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Golomb D, Bar I, Brosh-Nissimov T, Leshin-Carmel D, Cooper A, Raz O. Clinical insights: Brucellosis-induced febrile orchitis - A case report and treatment strategy. Urol Case Rep 2024; 55:102764. [PMID: 38911465 PMCID: PMC11190496 DOI: 10.1016/j.eucr.2024.102764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 06/02/2024] [Indexed: 06/25/2024] Open
Abstract
Brucellosis, a systemic infection, can affect various organs, including the genitourinary system, causing epididymo-orchitis in 2%-20 % of cases. This report details a 34-year-old Thai male migrant worker with febrile orchitis. Initial gentamicin treatment failed, but serological tests confirmed brucellosis, likely from raw dairy consumption. The patient was successfully treated with gentamicin, doxycycline, and rifampicin, resulting in complete symptom resolution. Brucella orchitis, though rare, should be considered in patients from endemic areas. Conservative treatment with combined antibiotics is typically effective.
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Affiliation(s)
- Dor Golomb
- Department of Urology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Ido Bar
- Department of Urology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Tal Brosh-Nissimov
- Infectious Diseases Unit, Samson Assuta Ashdod University Hospital, Ashdod, Israel
- Faculty of Health Sciences, Ben Gurion University in the Negev, Beer Sheba, Israel
| | - Daniel Leshin-Carmel
- Infectious Diseases Unit, Samson Assuta Ashdod University Hospital, Ashdod, Israel
- Faculty of Health Sciences, Ben Gurion University in the Negev, Beer Sheba, Israel
| | - Amir Cooper
- Department of Urology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Orit Raz
- Department of Urology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
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Bapir R, Abdalqadir AM, Aghaways E, Bayz HH, Abdullah HO, Ahmed SF, Abdalla BA, Hama JI, Muhammed BO, Hamahussein KF, Faraj FM, Kakamad FH. Brucella epididymo-orchitis: A single-center experience with a review of the literature. Arch Ital Urol Androl 2023; 95:11978. [PMID: 38193225 DOI: 10.4081/aiua.2023.11978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 10/23/2023] [Indexed: 01/10/2024] Open
Abstract
Brucella epididymo-orchitis (BEO) is a rare complication of brucellosis. Despite the high incidence of brucellosis in developing countries, few case series on BEO are available. This study focuses on the clinical presentations, diagnosis, and treatment of BEO with a review of the literature. This study included consecutive BEO patients diagnosed and treated at Smart Health Tower between 2021 and 2023. The required data were retrospectively collected from patients' profiles. The BEO diagnosis was established through scrotal Doppler ultrasound in cases with a positive Rose Bengal test and positive IgG and IgM results for brucellosis, in addition to scrotal pain and swelling. This study included 11 cases whose ages ranged from 22 to 55 years. Most of the cases presented with testicular pain (72.7%), followed by fever (63.6%) and arthralgia (63.6%). The right side (54.5%) was slightly more affected than the left side (45.5%). The major abnormal laboratory finding was an elevated C-reactive protein (82%). The treatment was conservative, in which a combination of gentamicin, doxycycline, and rifampicin was administered to the patients for about 6-8 weeks. One case underwent an orchiectomy due to the abscess formation. All the patients responded well to the treatment, with no recurrence. In the Middle East, brucellosis remains a concerning infectious disease. Early diagnosis, aimed at preventing abscess formation and other complications, takes first priority to avoid invasive interventions.
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Affiliation(s)
- Rawa Bapir
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan; Department of Urology, Sulaimani Surgical Teaching Hospital, Sulaimani; Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Kurdistan.
| | | | - Esmaeel Aghaways
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaimani, Kurdistan.
| | | | - Hiwa O Abdullah
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan; Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Kurdistan.
| | - Shaho F Ahmed
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan.
| | - Berun A Abdalla
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan; Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Kurdistan.
| | | | | | - Karokh Fadhil Hamahussein
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan; Kurdistan Center for Gastroenterology and Hepatology, Sulaimani, Kurdistan.
| | | | - Fahmi Hussein Kakamad
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan; Kscien Organization, Hamdi Street, Azadi Mall, Sulaimani, Kurdistan; College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaimani, Kurdistan.
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Alarbid A, Salem SM, Alenezi T, Alenezzi A, Alali K, Ajrawi F, Alhajry F. Early predictors of Brucella epididymo-orchitis. Urol Ann 2023; 15:158-161. [PMID: 37304522 PMCID: PMC10252786 DOI: 10.4103/ua.ua_178_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 05/04/2022] [Indexed: 06/13/2023] Open
Abstract
Introduction Epididymo-orchitis (EO) is a common urological condition. In endemic areas, EO may be the presenting picture of brucellosis. Early suspicion and proper diagnosis is necessary for patient recovery. Objective The aim of our study is to identify early predictors of Brucella EO. Patients and Methods We retrospectively collected the data of all patients who were treated at the Urology Unit, Farwaniya Hospital, with acute EO above the age of 12 years between April 2017 and February 2019. Data from electronic and hardcopy files were gathered and analyzed. The diagnosis of acute EO was based on clinical, laboratory, and radiological findings. A total of 120 patients under the diagnosis of EO, epididymitis, and orchitis were reviewed. Thirty-one patients were tested for Brucella based on the history of animal contact, ingestion of unpasteurized dairy products, or persistent fever for more than 48 h. of those patients, 11 tested positive for Brucella orchitis. Results A comparison between Brucella-positive and Brucella-negative patients regarding age, presence of fever, complete blood count (CBC) parameters, pyuria, and abscess formation was made. In the Brucella group, 72% of the patients had a history of animal contact compared to 33% in non-Brucella group (P = 0.006). When comparing CBC parameters in the two groups, Brucella group had statistically significant lower total leukocytic count and neutrophil count (mean ± standard deviation [SD]) 13.07 ± 4.22, 6.4 ± 9.98 versus Brucella negative group 17.35 ± 5.28, 7.8 ± 10.53, and P values were 0.037 and 0.004, respectively. Brucella group showed lymphocytosis (mean ± SD) 25.95 ± 9.78 versus non-Brucella group 13.22 ± 8.05 and P < 0.01. Conclusion Brucella orchitis constituted 9% of the orchitis patients treated in our hospital. Patients with a history of animal contact, EO with lymphocytosis, and relative neutropenia should raise the suspicion for Brucella orchitis in endemic areas.
