Subacute Brucellosis Research Articles

Ophthalmological findings in brucellosis

To evaluate the ophthalmological findings in patients diagnosed with acute, subacute or chronic brucellosis and to determine the effects of this disease on ocular structures. Eighty-seven patients diagnosed with brucellosis and 71 healthy cases (as a control group) were enrolled in this prospective study. All participants underwent a complete ophthalmic evaluation, including slit lamp biomicroscopic examination, Goldman applanation tonometry, specular microscopy, optical coherence tomography and fundoscopy with pupil dilation. Overall, ocular involvement was present in 47 eyes of 27 (31.03%) patients diagnosed with brucellosis and was most common in the chronic brucellosis group. In the acute brucellosis group, papillary conjunctivitis in 8 eyes of 4 patients and anterior uveitis in 10 eyes of 6 patients were noted. In the subacute brucellosis group, papillary conjunctivitis in 4 eyes of 2 patients and sequelae of anterior uveitis in 6 eyes of 3 patients were observed. In the chronic brucellosis group, panuveitis in 4 eyes of 2 patients, choroiditis in 4 eyes of 2 patients, and signs of previous anterior uveitis in 11 eyes of 6 patients were noted. Visual acuity was significantly worse in patients with acute anterior uveitis (AAU) or previous anterior uveitis (PAU) compared with the control cases. Ocular involvement should be kept in mind in patients with brucellosis, especially acute, and brucellosis should be included in the differential diagnosis of patients with anterior uveitis living in endemic areas, since the clinical presentation of the disease may not be overt.

Clinical Course and Treatment of Human Brucellosis in a Sample of Hospitalized Cases in Albania

Abstract Brucellosis remains a public health problem in many Mediterranean countries. In this work are presenting data of human brucellosis clinics and treatment in a sample of hospitalized patients. Methods: All patient charts at regional hospital in Gjirokastra, Albania were systematically reviewed, during the period 2016-2021. All hospitalized patients with a laboratory confirmed diagnoses of brucellosis were included in the study. Variables of interest were clinical symptoms, clinical course and treatment provided. Sub-acute brucellosis was defined as clinical persistence of 3-12 months while cases with clinical symptoms persisting for ≥12 months were defined as chronic brucellosis. Results: 79% of the 86 patients were male and residing in rural areas. Fever, profuse sweating and arthralgia were the most common clinical signs. Around 70% of the brucellosis patients showed all these three symptoms. Despite a systematic tendency for more frequent presence of high fever, increased sweating and arthralgia on younger patients we could not find statistically significant differences among demographic categories. 18.6% of cases presented persistence of clinical signs after at least 3 months from the moment of the diagnoses. Almost 7% of the cases were classified as chronic cases. 75.6% of all patients were treated with a combination of doxycycline and ceftriaxone antibiotic regime. Conclusions: The massive use of a cephalosporin in treatment of brucellosis cannot be justified and may reflect a larger problem related to population awareness and health provider attitudes concerning antibiotic use in Albania. The results of this study may assist future interventions to improve brucellosis case management at hospitals or primary health care level as well as national measures at a larger scale for control of the disease.

Diagnostic significance of hematological parameters in brucellosis

<b>Introduction:</b> Changes in hematological parameters are frequently observed in brucellosis patients. In this study, it was aimed to evaluate the diagnostic significance of some hematological parameters in patients with brucellosis<b>.</b><br /> <b>Material and methods: </b>In this case-control study, the data of brucellosis patients and healthy volunteers followed up in the Outpatient Clinic of Infectious Diseases between 2018 and 2020 were retrospectively examined. In the hemogram examination of patients with brucellosis and health volunteers; hematological parameters such as the leukocyte, hemoglobin, neutrophil, lymphocyte, monocyte, platelet, ratio of neutrophil/lymphocyte, ratio of platelet/lymphocyte, ratio of monocyte/lymphocyte and mean platelet volume were compared.<br /> <b>Results: </b>255 people, 169 (66.3%) of whom were diagnosed with brucellosis and 86 (33.7%) from the control group, were included to the study. These participants of 112 (43.9%) were male and 143 (56.1%) were female. The patients diagnosed with brucellosis, of 62 (36.7%) were considered acute, of 62 (36.7%) subacute, and of 45 (26.6%) chronic brucellosis. leukocyte, hemoglobin, neutrophil, and neutrophil/lymphocyte levels were found to be lower in the brucellosis group compared to the control group, while mean platelet volume level was found to be higher. Hemoglobin was found to be lower and mean platelet volume higher in all brucellosis subgroups.<br /> <b>Conclusion: </b>In this study, the following findings were determined to be important: the lowness of leucocyte and hemoglobin and highness of mean platelet volume in brucellosis patients, as well as the highness of lymphocyte levels and lowness of neutrophil/lymphocyte and platelet/lymphocyte levels in the subacute brucellosis subgroup. In addition, it was concluded that the mean platelet volume parameter can be used as a diagnostic test for brucellosis.

