Detection of Brucellae in blood cultures

In Silico Analysis of a Candidate Multi-epitope Peptide Vaccine Against Human Brucellosis

Brucellosis is one of the neglected endemic zoonoses in the world. Vaccination appears to be a promising health strategy to prevent it. This study used advanced computational techniques to develop a potent multi-epitope vaccine for human brucellosis. Seven epitopes from four main brucella species that infect humans were selected. They had significant potential to induce cellular and humoral responses. They showed high antigenic ability without the allergenic characteristic. In order to improve its immunogenicity, suitable adjuvants were also added to the structure of the vaccine. The physicochemical and immunological properties of the vaccine were evaluated. Then its two and three-dimensional structure was predicted. The vaccine was docked with toll-like receptor4 to assess its ability to stimulate innate immune responses. For successful expression of the vaccine protein in Escherichia coli, in silico cloning, codon optimization, and mRNA stability were evaluated. The immune simulation was performed to reveal the immune response profile of the vaccine after injection. The designed vaccine showed the high ability to induce immune response, especially cellular responses to human brucellosis. It showed the appropriate physicochemical properties, a high-quality structure, and a high potential for expression in a prokaryotic system.

Brucellosis an Unusual presentation as isolated septic mono-arthritis of the knee joint: A case report

Brucellosis is a zoonotic infection that is widely spread across the world. It is becoming more common in Middle Eastern countries such as Qatar, Saudi Arabia, and the Mediterranean region. Despite this, we need to remain vigilant as it is still prevalent in many parts of the world. The most common presentation is musculoskeletal, but it can also present as septic arthritis in the sacroiliac, hip, or knee joints. Brucella melitensis was only found in one extended culture of synovial fluid. Treatment involved a combination of antimicrobial therapy using gentamycin, doxycycline, and rifampin. A high level of suspicion for brucellosis is necessary for any patient coming from an endemic region with non-specific and chronic arthritis to ensure early diagnosis and treatment. In this case, we present a 28-year-old male who was diagnosed with Brucellosis after developing acute septic arthritis.

Exploring the Complex Landscape of Spine Brucellosis

INTRODUCTION

Brucellosis is an infectious illness contracted by humans through the consumption of unpasteurized milk and dairy items. Brucella organisms are diminutive, gram-negative, non-motile, and non-spore-forming facultative intracellular, aerobic intracellular coccobacilli residing within the reproductive organs of host animals, leading to conditions such as abortions and sterility. Numerous species of Brucella have been identified, with the following four exhibiting varying degrees of pathogenicity in humans: Brucella melitensis (originating from sheep), Brucella suis (associated with pigs), Brucella abortus (linked to cattle), and Brucella canis (found in dogs). B. melitensis and B. suis demonstrate the highest level of pathogenicity, while B. abortus and B. canis exhibit a more moderate degree of pathogenicity. The illness can progress to systemic involvement, with the musculoskeletal system being particularly susceptible to complications. Spinal epidural abscess is an infrequent complication that may occur during spondylitis caused by Brucella species. Epidural abscesses most commonly affect the lumbar vertebrae, while their involvement in the cervical spine is relatively rare.

OBJECTIVE

In this review, we explore spine brucellosis, covering its epidemiology, pathogenesis, clinical manifestations, diagnostics, and evolving treatments. We aim to enhance early detection, timely intervention, and patient outcomes.

PATIENTS AND METHODS

This retrospective chart analysis was conducted by revising all medical files for patients in whom spinal brucellosis was diagnosed and managed.

RESULTS

This study was conducted at King Hussein Medical Center (KHMC), Jordan, and included a total of 20 patients who were diagnosed with spine brucellosis during the study period. Within the final cohort, 65% of the patients were male (13/20), with an average age at diagnosis of 47.53±14.98 years (ranging from 4 to 61 years). The female group, on the other hand, had an average age at diagnosis of 51.12±15.55 years (ranging from 3 to 58 years). Statistical analysis of the data revealed no significant demographic differences between the two groups. Regarding the co-morbidities, no statistical differences were observed between the two groups. Examining the occupational status of the two groups, no differences were observed. Also, no differences were observed between the two groups regarding the residence place, or the spinal segment involved.

CONCLUSION

Spine brucellosis, although uncommon, poses a complex clinical challenge. Early diagnosis and a multidisciplinary approach are crucial for effective management. Further research is needed to refine diagnostic tools and treatment guidelines for spine brucellosis.

A novel, highly sensitive, one-tube nested quantitative real-time PCR for Brucella in human blood samples

IMPORTANCE

This study developed a highly sensitive and efficient method for the detection of brucellosis by introducing a one-tube nested quantitative real-time PCR (qPCR) approach, representing a remarkable advance in the field. The method demonstrated an impressive analytical sensitivity of 100 fg/μL, surpassing conventional qPCR and enabling the detection of even low levels of Brucella DNA. In addition, the study's comprehensive evaluation of 250 clinical samples revealed a specificity of 100% and a sensitivity of 98.6%, underscoring its reliability and accuracy. Most importantly, the new method significantly improved the detection rate of low-burden samples, reducing cycle threshold values by an average of 6.4. These results underscore the immense potential of this approach to facilitate rapid and accurate brucellosis diagnosis, which is critical for effective disease management and control.

