Human Brucellosis Research Articles

Spatiotemporal risk of human brucellosis under intensification of livestock keeping based on machine learning techniques in Shaanxi, China.

As one of the most neglected zoonotic diseases, brucellosis has posed a serious threat to public health worldwide. This study is purposed to apply different machine learning models to improve the prediction accuracy of human brucellosis (HB) in Shaanxi, China from 2008 to 2020, under livestock husbandry intensification from a spatiotemporal perspective. We quantitatively evaluated the performance and suitability of ConvLSTM, RF, and LSTM models in epidemic forecasting, and investigated the spatial heterogeneity of how different factors drive the occurrence and transmission of HB in distinct sub-regions by using Kernel Density Analysis and Shapley Additional Explanations. Our findings demonstrated that ConvLSTM network yielded the best predictive performance with the lowest average RMSE of 13.875 and MAE values of 18.393. RF model generated an underestimated outcome while LSTM model had an overestimated one. In addition, climatic conditions, intensification of livestock keeping and socioeconomic status were identified as the dominant factors that drive the occurrence of HB in Shaanbei Plateau, Guanzhong Plain, and Shaannan Region, respectively. This work provided a comprehensive understanding of the potential risk of HB epidemics in Northwest China driven by both anthropogenic activities and natural environment, which can support further practice in disease control and prevention.

Serological and bacterial prevalence of Brucella spp. in suspected patients: a risk factor analysis in North Khorasan, Iran

Background and Objectives: Brucellosis, a zoonotic bacterial disease caused by Brucella, affects humans and domestic animals, leading to significant economic loss. This study examined suspected cases in North Khorasan, Iran, to understand the prevalence of infection and its characteristics in this region. Materials and Methods: Blood specimens were collected from 200 patients suspected of brucellosis after obtaining in- formed consent. Serum samples were tested using RBPT, Wright, and 2-ME agglutination tests. Blood samples were cul- tured on Brucella agar, and positive cultures underwent biotyping and PCR assays. A questionnaire identified correlated risk factors. Results: RBPT, Wright, and 2-ME tests showed 25% brucellosis seroprevalence in symptomatic patients. In contrast, the prevalence was 2.5% among those with positive blood cultures. Notably, all culture-positive patients were also serologically positive, with titers exceeding 1:320 in Wright and 2-ME tests. Most positive cases were in people in their 30s, with B. mel- itensis biovar 1 identified as the causative agent, and the results were confirmed by multiplex PCR. Significant risk factors include contact with livestock and consumption of raw milk (P < 0.0001). Conclusion: The findings highlighted the importance of comprehensive diagnostic approaches for accurate identification of brucellosis. Furthermore, education regarding close contact with animals and pasteurization of dairy products is essential for controlling human brucellosis.

Brucellosis Coinfecting with Liver Hydatid Cyst: Case Report and Literature Review of Zoonoses Coinfection of Human Brucellosis.

Background: Brucellosis is a major global public health problem. Brucellosis usually coinfects with zoonoses because of their similar reservoir and infection routes. Materials and Methods: Here, we present a patient who was diagnosed with coinfecting with liver cyst and brucellosis. Results: A 57-year-old female farmer was hospitalized with right hip joint pain approximately 4 weeks earlier. The patient reported a history of hydatid cysts and a family history of brucellosis. Abdominal computerized tomography and ultrasonography revealed a liver hydatid cyst. The standard agglutination test titer of Wright's test was 1:100. Computerized tomography and magnetic resonance imaging revealed brucellosis hip arthritis. The patient was treated with a combination of doxycycline, rifampicin, and cefotaxime. The symptoms immediately improved. The patient was well and asymptomatic during the 6-month follow-up. We reviewed the literature on other zoonoses superinfection with brucellosis. Conclusion: Brucellosis coinfects with multiple zoonosis organisms and poses a serious health threat to humans. Awareness of possible brucellosis coinfection with other zoonoses, especially professionally exposed persons in endemic regions, is warranted.