89 Association of brucellosis and ankylosing spondylitis: a pediatric case report

IntroductionAnkylosing spondylitis is a common chronic rheumatic disease in male young adults. Brucellosis is a worldwide zoonosis and remains endemic in several Mediterranean countries, which may have features similar to other diseases, leading to serious problems of differential diagnosis. This case report described a case of a 14-year-old male diagnosed with ankylosing spondylitis whose exploration reveals associated subacute brucellosis.Methods and resultsA 14- years- old boy from Batna, born of a first degree consanguineous marriage, and the 2nd of a sibling of 05 children. He had no relevant past medical history. He complained of chronic polyarthritis of three years, affecting the large joints: hip, knees, ankles, elbows and wrists as well as the cervico-dorsolumbar spine. Pain on palpation of the tendon insertion zones without fever. Delayed growth in weight and height was found. He was misdiagnosed at disease onset as Rheumatic fever treated by Extencillin with vitamin D3 supplementation but no improvement was noticed.The Ultrasound examination of the joints revealed moderate effusion with synovial thickening of the hip (hip synovitis). CT scan of the cervical-dorsal-lumbosacral spine revealed a bilateral erosive sacroiliitis with cervical ankylosis of the posterior apophyseal joints at C2-C3, C3-C4, and C4-C5 levels. A biological inflammatory syndrome was found. Brucellosis serology (Rose Bengal and Wright) was positive twice (IgM and IgG). Quantiferon test was negative.The treatment of the Brucellosis was started (Doxicyclines, Gentamycin, and Rifampicin). Non-steroidal anti-inflammatory drugs were also prescribed.ConclusionBrucellosis is a differential diagnosis of spondyloarthritis. However, an association of both diseases might exist and should be adequately managed.Disclosure of InterestNone declared

1195. Comparative Analysis Between Acute and Sub-Acute Brucellosis

Abstract Background Brucellosis remains a public health problem. Its myriad and non-specific manifestations vary according to the clinical presentation. We aimed to compare the clinical and laboratory features between acute and sub-acute brucellosis. Methods We conducted a retrospective study including all patients hospitalized for acute and sub-acute brucellosis in the infectious disease department between 1992 and 2020. Results We encountered 104 patients (50.2%) with acute brucellosis and 103 patients (49.8%) with sub-acute brucellosis. Patients with sub-acute brucellosis were significantly older (45.1±17.2 years vs 36.5±17.5 years; p< 0.001). Male gender represented 64.4% of acute brucellosis cases and 67% of sub-acute brucellosis cases (p=0.6). Night sweats (78.8% vs 65%; p=0.027), myalgia (34.6% vs 21.4%; p=0.034) and asthenia (70.2% vs 45.6%; p< 0.001) were significantly more frequent among acute brucellosis cases. Back pain was significantly more frequent among sub-acute brucellosis cases (78.6% vs 28.8%; p< 0.001). Fever (89.4% vs 83.5%; p=0.2), weight loss (29.8% vs 32.4%; p=0.6) and arthralgia (56.7% vs 51.5%; p=0.4) were noted among acute and sub-acute brucellosis group, with no significant difference. Lymph nodes were significantly more frequent among acute brucellosis cases (15.5% vs 1.9%; p=0.002). Splenomegaly (13.5% vs 6.8%; p=0.1) and hepatomegaly (6.7% vs 5.8%; p=0.7) were more frequent among acute brucellosis group, with no significant difference. Laboratory investigations revealed leukopenia (21.2% vs 8.7%; p=0.012) and thrombocytopenia (19.2% vs 7.8%; p=0.016), which were significantly more frequent among acute brucellosis group. While elevated C-reactive protein levels were more frequent among sub-acute brucellosis group (52.4% vs 39.4%; p=0.06), elevated liver enzymes were more frequent among acute brucellosis group (38.8% vs 23.1%; p=0.087), with no significant difference. The mean duration of hospitalization was longer among sub-acute brucellosis cases (16±11 days vs 7±4 days; p< 0.001). Conclusion The presence of sweating, myalgia and asthenia associated with leukopenia and thrombocytopenia was suggestive of acute brucellosis, while back pain, especially among the elderly, was suggestive of sub-acute brucellosis. Disclosures All Authors: No reported disclosures