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Affiliation(s)
- Abdullah Alarbid
- Department of Urology, Farwaniya Hospital Kuwait, Al Farwaniyah, Egypt
| | | | - Turky Alenezi
- Department of Urology, Farwaniya Hospital Kuwait, Al Farwaniyah, Egypt
| | - Abdullah Alenezzi
- Department of Urology, Farwaniya Hospital Kuwait, Al Farwaniyah, Egypt
| | - Khaled Alali
- Department of Urology, Farwaniya Hospital Kuwait, Al Farwaniyah, Egypt
| | - Feras Ajrawi
- Department of Urology, Farwaniya Hospital Kuwait, Al Farwaniyah, Egypt
| | - Faisal Alhajry
- Department of Urology, Farwaniya Hospital Kuwait, Al Farwaniyah, Egypt
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Khodadadi J, Dodangeh M, Nasiri M. Brucellar epididymo-orchitis: Symptoms, diagnosis, treatment and follow-up of 50 patients in Iran. IDCases 2023; 32:e01736. [PMID: 36938337 PMCID: PMC10020095 DOI: 10.1016/j.idcr.2023.e01736] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction Epididymo-orchitis (EO) is a disease of both the epididymis and ipsilateral testis. Brucellar epididymo-orchitis (BEO) is an uncommon localized infection of the testis and epididymis which occurs in about 2-14 % of all patients with brucellosis as a result of urine Brucella removal or due to blood-borne septic metastasis. Methods Between January 2018 and June 2021, 50 patients with fever, chills, swelling, and pain of the testicle (testicles) were referred to our center. Two approaches were used for the treatment of brucellarepididymo-orchitis among these individuals. Intravenous Gentamicin and Doxycycline were used in seven cases, while Rifampicin was added to this combination for the remaining 43 patients. Intravenous Gentamicin was administered for 7 days and the other drugs were used for 45 days. All patients were followed up for six months by monitoring the symptoms and signs of the disease. Results None of the patients had been diagnosed with brucellosis before referral to our clinic. 43 patients were successfully treated by. Intravenous Gentamicin, Doxycycline and Rifampicin, whereas seven patients were fully treated using. Intravenous Gentamicin and Doxycycline. The two therapeutic groups were hospitalized for 7.56 ± 3.45 (3-23) and 10.14 ± 1.77 (8-13) days, respectively. Treatment failure, drug side effects, and disease complications were not observed in any of the cases over a 6-month follow-up period. Conclusions Physicians should be alert regarding Brucellarepididymo-orchitis (BEO) within the differential diagnosis of nonspecific epididymo-orchitis, especially in regions where the disease is endemic. Delay in diagnosis or inappropriate management of BEO may result in complications.
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Key Words
- 2 ME, 2-mercaptoethanol
- ALK, Anaplastic lymphoma kinase
- ALT, Alanine Aminotransferase
- AST, Aspartate aminotransferase
- BEO, Brucellar epididymo-orchitis
- Brucella
- Brucellar epididymo-orchitis
- Brucellosis
- CBC, Complete blood count
- EO, Epididymo-orchitis
- ESR, erythrocyte sedimentation rate
- Epididymo-orchitis
- Iran
- PMH, Past medical history
- STA, Standard tube agglutination testing
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Affiliation(s)
- Javad Khodadadi
- Department of Infectious Diseases, Faculty of Medicine, Qom University of Medical Sciences, Qom, Islamic Republic of Iran
| | - Milad Dodangeh
- MD-MPH, Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Maryam Nasiri
- Department of Infectious Diseases, School of Medicine, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
- Corresponding author.
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Hensel ME, Stranahan LW, Edwards JF, Arenas-Gamboa AM. Intratracheal inoculation results in Brucella-associated reproductive disease in male mouse and guinea pig models of infection. Front Microbiol 2022; 13:1029199. [DOI: 10.3389/fmicb.2022.1029199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Brucella species are considered a significant cause of reproductive pathology in male and female animals. Importantly, Brucella melitensis can induce reproductive disease in humans. Reproductive pathogenesis and evaluation of newly developed countermeasures against brucellosis studies have traditionally utilized female animal models. However, any potential, new intervention for use in humans would need to be evaluated in both sexes. Therefore, animal models for male reproductive brucellosis are desperately needed to understand disease progression. Accordingly, we evaluated guinea pigs and mice using B. melitensis 16 M in an intratracheal model of inoculation at different stages of infection (peracute, acute, and chronic) with an emphasis on determining the effect to the male reproductive organs. Aerosol inoculation resulted in colonization of the reproductive organs (testicle, epididymis, prostate) in both species. Infection peaked during the peracute (1-week post-infection [p.i.]) and acute (2-weeks p.i.) stages of infection in the mouse in spleen, epididymis, prostate, and testicle, but colonization was poorly associated with inflammation. In the guinea pig, peak infection was during the acute stage (4-weeks p.i.) and resulted in inflammation that disrupted spermatogenesis chronically. To determine if vaccine efficacy could be evaluated using these models, males were vaccinated using subcutaneous injection with vaccine candidate 16 MΔvjbR at 109 CFU/100 μl followed by intratracheal challenge with 16 M at 107. Interestingly, vaccination efficacy varied between species and reproductive organs demonstrating the value of evaluating vaccine candidates in multiple models and sexes. Vaccination resulted in a significant reduction in colonization in the mouse, but this could not be correlated with a decrease in inflammation. Due to the ability to evaluate for both colonization and inflammation, guinea pigs seemed the better model not only for assessing host-pathogen interactions but also for future vaccine development efforts.
