Standard Tube Agglutination Test Research Articles

#1061 Brucella infection in a patient with renal cystic disease and renal imaging changes before and after treatment: a case report

Abstract Background and Aims Brucellosis can affect nearly all systems. Genitourinary involvement is uncommon in patients with brucellosis, accounting for approximately 10% of cases. We diagnosed a rare case of renal cysts with brucellosis and reported renal imaging changes before and after treatment. Method A 38-year-old man was admitted to our hospital in September 2021 with complaints of elevated serum creatinine, proteinuria for more than 2 months, and intermittent fever for 2 weeks. In July 2020, the patient experienced fatigue, and a rash on all four extremities. He denied experiencing low back pain or joint swelling. Urine analysis revealed the following: BLD (+), Pro (+), 24-hour urine protein (24 h UP) 0.7 g; blood: Cr 11.88 mg/dL, UA 77.51 mg/dL, ALP 217 IU/L, and GGT 227 IU/L. MRI revealed multiple small punctate areas with short T1 signals in both kidneys and splenomegaly. Soon, he experienced persistent afternoon fever with a maximum temperature of 39.0°C, along with night sweats and left lumbar pain. There were no symptoms of cough, expectoration, or urinary tract irritation. The patient had diabetes mellitus and diabetic retinopathy. He has lived in the Inner Mongolia Autonomous Region. He denied having any contact with raw milk or mice. His father and sister had kidney disease and diabetes. In September 2021, the patient was admitted to our hospital. Urinalysis revealed BLD (-), Pro 0.3 g/L, and 24 hUP 1.39 g; blood: HGB 117 g/L, ALP 227 U/L, GGT 221 U/L, Cr 2.56 mg/dL, UA 88.79 mg/dL, and K 3.2 mEq/L. The infection indicators were as follows: the standard tube agglutination test (+) (Fig. 1), Brucella (+) in blood culture, a positive qualitative test for blood cryptococcal antigen and qualitative positive results for 6 Cryptococcus neoformans sequences in bronchoalveolar lavage fluid using next-generation sequencing. Ultrasound showed multiple cysts in both kidneys. It also showed uneven echogenicity in the left testis and visible lymph nodes in the left neck, bilateral axillae and groin. CT revealed cavitary nodules and ground-glass opacities in the right middle lobe, as well as splenomegaly. MRI revealed renal cysts (Fig. 2a, b, c) and abscesses (Fig. 2e, f, g). The patient was diagnosed with stage 3 chronic kidney disease (CKD), pulmonary cryptococcosis, and brucellosis associated with renal abscess, left orchitis, splenomegaly, multiple lymphadenopathies, rash, and hyperuricemia. Doxycycline, rifampicin, and fluconazole were administered. He had no fever, his low back pain had disappeared, and his rash were relieved. Results A reexamination after 2 months revealed the following: the urinalysis results revealed a BLD (-), Pro(-), and 24 hUP 0.15 g; blood: GGT 107 IU/L; ALP 72 IU/L; Cr 1.89 mg/dL; UA 0.22 mg/dL; and K 4.0 mEq/L. Ultrasound revealed a decrease in the size of the spleen. MRI revealed the liquefaction of renal abscesses. Brucella therapy has been found to be effective. Conclusion The patient was a young man who was infected with both Brucella and Cryptococcus. Although his hometown was in an area affected by an epidemic, his current residence was not affected. Namely, he was immunocompromised, which was associated with diabetes. After receiving anti-Brucella treatment, his symptoms disappeared, the renal abscess liquefied, but creatinine decreased to levels similar to those at onset without a decreasing trend. These findings suggest that the patient had underlying CKD that was not associated with Brucellosis. We believe that the CKD was diabetes and renal cysts. He had hyperuricemia, hypomagnesaemia, unexplained asymptomatic abnormal liver function, and mild proteinuria. Imaging indicated the presence of renal cysts. In addition to having diabetes, he had a family history of kidney disease and diabetes. We diagnosed the patient with CKD and as having autosomal dominant tubulointerstitial disease (ADTKD) associated with the HNF1B pathogenic gene mutation. This gene mutation is also rare in ADTKD patients. Genetic testing revealed that the causative genes include NM001303448. Potential causative genes included NM000128. The mutated genes mentioned above are not typical causative genes for HNF1B or other types of ADTKD.

Diagnosis of human brucellosis: Systematic review and meta-analysis.

