The prevalence of Brucella spp. in dairy products in the Middle East region: A systematic review and meta-analysis

Human and animal brucellosis and risk factors for human infection in Ethiopia: a systematic review and meta-analysis (2015-2024)

BACKGROUND AND OBJECTIVE

Brucellosis is a neglected zoonotic disease caused by Brucella species. Unlike most developed nations, the problem of brucellosis in Ethiopia remains a public and animal health concern. This study was conducted to determine the magnitude of brucellosis in animals (mainly cattle, sheep, goats, dogs and camels) and humans, and to identify the risk factors for human brucellosis.

METHODOLOGY

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to conduct this systematic review and meta-analysis, which was performed from May 2024 to July 2024. Academic databases such as PubMed, ScienceDirect, Scopus, PubMed Central, Web of Science, and Google Scholar were searched to identify articles focusing on brucellosis in humans and animals in Ethiopia. Data extraction was performed according to predefined inclusion and exclusion criteria. The included articles were appraised using the appraisal tool for cross-sectional studies to assess study quality. Publication bias and small study effects were examined using funnel plot observation and Egger's test, respectively. Statistical analysis was conducted using R software version 4.4.1.

RESULTS

Thirty-nine articles published between 2015 and 2024 were included in the final analysis from a total of 1,427 identified articles. The overall pooled seroprevalence of brucellosis was 5.0% (95% CI: 3.0, 6.0). The seroprevalence of brucellosis was higher in humans at 6.9% (95% CI: 4.9, 8.8) and lower in cattle at 3.5% (95% CI: 2.2, 4.7). There was high heterogeneity in the reports of brucellosis seroprevalence between studies (τ² = 0.0038, H² = 255.9, I² = 99.61%, Q-test = 1954.99, df = 56, p ≤ 0.001). Laboratory tests and study location were identified as factors contributing to potential sources of variation in the pooled seroprevalence. Drinking raw milk from aborted animals, touching aborted materials or fetuses, and occupation were among the risk factors for human brucellosis. No publication bias or small study effects were detected.

CONCLUSION

The findings indicate that brucellosis continues to pose a significant zoonotic threat, particularly to humans, where the seroprevalence is notably higher than in animals. These results highlight the need for targeted public health interventions and greater awareness to reduce the incidence of brucellosis, especially among high-risk populations.

Molecular epidemiology of brucellosis in Asia: insights from genotyping analyses

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

The Prevalence of Brucella Spp. in Dairy Products in Iran: A Systematic Review and Meta-Analysis

Brucellosis, a significant zoonotic disease, threatens food safety substantially, particularly in developing nations such as the Middle East. This study aimed to comprehensively assess the prevalence of Brucella spp. in Iranian milk and dairy products through a systematic review and meta-analysis. A thorough search of international and domestic databases from January 2008 to October 2023 identified 38 relevant studies encompassing 11,130 samples for meta-analysis. The overall prevalence of Brucella spp. in Iranian dairy products was 22% (95% CI: 16-28%). The highest and lowest overall prevalence of Brucella spp. in milk were found in raw goat milk 27% (95% CI: 11-42%) and raw camel milk 15% (95% CI: -0.42 to 72%), respectively. The overall prevalence of traditional cheese, ice cream, and cream is estimated to be 9% (95% CI: -16 to 35%), 2% (95% CI: -2.78 to 2.82%), and 9% (95% CI: -0.94 to 1.12%). Geographical disparities were evident, with Zanjan province reporting the highest contamination rate, 53%, while Razavi Khorasan province had the lowest, 1%. However, the prevalence of Brucella spp. in Iranian dairy products has fluctuated over time, with a significant association between the study year and sample size. Comprehensive planning, robust policy implementation, and rigorous monitoring are imperative to mitigate and ultimately eliminate Brucella contamination in dairy products effectively. Further research is essential to refine prevalence estimates and develop targeted prevention strategies to safeguard public health.

Is the milk we drink safe from elevated concentrations of prioritised heavy metals/metalloids? - A global systematic review and meta-analysis followed by a cursory risk assessment reporting

Milk has been globally recognised as a comprehensive and vital food source for centuries. However, the presence of heavy metals and metalloids (metal(loid)s) in milk is a global problem. As metal(loid)s are present in the soil due to natural geogenic and various anthropogenic activities, these metal(loid)s are bio-transferred into animal feed, which further results in the presence of metal(loid)s in milk due to bio transfer/accumulation. This systematic review collated information from published literature between 2000 and 2021. It focused on the global issue of metal(loid)s in milk, posing potential health risks. These contaminants enter the food chain through the bio-transfer/accumulation process from soil to animal feed to milk. The key metal(loid)s examined are arsenic (As), mercury (Hg), lead (Pb), and cadmium (Cd). A meta-analysis of 66 selected papers revealed the widespread presence of these contaminants in milk samples globally, with Pb being the most studied (43 %). This research estimated metal(loid)s levels or concentrations as 12.71 (95 % Confidence Interval (CI) = 0.16-25.26), 16.09 (95 % CI = 4.31-27.70), 197.04 (95 % CI = 75.28-318.18), 31.67 (95 % CI = 20.14-43.20) μg/kg (ppb) for As, Hg, Pb, and Cd, respectively using Stata™. The metal(loid) concentrations in milk were within the threshold limits other than Pb and Cd. Some studies in America, Africa, and Asia reported elevated Pb and Cd concentrations, raising health concerns. The simulated Risk Quotients (RQ) and Integrated Risk Quotient (IRQ) values generally remain above one, indicating potential human health risks. Notably, the IRQ value increases with more metal(loid)s consideration. Subgroup analysis indicates low-fat milk contains higher metal(loid)s concentrations. While metal(loid)s concentrations in milk largely comply with safety limits, some regions exhibit concerning concentrations. Therefore, continued surveillance to address potential health risks associated with metal(loid)s in milk is necessary to ensure dairy products' safety.