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Samkange A, van der Westhuizen J, Voigts AS, Chitate F, Kaatura I, Khaiseb S, Hikufe EH, Kabajani J, Bishi AS, Mbiri P, Hawanga NN, Mushonga B. Investigation of the outbreaks of abortions and orchitis in livestock in Namibia during 2016-2018. Trop Anim Health Prod 2022; 54:346. [PMID: 36242679 DOI: 10.1007/s11250-022-03342-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 10/04/2022] [Indexed: 11/28/2022]
Abstract
This study investigated outbreaks of seemingly related abortions and orchitis which occurred in the Khomas, Omaheke and Otjozondjupa regions of Namibia from 2016 to 2018, affecting cattle, sheep and goats. Fifty-nine questionnaires were administered, and 48 were completed giving an 81.4% return. The outbreaks were limited to Namibia's east and central regions, mainly on farms rearing cattle, sheep and goats and on farms with a mixture of these species. There was no significant difference between Khomas and other regions on abortion reporting at the farm level [X2 (1, N = 48) = 0.0002, p = 0.987851]. However, there was a significant difference in the abortions at the animal level among the three regions [X2 (2, N = 6246) = 239.8339, p = .00001]. In addition, the proportions of abortions calculated at the animal level at each farm were significantly different when the Khomas region was compared to the other regions. Seventeen cattle sera, 35 sheep sera, 52 caprine sera, 18 bovine liver samples, one caprine liver, five aborted cattle foetuses, two cattle placentas, 18 testes (one bull, eight bucks and nine rams) and ten bull sheath scrapings were collected and tested. Histopathology, microbiology, serology, immunohistochemistry, real-time PCR and mineral analytical techniques were used to establish the aetiology of the abortion and orchitis outbreaks. The gross and histopathological findings on the 18 testicles were characteristic of chronic orchitis. In aborted foetuses, significant histopathological findings included meconium aspiration, funisitis and cardiomyopathy. Placentitis and endometritis were the primary pathologies observed in cows. The bacteria isolated from microbiological samples included Enterococcus spp. (65.5% [19/29]), Enterobacter spp. (6.9% [2/29]) and Streptococcus spp. (10.3% [3/29]), Trueperella pyogenes (3.4% [1/29]), Stenotrophomonas maltophilia (3.4% [1/29]), Staphylococcus epidermidis (3.4% [1/29]), Providencia rettgeri (3.4% [1/29]) and Acinetobacter lwoffii (3.4% [1/29]), mostly opportunistic bacteria. On mineral analysis, 28%, 33%, 83%, 33% and 17% (n = 18) of cattle livers were low in copper, zinc, manganese, selenium and iron, respectively. Twenty-three percent (12/52) of the caprine sera were positive for Brucella melitensis on the Rose Bengal and complement fixation tests. Thirty-five ovine sera were tested for B. melitensis, B. ovis and Coxiella burnetii, and the prevalence for each was 2.9% (1/35). PCR tests on foetuses were all negative for Brucella spp., Coxiella burnetii, Chlamydia spp., Listeria monocytogenes, Salmonella spp., Campylobacter fetus spp., Leptospira pathogenic strains, bovine viral diarrhoea virus, Rift Valley fever virus, Anaplasma phagocytophilum and bovine herpes virus 4 Campylobacter fetus spp. and Trichomonas foetus spp. The authors concluded that Brucella spp., Enterococcus spp., Escherichia coli, Streptococcus spp., Trueperella pyogenes and Coxiella burnetii could have contributed to this outbreak. Micronutrient imbalances and pathogenic abiotic nanoparticles were also identified as possible contributors to the abortion outbreaks.
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Affiliation(s)
- Alaster Samkange
- School of Veterinary Medicine, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, P. Bag 13301, Windhoek, Namibia.
| | | | | | - Frank Chitate
- School of Veterinary Medicine, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, P. Bag 13301, Windhoek, Namibia
| | - Israel Kaatura
- School of Veterinary Medicine, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, P. Bag 13301, Windhoek, Namibia
| | - Siegfried Khaiseb
- Directorate of Veterinary Services, Central Veterinary Laboratory, Private Bag 13187, Windhoek, Namibia
| | - Emmanuel H Hikufe
- Directorate of Veterinary Services, Central Veterinary Laboratory, Private Bag 13187, Windhoek, Namibia
| | - Juliet Kabajani
- Directorate of Veterinary Services, Central Veterinary Laboratory, Private Bag 13187, Windhoek, Namibia
| | - Alec S Bishi
- School of Veterinary Medicine, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, P. Bag 13301, Windhoek, Namibia
| | - Pricilla Mbiri
- School of Veterinary Medicine, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, P. Bag 13301, Windhoek, Namibia
| | - Ndahafa N Hawanga
- School of Veterinary Medicine, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, P. Bag 13301, Windhoek, Namibia
| | - Borden Mushonga
- School of Veterinary Medicine, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, P. Bag 13301, Windhoek, Namibia
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Nahas RS, Alsulami A, Lashkar MO, Thabit AK. Brucella epidydimo-orchitis successfully treated with dual oral drug regimen: A case report with differential diagnoses of malignancy and tuberculosis. Radiol Case Rep 2022; 17:3485-3489. [PMID: 35912293 PMCID: PMC9334919 DOI: 10.1016/j.radcr.2022.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 07/02/2022] [Indexed: 12/01/2022] Open
Abstract
Brucellosis is a zoonotic disease caused by Brucella spp. When complicated, Brucella may affect any organ system, including the genitourinary system in the form of epidydimo-orchitis. Brucella orchitis is the second most common form of complicated brucellosis. The present case is for an adolescent who is otherwise healthy but presented with right testicular pain. Ultrasound imaging showed heterogeneous enlarged right testis with large heterogeneous mass and central necrosis. α-fetoprotein was normal and β-human choriogonadotropin was negative. Malignancy and tuberculosis were excluded based on histopathology and microbiology of the tissue biopsy, respectively. The history of raw dairy consumption and positive serology for B. melitensis and B. abortus established the diagnosis of Brucella epidydimo-orchitis. Treatment was successful with doxycycline and rifampin for four weeks. In pediatrics, it is important to rule out malignancy and make every attempt to avoid orchidectomy by making necessary investigations and involving infectious diseases consultation.
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Affiliation(s)
- Renad S. Nahas
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, 7027 Abdullah Alsulaiman St, Jeddah 22254-2265, Saudi Arabia
| | - Abdulsalam Alsulami
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, 7027 Abdullah Alsulaiman St, Jeddah 22254-2265, Saudi Arabia
| | - Manar O. Lashkar
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, 7027 Abdullah Alsulaiman St, Jeddah 22254-2265, Saudi Arabia
| | - Abrar K. Thabit
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, 7027 Abdullah Alsulaiman St, Jeddah 22254-2265, Saudi Arabia
- Corresponding author.
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Natesan K, Kalleshamurthy T, Nookala M, Yadav C, Mohandoss N, Skariah S, Sahay S, Shome BR, Kumar ORV, Rahman H, Shome R. Seroprevalence and risk factors for brucellosis in small ruminant flocks in Karnataka in the Southern Province of India. Vet World 2021; 14:2855-2862. [PMID: 35017831 PMCID: PMC8743770 DOI: 10.14202/vetworld.2021.2855-2862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Aim: Brucellosis is a zoonotic disease of high economic and public health importance in large and small ruminant populations worldwide. A cross-sectional study was conducted to determine the seroprevalence and risk factors of brucellosis in small ruminants in organized farms in the southern region of India. Materials and Methods: Farms exclusively rearing sheep and goats were selected based on the number of animals (small, medium, or large) and the location of the farm (urban, periurban, or rural). A total of 1499 serum samples; 1001 from sheeps and 498 from goats were sourced from six sheep and four goat farms and tested using Rose Bengal Plate and indirect Enzyme-Linked Immunosorbent Assay tests. Results: The apparent prevalence of brucellosis was higher in sheep (8.29%, 95% CI 6.7-10.1) than goats (5.82%, 95% CI 4.0-8.2). The true adjusted population level seroprevalence was also higher in sheep, at 7.7% (95% CI 6.0-9.6) than in goats, at 5.1% (95% CI 3.2-7.6). According to bivariate categorical analysis, six highly significant (p<0.001) animal- and farm-level risk factors for sheep were age, breed, number of lambings, history of abortion, rural farms, and presence of dogs on the farm. In goats, five significant risk factors were found: History of abortion, separate sheds, dogs on the farm, weekly veterinary consultation, and lack of brucellosis awareness. In a logistic regression model, abortion (OR adjusted 10.8, 95% CI 1.2-96.12), rural farms (OR adjusted 8.5, 95% CI 3.6-20.0), and absence of separate sheds on the farms (OR 1.9, 95% CI 1.1-3.5) were found to be significant risk factors for ovine brucellosis. Conclusion: The use of complementary measures to tackle the multiple animal- and farm-level risk factors may help to reduce the disease burden in the absence of a vaccination policy for small ruminants in India.