Brucellosis Seroprevalence in Cattle in China During 2014–2024: A Systematic Review and Meta-analysis

Brucellosis, caused by several species of Brucella, continues to be a significant illness that poses a global threat to public health. China remains a persistent hotspot for brucellosis, despite the implementation of extensive control measures. This study aims to conduct a systematic review and meta-analysis of the seroprevalence of bovine brucellosis in different breeds and regions of China from 2014-2024, and to provide predictions on the future prevalence patterns of brucellosis in cattle and humans. The analysis comprised a total of 80 research studies, which consisted of 187 datasets and a combined sample size of 3,130,706. We estimated the overall pooled seroprevalence of bovine brucellosis in China to be 1.5% (95% CI: 0.6-2.6%). Subgroup analysis revealed that the seroprevalence in dairy cattle was 3.1%, surpassing the seroprevalence in beef cattle (1.3%) and yak (1.5%). Regions that had authorized vaccination programs exhibited higher seroprevalence (1.8%) compared to regions that did not have vaccination (0.5%). Notably, the study observed a simultaneous rise in both the prevalence of brucellosis in cattle and the number of human brucellosis cases. This suggests that high-quality routine surveillance of brucellosis in cattle will be essential for predicting and responding to cases in humans. Additionally, given the existing prevention and control measures, brucellosis will likely continue to be prevalent in both cattle and people. This systematic review will assist policymakers in adjusting animal surveillance and interregional livestock movement policies, ultimately contributing to the public safety goal of preventing brucellosis in humans by controlling it in animals.

The Goat Cytotoxic T Lymphocyte-Associated Antigen-4 Gene: mRNA Expression and Association Analysis of Insertion/Deletion Variants with the Risk of Brucellosis

The cytotoxic T lymphocyte-associated antigen-4 (CTLA4) gene, a member of the immunoglobulin superfamily, is crucial for maintaining immune homeostasis and preventing autoimmune diseases. Studies have shown that polymorphisms in the CTLA4 gene are linked to an increased risk of brucellosis in humans, but its association with brucellosis in goats remains unexplored. In this study, the tissue expression profile of CTLA4 in goats was investigated, and the correlation between InDel polymorphisms in the CTLA4 gene and susceptibility to brucellosis in goats was examined. The findings reveal the widespread expression of CTLA4 in goat tissues, particularly in the spleen and testes. The tested goat populations presented genotypes insertion/insertion (II), insertion/deletion (ID), and deletion/deletion (DD) at both the P1 and P2 loci, and an association analysis revealed significant differences in the distribution of genotypes and allele frequencies at the P1 and P2 loci of the CTLA4 gene between the Brucella goat case and the control groups (p < 0.05). Specifically, compared with the II genotype, the P1 and P2 loci were significantly associated with an elevated risk of brucellosis development in goats under both the codominant (ID/II) and dominant (ID + DD/II) models (P1, p = 0.042, p = 0.016; P2, p = 0.011, p = 0.014). Additionally, haplotype analysis indicated that haplotypes IP1DP2, DP1IP2, and DP1DP2 were significantly associated with an increased risk of brucellosis in goats compared to the reference haplotype IP1IP2 (p = 0.029, p = 0.012, p = 0.034). Importantly, the Lipopolysaccharide (LPS) stimulation of peripheral blood monocytes and/or macrophages from goats with the II, ID, and DD genotypes resulted in increased CTLA4 expression levels in the II genotype, leading to a robust LPS-induced inflammatory response. Through bioinformatic analysis, the observed effect of the InDel locus on Brucella pathogenesis risk in goats could be attributed to the differential binding of the transcription factors nuclear factor kappaB (NF-κB) and CCAAT/enhancer-binding protein α (C/EBPα). These findings offer potential insights for breeding strategies against brucellosis.