Brucellosis, a widely spread zoonotic disease, poses significant diagnostic challenges due to its non-specific symptoms and underreporting. Timely and accurate diagnosis is crucial for effective patient management and public health control. However, a comprehensive comparative review of available diagnostic tests is lacking. This systematic review addressed the following question: 'What is the accuracy of the available tests to confirm human brucellosis?' Two independent reviewers examined articles published up to January 2023. The review included original studies reporting symptomatic patients with brucellosis suspicion, through any index test, with sensitivity and/or specificity as outcomes. As exclusion criteria were considered: sample size smaller than 10 patients, studies focusing on complicated brucellosis, and those lacking essential information about index or comparator tests. Sensitivity and specificity were assessed, with consideration for the index test, and 'culture' and 'culture and standard tube agglutination test (SAT)' were used as reference standards. Bias assessment and certainty of evidence were carried out using the QUADAS-2 and GRADE tools, respectively. A total of 38 studies reporting diagnostic test performance for human brucellosis were included. However, the evidence available is limited, and significant variability was observed among studies. Regarding the reference test, culture and/or SAT are deemed more appropriate than culture alone. Rose Bengal, IgG/IgM ELISA, and PCR exhibited equally high performances, indicating superior overall diagnostic accuracy, with very low certainty of the evidence. This systematic review underscores the potential of the Rose Bengal test, IgG/IgM ELISA, and PCR as promising diagnostic tools for brucellosis. However, the successful implementation and recommendations for their use should consider the local context and available resources. The findings highlight the pressing need for standardization, improved reporting, and ongoing advancements in test development to enhance the accuracy and accessibility of brucellosis diagnosis.

Incidence and warning signs for complications of human brucellosis: a multi-center observational study from China

BackgroundBrucellosis is a severe zoonotic disease that is often overlooked, particularly in impoverished countries. Timely identification of focal complications in brucellosis is crucial for improving treatment outcomes. However, there is currently a lack of established indicators or biomarkers for diagnosing these complications. Therefore, this study aimed to investigate potential warning signs of focal complications in human brucellosis, with the goal of providing practical parameters for clinicians to aid in the diagnosis and management of patients.MethodsA multi-center cross-sectional study was conducted in China from December 2019 to August 2021. The study aimed to investigate the clinical characteristics and complications of patients with brucellosis using a questionnaire survey and medical record system. The presence of warning signs for complications was assessed using univariate and multivariate logistic regression models. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used for variable screening and model evaluation.ResultsA total of 880 participants diagnosed with human brucellosis were enrolled. The median age of the patients was 50 years [interquartile range (IQR): 41.5–58.0], and 54.8% had complications. The most common organ system affected by complications was the osteoarticular system (43.1%), with peripheral arthritis (30.0%), spondylitis (16.6%), paravertebral abscess (5.0%), and sacroiliitis (2.7%) being the most prevalent. Complications in other organ systems included the genitourinary system (4.7%), respiratory system (4.7%), and hematologic system (4.6%). Several factors were found to be associated with focal brucellosis. These factors included a long delay in diagnosis [odds ratio (OR) = 3.963, 95% confidence interval (CI) 1.906–8.238 for > 90 days], the presence of underlying disease (OR = 1.675, 95% CI 1.176–2.384), arthralgia (OR = 3.197, 95% CI 1.986–5.148), eye bulging pain (OR = 3.482, 95% CI 1.349–8.988), C-reactive protein (CRP) > 10 mg/L (OR = 1.910, 95% CI 1.310–2.784) and erythrocyte sedimentation rate (ESR) elevation (OR = 1.663, 95% CI 1.145–2.415). The optimal cutoff value in ROC analysis was > 5.4 mg/L for CRP (sensitivity 73.4% and specificity 51.9%) and > 25 mm/h for ESR (sensitivity 47.9% and specificity 71.1%).ConclusionsMore than 50% of patients with brucellosis experienced complications. Factors such as diagnostic delay, underlying disease, arthralgia, eye pain, and elevated levels of CRP and ESR were identified as significant markers for the development of complications. Therefore, patients presenting with these conditions should be closely monitored for potential complications, regardless of their culture results and standard tube agglutination test titers.