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Affiliation(s)
- Krithiga Natesan
- Department of Bacteriology, Indian Council for Agricultural Research-National Institute of Veterinary Epidemiology and Disease Informatics, Bengaluru, Karnataka, India
| | - Triveni Kalleshamurthy
- Department of Bacteriology, Indian Council for Agricultural Research-National Institute of Veterinary Epidemiology and Disease Informatics, Bengaluru, Karnataka, India
| | - Mangadevi Nookala
- Department of Bacteriology, Indian Council for Agricultural Research-National Institute of Veterinary Epidemiology and Disease Informatics, Bengaluru, Karnataka, India
| | - Chaitra Yadav
- Department of Bacteriology, Indian Council for Agricultural Research-National Institute of Veterinary Epidemiology and Disease Informatics, Bengaluru, Karnataka, India
| | - Nagalingam Mohandoss
- Department of Bacteriology, Indian Council for Agricultural Research-National Institute of Veterinary Epidemiology and Disease Informatics, Bengaluru, Karnataka, India
| | - Somy Skariah
- Department of Bacteriology, Indian Council for Agricultural Research-National Institute of Veterinary Epidemiology and Disease Informatics, Bengaluru, Karnataka, India
| | - Swati Sahay
- Department of Bacteriology, Indian Council for Agricultural Research-National Institute of Veterinary Epidemiology and Disease Informatics, Bengaluru, Karnataka, India
| | - Bibek Ranjan Shome
- Department of Bacteriology, Indian Council for Agricultural Research-National Institute of Veterinary Epidemiology and Disease Informatics, Bengaluru, Karnataka, India
| | - Obli Rajendran Vinodh Kumar
- Division of Epidemiology, Indian Council for Agricultural Research-Indian Veterinary Research Institute, Bareilly, Uttar Pradesh, India
| | - Habibur Rahman
- International Livestock Research Institute, New Delhi, India
| | - Rajeswari Shome
- Department of Bacteriology, Indian Council for Agricultural Research-National Institute of Veterinary Epidemiology and Disease Informatics, Bengaluru, Karnataka, India
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Yu J, Li S, Wang L, Dong Z, Si L, Bao L, Wu L. Pathogenesis of Brucella epididymoorchitis-game of Brucella death. Crit Rev Microbiol 2021; 48:96-120. [PMID: 34214000 DOI: 10.1080/1040841x.2021.1944055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Brucellosis is a worldwide zoonotic disease caused by Brucella spp. Human infection often results from direct contact with tissues from infected animals or by consumption of undercooked meat and unpasteurised dairy products, causing serious economic losses and public health problems. The male genitourinary system is a common involved system in patients with brucellosis. Among them, unilateral orchitis and epididymitis are the most common. Although the clinical and imaging aspect of orchi-epididymitis caused by brucellosis have been widely described, the cellular and molecular mechanisms involved in the damage and the immune response in testis and epididymis have not been fully elucidated. In this review, we first summarised the clinical characteristics of Brucella epididymo-orchitis and the composition of testicular and epididymal immune system. Secondly, with regard to the mechanism of Brucella epididymoorchitis, we mainly discussed the process of Brucella invading testis and epididymis in temporal and spatial order, including i) Brucella evades innate immune recognition of testicular PRRs;ii) Brucella overcomes the immune storm triggered by the invasion of testis through bacterial lipoproteins and virulence factors, and changes the secretion mode of cytokines; iii) Brucella breaks through the blood-testis barrier with the help of macrophages, and inflammatory cytokines promote the oxidative stress of Sertoli cells, damaging the integrity of BTB; iv) Brucella inhibits apoptosis of testicular phagocytes. Finally, we revealed the structure and sequence of testis invaded by Brucella at the tissue level. This review will enable us to better understand the pathogenesis of orchi-epididymitis caused by brucellosis and shed light on the development of new treatment strategies for the treatment of brucellosis and the prevention of transition to chronic form. Facing the testicle with immunity privilege, Brucella is like Bruce Lee in the movie Game of Death, winning is survival while losing is death.HIGHLIGHTSWe summarized the clinical features and pathological changes of Brucellaepididymoorchitis.Our research reveals the pathogenesis of Brucella epididymoorchitis, which mainly includes the subversion of testicular immune privilege by Brucella and a series of destructive reactions derived from it.As a basic framework and valuable resource, this study can promote the exploration of the pathogenesis of Brucella and provide reference for determining new therapeutic targets for brucellosis in the future.
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Affiliation(s)
- Jiuwang Yu
- Mongolian Medicine School, Inner Mongolia Medical University, Hohhot, China
| | - Sha Li
- Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Lu Wang
- Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Zhiheng Dong
- Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Lengge Si
- Mongolian Medicine School, Inner Mongolia Medical University, Hohhot, China
| | - Lidao Bao
- Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Lan Wu
- Mongolian Medicine School, Inner Mongolia Medical University, Hohhot, China
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Rezaei M, Rabbani-Khorasgani M, Zarkesh-Esfahani SH, Emamzadeh R, Abtahi H. Lactococcus-based vaccine against brucellosis: IgG immune response in mice with rOmp16-IL2 fusion protein. Arch Microbiol 2021; 203:2591-2596. [PMID: 33689001 DOI: 10.1007/s00203-021-02241-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/10/2020] [Accepted: 02/12/2021] [Indexed: 01/18/2023]
Abstract
This study was designed to introduce the recombinant Lactococcus lactis MG1363 as a cell factory candidate for production of recombinant Brucella melitensis Omp16-Human IL2 (r-Omp16-IL2) and to suggest it as a promising safe, non-pathogenic mucosal live vaccine against brucellosis. Three groups of BALB/c mice (10 mice per group) were intragastrically administrated with phosphate-buffered saline (PBS), L. lactis harboring the empty pAMJ2008 plasmid and with L. lactis expressing rOmp-IL2. The first two groups were classified as control groups and the third one is indicated as treatment group. Another group was injected by the intraperitoneal (i.p.) route with purified rOmp16-IL2 protein. The total serum IgG of each group was assessed with indirect ELISAs at two days before immunization and also two weeks after the last immunization. Results showed that BALB/c mice intragastrically administrated with L. lactis expressing rOmp-IL2 had dominant IgG response compared to the control (PBS administrated) group (P < 0.05). The level of IgG was significantly increased by intraperitoneally injection of recombinant Omp-IL2 in adjuvant compared to the intragastrically administration of PBS and L. lactis/pAMJ2008 as control groups, and also compared to L. lactis/pAMJ2008-rOmp-IL2 (P < 0.05). Our findings provide the use of L. lactis rOmp16-IL2 as a new promising alternative safe strategy than presently live attenuated vaccines toward developing an oral vaccine or subunit-based vaccine against brucellosis.