MicroRNA -21 expression as an auxiliary diagnostic biomarker of acute brucellosis

BACKGROUND

This study aimed to measure the expression levels of peripheral blood miRNAs in brucellosis and their involvement in the different phases of the brucellosis.

METHODS

The expression levels of miRNAs including miR-210, miR-155, miR-150, miR-146a, miR-139-3p, miR-125a-5p, miR-29 and miR-21 were quantified in 57 brucellosis patients subgrouped into acute, under treatment & relapse phase and 30 healthy controls (HCs) using real-time polymerase chain reaction (RT-PCR). The receiver operating characteristic (ROC) analysis curve analysis was performed to find a biomarker for discrimination of different phases of brucellosis.

RESULTS

The expression of miR-155, miR-146a, miR-125a-5p, miR-29, and miR-21 was found to be elevated in the acute brucellosis patients compared to HCs. miR-29 changed in under-treatment patients, while miR-139-3p and miR-125a-5p showed alterations in relapse cases. The ROC curve analysis depicted the potential involvement of miR-21 in the pathogenesis of acute brucellosis.

CONCLUSION

The expression level of miR-21 is significantly augmented in acute brucellosis and has the potential to be a contributing diagnostic factor for acute infection.

The concentration and prevalence of potentially toxic elements (PTEs) in cheese: a global systematic review and meta-analysis

The present study aimed to systematically review the concentration of different PTEs, including Arsenic (As), Mercury (Hg), Lead (Pb), and Cadmium (Cd) in cheese among some databases between 2000 and 2021 (from 57 included studies). Estimated concentrations of 160.78 (95% CI = 119.24-202.28), 15.68 (95% CI = 11.88-19.48), 16.94 (95% CI = 13.29-20.59), and 2.47 (95% CI = 1.70-3.23) µg/kg were calculated for As, Pb, Cd, and Hg, respectively. Most of the studies for PTEs are related to Pb, about 40% of the studies, compared to As, which has fewer studies. The results showed that As and Hg concentrations were lower than the Codex Alimentarius Commission standard limits. Nevertheless, Cd and Pb concentrations were higher than the standard limit values. Results showed that cheese making, the ripening period, fat content, and texture are influential factors in a high level of Pb and Cd in cheese samples.

Seroprevalence and risk factors of brucellosis in dromedary camels (Camelus dromedarius) in Sudan from 1980 to 2020: a systematic review and meta-analysis

Camel brucellosis is a major public health concern in Sudan; however, there is no overall estimation of the prevalence of camel brucellosis in Sudan. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this study aimed to perform a meta-analysis of 30 eligible studies published before December 31, 2022, with a total of 70059 dromedary camels, to estimate the pooled prevalence of camel brucellosis and its risk factors in Sudan. The random effect model was used for the final analysis due to the significantly high heterogeneity among the included studies, and the results showed that the overall pooled prevalence of camel brucellosis was 17%, with a confidence interval (CI) of 12%-21%. The prevalence was higher in males than females (54% vs. 46%) and in adults than youngling (77% vs. 23%). The prevalence also varied by region, with central and northern Sudan having the highest prevalence (24%), compared to other regions of Sudan. Moreover, the prevalence of camel brucellosis appeared to be decreasing over time. The current study concluded that camel brucellosis infection is still endemic in many areas of Sudan, with the disease being especially prevalent in central and northern Sudan. Thus, this study provides valuable information for the prevention and control of camel brucellosis in Sudan. However, the significant heterogeneity among the included studies should be taken into account when interpreting these results. Finally, to provide adequate information, research must be updated, and more research must be conducted in many regions of Sudan.

Advances in the application of recombinase-aided amplification combined with CRISPR-Cas technology in quick detection of pathogenic microbes

The rapid diagnosis of pathogenic infections plays a vital role in disease prevention, control, and public health safety. Recombinase-aided amplification (RAA) is an innovative isothermal nucleic acid amplification technology capable of fast DNA or RNA amplification at low temperatures. RAA offers advantages such as simplicity, speed, precision, energy efficiency, and convenient operation. This technology relies on four essential components: recombinase, single-stranded DNA-binding protein (SSB), DNA polymerase, and deoxyribonucleoside triphosphates, which collectively replace the laborious thermal cycling process of traditional polymerase chain reaction (PCR). In recent years, the CRISPR-Cas (clustered regularly interspaced short palindromic repeats-associated proteins) system, a groundbreaking genome engineering tool, has garnered widespread attention across biotechnology, agriculture, and medicine. Increasingly, researchers have integrated the recombinase polymerase amplification system (or RAA system) with CRISPR technology, enabling more convenient and intuitive determination of detection results. This integration has significantly expanded the application of RAA in pathogen detection. The step-by-step operation of these two systems has been successfully employed for molecular diagnosis of pathogenic microbes, while the single-tube one-step method holds promise for efficient pathogen detection. This paper provides a comprehensive review of RAA combined with CRISPR-Cas and its applications in pathogen detection, aiming to serve as a valuable reference for further research in related fields.