Molecular Prevalence, Phylogenetic Analysis, and PCR-based Detection of Brucella melitensis in Humans and Cattle in Southern Khyber Pakhtunkhwa, Pakistan

Brucellosis is a bacterial disease due to Brucella melitensis, considered a zoonotic agent affecting humans and animals, especially in areas with high disease occurrence, south Khyber Pakhtunkhwa, Pakistan. This work was designed to evaluate the molecular rate of B. melitensis in humans and cattle species and also to perform a phylogenetic analysis between both species. A cross-sectional survey involving 800 participants, including 600 cattle and 200 human participants, underwent blood sample collection with conventional PCR and IS711 locus PCR amplification and Sanger sequencing. The findings detected Brucella melitensis in 37 of the 800 samples, with a molecular prevalence of 3.1% in cattle and 9% in humans. The molecular trees play a role in zoonotic transmission and point to the necessity of a further unified approach toward the management of brucellosis in both humans and animals. This is further backed by the use of 95% C.I for the prevalence rates making the results statistically robust. This research shows that using the IS711 insertion sequence is an efficient and selective method for identifying Brucella species.

Genomic analysis of Brucella isolates from animals and humans, Türkiye, 2010 to 2020.

BackgroundBrucellosis is a bacterial zoonosis causing severe illness in humans and animals and leading to economic losses in the livestock production in Türkiye and other endemic countries.AimWe aimed at investigating genomic differences of Brucella isolates from animals and humans in Türkiye.MethodsWe used whole genome sequencing (WGS) to assess the genetic diversity of Brucella isolates from 41 provinces in Türkiye and compared with isolates from other countries. We applied allele-based typing and core genome single nucleotide polymorphism (cgSNP) determination.ResultsOf the 106 Turkish Brucella isolates included, 57 were B. abortus and 49 were B. melitensis. One B. melitensis and two B. abortus isolates were identified as vaccine strains. Most (n = 55) B. abortus isolates clustered in three major branches, with no spatial discernible pattern. Of the B. melitensis isolates, 48 were assigned to the Eastern Mediterranean lineage with no discernible patterns between host species, location and sampling date. The Turkish isolates clustered with isolates from neighbouring countries such as Greece and Syria, but some also with isolates from human patients in European countries, like Germany, Norway and Sweden, suggesting that the source may be travel-related.ConclusionSeveral B. melitensis and B. abortus lineages are circulating in Türkiye. To decrease the prevalence and prevent brucellosis in animals and humans, stricter control measures are needed, particularly in areas where humans and animals have close contact. Furthermore, illegal transportation of animals across borders should be more closely controlled and regulated.

Investigated of Epidemiological and Incidence of Human Brucellosis in Southwest of Iran, a Retrospective Study from 2014 to 2021

Background: Brucellosis is the most common zoonotic disease worldwide, primarily caused by Brucella abortus, and can lead to potential infertility in both men and women. Objectives: The purpose of this study was to investigate the epidemiology of brucellosis over a seven-year period (2014 - 2021) in Andika city. Methods: This cross-sectional study utilized data from the medical records of brucellosis patients at the Health Vice-Chancellor of Jundishapur University of Medical Sciences, Ahvaz, during 2014 - 2021. The study variables included age, gender, history of contact with infected animals, place of residence, occupation, consumption of dairy products (milk, cheese, and yogurt), and education. The collected data were analyzed using SPSS software version 22. Results: A total of 162 patients were reported from 2014 to 2021. The highest number of brucellosis cases occurred in 2015. In this study, 42% of the patients were men and 58% were women. Of the total patients, 62.3% were from rural areas, while 37.7% were from other areas. Among occupational groups, homemakers had the highest frequency of brucellosis cases at 30.2%. The age group with the highest incidence was 21 - 30 years, at 21%. Conclusions: The results of this study indicate that the majority of patients were from rural areas and were female. The incidence of brucellosis in Andika city appears to be decreasing. Since human brucellosis incidence closely correlates with the incidence in animals, controlling the disease in animals can help reduce human cases.

Molecular epidemiology of brucellosis in Asia: insights from genotyping analyses.