Case Report: Metagenomic Next-Generation Sequencing Confirmed a Case of Spine Infection with Brucella melitensis in Non-Endemic Area

Brucellosis is a zoonotic disease caused by Brucella spp., with the highest prevalence found in the northern cities of China. In this case report, we present an occurrence of spinal infection caused by B. melitensis in a 67-year-old man residing in a non-endemic area of southern China. The patient initially presented with chest and back pain, which was not accurately diagnosed and treated at a local hospital. Subsequently, due to worsening pain, he was admitted to our hospital. To determine the cause of the infection, we performed CT-guided aspiration biopsy and collected biopsy tissue for metagenomic next-generation sequencing (mNGS) on the second day of hospitalization. Imaging investigations revealed involvement of the thoracic vertebrae, specifically thoracic 4-7 with the main focus on 5-6, accompanied by stenosis of the intervertebral space. The mNGS results indicated that the spine infection was caused by B. melitensis. The patient's history as a shepherd and a positive Rose Bengal plate test (RBPT) further supported the diagnosis of brucella spondylitis. In order to alleviate pain and restore spinal function, the patient underwent posterior internal fixation of the thoracic spine. Treatment was initiated with cefoperazone/sulbactam, followed by doxycycline. Subsequently, the patient was switched to a combination therapy of rifampicin and doxycycline for a duration of six weeks. The patient responded well to treatment, and his condition remained stable. In conclusion, brucellosis is a common disease that can be easily misdiagnosed. This case report highlights the potential value of mNGS in early and rapid diagnosis. We believe that mNGS can serve as an effective tool to improve the diagnosis of spine infections caused by this pathogen.

Hepatobiliary Brucellosis: Brucella Bacteremia Presenting with Refractory Hepatobiliary Infection

Brucellosis often presents with common and nonspecific symptoms such as fever, malaise, and arthralgia but can also involve primary organs. Intra-abdominal involvement is rare. We report a case of hepatobiliary brucellosis presenting as a refractory hepatobiliary infection in a healthy young adult with no underlying rheumatologic disease or history of exposure to risk factors. Detection of Brucella in the blood led to a shift in the patient's management and consequently her recovery.

High Seropositivity of Brucella melitensis Antibodies among Pregnant Women Attending Health Care Facilities in Mwanza, Tanzania: A Cross-Sectional Study

Background

Brucellosis is one of the most prevalent zoonotic neglected tropical diseases across the globe. Brucella melitensis (B. melitensis), the most pathogenic species is responsible for several pregnancy adverse outcomes in both humans and animals. Here, we present the data on the magnitude of B. melitensis antibodies among pregnant women in Mwanza, Tanzania, the information that might be useful in understanding the epidemiology of the disease and devising appropriate control interventions in this region. Methodology. A hospital-based cross-sectional study involving pregnant women was conducted at two antenatal clinics in Mwanza between May and July 2019. The pretested structured questionnaire was used for data collection. Blood samples were collected aseptically from all consenting women followed by the detection of B. melitensis antibodies using slide agglutination test. Descriptive data analysis was done using STATA version 17.

Results

A total of 635 pregnant women were enrolled with the median age of 25 (interquartile range (IQR): 16-48) years and median gestation age of 21 (IQR: 3-39) weeks. Seropositivity of B. melitensis antibodies was 103 (16.2 (95% CI:13.3-19.1)). On the multivariate logistic regression analysis, as the gestation age increases, the odds of being seropositive decreases (aOR:0.972 (95% CI: 0.945-0.999), P = 0.045). Furthermore, being a housewife (aOR:3.902 (95% CI:1.589-9.577), P = 0.003), being employed (aOR:3.405 (95% CI:1.412-8.208), P = 0.006), and having history of miscarriage (aOR:1.940 (95% CI:1.043-3.606), P = 0.036) independently predicted B. melitensis seropositivity among pregnant women in Mwanza.

Conclusion

High seropositivity of B. melitensis was observed among employed and housewife pregnant women in Mwanza. This calls for the need of more studies in endemic areas that might lead to evidence-based control interventions.

Predicting Factors of Brucella melitensis Bacteremia in Children Admitted with Brucellosis

Objective Brucellosis is the most common zoonotic disease. Isolation of Brucella melitensis in blood culture is accepted as the gold standard for diagnosis. This study aims to determine the predictive factors of B. melitensis bacteremia in pediatric patients followed up with brucellosis.

Methods Two-hundred twenty pediatric brucellosis patients were included in the study. The epidemiological, clinical, and laboratory data were recorded.

Results The patients comprised 63.2% males and 36.8% females with a mean age of 10.45 ±  4.36 years (range, 1–18 years), and 70.5% were younger than 14 years old. B. melitensis was isolated in the blood culture in 33.6% of patients. In the epidemiological history of pediatric patients with bacteremic brucellosis, there was a history of dealing with, owning, or working with livestock. In patients with brucellosis, fever and weight loss, hepatomegaly, and arthritis were more common in patients with bacteremia than in those without bacteremia. Among laboratory findings, leukopenia, low albumin value, and high C-reactive protein were calculated as predictors of Brucella bacteremia in patients with brucellosis.

Conclusion In regions where brucellosis is endemic, serum agglutination tests may be positive without clinical findings. Brucellosis can mimic many other diseases, so the definitive diagnosis is demonstrated by bacteremia. Blood cultures should be taken in patients with predictive factors suggestive of brucellosis.

Endovascular Stent Graft Repair for Mycotic Aorto-Iliac Aneurysm Due to Brucella

PURPOSE

Brucella aneurysms are very rare but life-threatening, and a standard treatment approach has yet to be established. The current study aimed to assess the safety and efficacy of endovascular treatment for Brucella aneurysms.

MATERIALS AND METHODS

The clinical data of 15 Brucella aortic-iliac aneurysm patients who underwent endovascular repair at 2 hospitals from January 2012 to December 2021 were retrospectively collected and analyzed.

