foot and mouth disease; but zoonoses, including anthrax and brucellosis, were also mentioned during focus group discussions. Potential pathways of exposure to brucellosis and other zoonoses included consumption of unpasteurized milk, handling infected aborted materials without protective measures and consumption of raw meat and raw blood. Consumption of unpasteurized milk and handling infected aborted materials without protectives were linked with high risk of exposure to household members living in rural areas, with the risk level within the peri-urban areas ranked very low to low for most of these risk practices. Conclusions: The results call for enhanced public education targeting vulnerable groups to mitigate risks of disease spread and other impacts of brucellosis within the affected pastoralist production systems.

Bovine tuberculosis at the human–livestock–wildlife interface and its control through one health approach in the Ethiopian Somali Pastoralists: A review

Pastoralism is a way of life in which food supply is produced from animals by using a variety of herding practices based on constant or partial herd mobility in the low land areas of Ethiopia. It covers 12% of the total livestock population and 61% of the total area of land in the country. As a result of their mobile lifestyle, pastoralists are almost completely excluded from the available health services. This review article focuses on bovine tuberculosis in the Ethiopian Somali Pastoralist. It describes Mycobacterium bovis in humans, livestock, and wildlife, and how the disease can be controlled by using One Health approach. Bovine tuberculosis is a chronic bacterial disease caused by Mycobacterium bovis. A study done from 2006 to 2008 on the prevalence of BTB in Ethiopian wildlife showed that sera from 20 of 87 animals (23%) were positive for BTB. In Ethiopia there is no comprehensive report about the status of M. bovis in wildlife populations that often share habitat with livestock. A study done on bovine tuberculosis in Somali pastoral livestock showed low prevalence of the disease. An individual animal prevalence of 2.0%, 0.4%, and 0.2% was reported in cattle, camels, and goats, respectively. In a simultaneous human and cattle study in a pastoralist areas of south-eastern Ethiopia, out of 163 human Mycobacterium tuberculosis complex isolates three were M. bovis. Due to the moderate resistance of the etiological agent to the environmental conditions in one hand and the capacity of its survival in acid milk for not less than 15 days on the other and the habitual consumption of unpasteurized milk by humans make this disease a vital zoonosis in Somali pastoralists in Ethiopia. M. bovis is a pathogen at the human-livestock-wildlife interface. Diseases transmitted between humans, livestock, and wildlife are increasingly challenging public and veterinary health systems. Therefore, studies concerning the burden of the diseases in wildlife, livestock and human beings in Somali Pastoralists should be undertaken. A One Health approach that takes the wellbeing of the pastoralists, the health of their livestock and environment into consideration is also necessary for the control of BTB.

Environmental factors associated with allergy in urban and rural children from the South African Food Allergy (SAFFA) cohort

The prevalence of allergic diseases differs in urban and rural populations. We sought to assess associations between environmental and dietary factors with allergic diseases in urban and rural South African children. Toddlers aged 12 to 36 months were assessed for food allergen and aeroallergen sensitization, atopic dermatitis, allergic rhinitis, asthma, and challenge-proved food allergy. Information was collected on family history of allergic diseases, household size, socioeconomic status, delivery mode, antibiotic and probiotic use, exposure to fermented and unpasteurized milk, antihelminth treatment, sunlight exposure, pet and farm animal exposure, cigarette smoke, and household cooking and heating fuels. Antenatal exposures to pets, livestock, and cigarette smoke were assessed. Asubsection completed questions on consumption of fruits and vegetables, fast foods, soft drinks/fruit juices, and fried/microwaved meat. Risk and protective factors differed between urban and rural settings. Exposure to farm animals in infants and their mothers during pregnancy was protective against allergic outcomes in the rural population. Consumption of unpasteurized milk is uncommon in this group of rural children and is unlikely to be an important factor in rural protection. In urban children birth by cesarean section is associated with food allergy, and consumption of fermented milk products is associated with reduced asthma and atopic dermatitis. In both cohorts antenatal maternal smoking and environmental smoking exposure were predominantly associated with asthma, and consumption of fast foods and fried meats were associated with allergy. In this rural environment exposure to livestock is the strongest protective factor. In urban communities, where animal contact is rare, risk factors include cesarian section, and protective factors include consumption of fermented milk products. Modifiable risk factors urgently require interventionsto prevent increasing allergy rates in countries undergoing rapid urbanization.

