Standard Tube Agglutination Titer Research Articles

The assessment of imaging diagnosis of brucellar spondylitis

Objective To explore the imaging features of brucellar spondylitis (BS). Methods The imaging data of 49 cases who were diagnosed as brucellar spondylitis by a positive standard tube agglutination titer test (≥1∶100) and (or) the isolation of brucella species from blood or other tissue at our institution between September 2012 and October 2016 were retrospectively reviewed. X-ray, CT scan and MRI examination was performed in 49, 28 and 42 cases, respectively, of which 19 cases underwent both CT scan and MRI examination. The imaging manifestations of the spine were analyzed. The χ2 test or Fisher's exact test were applied to compare the imaging manifestations of the patients who underwent both CT scan and MRI examination. Results Of the 49 patients, 34 patients (69.4%) had involvement of the lumbar vertebra. Forty-five patients (91.8%) had contiguous involvement at adjacent 2 vertebral bodies. There were 10 cases (20.4%) with bony spur or bone bridge, 3 cases (6.1%) with spondylolisthesis and 3 cases (6.1%) with slightly kyphosis deformity. There were 8 cases (28. 6%) showing bone destruction of more than half of the vertebral body and 6 cases (21.4%) with sequestra on CT. There were 14 cases (33.3%) with psoas abscesses, of which 2 (4.8%) had migrating abscess. Epidural abscesses with dural sac compression were found in 17 cases (40.5%) and 3 cases (7.1%) showed nerve roots compression. There were statistically significant differences in the detection of vertebral bone destruction, bone marrow edema, hyperosteogeny, intervertebral disc changes, abscess formation and sequestrum between CT and MRI (P<0.05). Conclusion BS has characteristic imaging features. The presence of bone destruction, sequestrum, and migrating abscess should warrant the possibility of BS. Key words: Brucellosis; Spondylitis; Tomography, X-ray computed; Magnetic resonance imaging; Diagnosis

Clinical manifestations, complications, and treatment of brucellosis: evaluation of 72 cases.

Brucellosis is an important disease in developing countries. We aimed to determine the epidemiologic, clinical, and laboratory characteristics of brucellosis, which still has a high morbidity in Turkey. Seventy-two patients with brucellosis, monitored at our clinic from January 2004 to July 2010, were reviewed retrospectively. The average age was determined to be 44.8 ± 18 years, and 40 of the patients were female (55.6%). The most frequent transmission route was the use of raw milk and dairy products, in 45 of the patients (62.5%). The most frequent complaints were joint pain, high fever, weakness, low back pain, and gastrointestinal symptoms, whereas the most frequent physical examination findings were fever, osteoarticular involvement, splenomegaly, hepatomegaly, and lymphadenopathy. All of the patients were positive for Rose Bengal testing. The standard tube agglutination titer was 1/160 or higher in 64 (88.9%) patients. Brucella melitensis was isolated from blood cultures of 13 (18.1%) patients and bone marrow cultures of 7 (9.7%) patients. Complications of sacroiliitis in 6 (8.3%), spondylodiscitis in 4 (5.6%), endocarditis in 2 (2.8%), neurobrucellosis in 1 (1.4%), and epididymo-orchitis in 1 (1.4%) of the patients were observed. Brucellosis has various clinical presentations. It should be included in the differential diagnosis of high fever and joint pains in endemic countries.

Epidemiological and clinical features of Brucella arthritis in 24 children

BACKGROUND AND OBJECTIVES:Brucellosis is considered the leading zoonotic disease of the Middle East. The disease has a wide spectrum of clinical manifestations and can result in complications with severe morbidity. The aim of this study was to evaluate the frequency, distribution and characteristics of arthritis in Iranian children with brucellosis.DESIGN AND SETTING:A retrospective descriptive study conducted in a referral children center in Tehran from 1997 to 2005.PATIENTS AND METHODS:Arthritis in children with brucellosis who were admitted to a specialized hospital was detected by clinical signs of the involved joint(s) and characteristics of joint fluid aspiration. Socio-demographic information was recorded.RESULTS:Of 96 patients diagnosed with brucellosis, 24 (25%) had Brucella arthritis 14 (58.3%) males and 10 (41.7%) females. Most common manifestations were fever in 21 patients (87.5%) and fatigue in 18 patients (75%). Monoarthritis was recorded in 15 patients (62.5%) of the cases with involvement of the knee in 8 (45%) and hip in 5 (29%), the ankle in 2 (8%) patients while 9 (37.5%) patients suffered from polyarthritis. None of the patients had axial joints involvement. Seventy-five percent of the subjects (18 patients) were from urban areas and 66.7% (16 patients) had consumed un-pasteurized cheese. Recurrence was not seen in any of the 24 patients who received a combination of co-trimoxazole for 6 weeks and gentamicin for 5 days.CONCLUSION:Childhood brucellosis is a challenging disease in Iran that has serious complications like arthritis. Therefore all physicians who work in endemic areas should be familiar with this disease and consider the possibility of brucellosis in all children who present with arthritis and arthralgia.

Soft tissue mass of the chest wall as the sole manifestation of brucellosis in a 7-year-old boy

We report the case of a child who presented with a subcutaneous mass on the left side of the chest wall of one month's duration. The mass was painful and increasing in size over time. He had a history of weight loss and a decrease in appetite, but no history of fever or trauma. He had ingested raw camel milk, but had no history of contact with animals. He was diagnosed by the standard tube agglutination titer and tissue culture for brucellosis, treated with surgery and three months of antibrucella antibiotics. The report includes a brief review of the current pediatric literature to familiarize pediatricians with this uncommon presentation.

