Importance of screening household members of acute brucellosis cases in endemic areas

Seroprevalences and local variation of human and livestock brucellosis in two villages in Gharbia Governorate, Egypt

This study aimed at assessing the epidemiology of brucellosis among both human and livestock populations in an endemic area in Egypt. A cross-sectional survey was conducted in two villages, where 616 inhabitants (aged 3-75 years) and 350 livestock of 97 households were enrolled. Sera were tested for Brucella spp. antibodies by tube agglutination test for both populations. Proportions of seropositive sera were 0.0 and 1.7% among the inhabitants, and 0.0 and 16% among livestock of villages I and II, respectively. Calculated seroprevalences considering the clustering of brucellosis within households were 0.03 for people and 5.2 for livestock in village II. The village variable (P=0.07) and keeping sheep in the household (P=0.01) were significant risk factors for human brucellosis, whereas only the village was significant for livestock (P<0.001). Sheep showed the highest seropositive proportions of brucellosis among livestock. No association could be detected between human and livestock brucellosis. In conclusion, we found local variation of seroprevalences of brucellosis among human and livestock in the two surveyed villages. Further epidemiological studies have to be conducted in randomly selected governorates, not only to confirm the low seroprevelance of human brucellosis, but also to assess the risk factors of livestock infection for terms of prophylaxis.

Protean clinical manifestations and diagnostic challenges of human brucellosis in adults: 16 years' experience in an endemic area

A prospective study was carried out to elucidate the clinical, epidemiological and laboratory features of human brucellosis. A total of 26 948 blood samples (from adults aged 15 years and above) were screened for serological evidence of brucellosis over a period of 16 years. The slide agglutination/Rose Bengal plate agglutination test gave positive results in 517 patients, of which 509 had detectable titres by the standard tube agglutination test (SAT). The diagnosis of brucellosis was documented in 495 (1.8 %) patients based on diagnostic titres (> or = 1 : 160, 490 cases) and rising titres from insignificant titres (four cases) by serology and for one case by blood-culture isolation alone. Blood cultures were carried out in 345 cases, of which 191 cases (55.3 %) yielded Brucella melitensis. In 77/79 cases undertaken for follow up, there was a steady fall in 2-mercaptoethanol (2ME) agglutination titres along with clinical improvement (P < 0.01). SAT titres remained detectable in most cases for a longer period in spite of an effective antimicrobial therapy and clinical recovery. A substantial number of patients (84.2 %) presented with fever, this being the only complaint in 51.1 % of the cases. Complications were present in 8.8 % of the patients (arthritis excluded): this included the unusual complications of hydrocele (two cases), Stevens-Johnson syndrome (one case) and urinary tract infection (one case). Brucella agglutinins were demonstrated in synovial, testicular, hydrocele and cerebrospinal fluids. There was no clinical suspicion of brucellosis in 439 cases (88.7 %) and the diagnosis was made only by routine serology. A two-drug regimen for 42-84 days with a follow-up 2ME test resulted in lower levels of relapse. These results suggest that, in endemic areas of the world, it should be mandatory to screen routinely for brucellosis due to protean clinical manifestations.

Health literacy in the field of infectious diseases: the paradigm of brucellosis

OBJECTIVES

Treatment outcome for infectious diseases, including brucellosis, may be influenced by patient awareness of the disease itself, as well as by compounding socioeconomic factors. We attempted to evaluate parameters of patient awareness and disease perception in brucellosis and the ways they influence outcome.

METHODS

We used a specifically developed questionnaire assessing various parameters of patient literacy on brucellosis in 70 patients with a new diagnosis of brucellosis. Patients were assessed by interviewing at the time of diagnosis and during follow-up. Awareness and perception of the disease, willingness for epidemiologic surveillance, mode of referral, treatment preferences, and adherence were evaluated.

RESULTS

Although basic disease awareness is high, willingness to collaborate in epidemiologic surveillance is limited. Patient education may improve adherence to treatment and willingness to undergo surveillance, but may also result in many false referrals for relapse. Level of academic education does not influence the results. Convenience is the major factor when determining treatment preferences.

CONCLUSION

Improving health literacy may result in improved treatment outcome and improved control of disease incidence. There is a need for constant evaluation of the quality and quantity of information distributed in order to reduce transmission of misinformation and occurrences of public anxiety.

Acute brucellosis in Saudi families: relationship between brucella serology and clinical symptoms

OBJECTIVE

To determine if screening family members of patients with acute brucellosis will enhance the detection rate of brucellosis and also to determine the relationship between symptoms and brucella serology.

MATERIALS AND METHODS

Family members from patients with acute brucellosis were interviewed and serologically screened. All seropositive family members were clinically and serologically followed for six months.

RESULTS

Twenty-five acute brucellosis patients and their 178 family members were enrolled from January 2001 to February 2002. Of the 178 family members, 40 (23%) manifested various symptoms, 138 (77%) were asymptomatic, with an overall seroprevalence rate of 34 (19%). The rate of seropositivity among the symptomatic family members was 23 (58%) and for the asymptomatic was 11 (8%) (P<0.001). The majority of the symptomatic family members (13 (57%)) had a high Brucella titer in comparison to one (9%) of the asymptomatic group (P<0.001). Acute brucellosis was diagnosed and treated in 18 (78%) of the symptomatic seropositive family members and in four (36%), of the asymptomatic seropositive family members with an acute brucellosis prevalence rate of 22 (12%). All family members with acute infection recovered without sequelae; one patient relapsed (5%).

CONCLUSION

Symptomatic family members are more likely to be seropositive with a high titer in comparison to the asymptomatic members.