Study of some cytokines in patients with brucellosis in Najaf province

Background: To evaluate the levels of pro-inflammatory cytokines for ‘Th1/Th2 brucellosis’ patients serum to determine ‘antimicrobial susceptibilities’ of Brucella strains.
 Methodology: The study comprised 35 individuals with acute brucellosis, and 21 patients with chronic brucellosis, identified clinically. A group of 20 healthy adult persons was also enrolled in the study. For all of the participants, blood cultures and standard tube agglutination tests for Brucella were performed. ELISA was used to detect cytokine levels in serum samples collected following the treatment period and detect Brucella strains celebrated from different sites of infection, and in order to find-out the susceptibilities against antibiotics including rifampicin (RIF), streptomycin (STR), doxycycline (DOX), and ciprofloxacin (CIP) via the gradient strip (E test).
 Results: The patients included 22 (39.29 percent) males and 34 (60.71 percent) females based on their gender and age. Fever was the most common clinical feature (92%), sweating came in second place (75%), followed by back pain with 18%. Patients with brucellosis had substantially higher blood levels of interleukin-6 (IL-6), interferon (IFN), and tumor necrosis factor-alpha (TNF-alpha) analogous to the control group (P = 0.05). IL-4 and IL-2 levels between the sick and control groups did not vary significantly. The amounts of these cytokines were found to be identical in acute and chronic individuals. Rendering to "minimum inhibitory concentrations (MIC) 90 levels," CIP was determined to be the most effective antibiotic. Then followed DOX and then STR, correspondingly. All of the samples were CIP and DOX susceptible; 18 (23.2%) strains were discovered to be only mildly sensitive to RIF, with MIC50 and MIC90 maximal values.
 Conclusions: Our findings point to an important role for IFN and proinflammatory cytokines in brucellosis pathogenesis. However, these changes were shown to be unrelated to the severity or activity of the illness. Furthermore, all strains were identified as Brucella strains. ciprofloxacin, doxycycline, rifampicin and streptomycin were found to be effective for the treatment of brucellosis.
 Key words: Antimicrobial Susceptibilities; Brucellosis; Cytokines; Interferon; Pro-Inflammatory Cytokines
 Citation: Abbas KF, Abdul-Hassan LS, Hadi OM, Almulla AF, Kathair ZY. Study of some cytokines in patients with brucellosis in Najaf province. Anaesth. pain intensive care 2024;28(1):39-43; DOI: 10.35975/apic.v28i1.2379
 Received: September 15, 2023; Reviewed: November 03, 2023; Accepted: December 23, 2023

Anticorpos anti-Brucella spp. em equídeos de tração em uma região semiárida do Nordeste do Brasil

ABSTRACT: The present study described the prevalence and factors associated with the seropositivity for anti-Brucella spp. antibodies in working equids in the semiarid regionofnortheastern Brazil. Blood samples were collected from 322 equids (76 horses, 155 mules and 91 donkeys). The Rose Bengal plate test (RBPT) was used as a screening method. Samples that were reactive in the RBPT were tested for confirmation using 2-mercaptoethanol (2-ME) and the standard tube agglutination test (STAT). Overall, 7.1% (23/322) of the samples were positive according to the RBPT. After confirmatory tests, the prevalence of brucellosis was found to be 6.5% (21/322). Among these cases, 33.3% (7/21) were horses, 42.8% (9/21) were mules and 23.9% (5/21) were donkeys. In the multivariate analysis, age over 10 years was considered to be a factor associated with the seropositivity (OR: 17.17; 95% CI: 2.582-164.7, P = 0.006) for anti-Brucella spp. antibodies. The significant prevalence of anti-Brucella spp. antibodies found in working equids and the wide distribution of positive animals demonstrates a worrying epidemiological situation regarding brucellosis in the study region. Age over 10 years was a risk factor associated with the seropositivity for anti-Brucella spp. antibodies in animals.

Seroprevalence of brucellosis among animal handlers in West Bengal, India: an occupational health study.

Brucellosis is a highly contagious zoonotic disease and a major human health problem worldwide. Due to its ways of transmission, direct or indirect contact with infected animals or their contaminated biological products, the disease exhibits strong occupational association with animal handlers comprising a significant population at risk. This study was undertaken to estimate the seroprevalence of brucellosis in animal handlers and to understand the epidemiological and serological aspects of the same. The animal handlers from the state of West Bengal, India were included in this study. It was a prospective and observational cohort study from November 2021 to March 2022. A total of 669 sera samples were collected from animal handlers and tested using various serological tests for Brucella antibodies. All serum samples were tested using the Rose Bengal plate test (RBPT), standard tube agglutination test (STAT), and enzyme-linked immunosorbent assay (ELISA). 106 (15.8%) patients were diagnosed with brucellosis among the total number of patients tested. Most of the patients affected with brucellosis belonged to the age group 51-60 years (23.5%). The seropositivity rate in male animal handlers was higher than female animal handlers in this study. More studies are needed to understand the occupational association of this disease. Awareness programs, safe livestock practices, and prevention of the disease by timely diagnosis must be implemented in order to control human brucellosis.

Seroprevalence of Brucellosis in Individuals Engaged in Animal Husbandry in Erzurum Region

Objective: Brucellosis is one of the most common zoonotic diseases in our country and the world. This study investigated the seroprevalence of brucellosis in individuals who were engaged in animal husbandry in Erzurum region, were over 18 years of age, or did not have any clinical complaints of brucellosis. Materials and Methods: Our study was conducted on 271 volunteers engaged in livestock farming in 20 districts of Erzurum province between 2020 and 2021. Brucella antibodies were investigated in blood samples using ELISA IgG, ELISA IgM, Rose Bengal, and Standard tube agglutination tests. A questionnaire was administered to the participants to investigate the risk factors of brucellosis. Results: The mean age of the participants was 43.6 ± 15.7.2 years (min:18, max:90), and there were 137 male (50.6%) and 134 female (49.4%) particpants. Seropositivity was detected with ELISA IgG in 40 of 271 participants (14.8%). Seropositivity was detected in the ELISA IgM test in 2 of these 40 participants (0.7%). Seropositivity was found in 46 participants (17%) in the Rose Bengal and 29 individuals in the STA test. According to the serology results, ELISA IgG positivity was higher in male participants compared to female participants (ratio=1.6). Among pet owners, ELISA IgG seropositivity was found higher than the participants who did not have pets (ratio=1.9). In the evaluation based on educational status, the rate of seropositivity was slightly higher in the participants who were illiterate and had a poor level of education. Conclusion: In our study, it was determined that the prevalence rate obtained by ELISA IgG was consistent with previous studies conducted in the region. No significant relationship was observed between the serology results of the participants and their gender and educational status. On the other hand, the positivity of ELISA IgG results was higher among the participants who had pets, and there was a significant relationship at the margin.