1423. Clinical Presentation Of Brucellosis: An Experience Of 29-Year Period

BackgroundBrucellosis is a multi-organ zoonotic disease which may present with a myriad manifestation. In our country, brucellosis remains endemic and represents a public health problem. We aimed to study the clinical, therapeutic and evolutionary features of brucellosis.MethodsWe conducted a retrospective study including all patients hospitalized for brucellosis in the infectious diseases department between 1990 and 2018. Positive blood cultures to Brucella spp and/or standard agglutination test (SAT) titer > 1/160 confirmed the diagnosis.ResultsDuring the study period, we encountered 216 cases of brucellosis, among whom 140 cases were males (64.8%). The mean age was 40±17 years. Patients came from rural areas (89.8%) and had a close contact with animals (70.8%). The consumption of unpasteurized milk was noted in 182 cases (84.2%). A family history of brucellosis was noted in 53 cases (24.5%). In total, 68 patients had a previous medical history of treated brucellosis (31.4%). There were 113 cases (52.3%) of acute brucellosis and 103 cases (47.7%) of sub-acute brucellosis. Spondylodiscitis (65 cases; 63.1%), neurobrucellosis (17 cases; 16.5%) and sacroiliitis (12 cases; 11.7%) were the most common forms of the sub-acute brucellosis. The revealing symptoms were fever (83.8%), night sweats (71.3%), arthralgia (55.1%) and back pain (53.2%). Laboratory investigations revealed leukopenia (14.4%), anemia (49%) and elevated C-reactive protein levels (42.1%). Blood cultures were positive to Brucella in 17.1% of the cases. Patients received a combination therapy based on doxycycline and rifampicin in 141 cases (65.2%). Triple therapy regimen including doxycycline, rifampicin and co-trimoxazole was prescribed in 51 cases (23.6%). The mean treatment duration was 52±20 days in the acute form and 6±3 months in the sub-acute form. The disease evolution was favourable in 94.4% of the cases. Sequelae were noted in 12% of the cases and relapse in 3.7% of the cases. Four patients were dead (1.9%).ConclusionDue to its various clinical presentation, the diagnosis of brucellosis might be delayed. High index of suspicion is required in order to promptly diagnose the disease. Control and eradication of brucellosis in animals are mandatory so as to eradicate brucellosis.Disclosures All Authors: No reported disclosures