Brucellosis infects humans and animals worldwide but is particularly prevalent in Asia. In many Asian countries, molecular diagnostic tools for accurate molecular diagnostics and molecular epidemiology are lacking. Nonetheless, some countries have conducted in-depth molecular epidemiological studies. The objective of this study was to reveal the genetic relationships, geographic origins, and distributions of Brucella strains across Asia for two primary species, B. abortus and B. melitensis. For this, we systematically searched genotyping data from published studies on the molecular epidemiology of Brucella species for both humans and livestock in Asia. We used data from multilocus sequence typing (MLST), multiple-locus variable-number tandem repeat analysis (MLVA), and whole genome sequencing analysis of Brucella strains. We also analyzed the MLVA genotypes of 129 B. abortus isolates and 242 B. melitensis isolates with known origins in Asia from an online MLVA database using MLVA-11 data in minimum spanning trees and MLVA-16 data in neighbor-joining trees. We found that the B. melitensis East Mediterranean lineage is predominant across the continent, with only a small number of samples from the Africa and Americas lineages, and none from the West Mediterranean lineage. The "abortus C" genotype was the most common group of B. abortus in Asia, with limited genetic variation for this species. Several studies also reported that Near Eastern countries frequently encounter human brucellosis cases of B. abortus from genotypes 42 and 43. Our study highlights the inconsistent collection of genetic data for Brucella species across Asia and a need for more extensive sampling in most countries. Finally, a consistent nomenclature is necessary to define various groupings of strains within a lineage (i.e., clade) so uniform terminology should denote particular genetic groups that are understood by all researchers.

A Review On Human Brucellosis: An Important Occupational Hazard

Human brucellosis is a re-emerging and neglected zoonotic disease caused by Brucella spp., with Brucella melitensis being the principal cause worldwide. Despite the disease's prevalence, serological surveillance is not routinely practiced, even in countries where Brucella is endemic. Although eradication efforts have been successful in many developed and developing countries, brucellosis continues to pose a significant health risk to both animals and humans. Transmission to humans occurs by direct or indirect contact with infected animals or their products. Veterinary professionals, especially those conducting per-vaginal examinations without proper protective gear, and animal handlers are particularly vulnerable to infection. The pathogenesis of brucellosis is complex, involving bacterial invasion of host cells, immune evasion, and the potential for chronic infection. In humans, brucellosis often becomes chronic, but in acute cases, it presents as undulant fever with nonspecific symptoms. To reduce morbidity and mortality, early diagnosis and timely antibiotic treatment are most important. For diagnosis of Brucella spp. reliable, rapid, sensitive, specific, easy-to-perform, and automated detection systems are urgently required. Currently, there is no safe and effective vaccine available for humans. Prevention relies on controlling the disease in domestic livestock, primarily through mass vaccination, effective heat treatment of dairy products, and hygienic precautions to minimize occupational exposure. Treatment requires prolonged antibiotic therapy with a combination of drugs. To control human brucellosis, awareness programs, safe livestock practices, and timely diagnosis are essential

A systematic review and meta-analysis of comparative clinical studies on antibiotic treatment of brucellosis

Brucellosis is a difficult to treat infection that requires antibiotic combinations administered over several weeks for clearance of infection and relapse prevention. This systematic review summarizes current evidence for antibiotic treatment of human brucellosis. PubMed, EMBASE, Scopus, CINAHL, Web of Science, and China Academic Journal databases were searched for prospective studies that had compared different antibiotic regimens for treating human brucellosis in the last 25 years. Thirty-four studies recruiting 4182 participants were eligible. Standard dual therapy with doxycycline + rifampicin had a higher risk of treatment failure compared to triple therapy which added streptomycin (RR: 1.98, 95% CI 1.17–3.35, p = 0.01) or levofloxacin (RR: 2.98, 95% CI 1.67–5.32, p = 0.0002), but a similar or lower risk compared to alternative dual antibiotic combinations (p > 0.05). The same combination had a higher risk of relapses compared to triple therapy which added streptomycin (RR: 22.12, 95% CI 3.48–140.52, p = 0.001), or levofloxacin (RR: 4.61, 95% CI 2.20–9.66, p < 0.0001), but a similar or lower risk compared to other dual antibiotic combinations (p > 0.05). Triple antibiotic therapy is more effective than standard dual therapy with rifampicin and doxycycline. However, the latter is also efficacious and suitable for uncomplicated disease.