RESULTS

Fifteen patients (12 men and 3 women) with a mean age of 59.3 years were included. Fourteen patients (93.3%) had a history of exposure to animals (cattle and sheep). All patients had aortic or iliac pseudoaneurysms, 9 abdominal aortic aneurysms (AAAs), 4 iliac aneurysms, and 2 AAA combined with iliac aneurysms. Endovascular aneurysm repair (EVAR) was performed in all patients without conversion to open surgery. Six cases were treated for emergency surgery due to aneurysm rupture. The immediate technique success rate was 100%, with no postoperative death. Two cases had the iliac artery ruptured again after operation because of lack of antibiotic treatment and was given endovascular treatment again. Once brucellosis is diagnosed, antibiotic treatment with doxycycline and rifampicin was initiated for all the patients until 6 months after operation. All patients survived over a median follow-up period of 45 months. Follow-up computed tomography angiography showed that all stent grafts remained patent, with no endoleak.

CONCLUSION

EVAR combined with antibiotics treatment is feasible, safe, and effective for Brucella aneurysms and represents a promising treatment option for these Brucella aneurysms.

CLINICAL IMPACT

Brucella aneurysms are very rare but life-threatening, and a standard treatment approach has yet to be established. The traditional operation management strategy is surgical resection and debridement of the infected aneurysm and the surrounding tissues. However, open surgical management in these patients causes severe trauma with high surgical risks and mortality (13.3%-40%). We tried to treat Brucella aneurysms with endovascular therapy, and the technique success and survival rate of the operation reached 100%. EVAR combined with antibiotics treatment is feasible, safe, and effective for Brucella aneurysms and represents a promising treatment option for some mycotic aneurysms.

Pediatric neurobrucellosis: a systematic review with case report

Pediatric neurobrucellosis represents a common anthropozoonosis in endemic areas but only anecdotal reports are available till date. Using appropriate search terms in the database platforms of MEDLINE, SCOPUS and Web of Sciences, we performed a systematic review of all the cases of pediatric neurobrucellosis published in the medical literature till date, in the light of a case report. The protocol was registered under PROSPERO (CRD42022333907). Our search strategy yielded 187 citations of which 51 citations were included. A total of 119 cases were reviewed. Of these cases, eight of them had insufficient data. The most common presentation was meningitis with or without encephalitis (n = 79, 71.2%). A high prevalence of cranial neuropathies (n = 22, 20.7%) was observed in the pediatric population in which abducens palsy was the most common (n = 9, 8.1%). Diagnosis was based on multimodal investigations including standard agglutination test (n = 44, 39.6%), Rose Bengal test (n = 37, 33.3%), blood culture (n = 23, 20.7%), serology (n = 20, 18.0%) and cerebrospinal fluid (CSF) culture (n = 11, 9.9%). Rifampicin-based triple drug regimen was the most commonly employed (83/102, 81.4%). Pediatric neurobrucellosis was associated with greater frequency of sequalae (5.4%), deafness (2.7%) and mortality (2.7%), when compared to that of general population. Neurobrucellosis mimics neuro-tuberculosis in various aspects. The review highlights several unique aspects of this entity in children. A high index of suspicion can ensure prompt diagnosis, timely initiation of management and favorable outcomes.

Brucellosis unusually presented as septic knee arthritis: A case report

Brucellosis is one of the world's most prevalent zoonotic illnesses. The most often afflicted joints are the sacroiliac joints, although spondylitis and peripheral arthritis are becoming increasingly prevalent. We described a case of a 40‐year‐old male patient with Brucellosis presented as septic knee arthritis.

Molecular characterization of Brucella spp. from seropositive herds of cattle farmed at the wildlife-livestock-human interface in Rwanda

Seroprevalence studies showed that brucellosis is prevalent in cattle in Rwanda with no recent study on the characterization of Brucella spp. Therefore, this study aimed to characterize Brucella spp. in seropositive herds of cattle farmed at the wildlife–livestock–human interface. Whole blood samples (n = 118), milk (n = 41), and vaginal swabs (n = 51) were collected from 64 seropositive herds. All samples (n = 210) were inoculated onto modified Centro de Investigacion y Tecnologia Agroalimentaria (CITA) selective medium. Cultures were analyzed to detect Brucella spp. using 16S−23S ribosomal DNA interspacer region (ITS) PCR, the Brucella cultures were speciated using AMOS and Bruce-ladder PCR assays. Brucella spp. were detected in 16.7% (35/210) of the samples established from the samples using ITS-PCR. The AMOS PCR assay identified mixed Brucella abortus and B. melitensis (n = 6), B. abortus (n = 7), and B. melitensis (n = 1) from cultures from blood samples; mixed B. abortus and B. melitensis (n = 1) and B. abortus (n = 4) from cultures from milk samples; mixed B. abortus and B. melitensis (n = 6), B. abortus (n = 8), and B. melitensis (n = 1) from cultures from vaginal swabs. Bruce-ladder PCR assay confirmed B. abortus and B. melitensis cultures. The isolation of Brucella spp. was significantly associated with districts, with the Nyagatare district having more isolates than other districts (p = 0.01). This study identified single or mixed B. abortus and B. melitensis infections in cattle samples in Rwanda, which emphasizes the need to improve brucellosis control at the wildlife–livestock–human interface and raise the awareness of cattle keepers, abattoir workers, laboratory personnel, and consumers of cattle products.

An Uncommon Case of Brucellar Spondylodiscitis: A Case Report

Introduction

Infective spondylodiscitis refers to simultaneous inflammation of vertebrae and disc and usually occurs through hematogenous spread. The most common presentation of brucellosis is febrile illness, but it can rarely present as spondylodiscitis. Rarely, human cases of brucellosis are diagnosed and treated clinically. We describe a case of previously healthy man in his early 70s who presented with symptoms suggestive of spinal tuberculosis, then diagnosed to have brucellarspondylodiscitis.