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Affiliation(s)
- Marzieh Rezaei
- Department of Cell & Molecular Biology and Microbiology, Faculty of Science and Biotechnology, University of Isfahan, 817467344, Isfahan, Islamic Republic of Iran
| | - Mohammad Rabbani-Khorasgani
- Department of Cell & Molecular Biology and Microbiology, Faculty of Science and Biotechnology, University of Isfahan, 817467344, Isfahan, Islamic Republic of Iran.
| | - Sayyed Hamid Zarkesh-Esfahani
- Department of Cell & Molecular Biology and Microbiology, Faculty of Science and Biotechnology, University of Isfahan, 817467344, Isfahan, Islamic Republic of Iran
| | - Rahman Emamzadeh
- Department of Cell & Molecular Biology and Microbiology, Faculty of Science and Biotechnology, University of Isfahan, 817467344, Isfahan, Islamic Republic of Iran
| | - Hamid Abtahi
- Molecular and Medicine Research Center, Arak University of Medical Science, Arak, Islamic Republic of Iran
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Abstract
Brucellosis is a bacterial disease of domestic animals and humans. The pathogenic ability of Brucella organisms relies on their stealthy strategy and their capacity to replicate within host cells and to induce long-lasting infections. Brucella organisms barely induce neutrophil activation and survive within these leukocytes by resisting microbicidal mechanisms. Very few Brucella-infected neutrophils are found in the target organs, except for the bone marrow, early in infection. Still, Brucella induces a mild reactive oxygen species formation and, through its lipopolysaccharide, promotes the premature death of neutrophils, which release chemokines and express "eat me" signals. This effect drives the phagocytosis of infected neutrophils by mononuclear cells that become thoroughly susceptible to Brucella replication and vehicles for bacterial dispersion. The premature death of the infected neutrophils proceeds without NETosis, necrosis/oncosis, or classical apoptosis morphology. In the absence of neutrophils, the Th1 response exacerbates and promotes bacterial removal, indicating that Brucella-infected neutrophils dampen adaptive immunity. This modulatory effect opens a window for bacterial dispersion in host tissues before adaptive immunity becomes fully activated. However, the hyperactivation of immunity is not without a price, since neutropenic Brucella-infected animals develop cachexia in the early phases of the disease. The delay in the immunological response seems a sine qua non requirement for the development of long-lasting brucellosis. This property may be shared with other pathogenic alphaproteobacteria closely related to Brucella We propose a model in which Brucella-infected polymorphonuclear neutrophils (PMNs) function as "Trojan horse" vehicles for bacterial dispersal and as modulators of the Th1 adaptive immunity in infection.
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Abstract
Objective: Brucellosis is a multisystemic disease which may affect all organs. Epididymo-orchitis is the most common form of genitourinary involvement. The aim of this study was to present our eight-year experience regarding the management of patients with brucellar epididymo-orchitis (BEO).Materials and method: The medical records of male brucellosis patients treated in two centers, between 2010 and 2018 were analyzed retrospectively. The diagnosis of epididymo-orchitis was made when the patients had scrotal pain, swelling, and enlarged tender testicles and/or epididymis on clinical examination. Brucellosis was diagnosed with a positive standard tube agglutination test or a positive blood culture.Results: Brucellosis was diagnosed in 996 male patients. Of these patients, 25 had a diagnosis of BEO (2.5%). All BEO patients suffered from enlarged painful testicles, however, testicular complaints were the only presentation symptoms in three of them. All patients received medical treatment alone except one patient with testicular abscess who underwent surgical drainage besides medical treatment. All patients recovered completely and no relapses have been detected during six-month follow-up.Conclusion: Patients with epididymo-orchitis should be investigated for brucellosis especially in endemic regions. To our knowledge, BEO patients may present with isolated testicular symptoms that make a diagnostic challenge.
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Affiliation(s)
- Hasan Tahsin Gozdas
- Department of Infectious Diseases and Clinical Microbiology, Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Tayibe Bal
- Department of Infectious Diseases and Clinical Microbiology, Siirt State Hospital, Siirt, Turkey
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Cift A, Yucel MO. Comparison of inflammatory markers between brucella and non-brucella epididymo-orchitis. Int Braz J Urol 2018; 44:771-778. [PMID: 29697933 PMCID: PMC6092658 DOI: 10.1590/s1677-5538.ibju.2018.0004.0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/26/2018] [Indexed: 11/30/2022] Open
Abstract
Objectives: Brucellosis is a multi-system infectious disease that is associated with inflammation, which causes an increase in acute phase reactants. Hematological inflammatory markers of brucellosis include mean platelet volume (MPV), red cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR). In this study, we aimed to evaluate the diagnostic value of hematological inflammatory markers in Brucella epididymo-orchitis (BEO), and to investigate the utility of these markers for differential diagnosis from non-Brucella epididymo-orchitis (non-BEO). Materials and Methods: We retrospectively reviewed the records of 22 BEO and 50 non-BEO patients. Hematological parameters were recorded and compared between the two groups. The main diagnostic criteria for BEO were positive clinical findings (i.e., testicular pain, tenderness and scrotal swelling), a positive Rose Bengal test result, standard tube agglutination (STA) titer ≥ 1/160, and/or a positive blood culture. Results: The most decisive factors in discriminating between BEO and non-BEO were NLR, RDW, and MPV, in decreasing order of their strength. Regardless of other factors, NLR values < 2.3 significantly increased the odds of BEO (OR=8.080, 95% CI: 1.929-33.843, p=0.004). After adjusting for other factors, RDW values >14.45% significantly increased the odds of BEO (OR=7.020, 95% CI: 1.749-28.176, p=0.006). Independent of the other factors, patients with MPV < 7.65 fL had a 6.336 times higher risk for BEO (95% CI: 1.393 - 28.822, p=0.017). Conclusion: Hematological inflammatory markers such as NLR, RDW, and MPV can aid in the differential diagnosis of BEO and non-BEO.