Brucellosis and One Health: Inherited and Future Challenges

One Health is the collaborative efforts of multiple disciplines to attain optimal health for people, animals and the environment, a concept that historically owes much to the study of brucellosis, including recent political and ethical considerations. Brucellosis One Health actors include Public Health and Veterinary Services, microbiologists, medical and veterinary practitioners and breeders. Brucellosis awareness, and the correct use of diagnostic, epidemiological and prophylactic tools is essential. In brucellosis, One Health implementation faces inherited and new challenges, some aggravated by global warming and the intensification of breeding to meet growing food demands. In endemic scenarios, disease awareness, stakeholder sensitization/engagement and the need to build breeder trust are unresolved issues, all made difficult by the protean characteristics of this zoonosis. Extended infrastructural weaknesses, often accentuated by geography and climate, are critically important. Capacity-building faces misconceptions derived from an uncritical adoption of control/eradication strategies applied in countries with suitable means, and requires additional reference laboratories in endemic areas. Challenges for One Health implementation include the lack of research in species other than cattle and small ruminants, the need for a safer small ruminant vaccine, the need to fill in the infrastructure gap, the need for realistic capacity-building, the creation of reference laboratories in critical areas, and the stepwise implementation of measures not directly transposed from the so-called developed countries.

Melamine in Iranian foodstuffs: A systematic review, meta-analysis, and health risk assessment of infant formula

The presence of melamine in food is one of the most significant threats to consumer health and food safety now confronting the communities. The goal of this systematic review and meta-analysis was to determine the melamine content of different food products available on the Iranian market. The pooled melamine concentration (95% confidence interval) on 484 samples of animal-based foodstuffs was as follows: 0.22 (0.08, 0.36 mg kg^-1) for milk, 0.39 (0.25, 0.53 mg kg^-1) for coffee mate, 1.45 (1.36, 1.54 mg kg^-1) for dairy cream, 0.90 (0.50, 1.29 mg kg^-1) for yoghurt, 1.25 (1.20, 1.29 mg kg^-1) for cheese, 0.81 (-0.16, 1.78 mg kg^-1) for hen eggs, 1.28 (1.25, 1.31 mg kg^-1) for poultry meat, 0.58 (0.35, 0.80 mg kg^-1) for chocolates, and 0.98 (0.18, 1.78 mg kg^-1) for infant formula. Based on the results of health risk assessment study on toddlers under 2 years old who ingested infant formula (as a melamine-sensitive group), all groups of toddlers are at an acceptable level of non-carcinogenic risk (THQ ≤ 1). Toddlers were classified according to their ILCR (carcinogenic risk) levels due to infant formula consumption as follows: under 6 months (0.0000056), 6-12 months (0.0000077), 12-18 months (0.0000102), and 18-24 months (0.0000117). The melamine carcinogenicity in infant formula for children had an ILCR value of 0.000001-0.0001 in the investigation, which was considerable risk. According to the findings, Iranian food products (notably infant formula) should be analyzed for melamine contamination on a regular basis.

A worldwide systematic review, meta-analysis and meta-regression of nitrate and nitrite in vegetables and fruits

This study aimed to conduct on the concentration of nitrate/nitrite (mg kg^-1) in vegetables and fruits with a special emphasize on the effect of climate condition. The highest concentration (mean and 95%CI) of nitrate/nitrite was determined in Rocket (4825.15; 3044.14-6606.16), Mizuna (3500; 2702.48-4297.52), and Bok choy (3407.40; 2841.39-3973.42) in vegetable group and in wolfberry (2395.83; 1611.89-3179.77), Jack fruit (237.8; 202.88-272.71) and Cantaloupe (220.32; -224.53 to 665.19) in fruits group. Brazil (2816.77), Estonia (2133.76), Republic of China, Taiwan (2118.28) were the nations with the highest average concentration of nitrate/nitrite in all samples taken from these nations across the globe. Furthermore, Chinese fruits contain the highest concentrations of nitrates/nitrites of other countries (500.57; 416.74-584.41). Nitrate is present in greater quantities in fruits (44.02; 42.12-45.93) and vegetables (438.31; 422.51-454.11) than nitrite; however, the quantity of nitrite has a relatively similar content in both. Our findings revealed that increase in humidity (> 60%), annual rainfall (> 1500 mm), average temperature (> 10 °C) and application of fertilizers lead to significant increase in accumulation of nitrate/nitrite composition of vegetables and fruits (p < 0.05). According to the results of rating countries using the Food Security Index (GFSI), countries with high scores-like Poland and Portugal, which have GFSI scores of 75.5 and 78.7 and average contamination levels of 8.26 and 11.08, respectively-have a trend of average nitrate/nitrite levels of fruit and vegetable products that is significantly decreasing (p = 0.00). Although GFSI levels and other environmental variables can influence nitrate/nitrite levels, fertilizer usage (kg ha^-1) is one of the most significant controllable and impactful factors in contaminants residue, which should be manage. The result of our study, will serve as a basis to estimate the dietary exposure to nitrates and nitrites from fruits and vegetables among populations around the world based on climatology and monitor the related health outcomes.

Presence of Brucella spp. in Milk and Dairy Products: A Comprehensive Review and Its Perspectives