Meta-genomic next-generation sequencing in the diagnosis of brucellosis: Five cases from a non-endemic area.

Metagenomic next-generation sequencing (mNGS) in diagnosis of human brucellosis is comparatively unexplored. This report details five human brucellosis cases diagnosed using mNGS based on Illumina sequencing platform, comprising three females and two males, four with epidemiological exposure. In cases 1 and 2, plasma mNGS results showed one positive and one negative for Brucella melitensis, and subsequent blood cultures were both positive. Cases 3, 4 and 5 involved spinal brucellosis, some with paravertebral abscesses. mNGS from infectious tissue samples successfully detected Brucella, with read counts ranging between 30 and 1314, yet cultures were negative in cases 4 and 5. Following antibiotic and surgical treatments, all patients showed clinical improvement. This report shows mNGS testing enhances the detection sensitivity of brucellosis diagnosis.

Seroprevalence of brucellosis among high-risk individuals in Madinah, Saudi Arabia.

Brucellosis is a highly contagious, neglected zoonotic disease of major importance worldwide. The disease is endemic in many countries, burdening healthcare systems and the livestock industry and representing a persistent public health concern in these countries. Brucellosis is considered an important occupational hazard for livestock workers. Limited studies have investigated human brucellosis in Saudi Arabia. Therefore, this study aimed to estimate the prevalence of brucellosis among employees of high-risk brucellosis professions, including veterinarians, animal herders, and abattoir workers in Madinah, Saudi Arabia, and to determine the associated risk factors. A cross-sectional study was conducted in Madinah, Saudi Arabia, during the period of January-March 2023. Ninety blood samples were collected from individuals occupationally at risk of exposure to Brucella infections. Serum samples were examined for immunoglobulins (Ig)M and IgG antibodies against Brucella using an indirect enzyme-linked immunosorbent assay. Before sample collection, a predesigned online questionnaire was used to collect the participants' sociodemographic characteristics and the probable risk factors for human brucellosis. A Chi-square test was used to compare the differences among groups; p < 0.05 were considered statistically significant. Among the 90 participants among the high-risk individuals, Brucella IgM and IgG seropositivity were found in 8 (8.8%) and 11 (12.12%) cases, respectively. IgM mono antibody positivity was observed in 4 (4.44%) and 7 (7.77%) of the study population who tested positive for IgG only. Dual positivity for IgM and IgG antibodies was observed in 4 (4.44%) participants. No significant association was determined between seropositivity and age, urbanicity, education, occupation, and duration of exposure (p > 0.05). Brucellosis is a high-risk occupational disease among workers with close contact with livestock. This study demonstrates that the seroprevalence of brucellosis among occupationally high-risk individuals in Madinah, Saudi Arabia, is relatively low compared to other countries in the region. Nevertheless, educational programs should be implemented to improve knowledge regarding brucellosis, particularly among high-risk individuals.

Updated therapeutic options for human brucellosis: A systematic review and network meta-analysis of randomized controlled trials.