Prevalence and risk factor investigation for exposure to Brucella species in surrogate stray cattle population reared in cow shelters in Punjab, India.

Bovine brucellosis is endemic in cattle in India, however not much is known on the prevalence of this disease in stray cattle populations of the country. This study aimed to estimate the prevalence and identify risk factors associated with brucellosis in the stray cattle populations reared in cow shelters (gaushalas) of Punjab, India. Blood samples were collected from 587 cattle reared in 23 cow shelters in 23 districts (one per district) of the Punjab and were tested using Rose Bengal plate test (RBPT), standard tube agglutination test (STAT) and Indirect Enzyme Linked Immunosorbent Assay (i-ELISA). Information on the sex and breed of the animal, total cattle population and presence of a separate shed for parturition were collected. An animal was considered exposed to Brucella infection based on a positive RBPT or STAT test and a positive i-ELISA test. Explanatory variables for the animal level disease status outcome variable were sex and breed of the animal and at the shelter level were shelter cattle population size and presence of a separate shed for parturition. Univariable binomial exact logistic regression analysis was conducted to assess the association of each explanatory variable with the binary outcome variable. Sixty-two animals were seropositive on RBPT, with an apparent seroprevalence of 10.56% (95% confidence interval [CI]: 8.33%, 13.31%) and the estimated true seroprevalence of 11.48% (95% CI: 8.9%, 14.64%). Sixty three animals were seropositive using STAT [apparent seroprevalence of 10.73% (95% CI: 8.48%, 13.50%) and the estimated true seroprevalence of 10.69% (95% CI: 8.27%, 13.67%)], and 68 using i-ELISA [an apparent seroprevalence of 11.58% (95% CI: 9.24%, 14.43%) and the estimated true seroprevalence of 13.28% (95% CI: 10.50%, 16.66%)]. Cross bred cattle had a lower risk of being test positive (odds ratio 0.16, p=0.04) as compared to indigenous cattle. Due to a ban on cow slaughter in the country, roaming stray cattle infected with brucellosis present a permanent risk of introduction of disease to the dairy farms and other vulnerable populations.

Evaluation of risk factors for the development of bacteremia and complications in patients with brucellosis: Is it possible to predict the clinical course?

Brucellosis is often confused with other diseases or accompanies the conditions it imitates. It causes treatment delays, failure, relapse, and complications. This study aimed to investigate bacteremia and complication predictors in Brucellosis patients. Early detection may help reduce relapse rates, length of hospital stay, and surgical intervention rates by providing appropriate treatment. We examined 220 adult patients diagnosed with Brucellosis in our tertiary care hospital in the Black Sea Region between January 01, 2010, and January 01, 2022. Patients with and without bacteremia and complications were compared regarding demographic characteristics, clinical features, and laboratory parameters. The mean age was 46.4 ± 15.8 years (18-96 years), and 61% were male. Low back pain and absence of muscle pain were independent risk factors for predicting bacteremia (p = 0.049, p = 0.043, respectively). Weakness /fatigue, weight loss, and 1/320 Standard Tube Agglutination Test (STAT) or Brucella Coombs Gel Test (BCGT) titers were independent risk factors that reduced the risk of complications; in contrast, low back pain and splenomegaly were independent risk factors for development of complications. (p = 0.025, p = 0.007, p = 0.008, p = 0.003, p = 0.021 respectively). Thrombocytopenia was related to complications. When the platelet cut-off value was taken as 160,000/µL in predicting complications, the sensitivity was 31.30%, and the specificity was 97.73% (p = 0.011). The risk of clinical progression and complications could be predicted with symptoms and signs such as myalgia, low back pain, weakness/fatigue, weight loss, splenomegaly, and easily accessible laboratory parameters such as serum STAT/BCGT titer and platelet level.

Testicular involvement of Brucellosis: A 10-year, multicentre study.