Case Report

A 72-year-old farmer presented to our orthopedic department with a history of chronic lower back pain. Spinal tuberculosis was suspected at a medical facilitynear his residence, based on magnetic resonance imaging consistent with infective spondylodiscitis, and the patient was referred to our hospital for further management. Investigations revealed that the patient had an uncommon diagnosis of Brucellar spondylodiscitis for which he was managed accordingly.

Conclusion

Brucellar spondylodiscitis may clinically mimic spinal tuberculosis; hence, it must be considered as a differential diagnosis in a patient presenting with the lower back pain (particularly in the elderly) and signs of a chronic infection. Screening serological testing is vital in early identification and management of spinal brucellosis.

Spinal brucellosis causing spondylodiscitis

Introduction

and Importance: Brucellosis is a common prevalent zoonotic disease in developing countries including Somalia. Brucellosis may affect many organs. However involvement in the spine and paravertebral muscles is common and may lead to diagnostic challenges since it presents with non-specific symptoms.

Case presentation

Here we report 18-year old male patient who presented with low back pain, low grade fever, difficult voiding and progressive lower extremity weakness for 5 months. The pain was localized to the lumbar vertebra (tender on palpation) and radiating to both lower limbs. There was slight weakness on the left lower limb (muscle power 3+/5). There were no associated sensory symptoms or deep tendon reflex abnormality. But he had mild urine retention.

Lumbar magnetic resonance imaging (MRI) revealed spondylodiscitis. Rose-Bengal test was positive for brucellosis. A Brucella standard tube agglutination test was positive at a titer of 1:64. Given the test results and the imaging finding, the patient was diagnosed with Spinal brucellosis. He was treated with oral doxycycline (100 mg, two times daily) and Rifampicin (600Mg) orally once daily for 6 months. Streptomycin was added during the first three weeks. The patient had massive improvement after 3 months of treatment, (the patient's symptoms almost disappeared).

Clinical discussion

Spinal brucellosis is characterized by the involvement of the vertebral column, interspinal spaces, and/or paraspinal areas. Its subacute or chronic forms typically affect the spinal column. Spinal brucellosis may cause Spondylitis, spondylodiscitis or epidural abscess causing spinal compression. This case presented with spondylodiscitis and was successfully treated without the need for surgical intervention.

Conclusions

Brucella spondylodiscitis, though uncommon and challenging, it should be kept in mind in the differential diagnosis of patients presenting with chronic back pain and lower extremity weakness living in endemic areas like Somalia. The duration of treatments should be prolonged in patients with worse physical condition.

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Spinal brucellosis is not uncommon cause of spondylodiscitis.

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Due to its non specific symptoms diagnosis can be challenging.

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It should be considered in the differential diagnosis especially for patient with chronic back pain living in endemic areas like Somalia.

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In this paper, we presented the case report of young man with spinal brucellosis who was treated successfully without the need for surgical intervention.

Diagnosis of brucellosis disease using data mining: A case study on patients of a hospital in Tehran

BACKGROUND

Brucellosis is a common zoonotic infection of humans from livestock. This bacterial infection is acquired from infected animals and their products. The pathogen of this disease is a genus of bacilli called Brucella, and no effective vaccine has been discovered yet for the prevention of human brucellosis.

OBJECTIVES

The present study is mainly conducted to diagnose brucellosis accurately and timely, using Data Mining techniques. Based on the knowledge discovered with Data Mining and opinions of specialist physicians, this study aims to propose instructions for diagnosing brucellosis.

MATERIALS AND METHODS

The dataset used in this study contains 340 samples and is extracted from the files of patients at Tehran Imam Khomeini Hospital from the years 2010-2020. Attributes of this dataset have been determined based on domain expert opinions, namely specialist physicians. After initial analysis and data pre-processing, various Data Mining techniques have been employed to diagnose brucellosis, including neural networks, Bayesian networks, and decision trees.

RESULTS

According to the recorded data, 270 people (approximately 79% of samples) had brucellosis. Some clinical symptoms were more prominent among infected patients, including fever, arthritis, tremor, decreased appetite, and nightly perspiration. Among all employed Data Mining techniques in this study, the decision tree with C5.0 pruning algorithm possessed the highest accuracy in diagnosing patients with brucellosis (approximately 99% accuracy). Based on the obtained final model, the most important factors for diagnosing brucellosis are the Wright test, Coombs Wright test, blood culture test, and living place.

DISCUSSION AND CONCLUSION

According to the results of this study, brucellosis can be diagnosed with a high accuracy using Data Mining techniques. Furthermore, the most significant factors for diagnosing brucellosis disease can be identified by Data Mining. Among all investigated techniques in this study, the decision tree with C5.0 pruning algorithm has the most accuracy in diagnosing brucellosis. Given the decision tree created by the C5.0 algorithm and the opinions of specialist physicians, some instructions are proposed based on a decision-making framework to classify referents into patient and non-patient groups. These instructions can accelerate the diagnosis, reduce therapeutic costs, and decrease treatment period.