The role of IL-6 gene (-174 C/G) polymorphism in patients with acute brucellosis

The interrelationship of the IL-6 polymorphism (-174C/G) and susceptibility to brucellosis is well known.The aim: to determine the polymorphism of IL-6 (-174C/G) in patients with acute brucellosisMaterials and methods. The article presents the results of a survey of 120 patients with acute brucellosis. The control group consisted of 30 healthy individuals. Patients of both groups are ethnic Azerbaijani who permanently reside in the Republic of Azerbaijan. The diagnosis of brucellosis was made on the basis of complaints, anamnesis, epidemiological and clinical data and the results of a specific study. Specific research methods were carried out by ELISA with the detection of IgM and IgG for brucella. In addition to the specific diagnostic data, the diagnosis of acute brucellosis took into account the duration of clinical symptoms up to 3 months after the first complaints appeared. All patients were tested for IL-6 polymorphism (-174C/G). The exclusion criteria for the study were age up to 18 years, confirmation of the diagnosis of subacute or chronic brucellosis, the presence of severe chronic comorbidity, which could significantly affect the reliability of the results. A detailed description of patients with brucellosis is presented. Among the surveyed individuals, men of young working age dominated. The criterion of severity was the following symptoms: fever, sweating, chills, headache, insomnia, low blood pressure, tachycardia, hepatosplenomegaly, levels of pro-inflammatory and anti-inflammatory cytokines.Results. Mild disease was established in 74 (61.7 %) people, while severe - only in 11 (9.1 %) patients. There were no statistically significant differences between different IL-6 genotypes between patients with brucellosis and healthy individuals. It was established that allele G was detected almost 3 times more often in patients with acute brucellosis compared to allele C.Conclusions. No statistically significant difference between different IL-6 genotypes (-174 C/G) in patients with brucellosis and healthy individuals was detected. The GC IL-6 genotype was significantly more often associated with severe brucellosis, while the GG genotype with mild

Predictors of therapeutic failure among patients with acute brucellosis treated by dual therapy with doxycycline‐rifampin

To determine the frequency of therapeutic failure among patients with acute and subacute brucellosis and to explore the predictors of failure. The study included 213 consecutive, naïve patients with acute and subacute brucellosis. All participants underwent clinical evaluation, chest radiography, stool microscopic examination and interferon-gamma release assay. Patients received the WHO-recommended therapy of doxycycline 200 mg/day and rifampin 900 mg/day, for 6 weeks. Mean age of the study population was 39.8 ± 12.2 years; 64.8% of them were males. The therapeutic failure rate was 16.4%. Adverse effects were reported by 13.1%. Multivariate analysis of factors associated with therapeutic failure revealed latent tuberculosis infection (LTBI) (OR 3.1, 95% CI, 1.9-24.6, P: 0.009), ascariasis (OR 2.6, 95% CI 1.5-17.9, P: 0.012), and the use of acid suppressive therapy (OR 2.1, 95% CI 1.2-19.5, P: 0.037) as the predictors of therapeutic failure. The prevalence of therapeutic failure among the Egyptian patients with acute/subacute brucellosis is increasing. Predictors of therapeutic failure are LTBI, ascariasis, and the use of acid suppressive therapy.

Different Clinical Presentations of Brucellosis.

BackgroundBrucellosis is one of the important multi-organ zoonotic infectious diseases. The forms of the clinical course of brucellosis in humans are acute, sub-acute and chronic.ObjectivesThe present study aimed to retrospectively analyze the clinical characteristics and complications in the clinical forms of human brucellosis in Iran.Patients and MethodsThe population included 957 patients admitted in the infectious diseases clinic affiliated to Babol University of Medical Sciences, Babol, Iran, within the past two decades. Data for the patients were obtained and documented in questionnaires. Patients were divided into three groups according to their history, symptoms and clinical presentation time: acute (0 - 2 months), sub-acute (3 - 12 months), and chronic (> 1 year).ResultsMost of the patients (73.8%) were in the acute stages of brucellosis, 22.6% had sub-acute brucellosis and 3.7% had chronic brucellosis. The most frequently observed symptoms were arthralgia (71%), sweating (66.7%), fever (57.2%) and backache (39.3%). The most common complication was arthritis (13.2%) in this study.ConclusionsThis infection was observed with a diversity of clinical manifestations. Therefore, diagnostic difficulty because of the various clinical presentations and the way to find undiagnosed complications should be investigated in the differential diagnosis of other diseases.

Hematological Profiles During Acute and Subacute Brucellosis in Sprague-Dawley Rats Experimentally Infected with B. abortus biotype 1

Hematological Profiles During Acute and Subacute Brucellosis in Sprague-Dawley Rats Experimentally Infected with B. abortus biotype 1

Brucellosis: a retrospective evaluation of 164 cases.