The genito-urinary system is one of the most common areas of involvement in brucellosis. To present the epidemiological, clinical, and laboratory characteristics of patients with testicular involvement associated with brucellosis, together with the diagnostic and therapeutic approaches. Patients followed up for brucellosis-related testicular involvement between January 2012 and November 2022 were included in the study. Brucellosis is defined as the production of Brucella spp. in cultures, or clinical symptoms together with the serum standard tube agglutination test titer of ≥ 1/160. Inflammation in scrotal Doppler ultrasonography was based on testicular involvement. A retrospective evaluation was made of the data of 194 patients with brucellosis-related testicular involvement. The rate of determination of testicular involvement in brucellosis was 2.57%. The most affected patients were determined in the 16-30 years age range. On presentation, brucellosis was in the acute stage in 83.7% of patients. The most common symptoms on presentation were swelling and/or pain in the testes (86.6%). In the patients where a spermiogram could be performed, oligospermia was determined in 41.7%, and aspermia in 8.3%. When the testicular involvement of brucellosis was evaluated, epididymo-orchitis was present at the rate of 55.7%, epididymitis at 27.3%, and testis abscess at 5.1%. Although epididymo-orchitis was the most frequently determined form of involvement in this study, there was also seen to be a significant number of patients presenting with epididymitis. Male patients presented with the clinical status of brucellosis should be questioned about swelling and pain in the testes to avoid overlooking testicular involvement.

Development and Application of an iELISA for the Detection of Antibody against Salmonella Abortusequi

Equine abortus salmonellosis is a bacterial disease that causes high abortion rates in susceptible equids and therefore significant economic losses. Although the tube agglutination test (TAT) is a commonly used serological test for S. Abortusequi, it is not highly specific or sensitive, and the development of more sensitive, specific and rapid assays is therefore urgently required. In this study, an indirect enzyme-linked immunosorbent assay (iELISA) was developed for the specific detection of flagellum protein (FljB) antibodies against S. Abortusequi. Negative sera from horses in China (n = 1030) were used to establish the baseline for a negative population, and reference antisera positive against other viruses or bacteria were used to test the cross reactivity of the technique. The performance of the FljB iELISA was evaluated against that of the standard TAT, and was tested using field serum samples. The FljB iELISA assay was 8–16 times more sensitive than TAT. ROC analysis showed that the FljB iELISA was accurate, with an area under the curve (AUC) = 0.9943 (95% CI, 0.9815–1.000). The diagnostic sensitivity (DSe) of the FljB iELISA was 98.9% (95% Cl, 93.84%–100.00%), which was higher than that of TAT (DSe 38.6; 95% CI, 29.14%–49.08%). The diagnostic specificity (DSp) of the iELISA was 100.0% (95% CI, 95.82%–100.0%). When the 508 clinical samples were tested, the FljB iELISA had a positive detection rate of 51.38% (261/508, 95% CI, 51.24%–51.51%), which was higher than that of TAT (44/508). We also performed a serological survey for S. Abortusequi infection, using a series of samples collected from across eighteen provinces of China in 2021. The results showed that all provinces except Jiangsu had a certain number of cases, and the positive rates ranged from 0% to 96.9%, indicating the wide spread of S. Abortusequi in China. The abovementioned results suggest that the FljB iELISA developed in this study is rapid, sensitive, specific, and repeatable and is likely to be a suitable test for large-scale serological surveys for the detection and control of S. Abortusequi infection.

COMPARISON OF CLINICAL, LABORATORY FINDINGS AND COMPLICATIONS IN BACTERIEMIC AND NONBACTERIEMIC BRUCELLOSIS: A SINGLE CENTER EXPERIENCE

Objective: Brucellosis is a systemic zoonosis that affects various organs or body systems and can mimic many diseases. Symptoms can range from acute febrile illness to chronic clinical manifestations with severe complications. In our study, we investigated the relationship between bacteremia and clinical and laboratory findings, and complications in patients with brucellosis.
 Material and Methods: Two hundred and twenty-three patients diagnosed with brucellosis between 2005 and 2020 in the department of infectious diseases and clinical microbiology of a tertiary care university hospital were included in the study. Rose Bengal test, Brucella standard tube agglutination test and culture (blood and/or bone marrow culture) were used for the diagnosis of brucellosis. The patients were divided into two groups according to their bacteremia status. Patients with positive culture were identified as bacteremia, and patients with negative culture were identified as non-bacteriemic.
 
 Results: A total of 223 patients were included in the study, of which 142 (63.7%) were male. While weight loss, fever and hematological complications were higher in bacteremia cases (p=0.001, p

Seroprevalence and risk factor analysis of small ruminant brucellosis in the semi–arid region of India