Generation and Selection of Specific Aptamers Targeting Brucella Species through an Enhanced Cell-SELEX Methodology

Brucellae are Gram-negative, aerobic, non-motile coccobacilli causing brucellosis in man and animals. The disease is one of the most significant yet neglected global zoonoses. Especially in developing countries, brucellosis is causing public health problems and economic losses to private animal owners and national revenues. Composed of oligonucleotides, aptamers are chemical analogues of antibodies that are promising components for developing aptamer-based rapid, sensitive, and specific tests to identify the Brucella group of bacteria. For this purpose, aptamers were generated and selected by an enhanced protocol of cell systematic evolution of ligands by exponential enrichment (cell-SELEX). This enhanced cell-SELEX procedure involved the combination of both conventional and toggle cell-SELEX to boost the specificity and binding affinity to whole Brucella cells. This procedure, combined with high-throughput sequencing of the resulting aptamer pools, comprehensive bioinformatics analysis, and wet lab validation assays, led to the selection of a highly sensitive and specific aptamer for those Brucella species known to circulate in Egypt. The isolated candidate aptamer showed dissociation constant (K_D) values of 43.5 ± 11, 61.5 ± 8, and 56 ± 10.8 nM for B. melitensis, B. abortus, and B. suis, respectively. This is the first development of a Brucella-specific aptamer using an enhanced combination of conventional and toggle cell-SELEX to the authors’ best knowledge.

Trakya Bölgesindeki Hastalardan İzole Edilen Brucella Kökenlerinin İn Vitro Antibiyotik Duyarlılığı

Amaç: Bu çalışmada, Brucella kökenlerinde tür tayini yapılması ve in vitro olarak doksisiklin, rifampisin, streptomisin, seftriakson, siprofloksasin ve ofloksasinine karşı antimikrobiyal duyarlılık oranlarının belirlenmesini amaçladık. Yöntem: Mayıs 1997-Ocak 2002 tarihleri arasında Trakya Üniversitesi Tıp Fakültesi Hastanesi, Klinik Mikrobiyoloji Laboratuvarında, yatan hastalardan alınan klinik örneklerde (bir adet BOS ve 41 adet kan kültürü örneğinde) 42 Brucella suşu izole edildi. Konvensiyonel yöntemler ile 42 Brucella suşunun, 41 Brucella. melitensis, bir tanesi ise Brucella abortus olarak tanımlandı. Agar dilüsyon yöntemi ile farklı iki pH’da (pH:5, pH:7) 48 ve 72 saatlik inkübasyon süreleri sonunda antibiyotiklerin etkinliği karşılaştırıldı. Minimum inhibitör konsantrasyonu (MİK) değerleri, intraselüler patojenlerin antibiyotik duyarlılık testi için hazırlanmış ‘Eucast Discussion Document E.Dis 6.1’ de önerildiği şekilde değerlendirildi. Bulgular: pH:7’de 48 ve 72 saatlik inkübasyonlar sonrası elde edilen sonuçlar karşılaştırıldığında, sadece ofloksasinin MİK50 ve MİK90 değerlerinin iki katına yükseldiği görüldü. pH:5’de 72 saatlik inkübasyon süresi sonunda rifampisinin etkinliği artarken, doksisiklin etkinliğinin değişmediği gözlenmiştir. Streptomisin, seftriakson, siprofloksasin ve ofloksasinin ise etkinliklerinin azaldığı gözlendi. Sonuç: Çalışmamızda pH:7’de ve 48 saatlik inkübasyon süresi sonunda MİK90 değerlerine göre antibakteriyel ilaçlar Brucella kökenleri üzerine etkili olarak saptandı. Doksisiklin, pH:5 ve pH:7’de, 48 ve 72 saatlik inkübasyon süreleri sonunda MİK90 değerlerine göre en etkili antibakteriyel ilaç olarak saptandı. Brucella cinsinde yer alan bakteriler fakültatif hücre içi mikroorganizmalardır ve hücre içi benzeri pH:5 olan ortamda streptomisin, seftriakson, siprofloksasin ve ofloksasinin etkinlikleri azalmaktadır. Bruselloz tedavisinde bu durum göz önünde bulundurulmalıdır.

Animal and human brucellosis in Algeria: a review

Tawla n Malṭa d aṭṭan ittenṭaḍen ɣer umdan i d-xeddment tbaktiriyin n tewsit Brucella spp. D aṭṭan amaḍlan u tella deg tmura n wagrakal am Lezzayer anda mazal txeddem axessar deg lmal. Ad d-nawi dagi tasɣunt tamatut ɣef tawla n Malṭa di Lezzayer, anda i tt-id-ufan yakan ɣer umdan seg 1895 u deg wass-nni mazal-itt d ugur ameqqran i yimeẓla n tdawsa. Tella tezqaft deg tejṛutin n yimdanen deg temnaḍt ɣer tayeḍ, tamnaḍt yennul ugar d tamnaḍt uzawaɣ i yesɛan weḥd-s aktamur alemmas (tajṛut/100 000 imezdaɣ) n 65.87 teḍfer-itt-id s 9.89 deg temnaḍt Agafa-Asamar ɣef wakken i d-iwekked uɣlif n tdawsa. Aktamur n tejṛutin n tawla n Malṭa n yizgaren iɛedda s uḍfar deg 5% ar 0,76% deg tlemmast n yiseggasen n 90 d 2014 s usileɣ imfeccec anda seld ṣa yiseggasen n wahil n takza d usnefren akked ucraḍ s tgezzayt REV-1 i d-ihegga uɣlif n tdawsa mazal yegguma ad isenger aṭṭan-agi. Ilaq daɣen ad negzu dakken anerni n umḍan n tejṛutin timaynutin n yimdanen i ittujerden kifkif-it akked tejṛutin ɣer tɣeṭṭen i yellan d aɛwin n temsalmit meqqren i umdan di Lezzayer.