Consuming raw milk and milk-based products that have not been produced under strict control conditions can cause brucellosis, a highly contagious zoonotic disease. It is a significant global public health concern, particularly in regions with poor management and limited resources, such as Latin America, North and East Africa, the Middle East, and South and Central Asia. The study aims to summarize the occurrence of human brucellosis linked to milk and milk products and the presence of Brucella species in dairy foods. To achieve this goal, a meta-analysis was conducted on 69 studies ranging from 2001 to 2022, which were categorized into two groups: the incidence of Brucella species in milk and milk products and the prevalence of human brucellosis resulting from the consumption of contaminated milk. The following milk and milk products showed the highest incidence of Brucella species: cow milk (1.86%–81.7%), buffalo milk (10.4%–61.67%), camel milk (0%–24%), goat milk (0%–88.8%), and cheese (0%–39.1%). Consuming unpasteurized milk and milk products has been identified as the leading cause of human brucellosis, with incidence rates varying from 33.9% to 100%. Several human brucellosis cases have been linked to consuming raw milk and cheese in Spain, Israel, and other countries. Various serological techniques are employed to detect Brucella-specific antibodies in milk. The milk ring test (MRT) and enzyme-linked immunoassay (ELISA) are the two most widely utilized methods for detecting these antibodies in milk. Recently developed dual biosensors are a powerful approach for early diagnosis of Brucella from milk. Real-time PCR can rapidly detect organisms, reducing the risk of lab contamination and false positive results. To prevent and control brucellosis, essential steps include proper pasteurization of milk and dairy products, using the milk ring test (MRT) to detect Brucella in individual and bulk milk, immunization, education, and increasing public awareness of the disease. The consumption of raw milk and milk-made products that are not produced under strictly controlled conditions poses a significant risk to human health, mainly due to the high incidence of Brucella contamination. Therefore, ensuring strict control measures in producing milk and milk-made products is crucial to preventing the spread of this disease and safeguarding human health.

An Epidemiological Study of Brucellosis in Different Animal Species from the Al-Qassim Region, Saudi Arabia

Brucellosis is a zoonotic bacterial illness that affects humans and a variety of domestic animals, especially ruminants. It is mostly transmitted through the consumption of contaminated drinks, foods, undercooked meat, or unpasteurized milk or contact with infected animals. Therefore, the present study aimed to investigate the seroprevalence of brucellosis in camels, sheep, and goat herds in the Qassim region, Saudi Arabia, using commonly used diagnostic serological procedures such as the Rose Bengal test (RBT), complement fixation test (CFT), and enzyme-linked immunosorbent assay (ELISA). The seroprevalence of brucellosis in camels, sheep, and goats was determined in the selected areas using a cross-sectional study design and a total of 690 farm animals of both sexes of different ages from the three animal species (274 camels, 227 sheep, and 189 goats). According to RBT results, 65 sera were positive for brucellosis, including 15 (5.47%) for camels, 32 (14.09%) for sheep, and 18 (9.50%) for goats. CFT and c-ELISA were performed as confirmatory tests on positive samples resulting from RBT. With c-ELISA, 60 serum samples were confirmed positive, in 14 (5.10%), 30 (13.21%), and 16 (8.46%) camels, sheep, and goats, respectively. There were 59 serum samples confirmed as positive for CFT, including 14 (5.11%), 29 (12.77%), and 16 (8.46%) for camels, sheep, and goats, respectively. Overall, the highest seroprevalence of brucellosis was found in sheep while the least was found in camels from the three tests (RBT, c-ELISA, and CFT). The highest seroprevalence of brucellosis was found in sheep while the least seroprevalence was found in camels. There was also a higher seroprevalence of brucellosis among female animals than males as well as among old animals than young animals. The study, thus, demonstrates brucellosis seroprevalence among farm animals (camels, sheep, and goats) and the significance of intervention measures against brucellosis incidence in both humans and animals through the creation of public awareness and other relevant policy measures such as livestock vaccination, effective hygiene management, and adequate quarantine or serological analysis for newly introduced animals.

Brucella spp. Contamination in Artisanal Unpasteurized Dairy Products: An Emerging Foodborne Threat in Tunisia

Brucellosis is a worldwide zoonotic disease transmitted to humans, predominantly by the consumption of contaminated raw milk and dairy products. This study aimed to investigate the occurrence of Brucella spp. in 200 raw milk, ricotta, and artisan fresh cheese samples, collected from individual marketing points in four districts in Tunisia. Samples were analyzed for the presence of Brucella spp. by IS711-based real-time PCR assay. Positive samples were further analyzed by qPCR for B. melitensis and B. abortus species differentiation. The DNA of Brucella spp. was detected in 75% of the samples, B. abortus was detected in 31.3%, and B. melitensis was detected in 5.3% of positive samples. A percentage of 49.3% of samples co-harbored both species, while 14% of the Brucella spp. positive samples were not identified either as B. abortus or B. melitensis. High contamination rates were found in ricotta (86.2%), cheese (69.6%), and raw milk (72.5%) samples. The study is the first in Tunisia to assess the occurrence of Brucella spp. contamination in artisanal unpasteurized dairy products and showed high contamination rates. The detection of both B. abortus and B. melitensis highlights that zoonotic high-pathogen agent control remains a challenge for food safety and consumer health protection and could represent a serious emerging foodborne disease in Tunisia.

Organized Violence and Organized Abandonment Beyond the Human: the Case of Brucellosis among Palestinians in Israel

This article explores how brucellosis became a racialized disease in Israel, where almost all patients are Palestinians. Informed by legal and historical research, the article demonstrates how colonial and settler-colonial policies have targeted Palestinians and their goats and contributed to the distribution of brucellosis along ethno-national lines. Goats, once ubiquitous to the landscape, became enemies of the Israeli state and were blamed for the “destruction” of nature. Under Israeli rule, legal policies not only seized and confiscated Palestinian land but also targeted goat grazing and led to a steep reduction in the number of goats. The resulting depeasantization and concentration of Palestinians in dense poor townships shaped goat grazing as a backyard practice with lack of trust in the hostile state and its brucellosis eradication campaigns. We argue that state policies of organized violence and organized abandonment have shaped the current ecology of brucellosis as a racialized disease.

IMPORTANCE The importance of this article is the novelty in combining public health, colonial studies, and legal research to understand the ecology of human brucellosis. This approach allows us to move from a “snap-shot” reading of diseases and cultural practices toward a reading of bacteria, animals, and humans within their political and historical context. The article uses a settler colonial lens to examine the racialized distribution of human brucellosis in Israel and traces colonial policies toward Palestinians and goats—both seen as unwanted intruders to the newly established Israeli nation state. We place these policies in a context of organized violence and organized abandonment, building on the work of Ruth Wilson Gilmore to read the power hierarchies of humans, animals, and diseases and how they shape practices and disease.