A multifaceted risk model of brucellosis at the human-animal interface in Egypt.

Brucellosis is a highly contagious zoonosis affecting humans and a wide range of domesticated and wild animal species. An important element for effective disease containment is to improve knowledge, attitudes and practices (KAP) of afflicted communities. This study aimed to assess the KAP related to brucellosis at the human-animal interface in an endemic area of Egypt and to identify the risk factors for human infection. A matched case-control study was conducted at the central fever hospitals located in six governorates in northern Egypt. Face-to-face interviews with cases and controls were conducted using a structured questionnaire. In total, 40.7% of the participants owned farm animals in their households. The overall mean practice score regarding animal husbandry, processing and consumption of milk and dairy products were significantly lower among cases compared with controls (-12.7±18.1 vs. 0.68±14.2, respectively; p<.001). Perceived barriers for notification of animal infection/abortion were predominate among cases and positively correlated with participants' education. The predictors of having brucellosis infection were consumption of unpasteurized milk or raw dairy products and practicing animal husbandry. Applying protective measures against infection significantly reduced its risk. A model predicting risk factors for brucellosis among those who own animal showed that frequent abortions per animal increased the chance for brucellosis infection among human cases by 50-fold (95% CI: 8.8-276.9), whereas the use of protective measures in animal care reduced the odds (OR=0.11 [95% CI: 0.03-0.45]). In conclusion, consumption of unprocessed dairy products was equally important as contact with infected/aborted animals as major risk factors for Brucella spp. infection among humans in Egypt. There is poor knowledge, negative attitudes and risky behaviours among villagers which can perpetuate the risk of brucellosis transmission at the human-animal interface. This supports the need for integrating health education into the national brucellosis control programme.

Real-time quantitative PCR-based detection of Coxiella burnetii in unpasteurized cow's milk sold for human consumption.

Coxiella burnetii is a zoonotic pathogen with a worldwide distribution that is responsible for Q fever in humans. It is a highly infectious bacterium that can be transmitted from cattle to humans through the consumption of unpasteurized milk. We report the molecular identification of C.burnetii in raw cow's milk being sold directly for human consumption in Brazil without official inspection or pasteurization. One hundred and twelve samples of raw milk were analysed by real-time quantitative PCR (qPCR), and C.burnetii was detected in 3.57% (4/112) of the samples at a concentration ranging from 125 to 404 bacteria per millilitre. The identification of this zoonotic pathogen in raw milk sold directly for human consumption is a public health concern since C.burnetii can be transmitted through the oral route. This result indicates that health education and other preventive measures should be officially implemented in Brazil to prevent the spread of infection. To our knowledge, this is the first qPCR-based detection of C.burnetii in raw milk samples from cows sold in Brazil that do not undergo official inspection or pasteurization.

Spinal brucellosis in Hulunbuir, China, 2011-2016.

Purpose: To investigate the demographic, epidemiological, clinical, and laboratory characteristics; treatment options; and outcome of human brucellosis with spine involvement at a major hospital in Hulunbuir, a brucellosis epidemic region of China.Patients and methods: A total of 842 patients with human brucellosis treated in the Department of Brucellosis, Hulunbuir People’s Hospital from January 2011 to December 2016 were included and analyzed in this study. The results of 67 brucellar spondylodiscitis (BS) cases were compared with those that were negative for spine involvements.Results: The mean age of spinal brucellosis patients was 50.5±10.2 years (43 males and 24 females; age range 29–70). The risk factors for transmission are direct contact with animals, such as working in the farm, and consumption of unpasteurized milk or daily products. Back pain (92.5%), fever (85.1%), sweating (62.7%), and fatigue (52.8%) were the most common symptoms. Magnetic resonance imaging (MRI) was performed in all the patients with spondylodiscitis. The sites of involvement were lumbar (81.2%), thoracic (8.7%), cervical (4.3%), thoracolumbar (2.9%), and lumbosacral (2.9%). All isolates from blood culture were identified as Brucella melitensis, with 61% biovar 3 and 39% biovar 1 isolates. The antimicrobial therapy for BS lasted for at least 3 months. In the presence of paravertebral or epidural abscess, longer treatment was conducted to avoid possible sequelae.Conclusion: In endemic areas such as Hulunbuir, BS should be considered in patients with back pain and fever. MRI is a highly sensitive imaging modality that can be used to differentiate BS from other spinal infections. This study will be helpful to establish strategies for prevention, surveillance, and management of spinal brucellosis in China.