Brucellosis is a public health problem that is prevalent in several developing countries. The clinical and laboratory characteristics of 164 cases of brucellosis in Bursa, Turkey, were retrospectively evaluated. The ages of the 164 patients ranged from 15-85 years. All of the patients underwent the Rose Bengal test and 163 (99.4%) patients tested positive. 122 (74.4%) patients were diagnosed with acute brucellosis, 31 (18.9%) with subacute brucellosis and 11 (6.7%) with chronic brucellosis. Focal involvement was found in 101 (61.6%) patients. Although patients with focal involvement had a higher white blood cell count (p = 0.002), those without focal involvement had higher aspartate transaminase and alanine transaminase values, and lower platelet values (p = 0.005, 0.007 and 0.039, respectively). Spondylodiscitis was observed on imaging in 58 (66.7%) of the 87 patients who presented with back pain. Among the 118 patients who were examined within the first month of treatment, 79 (66.9%) responded to treatment. The relapse rate was 11.6% among all 164 patients. Brucellosis should be considered as a differential diagnosis among patients who present with fever, and joint or back pain. Focal involvement should be investigated in the presence of leucocytosis, and subacute or chronic forms of brucellosis. To identify cases of spondylodiscitis, radiography should be performed in patients who present with back pain.

Study of the Pattern of Brucellosis in Menoufyia Governorate

Background and study aim : ELISA can determine specific antibody classes against brucella, It is a sensitive, simple and rapid test, thus help to study the pattern of the brucellosis. The aim of this article is to study the pattern of the brucellosis in Menoufyia governorate. . Patients and Methods: Sera from 150 individuals from confirmed brucellosis cases and 25 healthy individuals were tested for presence of IgG and IgM antibodies by ELISA assay. Culture positivity for brucellosis was used as the reference standard for diagnosis. Results: Serum IgG and IgM for brucellosis by ELISA test had increased values in confirmed brucella cases, ELISA IgM was highly specific (100%) in all groups and sensitive (96%) in acute brucellosis, (100%) in subacute brucellosis and (64%) in chronic brucellosis. While, ELISA IgG specificity in all groups was (80%) and the sensitivity in acute brucellosis was (88%), in subacute and chronic brucellosis was (100%). Conclusion: ELISA IgG and IgM test for brucella is a simple and reliable test in the diagnosis of pattern of the brucellosis.

The expression of γδT cells and other lymphocytes in patients with acute and subacute brucellosis and its significance

Objective To observe the variation of the levels of γδT cells, CD4+ and CD8+ T lymphocytes in patients with acute and subacute brucellosis before and after treatment. Methods A total of 159 patients with brucellosis were enrolled from the Second People′s Hospital of Tianjin between September 2009 and August 2014, of which 122 were with acute phase and 37 with subacute stage. γδT cells, CD4+ and CD8+ T lymphocytes in peripheral blood of all patients before and after treatment were detected by flow cytometry. Thirty healthy controls were also enrolled. Measurement data were analyzed using t test and nonparametric Kruskal-Wallis test. Results The medians of γδT cells, CD4+ and CD8+ T lymphocyte counts of brucellosis patients with acute stage before treatment were 84.0/μL, 780.5/μL and 774.0/μL, respectively, and those with subacute stage were 76.0/μL, 887.0/μL and 890.0/μL, respectively. Those in control group were 49.0/μL, 772.5/μL and 592.5/μL, respectively. γδT cells (U=114.5, P=0.001) and CD8+ T lymphocyte counts (U=1 185.5, P=0.003) in acute phase group were elevated than control group. γδT cells (U=359.0, P=0.013), CD4+ T lymphocyte counts (U=325.5, P=0.004) and CD8+ T lymphocyte counts (U=316.5, P=0.003) in subacute phase group were increased than control group. CD4+ T lymphocyte counts in subacute phase group were elevated than acute phase group (U=1 619.0, P=0.009). There were 31 patients with acute phase and 30 patients with subacute phase who completed 6-week treatment. γδT cells ([120.7±104.9/μL vs 82.2±85.3]/μL vs [120.7±104.9/μL vs 82.2±85.3]/μL; t=3.568, P=0.001), CD4+ T lymphocyte ([802.1±300.6/μL vs 663.0±280.6]/μL vs [802.1±300.6/μL vs 663.0±280.6]/μL; t=2.904, P=0.007) and CD8+ T lymphocytes counts ([908.1±422.7]/μL vs [651.1±241.7]/μL; t=3.885, P=0.001) of brucellosis patients with acute stage before and after treatment were significantly different. γδT cells ([67.1±38.4]/μL vs [48.4±32.1]/μL; t=2.695, P=0.012), CD4+ T lymphocytes ([817.1±147.4/μL vs 650.8±196.5]/μL vs [817.1±147.4/μL vs 650.8±196.5]/μL; t=5.301, P<0.01) and CD8+ T lymphocytes counts ([703.7±191.5/μL vs 537.4±186.0]/μL vs [703.7±191.5/μL vs 537.4±186.0]/μL; t=5.152, P<0.01) of brucellosis patients with subacute stage after treatment were significantly decreased compared with those of patients before treatment. Conclusions γδT cells, CD4+ and CD8+ T lymphocytes in patients with acute and subacute brucellosis are all in a state of immune activation. The levels of activation are highly correlated with disease progression. And detection of the variation of these cells contributes to understand the immune state of the acute and subacute brucellosis. Key words: Brucellosis; γδT cells; CD4-positive T-lymphocytes; CD8-positive T-lymphocytes; Flow cytometry