Comparison of PCR and Conventional Serological Methods for Detection of Brucella spp. in Ovine and Caprine Blood Serum

Brucellosis is an anthropozoonotic disease. Infection of livestock with Brucella is endemic in most parts of Iran. Sistan-Baluchestan is bordered on the east by the countries of Afghanistan and Pakistan. The high prevalence of brucellosis in livestock in the eastern neighboring countries results in transmission of the disease to this province. The present research aimed to determine the prevalence of brucellosis in small ruminants in the Sistan region of Iran and to compare serological and molecular tests for the detection of brucellosis. Blood samples were taken from 150 randomly selected sheep and goats, and sera were separated. All sera were analyzed by serological (Wright and 2-ME) and molecular (Polymerase Chain Reaction (PCR)) tests. Serological tests were carried out according to the instructions of the Iranian Veterinary Organization The degree of agreement between serological tests and PCR was determined by kappa value. In this study, 17 cases (11.3%) were identified as positive by the PCR method. Wright and 2-ME tests had the highest agreement with PCR in titers ≥2/80 and ≥2/40, respectively. The results of this study show that the brucellosis in sheep and goats has a greater prevalence in the Sistan region than in most other parts of Iran, and this is important in terms of public health. It is suggested that brucellosis vaccination coverage in livestock be increased in this area and that the people in Sistan region must be notified about methods for preventing brucellosis. Also, further studies to compare conventional serologic tests with the gold standard test are recommended.

Bayesian Estimation of the Prevalence and Test Characteristics (Sensitivity and Specificity) of Two Serological Tests (RB and SAT-EDTA) for the Diagnosis of Bovine Brucellosis in Small and Medium Cattle Holders in Ecuador

In Ecuador, a national program for bovine brucellosis control has been in implementation since 2008. Given the costs, small- and medium-sized livestock holders are not completely committed to it. The objective of this study was to determine true prevalence (TP) of bovine brucellosis in small- and medium-sized herd populations, as well as the diagnostic sensitivity and specificity of the Rose Bengal (RB) test and the sero-agglutination test (SAT)-EDTA using a Bayesian approach. Between 2011 and 2016, 2733 cattle herds were visited, and 22,592 animal blood samples were taken in nineteen provinces on mainland Ecuador. Bayes-p and deviance information criterion (DIC) statistics were used to select models. Additionally, risk-factor analysis was used for herds according to their brucellosis test status. True prevalence (TP) in herds was estimated by pool testing. National seroprevalence of farms was 7.9% (95% CI: 6.79–9.03), and TP was 12.2% (95% CI: 7.8–17.9). Apparent prevalence (AP) in animals was 2.2% (95% CI: 1.82–2.67), and TP was 1.6% (95% CrI: 1.0–2.4). Similarly, the sensitivity of the RB was estimated at 64.6% (95% CrI: 42.6–85.3) and specificity at 98.9% (95% CrI: 98.6–99.0); for the SAT-EDTA test, sensitivity was 62.3% (95% CrI: 40.0–84.8) and 98.9% (95% CrI: 98.6–99.1) for specificity. Results of the two tests were highly correlated in infected and uninfected animals. Likewise, high spatial variation was observed, with the Coastal Region being the zone with the highest TP at 2.5%. (95% CrI: 1.3–3.8%) in individual animals and 28.2% (95% CI: 15.7–39.8) in herds. Risk factors include herd size, type of production (milk, beef, and mixed), abortions recorded, and vaccination. The results of this study serve to guide authorities to make decisions based on parallel testing at the beginning of a bovine brucellosis program for small livestock holders to increase sensitivity level of the screening tests in Ecuador.

Ruptured Aneurysm of the Common Iliac Artery Caused by Brucella melitensis: A Case Report

Introduction

Brucella is a genus of aerobic Gram negative bacteria that causes the disease brucellosis. It is considered a zoonotic infection transmitted to humans by ingestion of unpasteurised dairy products. Although aortic involvement is rarely seen, it can be a life threatening complication of this disease. This case report describes a ruptured aneurysm of the common iliac artery (CIA) due to secondary infection by Brucella melitensis.

Report

A 79 year old man with a known isolated aneurysm of the CIA presented with acute abdominal pain. Contrast enhanced computed tomography (CT) revealed rupture of the aneurysm. The patient underwent prompt endovascular repair. Several weeks after an uneventful recovery, the patient presented with spiking fever and abdominal discomfort. CT revealed an abscess anterior to the CIA. Blood and pus cultures grew B. melitensis. In recurrent re-admissions, conservative antibiotic therapy proved to be insufficient. Eventually, neo-aorto-iliac system (NAIS) reconstruction using bilateral femoral veins was performed to provide definitive treatment four months after initial presentation.

Conclusion

Although Brucella infected aneurysms are rare, they are associated with life threatening disease. Diagnosing this type of brucellar infection can be challenging owing to the long incubation time needed for blood and tissue cultures. Definitive treatment of these aneurysms often needs open surgery and antibiotics for complete treatment. Vigilant surveillance is required to monitor for post-operative complications such as graft infection, recurrent (false) aneurysm, and abscess formation.

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Brucella species are a genus of aerobic Gram negative bacteria.

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Infected aneurysms caused by Brucella species are rare.

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Although rare, this clinical condition is associated with life threatening disease.

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Treatment consists of open surgery combined with antibiotic therapy.

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Endovascular procedures can be used as bridge to surgery or as palliative therapy.