Objective: To study the occurrence of brucellosis in small ruminants in a district of Southern India. Methods: A total of 425 serum samples (215 sheep and 210 goats) were collected from January to March 2022 using a multistage sampling method. The serum samples were subjected to three serological tests that were employed in this study, namely RBPT (Rose Bengal Plate Test), STAT (Standard Tube Agglutination Test), and I-ELISA. The risk factors were determined by collecting data through a questionnaire and establishing correlations between the responses and seropositivity within a specific flock. Result: Among the 425 samples collected, 91 samples (21.4%) were positive by RBPT, 124 samples (29.2%) by STAT and 156 samples (36.7%) by I-ELISA in sheep and goats. Sheep showed higher seropositivity in all three tests than goats. Analysis of multivariable logistic regression showed that age (>3 vs.<3 years; OR: 2.262, 95% CI: 1.414–3.618), abortion history (yes vs. no; OR: 1.837; 95% CI: 1.098–3.071), vaginal discharges (yes vs. no; OR: 2.334; 95% CI: 1.421–3.835), the migratory herd (yes vs. no; OR: 2.197; 95% CI: 1.369–3.527), and place of disposal of the foetus (yes vs. no; OR: 2.093; 95% CI: 1.320–3.318) were significant risk factors of brucellosis. Conclusions: Livestock owners and consumers of sheep and goats should be educated about brucellosis and prevention strategies to mitigate its uncontrolled spread and lower the potential threat of human brucellosis. Choosing the right rearing practices, enhancing husbandry procedures, changing farmer's perspectives on brucellosis, and inclusion of small ruminants in brucellosis control programs are all key management approaches that can aid in the prevention and control of Brucella infection in small ruminants.

Novel markers in predicting Brucella sacroiliitis: The platelet large cell ratio and basal immature reticulocyte fraction

Objective: To present platelet large cell ratio (P-LCR), reticulocyte, and immature reticulocyte fraction (IRF) values as novel parameters in diagnosis and response to treatment in patients developing sacroiliitis. Methods: Sixty-eight patients with clinical symptoms and Brucella standard tube agglutination (Wright) or Brucella Coombs agglutination test titers ≥1:160 were included in the study. Two groups were established, one developing sacroiliitis and another with no sacroiliitis development. P-LCR, reticulocyte, and IRF levels were measured using a Sysmex XN-9000 device (Japan). These were then compared between the two groups. Results: Reticulocyte (P=0.037) and IRF (P=0.026) levels were significantly lower among the patients developing sacroiliitis compared to the non-sacroiliitis group, while P-LCR (P=0.003) levels were significantly higher. P-LCR had the most powerful correlation with sacroiliitis development. Significant negative correlation was observed between reticulocyte, IRF levels and sacroiliitis. Conclusions: Elevated P-LCR levels were observed as a marker of persisting inflammation in patients developing sacroiliitis, while low reticulocyte and IRF levels secondary to bone marrow involvement were detected. These three parameters emerged as highly significant markers in terms of diagnosis and reflecting responses to treatment in organ involvement such as sacroiliitis in brucellosis. These are presented as inexpensive, and easily accessible novel parameters.

Brucella Olgularında Ağrı Prevalansı ve Yaşam Kalitesinin Değerlendirilmesi

Objective: Pain is an inevitable symptom in Brucellosis, which causes a wide clinical spectrum. In this study, we aimed to examine the effect of pain on presence, severity, localization, analgesic intake and quality of life in patients diagnosed with Brucella.
 Materail and Methods: Patients diagnosed with Brucella based on clinical and laboratory findings were included in the study. Age, gender, clinical stage of Brucella, organ involvement, serum C-reactive protein (CRP) level and standard tube agglutination test (STA) titer of the patients were recorded. The Brief Pain Inventory (BPI) and the Turkish Version of the World Health Organization Quality of Life Scale Short Form (WHOQOL-BREF-TR) were administered face-to-face to the patients.
 Results: The median age of 92 Brucella patients included in the study was 40.5 years. 54.3% of the patients were male and 45.7% were female. At admission, 57.6% were acute, 31.5% subacute, and 10.9% chronic. Organ involvement was present in 31.5% of the patients. At the time of diagnosis, 89.1% of the patients had pain complaints. Pain localization was most frequently in the knee, back, hip and shoulder, respectively. 51.1% of the patients were using nonsteroidal anti-inflammatory drugs (NSAIDs) at least once a day. There was no statistically significant correlation between age, disease stage, organ involvement, serum CRP level and STA titer and WHOQOL-BREF and VAS measurement values. WHOQOL-BREF Psychological (p=0.003) and WHOQOL-BREF Social (p=0.008) measurement values were found to be higher in women than men.
 Discussion and Conclusion : Pain is a common symptom in Brucella patients. Regardless of age, laboratory parameters and organ involvement, pain in Brucella patients should be questioned at all clinical stages. It affects the quality of life and may cause undesirable side effects by causing frequent painkiller intake.

Monoclonal Antibody based Blocking ELISA for Diagnosis of Brucellosis

Background: Porcine brucellosis is a contagious and emerging zoonosis but neglected in most of the endemic countries including India. The disease in pigs is rarely reported due to non-availability of diagnostics or major focus is on bovine brucellosis. Hence, the necessity was felt to diagnose porcine brucellosis by Monoclonal antibody based ELISA, RBPT and STATS for the detection of anti-Brucella antibodies and to record spatial seroprevalence of porcine brucellosis in the country. Methods: The Rose Bengal Plate Test (RBPT), Standard tube agglutination test (STAT) and Bru Alert monoclonal antibody based c-ELISA was employed to screen 148 sera samples for the presence of Brucella antibody. Result: A total 148 samples were collected and tested, the overall prevalence of Brucella infection in pig was 43.2% per cent (64/148) by C-ELISA followed by RBPT 40% (60/148) and STAT 25% (40/148) in the study area comparatively high seropositivity was found in female animals. The agreement between the two test was excellent (Kappa = 0.167) and also, chisquare test indicated an evidence of strong diagnostic weapon for detection of swine brucellosis.