Brucellosis impairs endothelial functions in chronic symptomatic patients without overt cardiac involvement.

Brucellosis is an important infectious disease, especially in developing countries, and may involve any organ, including the cardiovascular system. This study aimed to assess cardiac and endothelial functions in brucellosis patients. Seventy-three patients with brucellosis and seventy-five healthy volunteers from Turkey were enrolled between 2011 and 2013 in this cross-sectional study. Diagnosis was established by the Rose-Bengal test, positive Brucella standart tube agglutination test, and Coombs STA and/or isolation Brucella species from blood. Cases were divided into three groups: Group I; acute brucellosis, Group II; subacute brucellosis, and Group III; chronic brucellosis. Healthy individuals comprised Group IV. All patients underwent transthoracic echocardiography and brachial artery flow-mediated dilatation (FMD) test. Groups I to IV comprised 35, 18, and 20 patients, and 75 controls respectively. The most frequent symptoms were arthralgia (82%), fever (92%), and fatigue (97%). Echocardiography revealed no difference among the 4 groups regarding left ventricular systolic and diastolic functions and valvular functions. Brachial artery diameter after hyperemia was significantly different among the groups (p=0.002). Post hoc test showed Group III to have significantly lower brachial artery diameter after hyperemia compared to other groups (p=0.02, p=0.004 and p=0.001, respectively). FMD was also significantly lower in Group III compared to Groups I, II and IV (p<0.001 for each). Brucellosis impairs endothelial functions in chronic symptomatic patients without overt cardiac involvement.

Preliminary Study of an Immunochromatography Test for Serological Diagnosis of Canine Brucellosis

The most widely used screening test for the diagnosis of brucellosis in the dog is the rapid slide agglutination test in the presence of 2-mercaptoethanol (2ME-RSAT). The diagnosis is partially confirmed by the agar gel immunodiffusion test (AGID) and definitively confirmed by bacteriological isolation. Some chronic cases not detected by these tests may be detected by ELISA tests. The use of 2ME-RSAT in routine clinical practice requires a microscope and an experienced operator. An immunochromatographic diagnostic test for canine brucellosis (FASTest(®) Brucella c., Megacor, Hörbranz, Austria) has been recently released. In this study, we compared the diagnostic performance of the FASTest with those of 2ME-RSAT, AGID and ELISAs. Sera from 17 healthy dogs used as negative controls yielded negative results by FASTest, indicating a 100% specificity in this sample. Among 27 sera of dogs with acute or subacute brucellosis confirmed by B. canis isolation, all of which were positive by RSAT and ELISAs, the FASTest was positive in 24 cases and AGID in 23. In acute and subacute cases, the sensitivity of FASTest was 89%. Sera from six dogs with bacteriologically confirmed chronic brucellosis, which were positive by ELISAs but negative by 2ME-RSAT, were also tested; 1 was positive by FASTest and 4 were positive by AGID. These preliminary results indicate a good specificity of the FASTest (100% in this sample) but an unacceptable sensitivity as a screening test. In cases with chronic brucellosis, the sensitivity of the FASTest was lower than that of ELISAs but this assay could make a good intermediate test to be run after a positive RSAT and before running an AGID.