In clinical practice guidelines, there is no consensus about the medications that should be initially offered to patients with brucellosis. To provide informative evidence, we compared and ranked brucellosis medications based on their efficacy and safety. For this systematic review and network meta-analysis, we searched 4 English databases and 3 Chinese databases, from the date of database inception to December 13, 2023. We included randomized controlled trials (RCTs) involving children and adolescents with brucellosis, comparing different antibiotic regimens. We excluded studies explicitly targeting patients with spondylitis brucellosis, endocarditis brucellosis, and neuro-brucellosis. The primary outcomes were overall failure (efficacy) and side effects (safety). Secondary outcomes were relapse and therapeutic failure. Pairwise meta-analysis was first examined. Data were analyzed using random effects network meta-analysis, with subgroup and sensitivity analyses performed. The Confidence in Network Meta-Analysis (CINeMA) framework was used to assess the certainty of evidence. The protocol was preregistered in PROSPERO (CRD42023491331). Of the 11,747 records identified through the database search, 43 RCTs were included in the network meta-analysis. Compared with standard therapy (Doxycycline + Rifampicin), Rifampicin + Tetracyclines (RR 4.96; 95% CI 1.47 to 16.70; very low certainty of evidence), Doxycycline + TMP/SMX (RR 0.18; 95% CI 0.06 to 0.52; low certainty of evidence), Doxycycline + Quinolones (RR 0.27; 95% CI 0.11 to 0.71; low certainty of evidence), Streptomycin + Tetracyclines (RR 0.04; 95% CI 0.01 to 0.16; low certainty of evidence), and Single (RR 0.05; 95% CI 0.02 to 0.16; moderate certainty of evidence) were less efficacious. Doxycycline + Gentamicin ranked the best in efficacy (SUCRA values: 0.94), the second is Triple (SUCRA values: 0.87), and the third is Doxycycline + Streptomycin (SUCRA values: 0.78). Brucellosis medications differ in efficacy and safety. Doxycycline + Gentamicin, Triple, and Doxycycline + Streptomycin have superior efficacy and safety. Treatment of brucellosis should strike a balance between efficacy, safety, and cost.

Obtaining and Characterization of Experimental Diagnostic Brucellosis Rabbit Sera for the Development of a National Standard for Brucellosis Serum

Relevance. The production of brucellosis diagnosticums is currently being established in the medical and veterinary practice of the Republic of Uzbekistan. However, due to the lack of a national standard serum in the country and the high cost of analog standard serums on the market, problems may arise in the production of diagnostic tools. In addition, the lack of national standard serums causes problems in quality control of commercial and local antigens, hinders the development of local drugs – brucellosis diagnostics, which reduces the effectiveness of serological diagnosis of brucellosis in humans and animals. Given the above, it becomes necessary to develop and produce a standard serum with a high level of safety, which will improve the methods of laboratory diagnosis of various forms of brucellosis in patients and animals to identify hidden foci of infection in Uzbekistan. The aim of the study is to obtain and characterize experimental standard diagnostic brucellosis rabbit sera for the development of national and industry standard serum with appropriate titers. Materials and Methods. The experiments were carried out in full compliance with the European Council Directive 2010/63/EU on compliance with ethical principles in working with laboratory animals and the experiments were carried out on the basis of the methodological manual «Methods and rules of work» approved by the Ministry of Health of the Republic of Uzbekistan in 2016 with laboratory animals in experimental microbiological and immunological studies. To obtain positive standard sera against brucellosis pathogens, 12 rabbits weighing from 2.2 kg to 4.6 kg, aged 6 to 12 months, were used. The animals were kept under identical conditions on a standard vivarium diet. For the experiment, animals adapted to the conditions of the study were selected and kept in quarantine for 21 days. The maintenance and conduct of the studies followed international rules for the humane treatment of animals. Results and Discussion. During the evaluation of the heterologic specificity of the obtained sera for 23 collection and hospital strains, a weakly positive response (+) was observed in 16.7% of cases. Rabbit sera positive for heterologic specificity were adsorbed on suspensions of inactivated microorganisms (Citrobacter spp. and Enterobacteriaceae spp.) - no significant drop in titer was observed, and cross-agglutination was eliminated. A significant increase in the total protein level was noted after the first and fourth immunizations. Before the first immunization, the total protein level was 59.57 g/l, and after the fourth immunization, it increased threefold to 157.17 g/l. There was also an increase in albumin and globulin (33.2 g/L and 26.37 g/L, respectively) to 79.37 g/L and 77.43 g/L, respectively. IgM levels remained almost unchanged, increasing 3.5-fold after the second immunization and decreasing to 0.24 mg/ml after the fourth immunization. An increase in the level of IgG after the second and third immunizations was revealed, followed by a decrease after the fourth immunization. Conclusion. The obtained national and industry standard diagnostic polyvalent brucellosis sera, as well as the developed methods of laboratory control of its quality and efficiency testing will make it possible to produce candidate standard serum samples for agglutination reaction test and detection of Brucella strains. The obtained standard serum samples will be further used for control of the produced immunobiological diagnostic preparations and provision of unified requirements to their quality. The goal was achieved – improving the serological diagnosis of brucellosis, laying the foundation for further study and standardization of serum.