Brucella-positive raw milk cheese sold on the inner European market: A public health threat due to illegal import?

Travel and migration are the major drivers of human brucellosis in Western Europe. The infection is usually transmitted through the consumption of unpasteurized milk or dairy products in or from endemic regions. Although eradicated from livestock in Germany and most Member States of the European Union, considerable numbers of domestic human brucellosis cases have been reported annually. The actual source of these autochthonous cases in non-endemic countries remains to be elucidated.We therefore evaluated the presence of Brucella spp. in 200 cheese samples originating from endemic countries which were sold at weekly markets, in supermarkets and by delis in Berlin (Germany) as well as online. The cheese samples included loose, non-labelled and pre-packed, labelled cheese of five types (brine, cream, soft, semi-hard and hard cheese), made from bovine, ovine and caprine milk. The cheese was mainly declared as raw milk cheese by the retailers. We screened for and confirmed the presence of Brucella-DNA in cheese using genus-specific quantitative real-time PCRs targeting IS711 and bcsp31, respectively. The molecular prevalence of Brucella was 20.5% (n = 41), but viable Brucellae could not be isolated from the positively tested samples using classical culture methods. The logistic regression model indicated that Brucella was significantly more often detected in late summer purchases (p = 0.036) as well as in cheese from Bulgaria, France, Greece and Turkey (p = 0.017). In contrast to the vendor information, essentially only three positive cheese samples were made from raw milk. Moreover, positive samples clustered at certain vendors which indicates large-scale illegal imports.In summary, Brucella in imported raw milk cheese seems to be still a challenge for food safety standards in the European Union. Uncontrolled import of dairy products from endemic regions might explain human Brucella infections acquired in non-endemic EU countries.

Current therapeutic strategy in osteoarticular brucellosis.

Brucellosis is a common zoonotic disease with high morbidity. In the majority of human cases, the causative agent is B. melitensis. Infection is transmitted to humans by direct/indirect contact with the contaminated animal products (e.g., consumption of unpasteurized milk), infectious aerosols and aborted fetus. Brucellosis often affects middle-aged adults and young people. Patients with brucellosis tend to have non-specific symptoms, including fever, chills, night sweats, joint pain and myalgia. Brucellosis affects various organs and tissues. The osteoarticular system is one of the most commonly described affected systems in humans. In several clinical studies, the prevalence of Osteoarticular Brucellosis (OB) is reported as 2-77%. Most important osteoarticular clinical forms osteomyelitis, spondylitis, sacroiliitis, arthritis and bursitis. Spondylitis and spondylodiscitis are the most frequent complications. Spondylodiscitis often affects the lumbar (especially at the L4- L5 levels) and low thoracic vertebrae than the cervical spine. Back pain and sciatica radiculopathy are the most common complaints about patients. Sacroiliitis is associated with severe pain, especially back pain in affected individuals. Spinal destructive brucellar lesions are also reported in adults in previous studies. Brucellosis is diagnosed with clinical inflammatory signs (eg. tenderness, pain) of the affected joints together with positive serological tests and positive blood/synovial fluids cultures. Serological test measures the total amount of IgM/IgG antibodies. Standard agglutination test (SAT) titer ≥1:160 is in favor of brucellosis diagnosis. Enzyme-Linked Immunosorbent Assay (ELISA) and Polymerase chain reaction (PCR) are other types of diagnostic tests. Radiological assessments, such as joint sonography, computed tomography, magnetic resonance imaging, are the most helpful radiological methods to diagnose spinal brucellosis.The agents commonly used in the treatment of brucella spondylitis are doxycycline, streptomycin, gentamicin, ciprofloxacin, trimethoprim/sulfamethoxazole and rifampicin. The recommended regimens for treatment of brucella involve two or three antibiotics combinations. No standard treatment, physicians prescribe drugs based on conditions of the disease. Patients need a long-term (usually at three months) antibiotic therapy for mainly aiming to prevent relapses. Surgery may be required for patients with spinal abscess. This review focused on physicians’ awareness for osteoarticular involvement, clinical presentation, diagnosis and current treatment of OB.