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Affiliation(s)
- Ali Cift
- Department of Urology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Mehmet Ozgur Yucel
- Department of Urology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
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Cloning, expression and purification of virB10 protein of Brucella melitensis and evaluation of its role as a serological marker for Brucella infection in experimental and natural host. Protein Expr Purif 2018; 145:53-58. [PMID: 29305897 DOI: 10.1016/j.pep.2017.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/13/2017] [Accepted: 12/30/2017] [Indexed: 01/18/2023]
Abstract
Brucellosis is a zoonotic disease caused by various species of the genus Brucella. The control of this disease mainly depends on its accurate and early diagnosis. Culture methods employed for diagnosis are time consuming and require well equipped biosafety level 3 laboratories and hence serological tests are favored alternative for brucellosis diagnosis. At present serological diagnosis is based on LPS (lipopolysaccharide) which is less specific as it shows cross reactivity with other gram-negative bacteria. There is a need to develop serological diagnostic assay based on purified recombinant antigen of Brucella. T4SS (Type IV Secretion System) is an important virulent factor of Brucella and required for infection suggesting their expression in vivo and can be targeted as serological marker for infection. To test this concept, the present study is designed to clone, express and purify virB10 gene of Brucella T4SS under denaturing conditions and to evaluate its use as serological marker of Brucella infection. The immunoreactivity of this recombinant antigen was checked with antisera collected after experimental infection in Balb/C mice with B. melitensis 16M, BR31 (human clinical isolate) and Y. enterocolitica O:9. The recombinant protein was also tested against a panel of 46 bovine sera samples collected from Leh, India. Antibody response against VirB10 was detected in experimental and natural host suggesting that it can be explored as potential target for serodiagnosis of Brucella infection.
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Osman AY, Saharee AA, Jesse FF, Kadir AA. Comparative study of immunopathophysiological responses induced by B. melitensis and its lipopolysaccharide in mouse model infected via intranasal route of exposure. Microb Pathog 2017; 110:365-374. [DOI: 10.1016/j.micpath.2017.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 07/06/2017] [Accepted: 07/10/2017] [Indexed: 11/24/2022]
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Bosilkovski M, Kamiloski V, Miskova S, Balalovski D, Kotevska V, Petrovski M. Testicular infection in brucellosis: Report of 34 cases. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2016; 51:82-87. [PMID: 27036087 DOI: 10.1016/j.jmii.2016.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/09/2015] [Accepted: 02/01/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND/PURPOSE To present clinical and laboratory features, treatment options, and outcome in patients with brucellar testicular infection and to compare them with analogous in brucellar patients without testicular involvement. METHODS Thirty four brucellar patients with testicular infection treated in two general hospitals in the Republic of Macedonia, during the period 1998-2009, were retrospectively analyzed. Their clinical and laboratory characteristics were compared with analogous in 364 male brucellar patients without testicular infection, who were treated at the same hospitals during the same time period. RESULTS Brucellar testicular infection was evident in 34 (8.5%) out of 398 male patients with brucellosis. The median age of the patients was 46.5 years. In all patients testicular involvement was presented as an acute form with a median duration of 5 days (range, 2-14 days) prior to diagnosis. Twenty-three of the patients had at least one other simultaneous focal infection. After starting with the treatment testicular infection lasted a median 10 days, range 7-21 days. Brucellar patients with testicular infection when compared with other brucellar patients more frequently manifested fever (97% vs. 61%), concomitant spondylitis (32% vs. 16%), and urinary system involvement (12% vs. 2%). Also, the relapse rate in patients with testicular involvement was significantly higher (24% vs. 9%). CONCLUSION In endemic regions brucellosis should be taken into consideration in any patient with testicular infection. Brucellar testicular involvement is usually characterized with a severe acute clinical presentation and a high percentage of relapses which entails the need of timely recognition and proper treatment duration of at least 60 days.
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Affiliation(s)
- Mile Bosilkovski
- Medical Faculty "Ss Cyril and Methodius University", Skopje, Macedonia.
| | - Viktor Kamiloski
- Medical Faculty "Ss Cyril and Methodius University", Skopje, Macedonia
| | - Silvana Miskova
- Department for Infectious Diseases, Medical Center, Veles, Macedonia
| | - Danco Balalovski
- Department for Infectious Diseases, Medical Center, Bitola, Macedonia
| | - Vesna Kotevska
- Medical Faculty "Ss Cyril and Methodius University", Skopje, Macedonia; Institute for Clinical Microbiology, Skopje, Macedonia
| | - Mile Petrovski
- Medical Faculty "Ss Cyril and Methodius University", Skopje, Macedonia
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Ismayilova R, Nasirova E, Hanou C, Rivard RG, Bautista CT. Patterns of brucellosis infection symptoms in azerbaijan: a latent class cluster analysis. J Trop Med 2014; 2014:593873. [PMID: 25580137 PMCID: PMC4279714 DOI: 10.1155/2014/593873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 11/27/2014] [Indexed: 12/14/2022] Open
Abstract
Brucellosis infection is a multisystem disease, with a broad spectrum of symptoms. We investigated the existence of clusters of infected patients according to their clinical presentation. Using national surveillance data from the Electronic-Integrated Disease Surveillance System, we applied a latent class cluster (LCC) analysis on symptoms to determine clusters of brucellosis cases. A total of 454 cases reported between July 2011 and July 2013 were analyzed. LCC identified a two-cluster model and the Vuong-Lo-Mendell-Rubin likelihood ratio supported the cluster model. Brucellosis cases in the second cluster (19%) reported higher percentages of poly-lymphadenopathy, hepatomegaly, arthritis, myositis, and neuritis and changes in liver function tests compared to cases of the first cluster. Patients in the second cluster had a severe brucellosis disease course and were associated with longer delay in seeking medical attention. Moreover, most of them were from Beylagan, a region focused on sheep and goat livestock production in south-central Azerbaijan. Patients in cluster 2 accounted for one-quarter of brucellosis cases and had a more severe clinical presentation. Delay in seeking medical care may explain severe illness. Future work needs to determine the factors that influence brucellosis case seeking and identify brucellosis species, particularly among cases from Beylagan.
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Affiliation(s)
| | - Emilya Nasirova
- Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Colleen Hanou
- Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Robert G. Rivard
- U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA
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Savasci U, Zor M, Karakas A, Aydin E, Kocaaslan R, Oren NC, Coskun O, Turhan V, Gul HC, Cicek AF, Aydur E, Eyigun CP. Brucellar epididymo-orchitis: a retrospective multicenter study of 28 cases and review of the literature. Travel Med Infect Dis 2014; 12:667-72. [PMID: 25457303 DOI: 10.1016/j.tmaid.2014.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 08/03/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To review retrospectively the clinical symptoms, laboratory findings and treatment outcomes of patients with Brucellar epididymo-orchitis. MATERIAL AND METHOD Retrospective data of 28 patients with Brucellar epididymo-orchitis who admitted to four medical centers between 2005 and 2013 were retrospectively reviewed. Positive blood culture, positive Rose Bengal test results or high agglutination titres of ≥ 1/160 with the positive clinical and ultrasonographic findings of orchitis were accepted as the main criteria for Brucellar epididymo-orchitis. RESULTS The mean patient age was 31 ± 16.9 years. Testicular involvement was on the left side in 16 patients and on the right side in 11 patients, one had bilateral disease. Testicular pain and swelling were the most common symptoms and elevation of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and leucocytosis were the most common laboratory findings. Initial treatment was orchidectomy in six patients due to malignancy suspicion. All but three patients were successfully treated with antibiotic combinations of rifampicin, doxycycline and streptomycin. Two of three treatment resistant patients underwent orchidectomy. CONCLUSION Brucellosis is a common cause of epididymo-orchitis in endemic regions. Early diagnosis and treatment is crucial in the management and thus it must be kept in mind in endemic and non-endemic regions.