Brusellozlu Hastalarda Serum Bakır ve Çinko Düzeylerindeki ve Bakır/Çinko Oranlarındaki Değişiklikler

Objective: To determine the alterations of serum copper (Cu) and zinc (Zn) levels and Cu/Zn ratio in patients with brucellosis. Material and Methods: A total of 170 individuals were included in the study. Of these, 45 (26.5%) currently had acute or sub-acute brucellosis, 35 (20.6%) were previously diagnosed with acute or sub-acute brucellosis and successfully treated, and 90 (52.9%) were healthy volunteers. After fasting overnight for 10 hours, 5 ml of venous blood was taken.from all subjects. Serum Cu and Zn levels were measured using a Unicam 929 Atomic Absorption Spectrophotometer. SPSS 16.0 was used for data analysis. Results: Mean serum Cu levels of 45 patients with acute or sub-acute brucellosis, 35 patients previously diagnosed with acute or sub-acute brucellosis and 90 healthy volunteers were 88.6±26, 58.7±13 and 56.7±16 µg/dL, respectively. Mean serum Zn levels of 45 patients with acute or sub-acute brucellosis, 35 patients previously diagnosed with and treated successfully for acute or sub-acute brucellosis and 90 healthy volunteers were 38.3±12, 58.5±14, and 55.8±13 µg/dL, respectively. Serum Cu levels (p<0.001) and Cu/Zn ratios (p<0.001) were statistically significantly higher while serum Zn levels (p<0.001) were lower in patients with acute or sub-acute brucellosis when compared to the individuals who previously diagnosed with acute or sub-acute brucellosis and the healthy volunteers. Conclusion: This study revealed significant alterations of serum Cu and Zn levels, and Cu/Zn ratios in patients with acute or sub-acute brucellosis. Serum Cu, Zn, and Cu/Zn ratios may be available biomarkers in the course of acute or sub-acute brucellosis.

Presentation of brucellosis in an endemic area; west of IRAQ

Background: brucellosis in enzootic bacterial infection of animals and human through infected animals milk, urine, vaginal secretions, uterine products & uncooked infected meat. leads to clinical human infection with brucellosis. Objectives: this study was introduced to look for endemicity, presentation& rate of infection of brucellosis in Anbar Governorate West of Iraq. Materials & methods: one hundred four (104) patients had clinical features of brucellosis investigated serologically, blood cultures. received antibrucella of triple antibiotics for minimum 6 weeks followed up regularly till they cured, during the period from 30.12.2009 to 30.12.2010. Results: one hundred four (104) cases were diagnosed, fifty four of them (54) were females and fifty (50) were males all of them were adults .Ninety six (96) cases were presented with subacute brucellosis, three (3) cases with knee joint arthritis, (four) 4 cases with sciatic nerve radiculopathy and one case of neurobrucellosis. Conclusion: the study proved that Anbar Governorate is endemic with brucella infection with mild symptoms in most cases and good response with no relapse rate with triple antibrucella antibiotics.