Screening milk for bovine tuberculosis in dairy farms in Central Province, Sri Lanka

Bovine tuberculosis is a chronic bacterial disease caused by Mycobacterium bovis. It can be transmitted to humans through direct contact with infected cattle or consumption of unpasteurized milk and milk products. The current study was performed to assess whether raw milk produced in three large scale dairy farms in Central Province of Sri Lanka contain any M. bovis. Raw milk samples were collected from 330 cows representing 230 single intradermal comparative cervical tuberculin test reactors and 100 none-reactors. All milk samples were cultured on Lowenstein Jensen medium with/ without sodium pyruvate for the isolation of Mycobacterium spp., and slopes were observed for the occurrence of growth daily for the first week and then at weekly intervals for 8 weeks. Direct Polymerase Chain Reaction (PCR) was performed simultaneously on all milk samples to detect M. bovis after extracting DNA with a commercial kit. The minimum detection level of M. bovis for PCR in milk was 200 CFU/mL. Only two milk samples from reactive cows were positive for acid fast bacilli. However, their cultures were confirmed as non-tuberculous mycobacteria by PCR. Consequently, all milk samples were confirmed negative for M. bovis according to direct PCR. It was concluded that the milk samples from three large scale dairy farms in Central Province of Sri Lanka did not contain M. bovis.

ANTIBIOTICS IN THE MANAGEMENT OF BRUCELLOSIS

Brucellosis is the most common zoonotic bacterial infection in the world. The causative organism is Brucella spp. and the incubation of period is 5 days to 5 months. Although immunological tests are widely used for the diagnosis but cultures of the blood or other clinical specimens is the gold standard for the diagnosis. Outbreaks of brucellosis occur from time to time. It spreads mostly in the communities having close contact with the sheep and cattle, like farmers, cattle grazers, veterinary workers, and butchers. In the urban situation the outbreaks usually occur due to consumption of unpasteurized milk or its products. The clinical features of brucellosis are protean but the major one is a prolonged fever. Infected animals are the reservoirs and the sources of infection. Antibiotics have a major role in the management of brucellosis. Although a single antibiotic may be effective but a combination is preferred to prevent the chances of development of resistance and recurrence of disease. Antibiotics commonly used in the management of brucellosis are doxycycline, rifampicin, streptomycin, fluoroquinolones, cotrimoxazole, and chloramphenicol. Resistance to one or the other antibiotic have been reported from time to time. Dual therapy is commonly prescribed and triple therapy is used in serious conditions like neuro-brucellosis, endocarditis, or recurrence. The objective of this review was to evaluate the effects of various antibiotic regimens in the management of brucellosis. Antibiotic resistance is a problem which can aggravate the situation in future. We suggest that antibiotics’ use should be rationalized to prevent future drug resistance. At least dual therapy should be used to prevent the chances of recurrence and triple therapy for complicated cases and in cases of relapse. There should be no compromise on the optimal doses and duration of therapy.

Tick-borne encephalitis virus in cows and unpasteurized cow milk from Norway.