Genetic identification of the causative agent of Brucellosis

The development of animal husbandry suffers various kinds of losses due to the spread of infectious diseases among animals, in particular Brucellosis. A challenge faced by Brucella researchers has been the accurate identification of new isolates within the genus while preserving sufficient, and not excessive, biosafety and biosecurity requirements. The availability of discriminatory molecular typing tools to inform and assist conventional epidemiological approaches would be invaluable in controlling these infections, but efforts have been hampered by the genetic homogeneity of the genus. In this work, for better identification of infection, for control and monitor the source of outbreaks in prosperous areas was carried out identification of Brucella spp. strains which circulating in the Kostanay region. For this was used using multilocus analysis of a variable number of tandem repeats sequenced by 16 s – PNK on a genetic analyzer (sequencer). According to the results of a study of cattle, cultures of microorganisms were infected: No. 4, 5, 7, 8. Comparison of the obtained results with similar results of domestic and foreign works by A. Shevtsov, G. Borrello, P. Le Fleche, G. Garofolo suggest that the genotyping of local strains has an importance in the molecular epizootology of the Republic of Kazakhstan.

Risk factors, outcomes and time to detect positive blood culture among cases with acute brucellosis

BACKGROUND

Brucellosis causes a disabling human disease and loss of animals' lives. The clinical significance of Brucella bacteremia is still unclear and Brucella identification in blood culture is suboptimal.

METHODS

This was a retrospective study conducted in Medina in Saudi Arabia from August 2016 to May 2019. We included cases with brucellosis symptoms and a positive culture or serological evidence for brucellosis, comparing bacteremic with non-bacteremic brucellosis cases for the rates of complications, infection relapses and brucellosis development. Also, we estimated blood culture positivity rates and the time to detect Brucella in an automatic blood culture instrument.

RESULTS

Of the total number of 147 cases, 62 (42%) had a positive blood culture for Brucella, and the blood culture instrument (BACT/ALERT 3D) detected all positive blood cultures within 3 d of incubation. We found higher rates of chronic brucellosis in bacteremia than non-bacteremia cases (OR 7.25, 95% CI 1.41 to 37.23; p=0.018). Patients aged <15 y developed a higher rate of bacteremia than those aged ≥15 yr (OR 11.93 95% CI 1.37 to 103.75; p=0.025).

CONCLUSION

Brucella bacteremia is an independent predictor for the development of chronic infection. Brucella bacteremia cases may need long follow-up periods and a more thorough evaluation to exclude deep-seated infection.

Bovine brucellosis - a comprehensive review

Brucellosis is a zoonotic disease of great animal welfare and economic implications worldwide known since ancient times. The emergence of brucellosis in new areas as well as transmission of brucellosis from wild and domestic animals is of great significance in terms of new epidemiological dimensions. Brucellosis poses a major public health threat by the consumption of non-pasteurized milk and milk products produced by unhygienic dairy farms in endemic areas. Regular and meticulous surveillance is essentially required to determine the true picture of brucellosis especially in areas with continuous high prevalence. Additionally, international migration of humans, animals and trade of animal products has created a challenge for disease spread and diagnosis in non-endemic areas. Isolation and identification remain the gold standard test, which requires expertise. The advancement in diagnostic strategies coupled with screening of newly introduced animals is warranted to control the disease. Of note, the diagnostic value of miRNAs for appropriate detection of B. abortus infection has been shown. The most widely used vaccine strains to protect against Brucella infection and related abortions in cattle are strain 19 and RB51. Moreover, it is very important to note that no vaccine, which is highly protective, safe and effective is available either for bovines or human beings. Research results encourage the use of bacteriophage lysates in treatment of bovine brucellosis. One Health approach can aid in control of this disease, both in animals and man.

Epidemiological and clinical characteristics of bacteremic brucellosis

Objective

To retrospectively investigate the epidemiological features, clinical manifestations and laboratory characteristics of bacteremic brucellosis.

Methods

Brucellosis patients admitted to our clinic from January 2015 to December 2017 were included in the study. Patient electronic medical records were reviewed for epidemiological features, clinical manifestations, and laboratory findings.

Results

A total of 132 brucellosis patients were analyzed (64 cases with bacteremic brucellosis and 68 cases with nonbacteremic brucellosis). The median duration from exposure to onset of symptoms was 6.9 weeks (range: 1 day to 32 weeks) and 21.9 weeks (range: 1–76 weeks) in patients with bacteremic and nonbacteremic brucellosis, respectively. More bacteremic than nonbacteremic patients presented with fever and chills. Arthritis was observed in 34 (25.8%) patients, and was more commonly observed in nonbacteremic patients. Using C-reactive protein (CRP) and procalcitonin (PCT) as serological markers, the areas under the receiving operating characteristic curves were 0.64 [95% confidence interval (CI): 0.54–0.73] and 0.61 (95% CI: 0.51–0.70), respectively, for distinguishing bacteremic from non-bacteremic brucellosis.

Conclusion

Fever and chills were frequently observed in bacteremic brucellosis patients, whereas arthritis was more common in nonbacteremic brucellosis patients. Serum CRP and PCT can be used as potential serological markers for diagnosing bacteremic brucellosis.

Spinal Brucellosis: A Case Report and Review of the Literature

Introduction:

The most common location of infection of brucellosis is the musculoskeletal system. It is estimated that the spine is involved in 2–54% of brucellosis infections, with the lumbar spine most commonly affected. We report an uncommon case of brucellar spondylodiscitis, in addition to the pathology, common presentation, and management of spinal brucellosis through additional literature review.

Case Report:

A 65-year-old Hispanic male presented to an orthopedic spine surgeon with signs and symptoms concerning for metastatic disease to the spine. Investigation revealed that the patient had the rare diagnosis of brucellar spondylodiscitis. This only became apparent after detailed questioning of the patient’s history revealed his employment within a Mexican meat slaughterhouse and a regular consumer of unpasteurized Mexican cheeses.

Conclusion:

Although uncommon, brucellosis spondylodiscitis should remain as a differential diagnosis in any patient who presents with back pain and fever. Detailed history taking and thorough physical examination remain vital in the work-up of brucellar spondylodiscitis. Understanding the pathology, radiographic findings, and necessary work-up are essential to properly treat this infection.