CYTOKINE LEVELS IN PATIENTS WITH BRUCELLOSIS AND THEIR RELATIONS WITH THE TREATMENT

Purpose: To determine the serum levels of proinflammatory and some of the Th1/Th2 cytokines in brucellosis and their alterations with treatment and outcome. Methods: Twenty-eight acute and seven subacute brucellosis patients diagnosed clinically were included in the study. Twenty healthy volunteers were also included. Brucella standard tube agglutination tests and blood culture were conducted on all subjects. Cytokine levels of pre-and post-treatment period serum samples were measured by ELISA. Results: The mean serum levels of IL-6, IFN-γand TNF- αwere significantly higher in brucellosis patients compared to the control group (P < 0.05). No significant differences were found between patient and control groups in terms of IL-1β, TGF-β1, IL-2, IL-4 and IL-8 levels. There was a positive correlation between IFN-γ, TNF- αand IL-6 levels with CRP levels. IL-6, IFN-γand TNF- αlevels measured after treatment were statistically significantly lower than pre-treatment values (P < 0.001). No differences were found in the levels of these cytokines between acute and subacute patients’ sera. IL-6, IFN-γand TNF- αlevels were higher in acute or subacute brucellosis patients. Conclusions: Although the levels of the cytokines were decreased significantly with effective and adequate treatment these alterations did not correlate with the extent or activity of the disease.

Cytokine levels in patients with &lt;i&gt;Brucellosis&lt;/i&gt; and their relations with the treatment

To determine the serum levels of proinflammatory and some of the Th1/Th2 cytokines in brucellosis and their alterations with treatment and outcome. Twenty-eight acute and seven subacute brucellosis patients diagnosed clinically were included in the study. Twenty healthy volunteers were also included. Brucella standard tube agglutination tests and blood culture were conducted on all subjects. Cytokine levels of pre- and post-treatment period serum samples were measured by ELISA. The mean serum levels of IL-6, IFN-gamma and TNF-alpha were significantly higher in brucellosis patients compared to the control group ( P < 0.05). No significant differences were found between patient and control groups in terms of IL-1beta , TGF-beta 1, IL-2, IL-4 and IL-8 levels. There was a positive correlation between IFN-gamma, TNF-alpha and IL-6 levels with CRP levels. IL-6, IFN-gamma and TNF-alpha levels measured after treatment were statistically significantly lower than pre-treatment values ( P < 0.001). No differences were found in the levels of these cytokines between acute and subacute patients' sera. IL-6, IFN-gamma and TNF-alpha levels were higher in acute or subacute brucellosis patients. Although the levels of the cytokines were decreased significantly with effective and adequate treatment these alterations did not correlate with the extent or activity of the disease.

Diagnostic usefulness of antibodies against ribosome recycling factor from Brucella melitensis in human or canine brucellosis.

The diagnostic usefulness of an enzyme-linked immunosorbent assay (ELISA) using a purified recombinant ribosome recycling factor from Brucella melitensis (CP24 antigen) was tested in human and canine infections caused by smooth and rough Brucella species, respectively. Anti-CP24 antibodies were detected in 9 (43%) of 21 consecutive cases of canine brucellosis and in 8 (53%) of 15 dogs followed for 60 days after the diagnosis of acute brucellosis. Among eight patients with acute brucellosis, anti-CP24 antibodies were detected in four in the 10 weeks following diagnosis, but the remaining four were negative during the whole follow-up (22 weeks). The frequency of anti-CP24 antibodies was also low among 24 patients with subacute brucellosis and 23 patients with chronic illness (29 and 26%, respectively). While all patients positive for anti-CP24 antibodies were also positive for antibodies to total cytoplasmic proteins of Brucella (CP), five were negative for antibodies to another cytoplasmic protein, the Brucella lumazine synthase (BLS). When a larger sample of 35 human sera negative for anti-BLS antibodies was assayed, 85.7% were positive for anti-CP24 antibodies, suggesting that the combined measurement of both reactivities could yield a higher sensitivity than any test alone. To test this hypothesis, an ELISA combining both antigens was designed. The percentage of positive results among chronic cases was higher for this assay than for the individual measurement of anti-CP24 or anti-BLS antibodies (83 versus 26 and 65%, respectively) and was closer to the value obtained for anti-CP antibodies (91%). The frequency of anti-CP24 antibodies is low in both canine and human brucellosis. In the latter case, however, an ELISA combining CP24 and BLS is more sensitive than assays measuring anti-CP24 or anti-BLS antibodies separately and almost as sensitive as the ELISA using CP.