Tick-borne encephalitis virus (TBEV) is recognized as the most important zoonotic tick-transmitted virus in Europe. TBEV is mainly transmitted to humans through bites from TBEV-infected ticks (Ixodes ricinus and Ixodes persulcatus). However, alimentary infection after consumption of unpasteurized milk and cheese from domestic ruminants has been reported. There is little information about TBEV in ruminants in Norway. The objectives of this study were to analyse unpasteurized cow milk for TBEV RNA and to study the presence of IgG antibodies to TBEV in the same animals. A total of 112 milk and blood samples were collected from cows from five different farms spread from southern to northern Norway. The milk samples were analysed by an in-house reverse transcription (RT) real-time polymerase chain reaction and confirmed by pyrosequencing. Serum samples were screened by a commercial enzyme-linked immunosorbent assay and verified by a TBEV-specific serum neutralization test. We found TBEV RNA in unpasteurized milk collected from farms in the municipalities of Mandal, Skedsmo and Brønnøy in 5.4% of the tested animals. Specific antibodies to TBEV were only detected in Arendal, where 88.2% of the tested animals were positive. Further studies on milk containing TBEV RNA should be performed to conclude if TBEV found in unpasteurized milk in Norway is infectious, which could be of great importance in a One Health perspective.

Staphylococci in dairy goats and human milkers, and the relationship with herd management practices

Staphylococci are the most common bacteria isolated from goat milk. This includes Staphylococcus aureus, an important animal and human pathogen, and various coagulase negative staphylococci or CNS. In this study, we identified S. aureus isolates from goat milk samples and nares and from the hands and noses of people milking the goats, as well as CNS from goat milk. A total of 497 milk samples, 502 goat nasal swabs and 97 human swabs were collected on 30 North Carolina goat dairies. A survey was used to elicit information on herd management practices for each dairy and to aid in the assessment of the association between those practices and the presence of staphylococci. We found a very low prevalence of 1.4% (6/497) of S. aureus in milk, but a considerably higher prevalence of 46.2% (232/502) S. aureus in goat nasal swabs. Nearly one-third (32.6%; 162/497) of goat milk samples were CNS-culture-positive, with S. simulans, S. caprae, S. xylosus and S. chromogenes commonly isolated. Milkers’ hands and nasal swab samples were more frequently positive (25.8%; 25/97) for S. aureus than were goat milk samples (1.4%; 6/497). A wide range of milking routines was found, and gloves were not commonly worn by milkers (only 10% of farms milkers always wore gloves). The most common use of milk was home consumption and 28 of the 30 goat dairies reported the consumption of unpasteurized milk.

Development and testing of a new tick-borne encephalitis virus vaccine candidate for veterinary use

In tick-borne encephalitis (TBE) endemic areas, consumption of unpasteurized milk or milk products from grazing domestic ruminants (goats, cattle, and sheep) represents a risk of TBE virus (TBEV) infection for humans. In addition to vaccination of humans, human alimentary TBEV infections can be avoided by pasteurizing milk or by vaccination of the ruminants. However, there is presently no TBEV vaccine for veterinary use. Here, we developed a new veterinary TBE vaccine candidate based on cell culture-derived, purified, and formaldehyde-inactivated TBEV (strain Hypr). The safety and immunogenicity of the vaccine was evaluated in mice and sheep and was well-tolerated while eliciting the production of high levels of virus-neutralizing antibodies. Vaccination provided full protection against lethal TBE in mice, prevented development of viremia in sheep and presence of TBEV in milk of lactating ewes. This vaccine is a good candidate for immunization of ruminants to prevent alimentary milk-borne TBEV infections in humans.

Outbreak of human brucellosis in Southern Brazil and historical review of data from 2009 to 2018.

BackgroundHuman brucellosis (HB) is a bacterial zoonosis that is more frequent in low income and middle-income countries; it is sometimes associated with outbreaks. The aim of this study was to describe the largest outbreak of HB in Brazil.MethodsA retrospective cohort study of patients suspected of having contracted HB in the state of Paraná, Southern Brazil from January 2009 to January 2017. Following an outbreak of 51 cases of HB in a slaughterhouse at Paiçandu in 2014, HB was defined as an obligatory reportable disease in the State. Diagnostic tests for HB included serum agglutination, ELISA (IgG or IgM) and polymerase chain reaction (PCR). Clinical, laboratorial and epidemiological data were analyzed. A P value of 0.05 was considered statistically significant.ResultsOut of a total of 3,941 patients, 754 presented with a positive test result for HB. After 2014, there was a significant increase in the number of cases, exceeding 100 cases per trimester. In the beginning of 2015, the workgroup of HB started several actions for prevention and treatment, and the number of cases progressively diminished to fewer than 20 cases per trimester. Of 191 reported cases, an occupational risk was found in 84.7%; most cases occurred in farmers (60.0%), veterinarians (17.6%) and slaughterhouse workers (14.7%). Manipulation of animals and unpasteurized milk consumption were associated with positive Brucella IgM ELISA with an odds ratio (OR) of 1.42 (1.09–1.84) and 1.48 (1.01–2.15), respectively.ConclusionsHB outbreaks can occur in low to middle-income countries and are associated with slaughterhouse work, handling of unpasteurized milk and animal manipulation. Intensive programs for control of HB are important to reduce the number of cases.