Brucellosis control methods with an emphasis on vaccination: a systematic review

INTRODUCTION

Brucellosis is considered as one of the main zoonotic infections and a major public health concern worldwide. The aim of the present study was to evaluate various strategies for controlling brucellosis with an especial emphasis on efficacy of vaccination.

AREAS COVERED

International databanks (Web of Science, PubMed, Embase) were searched for potentially relevant studies published from January 1, 2011 to March 25, 2021 using the following keywords: "Brucella", "Brucella abortus", "Brucella melitensis", "Brucella canis", "Brucella suis", "brucellosis", "Bang disease", "undulant fever", "Malta fever", "vaccination", "vaccine", and "immunization". The literature search was restricted to original articles published in English.

EXPERT OPINION

Various methods are employed to prevent and control brucellosis, such as removing sick animals by slaughtering, separating sick animals from the herd, and vaccination. Preventing, controlling, and eradicating brucellosis requires a lot of financial support, perseverance, and time. In order to conduct a detailed study, it is recommended that more studies be conducted in developing countries and different parts of the world.

Brucellosis prevalence in yaks in China in 1980-2019: A systematic review and meta-analysis

In the Qinghai-Tibet Plateau of China, the yak is an animal of particular economic interest, which provides protein and income for herders in daily life. Brucellosis is a bacterial disease that can infect humans and animals, including yaks. It can damage the yak reproductive system, causing miscarriage and orchitis. At the same time, brucellosis threatens the health of herders. We performed this meta-analysis using R software to explore the combined prevalence and risk factors of brucellosis in yak in China. Variability was assessed by the I² statistic and Cochran Q statistic. We identified 52 publications of related research from four databases (Wanfang Data, VIP Chinese Journal Database, China National Knowledge Infrastructure, and of PubMed). The pooled prevalence of yak brucellosis was 8.39 %. Prevalence was highest in Southwestern China (11.1 %). The point estimate of brucellosis in yak from 2012 to 2016 was the highest (11.47 %). The point estimate of age ≤ 12 months (1.44 %) was lower than that of age > 12 months (15.6 %). This study shows that yak brucellosis is serious, and its incidence is higher than before 2012. We recommend carrying out large-scale yak brucellosis investigations in Western China and conducting comprehensive testing planning. The detection of brucellosis in adult animals should be strengthened to reduce the economic loss caused by brucellosis to herders and to improve public health.

The concentration of potentially hazardous elements (PHEs) in drinking water and non-carcinogenic risk assessment: A case study in Bandar Abbas, Iran

In this study, concentration of potentially hazardous elements (PHEs) including slice (Si), strontium (Sr), aluminum (Al), Fluoride (F), Iron (Fe), Zinc (Zn), Barium (Ba), Lead (Pb), Lithium (Li), Vanadium (V), selenium (Se), Chrome (Cr), Arsenic (As) and Uranium (U) in tap drinking water (n = 40) and filtration plant (n = 22) in Bandar Abbas city between March to July 2020 were analyzed. Analysis of PHEs ions was conducted by inductively coupled plasma mass spectrometry (ICP-MS). Also, concentration of F was measured by SPADNS Method. The non-carcinogenic risk in the exposed population (adult and children) were estimated. Concentration of PHEs between tap drinking water and filtration plant was compared using T statistical test. In addition, association among PHEs in tap drinking water and water filtration plant using Pearson correlation coefficient. The rank order of PHEs in tap drinking water was Si (6356.25 μg/l) > Sr (3980 μg/l) > Al (115.42 μg/l) > Fe (30.00 μg/l) > Zn (14.59 μg/l) > Ba (13.91 μg/l) > Pb (13.01 μg/l) > Li (11.60 μg/l) > V (4.43 μg/l) > Se (4.17 μg/l) > Cr (2.51 μg/l) > As (2.00 μg/l) > U (0.65 μg/l) > F (0.31 μg/l) and also in filtration plant was Si (1825.00 μg/l) > Sr (539.00 μg/l) > Fe (45.00 μg/l) > Al (26.00 μg/l) > Zn (8.08 μg/l) > Ba (2.24 μg/l) > Se (1.36 μg/l)> Pb(1.28 μg/l) > Li (1.26 μg/l) > Cr (1.17 μg/l) > F (0.66 μg/l) > V (0.61 μg/l) > As (LOD < ) ~ U (LOD <). The most of PHEs in tap drinking water was considerable different with filtration plant (p value < 0.05) therefore the chemical quality of tap drinking water should be more attention. The results of non-carcinogenic risk assessment revealed that TTHQ in the adults and children due to drinking tap water content of PHEs was 2.59E-3 and 6.05E-3 and filtration plant was 8.88E-04 and 2.07E-03, respectively. Therefore, TTHQ in adults and children was lower than 1; therefore, consumers are in the safe range due to drinking tap water and water filtration plant content of PHEs.

Re-do pericardial reconstruction of the aortic valve in Brucella endocarditis

We report a 12-year-old boy who had undergone an auto-pericardial aortic valve implantation 3 years ago for rheumatic aortic regurgitation. He presented with Brucella endocarditis of the auto-pericardial leaflets with new-onset severe aortic regurgitation, congestive cardiac failure and systemic sepsis. He had an aortic root abscess with multiple pseudoaneurysms in relation to the aortic sinus. Following medical stabilisation, he underwent re-do surgery with debridement of the root abscess, closure of the pseudoaneurysms, excision of the auto-pericardial aortic leaflets and reconstruction of the aortic valve with donor pericardium. He had an uneventful recovery and is asymptomatic on follow-up.