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Affiliation(s)
- Umit Savasci
- Sarıkamış Military Hospital, Department of Infectious Diseases and Clinical Microbiology, Kars, Turkey
| | - Murat Zor
- Sarıkamış Military Hospital, Department of Urology, Kars, Turkey.
| | - Ahmet Karakas
- Gulhane Military Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Emsal Aydin
- Kafkas Application and Research Hospital of Medicine Faculty, Department of Infectious Diseases and Clinical Microbiology, Kars, Turkey
| | - Ramazan Kocaaslan
- Kafkas Application and Research Hospital of Medicine Faculty, Department of Urology, Kars, Turkey
| | - N Cem Oren
- Sarıkamış Military Hospital, Department of Radiology, Kars, Turkey
| | - Omer Coskun
- Gulhane Military Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Vedat Turhan
- GATA Haydarpasa Training Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - H Cem Gul
- Gulhane Military Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - A Fuat Cicek
- Gulhane Military Hospital, Department of Pathology, Ankara, Turkey
| | - Emin Aydur
- Gulhane Military Hospital, Department of Urology, Ankara, Turkey
| | - Can Polat Eyigun
- Gulhane Military Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
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Garshasbi M, Ramazani A, Sorouri R, Javani S, Moradi S. Molecular detection of Brucella species in patients suspicious of Brucellosis from Zanjan, Iran. Braz J Microbiol 2014; 45:533-8. [PMID: 25242938 PMCID: PMC4166279 DOI: 10.1590/s1517-83822014005000048] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 09/09/2013] [Indexed: 11/21/2022] Open
Abstract
Brucella is an intracellular pathogen capable of infecting animals and humans. The aim of this study was to identify Brucella spp in sera of high risk individuals by a polymerase chain reaction (PCR)-based method. A total of 180 patients suspected to have Brucellosis were examined by serological tests. To establish a PCR protocol for diagnosis of active brucellosis, DNA was extracted from the serum samples by using a commercial kit. PCR amplification was done for detection of Brocella DNA using BCSP31 target gene and IS711 locus. The PCR assay showed that an amplicon of 223 bp was obtained in 73.8% (133/180) of the tested sera using primers (B4/B5) derived from a gene encoding the 31-kDa Brucella abortus antigen. In another PCR, an amplicon of 498 bp was obtained in 63.8% (115/180) of the samples using Brucella abortus-specific primers derived from a locus adjacent to the 3'-end of IS711, and also an amplicon of 731 bp was produced in 4.4% (8/180) of the tested samples using Brucella melitensis-specific primers. When the Wright method was used as a gold standard, the sensitivity and specificity of the PCR technique for genus identification were found to be 96 and 80.7%, respectively. However, the sensitivity value obtained with the species-specific PCR method was 82%, and specificity was similar to that previous reported. This is the first report of a high frequency of Brucella abortus in patients suspicious of Brucellosis from the Zanjan province.
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Affiliation(s)
- Maryam Garshasbi
- Department of Microbiology Faculty of Medical and Basic Sciences Islamic Azad University Zanjan Iran Department of Microbiology, Faculty of Medical and Basic Sciences, Islamic Azad University, Zanjan, Iran
| | - Ali Ramazani
- Biotechnology Department, School of Pharmacy Zanjan University of Medical Sciences Zanjan Iran Biotechnology Department, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Rahim Sorouri
- Molecular Biology Research Center Baqiyatallah University of Medical Sciences Tehran Iran Molecular Biology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Siamak Javani
- Biotechnology Department, School of Pharmacy Zanjan University of Medical Sciences Zanjan Iran Biotechnology Department, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Soheila Moradi
- Department of Microbiology Faculty of Medical and Basic Sciences Islamic Azad University Zanjan Iran Department of Microbiology, Faculty of Medical and Basic Sciences, Islamic Azad University, Zanjan, Iran
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Epididymoorchitis as the first finding in patients with brucellosis. Adv Urol 2013; 2013:765023. [PMID: 24454352 PMCID: PMC3888676 DOI: 10.1155/2013/765023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 10/15/2013] [Indexed: 11/22/2022] Open
Abstract
Purpose. Acute scrotal pain as the first symptom of brucellosis is rarely observed. We aimed to evaluate the data of male patients with brucellosis and epididymoorchitis as the initial diagnosis. Material and Methods. The data of seven patients presented with testicular pain, hyperemia, swelling, and increased fever were reviewed. Concomitant focal diseases as well as clinical, laboratory, and radiological findings were retrospectively evaluated. Results. The mean age of the patients was 22.28 ± 7.78 (16–35) years. All patients presented with scrotal pain, swelling, and increased sweating. Additional findings included fever, asthenia, arthralgia, dysuria, shiver and rash, weight loss, and vomiting in 6, 5, 4, 4, 3, 2, and 1 patient, respectively. In all of 7 patients, the agglutination tests of Rose-Bengal and Wright were positive. Coombs test was positive only in 3 patients. The patients underwent antibiotic and conservative treatment. No relapse was observed following the treatment. Conclusion. In endemic regions, epididymoorchitis caused by brucellosis should be considered in the differential diagnosis of patients presenting with acute scrotal pain. Clinical and serological findings are sufficient for the diagnosis. Conservative management combined with antibiotic therapy is adequate for managing brucellar epididymoorchitis.