Seroprevalence of human brucellosis in Turkey: A comprehensive meta-analysis.

Brucellosis remains a common zoonotic disease, in developing countries, as well as in Turkey where it is endemic, underdiagnosed, and underreported. The aim of this meta-analysis was to provide a comprehensive estimate of seroprevalence with a large sample size, covering all regions of Turkey, including both grey literature and published studies. A systematic search was performed in MEDLINE (via PubMed), TürkMedline (National Health Sciences-Periodicals Database), and YÖKSİS database (Higher Education Council Information System) until May 5th, 2023. The quality of the studies was evaluated independently using Joanna Briggs Institute (JBI) critical assessment tool for prevalence studies. A random-effects model (DerSimion and Laird) was utilized to estimate the overall pooled prevalence. A sensitivity analysis was performed, excluding studies with a high risk of bias. The subgroup analyses and meta-regression were conducted to explore sources of heterogeneity. Egger test and funnel plot were used to assess publication bias. The meta-analysis included 30 studies in total published between 1999 and 2021 with 51,560 individuals. In Turkey, the pooled seroprevalence of human brucellosis was estimated to be 4.5% (95% confidence interval [CI]: 3.8%-5.3%). According to the subgroup analysis, a higher seroprevalence was found in rural areas (8.0%, 95% CI: 5.4%-10.7%), high-risk occupational groups (9.9%, 95% CI: 5.3%-14.6%), and the Central East Anatolia Region (13%, 95% CI: 3.2%-22.8%). The meta-regression analysis identified living in rural areas and certain geographic regions as significant risk factors associated with higher seroprevalence. This meta-analysis revealed a significant burden of human brucellosis in Turkey. The findings highlight the need for public health measures and targeted interventions to reduce the burden of this zoonotic disease, especially in rural areas, high-risk occupational groups, and the East Anatolia Region.

Human Brucellosis in Iraq: Spatiotemporal Data Analysis From 2007-2018.

Brucellosis is both endemic and enzootic in Iraq, resulting in long-term morbidity for humans as well as economic loss. No previous study of the spatial and temporal patterns of brucellosis in Iraq was done to identify potential clustering of cases. This study aims to detect the spatial and temporal distribution of human brucellosis in Iraq and identify any changes that occurred from 2007 to 2018. A descriptive, cross-sectional study was conducted using secondary data from the Surveillance Section at the Communicable Diseases Control Center, Public Health Directorate, Ministry of Health in Iraq. The trends of cases by sex and age group from 2007 to 2018 were displayed. The seasonal distribution of the cases from 2007 to 2012 was graphed. We calculated the incidence of human brucellosis per district per year and used local Getis-Ord Gi* statistics to detect the spatial distribution of the data. The data were analyzed using Microsoft Excel and GeoDa software. A total of 51,508 human brucellosis cases were reported during the 12-year study period, with some missing data for age groups. Human brucellosis persisted annually in Iraq across the study period with no specific temporal clustering of cases. In contrast, spatial clustering was predominant in northern Iraq. There were significant differences in the geographic distribution of brucellosis. The number of cases is the highest in the north and northeast regions of the country, which has borders with nearby countries. In addition, people in these areas depend more on locally made dairy products, which can be inadequately pasteurized. Despite the lack of significant temporal clustering of cases, the highest number of cases were reported during summer and spring. Considering these patterns when allocating resources to combat this disease, determining public health priorities, and planning prevention and control strategies is important.