The concentration of potentially hazardous elements (PHEs) in the muscle of blue crabs (Callinectes sapidus) and associated health risk

In this study, the concentration of potentially hazardous elements (PHEs) in the muscle of Blue crabs (Callinectes sapidus) from the Strait of Hormuz was analyzed and following the health risk in the consumers by uncertainty and sensitivity analysis in the Monte Carlo simulation (MCS) technique was estimated. Fifty-eight blue card samples (male blue crabs = 33 samples; female blue crabs = 25 samples) were collected in the Strait of Hormuz from May to September 2020 for analysis of Nickel (Ni), Lead (Pb), Cadmium (Cd), and Iron (Fe) using Flame Absorption Spectrometer (FAAS). The order of PHEs in the in muscle male blue crabs was Fe (414.37 ± 288.07 μg/kg.ww) > Pb (238.78 ± 87.83 μg/kg.ww) > Ni (92.57 ± 39.72 μg/kg.ww) > Cd (52.73 ± 18.39 μg/kg.ww) and in female blue crabs Fe (461.16 ± 320.56 μg/kg.ww) > Pb (230.79 ± 125.59 μg/kg.ww) > Ni (84.13 ± 46.07 μg/kg.ww) > Cd (67.412 ± 43.93 μg/kg.ww). The concentration of PHEs muscle of male blue crabs and female blue crabs was not significantly different (P-value > 0.05). Uncertainty of non-carcinogenic risk revealed that P95% of total target hazard quotient (TTHQ) in the adult and children consumers due to ingestion male blue crabs was 5.30E-3 and 1.08E-3, respectively, and P95% of TTHQ in the adult and children due to ingestion female blue crabs was 7.05E-3 and 1.20E-3, respectively. P95% of TTHQ in both adult and children consumers was lower than one value. Therefore, consumers are at the acceptable range of the non-carcinogenic risk due to ingestion muscle of male and female blue crabs in Bandar Abbas. Although the non-carcinogenic risk of blue crab was in the safe range, due to the increase in its consumption and the increase of pollution sources in the Persian Gulf, it is recommended to monitor PHEs in Blue's muscle crabs.

Short- and long-term follow-up outcomes of patients with Brucella endocarditis: a systematic review of 207 Brucella endocarditis Cases

Brucella endocarditis is a fatal complication and the most frequent cause of death for human brucellosis. This study aimed to systematically review the literature on the follow-up outcomes of Brucella endocarditis and analyze the determinants affecting the follow-up outcomes. The databases PubMed, Web of Science, Embase, and Cochrane were searched using keywords and suitable combinations. All studies reporting the follow-up outcomes of Brucella endocarditis were included. Finally, a total of 76 studies (207 patients), including cases or case series, were included. The event rate for patients who underwent short- and long-term follow-up was 12.0% (2 relapsed and 1 died) and 8.1% (6 relapsed and 8 died), respectively. The differences in outcomes between different age groups (18–39, 40–59, and ≥60) were significant (P < 0.05, P = 0.035). The outcomes of the 18–39 age group were worse than those of the 40–59 age group (OR, 0.277; 95% CI, 0.103–0.748; P = 0.011). Accordingly, follow-up (both short- and long-term follow-up) is essential for Brucella endocarditis patients, especially for younger patients (18–39 years) in the first 6 months after treatment. The burden of Brucella endocarditis related complications were immense. Further studies are needed to explore age-based epidemiology of Brucella endocarditis and the exact influencing factors of the follow-up outcomes.

Seroprevalence and Associated Risk Factors of Bovine Brucellosis in District Gujranwala, Punjab, Pakistan

Simple Summary

Our study estimated the seroprevalence of brucellosis in bovine herds and identified the important risk factors associated with the occurrence of the disease at livestock farms. A total of 220 sera from 46 bovine herds of district Gujranwala, Punjab, Pakistan, was collected and subjected to brucellosis screening by serology. It resulted in 58.7% herd-based and 22.7% individual animal-based seroprevalence. Age, herd size and previous history of abortion came out as associated risk factors. Strict biosecurity, personal protection, quarantine measures and routine screening are recommended at livestock-holdings/farms, whereas disease awareness and pasteurization of milk are recommended for the general population to prevent zoonosis.

Abstract

Bovine brucellosis is a contagious zoonotic disease that causes economic losses through abortion and infertility. A cross-sectional study was designed to determine the seroprevalence and associated risk factors of bovine brucellosis in district Gujranwala of Punjab, Pakistan. A total of 220 bovine sera (112 from buffaloes, 108 from cattle) from 46 unvaccinated herds were collected. Parallel testing by the Rose Bengal Plate Test (RBPT) and Indirect Enzyme-linked Immunosorbent Assay (I-ELISA) showed a 58.7% (27/46) herd-level and 22.7% (50/220) animal-level seroprevalence. Seroprevalence was higher (p < 0.001, OR = 7.62) in adult animals (37.2%) compared to younger animals (4.9%). A herd size of >10 animals (p = 0.021, OR = 7.83), less housing space (p = 0.037, OR = 6.39) and history of abortion at the farm (p = 0.023, OR = 5.6) were found as risk factors associated with the seropositivity of brucellosis. There was a substantial agreement between the RBPT and I-ELISA results (Cohen’s kappa coefficient (κ) = 64.16, percent agreement = 89.5%). In conclusion, a relatively higher seroprevalence was found compared to the previous reports from the country. Standardization and validation of the advanced diagnostic tests would be needed. Biosecurity, personal protection, quarantine measures and routine screening of animals at the farm level and disease awareness programs and consumption of pasteurized milk in the human population will be helpful in preventing the transmission/zoonosis of the disease.