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Dean AS, Crump L, Greter H, Hattendorf J, Schelling E, Zinsstag J. Clinical manifestations of human brucellosis: a systematic review and meta-analysis. PLoS Negl Trop Dis 2012; 6:e1929. [PMID: 23236528 PMCID: PMC3516581 DOI: 10.1371/journal.pntd.0001929] [Citation(s) in RCA: 273] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 10/15/2012] [Indexed: 12/13/2022] Open
Abstract
Background The objectives of this systematic review, commissioned by WHO, were to assess the frequency and severity of clinical manifestations of human brucellosis, in view of specifying a disability weight for a DALY calculation. Methods/Principal Findings Thirty three databases were searched, with 2,385 articles published between January 1990–June 2010 identified as relating to human brucellosis. Fifty-seven studies were of sufficient quality for data extraction. Pooled proportions of cases with specific clinical manifestations were stratified by age category and sex and analysed using generalized linear mixed models. Data relating to duration of illness and risk factors were also extracted. Severe complications of brucellosis infection were not rare, with 1 case of endocarditis and 4 neurological cases per 100 patients. One in 10 men suffered from epididymo-orchitis. Debilitating conditions such as arthralgia, myalgia and back pain affected around half of the patients (65%, 47% and 45%, respectively). Given that 78% patients had fever, brucellosis poses a diagnostic challenge in malaria-endemic areas. Significant delays in appropriate diagnosis and treatment were the result of health service inadequacies and socioeconomic factors. Based on disability weights from the 2004 Global Burden of Disease Study, a disability weight of 0.150 is proposed as the first informed estimate for chronic, localised brucellosis and 0.190 for acute brucellosis. Conclusions This systematic review adds to the understanding of the global burden of brucellosis, one of the most common zoonoses worldwide. The severe, debilitating, and chronic impact of brucellosis is highlighted. Well designed epidemiological studies from regions lacking in data would allow a more complete understanding of the clinical manifestations of disease and exposure risks, and provide further evidence for policy-makers. As this is the first informed estimate of a disability weight for brucellosis, there is a need for further debate amongst brucellosis experts and a consensus to be reached. Brucellosis is a bacterial disease transmitted to humans by consumption of infected, unpasteurised animal milk or through direct contact with infected animals, particularly aborted foetuses. The livestock production losses resulting from these abortions have a major economic impact on individuals and communities. Infected people often suffer from a chronic, debilitating illness. This systematic review on the symptoms of human brucellosis is the first ever conducted. Using strict exclusion criteria, 57 scientific articles published between January 1990–June 2010 which included high quality data were identified. Severe complications of brucellosis infection were not rare, with 1 case of endocarditis and 4 neurological cases per 100 patients. One in 10 men suffered from testicular infection, which can case sterility. Debilitating conditions such as joint, muscle, and back pain affected around half of the patients. Given that most patients had fever, brucellosis poses a diagnostic challenge in malaria-endemic areas where fever is often assumed to be malaria. More high quality data is needed for a more complete understanding of the clinical manifestations of disease and exposure risks, and to provide further evidence for policy-makers.
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Affiliation(s)
- Anna S. Dean
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Lisa Crump
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Helena Greter
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Jan Hattendorf
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Esther Schelling
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Jakob Zinsstag
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
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Tsu JHL, Law DMC, Lo AKL, Chiu Y, Chan SWH, Liu PL. Epididymo-orchitis due to Brucella melitensis: A case report in a nonendemic area and review of the literature. SURGICAL PRACTICE 2011. [DOI: 10.1111/j.1744-1633.2011.00559.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Najafi N, Ghassemian R, Davoody AR, Tayebi A. An unusual complication of a common endemic disease: clinical and laboratory aspects of patients with brucella epididymoorchitis in the north of Iran. BMC Res Notes 2011; 4:286. [PMID: 21834966 PMCID: PMC3170334 DOI: 10.1186/1756-0500-4-286] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 08/11/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brucella epididymoorchitis(BEO) is a focal complication of human brucellosis and has been reported in 2-20% of patients with brucellosis. Brucellosis is an endemic disease in Iran. The incidence of the disease in this country is 34 per 100 000 per year. METHODS In a retrospective study, we identified 30 cases of Brucella epididymoorchitis in two teaching hospitals in the north of Iran during 1997-2009. FINDINGS Epididymoorchitis occurred in 11.1% of male patients with brucellosis. The average age was 25.5 ± 12.43 years. Pain and scrotal swelling (100%) and fever (96.7%) were the most common symptoms. Different treatment regimens were administered including doxycycline plus rifampin (60%), doxycycline plus rifampin plus aminoglycoside for the first two weeks (36.6%) and doxycycline plus cotrimoxazole(3.4%). Ten percent of the patients did not respond to antibiotic therapy and required surgical drainage or orchiectomy. CONCLUSIONS In brucellosis endemic areas, clinicians who encounter patients with epididymoorchitis should consider the likelihood of brucellosis. A careful history and physical examination and an immediate laboratory evaluation help to make a correct diagnosis. Generally, classical therapy of brucellosis is adequate for the treatment of epididymoorchitis.
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Affiliation(s)
- Narges Najafi
- Department of infectious disease, North Iranian tropical and infectious disease research center, Mazandran university of medical sciences, Iran.
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Celen MK, Ulug M, Ayaz C, Geyik MF, Hosoglu S. Brucellar epididymo-orchitis in southeastern part of Turkey: an 8 year experience. Braz J Infect Dis 2010. [DOI: 10.1016/s1413-8670(10)70021-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Hasanjani Roushan MR, Baiani M, Javanian M, Kasaeian AA. Brucellar epididymo-orchitis: Review of 53 cases in Babol, northern Iran. ACTA ACUST UNITED AC 2009; 41:440-4. [DOI: 10.1080/00365540902968043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hadadi A, Rasoulinejad M, HajiAbdolbaghi M, Mohraz M, Khashayar P. Clinical profile and management of brucellosis in Tehran - Iran. Acta Clin Belg 2009; 64:11-5. [PMID: 19317236 DOI: 10.1179/acb.2009.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Brucellosis is one of the most frequent infectious diseases in many regions of Iran. The purpose of this study was to evaluate different clinical, laboratory and therapeutic aspects of this disease. METHOD This retrospective descriptive study was performed on patients referred to two teaching hospitals in Tehran/Iran with brucellosis diagnosis during the years 1998 - 2005. Patients' signs and symptoms, laboratory findings and clinical responses were evaluated during the study period. RESULTS More than half of the 415 patients enrolled in this study were female. The duration of the symptoms was reported to be less than 2 months in 83.85% of the patients prior to being examined in our centre. While sweating and fever were the most common symptoms, peripheral arthritis, sacroiliitis and splenomegaly were the most frequently reported signs. Rifampin plus cotrimoxazole was the most common regimen administered in these cases (32%) and relapse was also more frequently seen in this group of patients (13.8%), whilst doxycycline and cotrimoxazole led to the least number of relapses (2.5%). CONCLUSIONS Brucellosis is known to have various manifestations, so it should be considered as one of the differential diagnoses of any patient referred with different organs involvement accompanied with or without fever. Relapse is one of the complications reported even following an appropriate treatment.
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Affiliation(s)
- A Hadadi
- Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Brucella glomerulonephritis resulting in end-stage renal disease: a case report and a brief review of the literature. Int Urol Nephrol 2008; 40:529-33. [DOI: 10.1007/s11255-007-9311-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Accepted: 11/19/2007] [Indexed: 10/22/2022]
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