Human brucellosis in a non-susceptible host: a case report

Clinical human brucellosis is quite rare in India, that too in an non susceptible host. This report describes a case of clinical human brucellosis in India. This case involved a 36 years old male, a professor in an Engineering college. He presented with complaints of fever for 4 months with myalgia, generalized tiredness, loss of weight and loss of appetite. On evaluation, total counts and ESR was elevated and all other investigations were normal. Based on history, common causes like occult tuberculosis or autoimmune diseases were considered. But, blood cultures grew Brucella melitensis in all 2 samples and a diagnosis of brucellosis was made. He was treated with Rifampicin and Doxycycline. Suspicion of brucellosis in this patient is low because the patient has no history of contact with animals, consumption of unpasteurized milk or occupational exposure. So, the health care practitioners should be aware of this possibility of this zoonotic infection as a differential diagnosis in patients with nonspecific symptoms and unexplained prolonged fever.

Serological, cultural and molecular evidence of Brucella melitensis infection in goats in Al Jabal Al Akhdar, Sultanate of Oman.

Brucellosis, one of the most common zoonotic diseases and has significant public health and economic importance worldwide. Few studies and reports have been performed to estimate the true prevalence of animal brucellosis in the Sultanate of Oman; however, no incidence of the disease was previously reported in Al Jabal Al Akhdar. The purpose of this study was to investigate the prevalence of brucellosis in goats in eight villages in Al Jebal Al Akhdar, Sultanate of Oman, namely: Al Aqaieb, Al Helailat, Al Ghilayil, Hail Al Hedap, Da'an Al Hamra, Shnoot, Al Qasha'e and Al Sarah, Al Jabal Al Akhdar in the Sultanate of Oman. In this study we used different diagnostic serological tests, namely, RBT, I‐ELISA and CFT to study the prevalence of Brucella infection in goats in Al Jabal Al Akhdar. Statistical analysis using Kappa statistics was used to compare the performance of the serological tests. Biochemical tests and species‐specific Multiplex PCR were used to identify the brucella species involved in the infection. A structured questionnaire and Chi‐square (x2) statistical analysis was used to identify related brucellosis risk factors. This study is the first to reveal brucellosis infection in goats in eight villages in Al Jebal Al Akhdar, Sultanate of Oman, namely: Al Aqaieb, Al Helailat, Al Ghilayil, Hail Al Hedap, Da'an Al Hamra, Shnoot, Al Qasha'e and Al Sarah, with an overall seroprevalence of 11.1%. The study also compared the performance of three different serological tests, namely, RBT, I‐ELISA and CFT. Statistical analysis using Kappa statistics showed that the degree of agreement was best seen between RBT and CFT (96%), followed by RBT, I‐ ELISA (91.4%) and CFT and I‐ ELISA (89.2%). Biochemical tests and species‐specific Multiplex PCR showed the typical profile for B. melitensis. A structured questionnaire and Chi‐square (x2) statistical analysis indicated that the presence of abortion is the major risk factor for the prevalence of brucellosis, whereas age and sex were not significant factors in the tested animals. Besides, poor knowledge about brucellosis, consumption of unpasteurized milk or milk products, free trade of animals and the introduction of new animal breeds to herds were all contributing risk factors to the prevalence of brucellosis. The prevalence of human brucellosis obtained verbally from pastoralists gave an insight that brucellosis could pose a public health hazard, especially in those high‐risk groups, mainly the pastoralists in the study area. Because of their constant and increasing interaction with their animals, pastoralists could be at a high risk of occupational infection.