Seroprevalence of Brucellosis in Buffalo Worldwide and Associated Risk Factors: A Systematic Review and Meta-Analysis

Background: Brucellosis is an important zoonotic disease caused by Brucella spp. Brucellosis is widely distributed in more than 160 or 170 countries around the world, where it poses a huge threat to animal husbandry and human health. About 150 million head of water buffalo, distributed across more than 40 countries worldwide, are kept for the purposes of service, milk, and meat. High incidence of Brucella spp. in buffalo has negatively affected dairy products and meat products.

Results: We searched all research related to seroprevalence of brucellosis in water buffalo anywhere in the world in PubMed, Science Direct, SpringerLink, China National Knowledge Infrastructure, Wanfang Database, and VIP Chinese Journal Databases. A total of 26 articles published from 1985 to 2020 met the final selection criteria. The overall seroprevalence of buffalo brucellosis worldwide was 9.7%. The seroprevalence before 2010 (20.8%) (95% CI: 5.6–42.2) was much higher than the seroprevalence rate from 2010 to 2020 (4.2%) (95% CI: 1.8–7.5). Subgroup analysis by feeding mode found that the point estimate of seroprevalence in stock buffalo (11.5%) (95% CI: 3.6–23.0) was higher than that in captive buffalo (10.6%) (95% CI: 4.9–18.1). Subgroup analysis by farming mode found that the seroprevalence was higher in captive-bred buffalo (10.7%) (95% CI: 6.6–15.7) than in intensively farmed buffalo (8.5) (95% CI: 0.9–22.2). The seroprevalence in buffalo living in dry lands (6.4%) (95% CI: 2.0–12.9) is greater than that in buffalo living in wetlands (5.1%) (95% CI: 1.8–10.4) (P < 0.05). The seroprevalence in female buffalo (10.1%) (95% CI: 3.4–19.7) was higher than that in male buffalo (4.4%) (95% CI: 2.0–7.4). The seroprevalence in lactating buffalo was higher than that in buffalo of other ages (26.9%) (95% CI: 1.8–66.5). Subgroup analysis by detection method found that the seroprevalence detected by the complement fixation test (27.3%) (95% CI: 0.7–70.8) was much higher than that detected by other methods.

Conclusion: The results of this meta-analysis showed that buffalo brucellosis infection is very common in buffalo herds around the world. Although the seroprevalence of brucellosis in buffalo and humans is relatively low, serious effects upon animal husbandry and public health make it necessary to take effective control and preventive measures to control the spread of this disease.

Working towards development of a sustainable brucellosis control programme, the Azerbaijan example

Brucellosis caused by Brucella abortus and Brucella melitensis is endemic in the Republic of Azerbaijan but a complex mix of fiscal, political and technical constraints has impeded regulatory authority decision making for adoption of a sustainable national control programme. This paper reports a series of epidemiologic studies of the disease in animals and humans which we conducted between 2009 and 2020. A preliminary study and a subsequent larger study using vaccination of all non-pregnant female sheep and goats of breeding age and all females between 3 and 8 months with conjunctival Rev1 vaccine both recorded significant reduction in small ruminant seroprevalences. A case control study of winter pasture flocks found many case and control farmers used raw milk to make dairy products for sale, ate fresh cheese and sold dairy products in unregulated markets. Almost all farmers expressed willingness to pay a portion of the costs associated with elimination of brucellosis from their flocks. A pilot human study in 2009 led to a large study in 2017 which recorded an overall seroprevalence of 8.1% in humans. Persons in farm related occupations were at greater risk than urban persons and males were more likely to be seropositive than females. Risk factors included keeping small ruminants, using raw milk cheese and slaughtering animals whereas having heard education information about brucellosis and vaccinating against brucellosis were protective.

Global Comprehensive Literature Review and Meta-Analysis of Brucella spp. in Swine Based on Publications From 2000 to 2020

Background: Brucellosis, a zoonotic disease, infects various hosts, including swine and humans. It has reemerged in recent years as a public health concern, and current studies on brucellosis infection in swine have been conducted worldwide. However, no meta-analyses of global brucellosis infection in swine have been published. The aim of this study was to provide an overview of Brucella species (spp.) in swine worldwide and the factors associated with its persistence.

Results: We searched seven databases for published epidemiological studies on brucellosis in pigs, including the Chinese National Knowledge Infrastructure, Wanfang Data, SpringerLink, ScienceDirect, Web of Science, the VIP Chinese Journal Database and PubMed. We selected 119 articles published from January 1, 2000 to January 3, 2020 for inclusion in the meta-analysis and analyzed the data using a random-effects model. Funnel plots and Egger's test showed significant publication bias in the included studies. The results of the sensitivity analysis showed that our study was relatively stable and reliable. The prevalence of brucellosis in swine was 2.1% (95% CI: 1.6–2.6), of which the highest infection rate, which was found in Europe, was 17.4% (95% CI: 11.1–24.9). The prevalence in feral pigs (15.0%, 95% CI: 8.4–23.2) was higher than that in domestic pigs (1.1%, 95% CI 0.2–2.5). The prevalence in high-income countries (15.7%, 95% CI 8.0–25.3) was significantly higher than that in middle- (0.8%, 95% CI 0.5–1.1), and low-income countries (0.1%, 95% CI 0.0–0.2). The prevalence was highest in finishing pigs at 4.9% (95% CI 0.9–11.0), and lowest among suckling pigs at 0% (95% CI 0.0–0.5).