Spinal brucellosis causing spondylodiscitis

Introductionand Importance: Brucellosis is a common prevalent zoonotic disease in developing countries including Somalia. Brucellosis may affect many organs. However involvement in the spine and paravertebral muscles is common and may lead to diagnostic challenges since it presents with non-specific symptoms.Case presentationHere we report 18-year old male patient who presented with low back pain, low grade fever, difficult voiding and progressive lower extremity weakness for 5 months. The pain was localized to the lumbar vertebra (tender on palpation) and radiating to both lower limbs. There was slight weakness on the left lower limb (muscle power 3+/5). There were no associated sensory symptoms or deep tendon reflex abnormality. But he had mild urine retention.Lumbar magnetic resonance imaging (MRI) revealed spondylodiscitis. Rose-Bengal test was positive for brucellosis. A Brucella standard tube agglutination test was positive at a titer of 1:64. Given the test results and the imaging finding, the patient was diagnosed with Spinal brucellosis. He was treated with oral doxycycline (100 mg, two times daily) and Rifampicin (600Mg) orally once daily for 6 months. Streptomycin was added during the first three weeks. The patient had massive improvement after 3 months of treatment, (the patient's symptoms almost disappeared).Clinical discussionSpinal brucellosis is characterized by the involvement of the vertebral column, interspinal spaces, and/or paraspinal areas. Its subacute or chronic forms typically affect the spinal column. Spinal brucellosis may cause Spondylitis, spondylodiscitis or epidural abscess causing spinal compression. This case presented with spondylodiscitis and was successfully treated without the need for surgical intervention.ConclusionsBrucella spondylodiscitis, though uncommon and challenging, it should be kept in mind in the differential diagnosis of patients presenting with chronic back pain and lower extremity weakness living in endemic areas like Somalia. The duration of treatments should be prolonged in patients with worse physical condition.

Brucellosis in livestock: First study on seroepidemiology, risk factors, and preventive strategies to manage the disease in Famenin, Iran.

Background and Aim:Brucellosis is an infectious disease in humans and livestock. The disease is endemic in many regions of Iran, for example, Hamedan Province. Knowledge of infection rate and associated risk factors is essential to control and prevent the disease. The study aimed to estimate the prevalence of brucellosis and associated risk factors in cattle, sheep, and goats in Famenin, Hamedan Province, West of Iran.Materials and Methods:Blood samples of 1758 animals (1470 sheep, 190 goats, and 98 cattle) were obtained in different rural regions of Famenin. The samples were evaluated to detect of Brucella-antibodies using rose Bengal plate test (RBPT), Wright standard tube agglutination test (SAT), and 2-Mercapto-Ethanol (2-ME) techniques. The risk factors associated with brucellosis such as age, gender, history of vaccination against brucellosis, and abortion history in animals were evaluated. In the sampling process, the critical gaps related to the distribution of brucellosis in the herds and regions are identified for designing the strategies to prevent and control the disease.Results:About 6.88% and 89.31% of animals had a history of abortion and vaccination against brucellosis, respectively. Most of the animals were female (92.49%) and in the range of 2–3 age old (39.8%). The antibodies to the Brucella-infection in animals were 2.73% with RBPT and 1.30% with SAT and 2-ME. The prevalence of brucellosis was detected 1.3% among individual animals and 11% among herds. This rate was 1.43% for sheep and 1.05% for goats, with no significant statistical difference. No seropositive case was detected in cattle samples using RBPT, STAT, and 2-ME. The highest rate of brucellosis (6.25%) was detected in Emamzadeh-Pirnahan region (22.2% goats and 5.6% sheep). In sheep, most cases of the disease were in 3–4 age-old group (1.92%), animals without a history of abortion (1.58%), and without a history of vaccination against brucellosis (2.80%). Furthermore, 5.94% of males and 1.11% of females were detected positive for brucellosis (p < 0.001). The chance of brucellosis in rams was 5.6 folds higher than in others (odds ratio = 5.64). Brucellosis in goats was detected 2.94% and 1.89% in the age groups <1 and 2–3 year-old. Furthermore, 1.22% of females and 1.34% of animals without a history of abortion were positive. Brucellosis was found in 0.61% of vaccinated and 3.85% of non-vaccinated goats. Except for gender in sheep, no significant statistical correlation (p > 0.05) was observed between prevalence of brucellosis and risk factors. In farmers, low level of information about the transmission and also control and preventive methods of the disease was dominant. Consumption of traditional and unpasteurized dairy products is also very common in the studied regions.Conclusion:This is a comprehensive evaluation of animal brucellosis parallel to humans’ cohort study in the Famenin region for the first time. Although the rate of brucellosis in animals is low in the region, explaining the risk factors to farmers, mass vaccination, regular screening of animals, and culling the positive animals are very important for controlling and reducing the disease in the region.