Authors’ Response to Peer Reviews of “Human Brucellosis in Iraq: Spatiotemporal Data Analysis From 2007-2018”

Authors’ Response to Peer Reviews of “Human Brucellosis in Iraq: Spatiotemporal Data Analysis From 2007-2018”

Human brucellosis and associated risk factors in the Middle East region: A comprehensive systematic review, meta-analysis, and meta-regression

IntroductionHuman brucellosis, caused by the bacteria Brucella, is a significant infectious disease globally, also known as Mediterranean fever or Malta fever. MethodsThis meta-analysis and systematic review focuses on the prevalence rate, risk factors, and diagnostic methods of human brucellosis in Middle Eastern countries, where the disease remains a significant public health issue. The analysis included 92 studies conducted between 1993 and 2024, following specified inclusion and exclusion criteria among symptomatic patients across these countries. The prevalence rate was calculated by dividing positive samples by total samples. The I2 index and Chi-squared test assessed study heterogeneity. Significant heterogeneity occurred when I2 exceeded 50 %. ResultsThe highest prevalence rate was observed in Oman, Lebanon, and Kuwait countries, emphasizing a notable burden of Brucella infection in these regions. Risk factors associated with human brucellosis were identified, with unpasteurized dairy consumption and close animal contact being predominant. Various professions such as farmers, dairy factory workers, and agriculture workers showed higher prevalence rate. Gender analysis indicated a prevalence rate of 18.02 % (95 % CI: 11.55–25.51 %) in males and 13.61 % (95 % CI: 10.8–16.68 %) in females, with no significant difference in hospitalization rates. The prevalence rate of Brucella spp. was varied across detection methods, with immunocapture agglutination assay (Brucellacapt) showing the highest estimated prevalence rate of (44.04 %, 95 % CI: 27.71–61.04), followed by PCR (39.84 %, 95 % CI: 20.14–61.39) and culture (29.22 %, 95 % CI: 17.89–42.03). Among Brucella species, Brucella melitensis (B. melitensis) and Brucella abortus (B. abortus) were the highest prevalence rate. Although statistically insignificant, the meta-analysis also revealed an upward trend in prevalence rate from 1993 to 2024, (P value = 0.277). DiscussionThis comprehensive review emphasizes the need for tailored strategies to control brucellosis in the Middle East, highlighting the importance of timely diagnosis, public awareness, and effective treatment protocols. These findings provide valuable insights for policymakers and healthcare professionals working to mitigate the impact of this disease in the region.

Association Between Diagnostic Delays and Spinal Involvement in Human Brucellosis: A Retrospective Case-Control Study.

Spinal involvement is a common but serious complication of human brucellosis. However, information on the risk factors associated with spinal involvement in individuals with brucellosis is limited. This retrospective case-control study aimed to determine the potential risk factors associated with spinal complications in inpatients with brucellosis. During the study period, brucellosis was diagnosed in 377 patients, of whom 108 (28.64%) showed spinal involvement. Those with spinal involvement were significantly older than patients in the control group (mean age [standard deviation], 53.25 [10.48] vs 43.12 [13.84] years, respectively; P < .001). The diagnostic delays were significantly longer in patients with spinal involvement than in the control group (mean delay [standard deviation], 11.17 [13.55] vs 6.03 [8.02] weeks; P = .001). Age >40 years (odds ratio, 5.42 [95% confidence interval, 2.65-11.05]; P < .001) and diagnostic delay >4 weeks (2.94 [1.62-5.35]; P < .001) were independently associated with spinal involvement in brucellosis. The lumbar spine at the L3-5 level was the most affected (152 of 249 [61.04%]). Back pain (92 of 108 in case patients vs 21 of 108 in controls; P < .001) and splenomegaly (23 vs 42 of 108, respectively; P = .005) differed significantly between the 2 groups. Age >40 years and diagnostic delay >4 weeks increased the risk of spinal involvement in brucellosis. Therefore, the time from symptom onset to diagnosis should be shortened, using effective measures to reduce spinal involvement risk.