Seroepidemiological and Microbiological Study of Brucellosis in Kuwait

Objective: The primary objective of the study was to determine the prevalence of brucellosis and the antimicrobial susceptibility pattern of local Brucellae isolates in the Infectious Diseases Hospital, Kuwait. Subjects and Methods: A single serum sample was collected from each of 1,836 patients of different nationalities from January 2000 to December 2001. Any patient with a provisional diagnosis of fever or brucellosis had a standard tube agglutination (STA) test for the quantitation of Brucella antibodies. Blood cultures were done in 166 of 455 patients with significant STA titers, using the Bactec system. Antimicrobial susceptibility testing of 123 isolates of Brucella spp. was done against 8 antimicrobial agents. Results: A total of 455 serum samples (24.8%) having an STA titer of ≧1:160 were presumptively diagnosed as cases of brucellosis. The peak isolation was in April and May. Brucella spp. were isolated from 123 blood cultures (74.1%). The blood culture isolation rate was significantly higher in patients with an STA titer of ≧1:1,280 than in those with an STA titer of ≤1:160 (p < 0.05). Antimicrobial susceptibility testing showed good in vitro activity of tetracycline, gentamicin, amikacin, streptomycin and ciprofloxacin against all isolates. Azithromycin had good anti-Brucella activity against only 42% of the isolates, while rifampicin and trimethoprim-sulfamethoxazole showed low in vitro anti-Brucella activity against 8 and 25% of the isolates, respectively. Conclusion: Brucellosis is quite common in Kuwait. Kuwaiti and Bangladeshi nationals were most affected. Significant titers on the STA test were detected in 24.8% of serum samples. Good in vitro activity against all isolates was found with tetracycline, gentamicin, amikacin, ciprofloxacin and streptomycin, and low activity with azithromycin, rifampicin and trimethoprim-sulfamethoxazole.

The diagnosis of brucellosis by use of BACTEC 9240 blood culture system

The diagnosis of brucellosis is generally made when a standard tube agglutination titer of 1/160 or more for anti- Brucella antibodies in the presence of compatible clinical signs and symptoms. However isolation of the organism from blood or bone marrow is the proof of the disease. In this study we aimed to describe the rate and duration of isolation of Brucella spp. from blood and bone marrow by use of automated blood culture system (BACTEC 9240). Between 1997 to 2001, 23 adults were diagnosed as brucellosis. Blood culture was obtained in all and simultaneous bone marrow culture in 18 and both specimens were cultured by BACTEC 9240. Brucella was isolated from blood and bone marrow cultures in 19 (82.6%) and 13 (81.2%) respectively. All positive blood cultures yielded within 7 days and bone marrow cultures in 4 days. We concluded that automated BACTEC culture systems can isolate Brucella spp. in a fast and efficient way.

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

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

Epidemiology, Etiology, and Clinical Features of Septic Arthritis in Children Younger Than 24 Months

To examine the incidence, etiology, and clinical features of septic arthritis in patients younger than 24 months. Retrospective, 1988 through 1993 period, chart review-based survey. All children with bacteriologically proved septic arthritis that was diagnosed at a medical center serving southern Israel (population 320,000). Septic arthritis was defined by clinical evidence of joint inflammation and a positive synovial fluid or blood culture, antigen detection test, or a standard tube agglutination titer of 160 or greater for Brucella species. None. During the 6-year period, 40 children had septic arthritis diagnosed. Twenty-six (65%) were male. The annual incidence of septic arthritis was 37.1 per 100,000. The two most common organisms isolated were Kingella kingae in 19 (48%) and Haemophilus influenzae type b in eight (20%). The clinical presentation was frequently mild: a body temperature of less than 38.3 degrees C was recorded in 14 (35%) of 40 children, leukocyte count of less than 15 x 10(9)/L in 13 (34%) of 38, and erythrocyte sedimentation rate of less than 30 mm per hour in four (11%) of 35. In eight (36%) of 22 patients, less than 50 x 10(9)/L leukocytes were counted in the synovial fluid. The diagnosis of septic arthritis in young children requires a high index of suspicion, and the disease cannot be excluded on the basis of lack of fever or normal results of laboratory tests. Kingella kingae appears to be the most common cause of septic arthritis in patients younger than 24 months, although confirmatory studies from other geographic areas are still needed.

An agar--gel immunodiffusion test for detection of Brucella antibodies in human serum.

A comparison was made of results obtained with a Brucella agar--gel immunodiffusion (AGID) test and the standard tube-agglutination test on 612 human sera. Agreement between the tests was 97% when the titer was 1:160 or higher. Of 448 sera that showed no agglutination titer, 447 were negative with the AGID test. Results of the AGID test were also compared to those obtained with the 2-mercaptoethanol (2-ME) agglutination test on 148 sera that demonstrated a standard tube-agglutination titer of 1:20 or higher. All sera with a 2-ME-agglutination titer of 1:40 or higher were positive with the AGID test. Of 123 sera that showed no 2-ME-agglutination titer, 21 were positive with the AGID test. Two of these 21 sera were obtained from patients with bacteriologically proven brucellosis, and eight were from abattoir employees with suspected but not bacteriologically proven brucellosis.