Conclusion: The Brucella prevalence in pig herds currently is distributed widely throughout the world. In some countries, swine brucellosis may be a neglected zoonotic disease. We recommend long-term monitoring of the prevalence of brucellosis in domestic and wild pig herds. Attention should also be paid to animal welfare on intensive pig farms; controlling the breeding density may play an important role in reducing the spread of brucellosis among pigs.

The concentration and probabilistic risk assessment of potentially toxic elements in fillets of silver pomfret (Pampus argenteus): A global systematic review and meta-analysis

The contamination of fish type products such as silver pomfret fish fillets by potentially toxic elements (PTEs) has raised global health concerns. Related studies regarding the concentration of PTEs in fillets of silver pomfret fish were retrieved among some international databases such as Scopus, PubMed and Embase between 1 January 1983 and 10 March 2020. The pooled (mean) concentration of PTEs in fillets of silver pomfret fish was meta-analyzed with the aid of a random-effect model (REM). Also, the non-carcinogenic risk was estimated via calculating the 95th percentile of the total target hazard quotient (TTHQ). The meta-analysis of 21 articles (containing 25 studies or data reports) indicated that the ranking of PTEs in fillets of silver pomfret fish was Fe (11,414.81 µg/kg wet weight, ww) > Zn (6055.72 µg/kg ww) > Cr (1825.79 µg/kg ww) > Pb (1486.44 µg/kg ww) > Se (1053.47 µg/kg ww) > Cd (992.50 µg/kg ww) > Ni (745.23 µg/kg ww) > Cu (669.71 µg/kg ww) > total As (408.24 µg/kg ww) > Co (87.03 µg/kg ww) > methyl Hg (46.58 µg/kg ww). The rank order of health risk assessment by country based on the TTHQ for adult consumers was Malaysia (2.500) > Bangladesh (0.886) > Iran (0.144) > China (0.045) > Pakistan (0.020) > India (0.015), while the corresponding values for child consumers was Malaysia (11.790) > Bangladesh (4.146) > Iran (0.675) > China (0.206) > Pakistan (0.096) > India (0.077). The adult consumers in Malaysia and children in Malaysia and Bangladesh were at considerable non-carcinogenic risk. Therefore, following the recommended control plans in order to reduce the health risk associated with the ingestion of PTEs via consumption of silver pomfret fish fillets is crucial.

Scenario of pathogenesis and socioeconomic burden of human brucellosis in Saudi Arabia

Brucellosis is considered a prevailing endemic infectious disease in the Kingdom of Saudi Arabia and represents a health problem with socio-economic burden. There are two main Brucella species that cause human brucellosis; Brucella abortus, and Brucella melitensis. The clinical features range from asymptomatic to the acute symptoms of fever, joint pain, muscle pain, headache, nausea/vomiting, anorexia and malaise in addition to the subsequent complications that might occur. The endemicity of brucellosis might be explained due to obstacles in controlling the importation of animals for slaughtering during Hajj periods and for several other predisposing factors. The distribution of the disease is all over the country and the most prevalent part is the south followed by north and then the east and central parts. However, in the complexity of brucellosis control measures, there are several activities which have been implemented to tackle the disease such as mass vaccination of animals, regulating importation of slaughter animals, and improving public awareness. This review provides a detailed description of the status of brucellosis in Saudi Arabia, which includes epidemiology, clinical characteristics, virulence and pathophysiology, and prevention of the disease.

Sheep Brucellosis in Kuwait: A Large-Scale Serosurvey, Identification of Brucella Species and Zoonotic Significance

Brucellosis is a common zoonotic disease of major concern in humans of Kuwait, and B. melitensis causes most human cases. The disease is endemic in small ruminants, cattle, and camels for decades, causing substantial economic losses in livestock production. However, a nationwide large-scale investigation of brucellosis in the small ruminant population has not been done in the past two decades. A serosurvey of sheep brucellosis in the five districts of Kuwait with most animal production farms was done between 2016 and 2019. In total, 67,054 serum samples from 233 sheep herds were collected and tested. Additionally, milk and tissue samples were collected from 46 seropositive cases for bacteriology. Thirty persons from seven seropositive farms were tested by serology. The incidence of seropositive cases was 7% in districts devoid of vaccination, while it was 4.7% in farms with history of vaccination. The serosurvey revealed that 89% of non-vaccinated herds (n = 181) were seropositive by Rose Bengal test (RBT), buffered acidified plate antigen test (BAPAT), and complement fixation test (CFT). Prevalence of 100% was reported for non-vaccinated sheep herds from Al-Wafrah and Al-Jahra districts, followed by those from Al-Salmi (88.24%), Al-Abdali (86.7%) and Kabd (75.6%). Implementation of vaccination with B. melitensis Rev.1 vaccine and test-and-slaughters in 20 herds reduced the seroprevalence to 33.3% and 25% in herds from Al-Jahra and AL-Wafrah, respectively. B. melitensis was isolated from 20 samples (43.5%). More than half of the examined animal owners (56.6%) tested positive for Brucella using RBT, BAPAT and CFT. The high numbers of infected herds and high prevalence in herdsmen are alarming. Thus, control measures have to be ensured immediately. The epidemiological situation in Kuwait is similar to those of the neighboring countries and the combined action of these states is needed. The understanding of the economic and public health impact of brucellosis in Kuwait needs to grow.

Brucella prosthetic valve endocarditis with septic and cardiogenic shock

A young man with aortic prosthetic valve replacement, presented with prolonged fever and diagnosed with brucella endocarditis based on positive transthoracic echo findings with high titer positive brucellacapt serology. He was started on medical treatment with doxycycline and rifampin to which gentamicin and ceftriaxone were added and he was planned for surgical intervention. Unfortunately, the patient developed cardiogenic with septic shock before performing surgery and died within 24 h soon after admission.