Assessment of index value performance of enzyme immunoassay test in predicting the diagnosis of human brucellosis.

Clinical presentation of brucellosis is variable. Therefore, it must be confirmed with laboratory findings. Standard tube agglutination test (STAT) is commonly used for diagnosis of brucellosis. ELISA tests differentiate between IgM and IgG antibodies. However, there are evidences revealing that they do not have sufficient specificity. This study aimed to determine an ELISA optimal index value in the diagnosis of brucellosis. Brucella STAT and ELISA IgM/IgG tests of patients admitted to the hospital with signs and symptoms of brucellosis between January 2017 and December 2019 were evaluated in the Microbiology Laboratory. ELISA IgM and IgG serum median index value was significantly higher in STAT positive (1 ≥ 1:160) group (p < 0.001 for both). By ROC analysis of 117 patients, when the IgM index value was determined to be 2.44, the sensitivity, specificity, positive and negative predictive values were 85.7%, 71.4%, 60%, and 90.9%, respectively, and when the IgG index 7.85 was determined, these values were 85.7%, 53.7%, 36.7%, and 92.3%, respectively was detected. In this study, it was revealed that Vircell Brucella had a good clinical diagnostic performance for index value of 2.44 for IgM test kit and 7.95 for IgG test kit. If the diagnosis of brucellosis is correctly predicted with index values in Brucella IgM and IgG tests before STAT analysis, they can be used in the process of clinical decision. In addition to the results of Brucella ELISA, reporting index values and determining optimal index values for each laboratory can help the diagnosis of brucellosis.

2009-2019 Yılları Arasında Sivas Cumhuriyet Üniversitesi Tıp Fakültesi Çocuk Kliniği’nde Bruselloz Saptanan Çocuk Hastaların Demografik, Klinik, Laboratuvar Bulguları ve Tedavilerinin Değerlendirilmesi

Purpose: The purpose of the present study is to evaluate the demographical and clinical characteristics, laboratory findings, all symptoms, treatments received, durations of hospital stay and prognosis after treatment of the pediatric patients with brucellosis diagnosis followed-up in the Pediatrics Department of the Research and Application Hospital of Sivas Cumhuriyet University. Materials and Methods: In this study, 51 patients within the age group 0 and 18, who were diagnosed with brucellosis and who presented to the Pediatrics Department of Research and Application Hospital of Sivas Cumhuriyet University between January 1st, 2009 and December 31st, 2019, were included. The files of the patients were analyzed retrospectively. The diagnosis was made in all patients with the presence of history, clinical symptoms and findings by the positivity (≥1/160) of the Standard Tube Agglutination Test (STA) and/or by the growth of Brucella species in the blood culture. The time the patients who were included in the study presented to the hospital, their ages, gender, place of residence, intake of raw milk and dairy products, contact history with farm animals, time elapsed until diagnosis, Brucella history in the other members of the family, the properties of their houses, the number of people living in the house, social insurance, physical examination findings, laboratory findings, all symptoms of the patient, treatments received, duration of hospital stay, complications and prognosis after treatment were examined and recorded. Findings: 41 of the patients (80.4%) were males and 10 of them (19.6%) were females. The ages of the patients were between 2 and 17, and the average age was 10.9±4.10. The time it took between the patients’ onset of complaints and the diagnosis of brucellosis varied between 1 and 30 days, and the average number of days was 10. The most frequent complaint was fever which was seen in 39 (76.5 %) patients. The second most frequent complaint was joint pain observed in 34 (66.7 %) patients. 15 (29.4 %) of the patients presented with fever and 12 (23.5 %) patients had joint swelling. Statistically significant difference was observed between the Erythrocyte Sedimentation Rates (ESH), C-Reactive Protein (CRP) values before and after the treatment (p=0.001, p=0.002). Before the treatment, Platelets (PLT), Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) were significantly high (p=0.010, p=0.000, p=0.000). Conclusion: Because Turkey is an endemic zone for Brucellosis, Brucellosis must be considered for every child with complaints of long-lasting fever, perspiration and joint pain. Both clinical and serological evaluations of the family members of the patient with brucellosis diagnosis might be needed. This would enable the early diagnosis and treatments of probable cases. Diagnosis and treatment of the disease in the early stage, awareness-raising in public against consuming raw milk and/or dairy products in places where animal breeding is prevalent, especially in the rural areas, training of the public and the health personnel on the causes of Brucellosis transmission and the methods of protection from Brucellosis would be the precautions to be protected from this infection and would lead to a reduction in the development of complications.