Comparative study of IS711 and bcsp31-based polymerase chain reaction (PCR) for the diagnosis of human brucellosis in whole blood and serum samples

BACKGROUND

Clinical diagnosis of human brucellosis (HB) is often difficult due to non-specific symptoms. Immunological tests have been the most common method used in HB diagnosis, but molecular methods based on quantitative polymerase chain reaction (qPCR) have largely replaced these diagnostic methods. The aim of this study was to validate a HB diagnostic qPCR method; assessing different target Brucella genes, and the influence of biological matrices (serum vs. whole blood) on analytical parameters.

MATERIAL AND METHODS

Two target genes, IS711 and bcsp31, for HB molecular diagnosis were evaluated, together with biological matrix type (whole blood and serum) using samples spiked with Brucella abortus. In addition, diagnostic parameters of this qPCR method were evaluated in paired whole blood and serum samples from patients with suspected HB.

RESULTS

Both genes could be potential diagnostic targets, but IS711 showed a lower limit of detection. In spiked matrix experiments, whole blood showed a lower limit of detection than serum after probit regression (224 vs. 3681 CFU/mL) and ANOVA analysis showed a significant (p < 0.001) difference between the Cq of whole blood at all dilutions and that of serum. In 12 paired clinical samples, no serum samples and only one whole blood sample tested positive for Brucella using this qPCR detection method.

CONCLUSIONS

This standardized qPCR-based Brucella detection method could improve diagnosis of HB, serving as a rapid, highly sensitive, and specific test. Whole blood is better suited to qPCR-based HB diagnosis due to the presence of higher target DNA loads in this matrix, compared to serum.

The implications of Rose Bengal test seroconversion in the diagnosis of brucellosis in children in an endemic region

BACKGROUND

The Rose Bengal test (RBT) is a commonly used simple serological test for brucellosis. We assessed brucellosis in individuals <18 years for RBT performance; duration of RBT positivity following infection; and potential factors associated with RBT seroconversion timing.

METHODS

The medical files of first hospital admissions of brucellosis, 2005-2014, southern Israel, were retrospectively reviewed.

RESULTS

Overall, RBT was positive in 99% of 416 primary brucellosis admissions. The mean age was 9.8 ± 4.5 years; all patients were of Bedouin ethnicity. Of 273 patients with subsequent RBT testing, RBT remained positive in 169 cases (duration range: 0.1-122 months). Overall, 104 patients had subsequent negative RBT result (duration range: 0.9-127; median: 29.9 months). Comparing fast (<30 months) vs. slow (≥30 months) seroconversion, IgM titres ≥1:640 were more common in fast seroconversion episodes (53% vs. 23%, p = .003). Anaemia was more common in the slow seroconversion group (76% vs. 52%, p = .02). Age, gender, ethnicity, fever, arthralgia, thrombocytopenia, leukopenia, liver enzymes, bacteraemia and adequate treatment rates were similar.

CONCLUSIONS

RBT positivity rate in first hospital visit was high. Fast negative seroconversion was associated with high IgM titres and lower anaemia rates at first presentation. These findings may assist early recognition of long-lasting brucellosis patients in endemic regions.

Factors Associated With Single and Recurrent Bacteremia in Childhood Brucellosis

BACKGROUND

Data regarding risk factors of bacteremic brucellosis, and specifically recurrent bacteremia, are scarce. We assessed patients with childhood brucellosis, differentiating between those having culture-negative, single-bacteremic, and recurrent-bacteremic episodes.

METHODS

The medical files of pediatric brucellosis patients, from 2005 through 2014, were reviewed retrospectively. Univariate and multivariate analyses were performed to compare demographic and clinical characteristics of culture-negative, single-bacteremic, and recurrent-bacteremic (≥30 days between positive cultures) episodes.

RESULTS

Of all 436 brucellosis cases, 22% were culture-negative, 72% were single-bacteremic, and 6% were recurrent-bacteremic. In a univariate analysis, single-bacteremic episodes were associated with fever (90% vs 65% and 40% in culture-negative and recurrent bacteremia, respectively) and elevated glutamic oxaloacetic transaminase (GOT) levels. Recurrent-bacteremic episodes were associated with anemia (26% vs 14% and 9% in single bacteremia and culture negative, respectively), elevated GOT, low immunoglobulin M (IgM) titers (56% vs 89% and 99%, respectively), and lower levels of adequate treatment (74% vs 94% and 86%, respectively). In multivariate analyses, single bacteremia was associated with fever (odds ratio [OR], 3.595, compared with culture negative), while recurrent bacteremia was inversely associated with IgM titers ≥1:160 (OR, 0.022 and 0.226 compared with culture negative and single bacteremia, respectively) and fever (OR, 0.108 compared with single bacteremia).

CONCLUSIONS

Brucellosis episodes are commonly complicated with bacteremia. Single-bacteremic episodes were associated with high-grade fever and elevated liver enzymes, possibly indicating high bacterial virulence. Recurrent-bacteremic episodes were associated with poor treatment at initial diagnosis, along with low rates of fever, low IgM titers, and high anemia rates, possibly indicating impaired host response. Physicians should consider treatment modifications for suspected recurrent-bacteremic brucellosis, including monitoring treatment adherence, and possibly administering prolonged treatment.

Utility of the Rose Bengal Test as a Point-of-Care Test for Human Brucellosis in Endemic African Settings: A Systematic Review

In endemic African areas, such as Tanzania, Brucella spp. cause human febrile illnesses, which often go unrecognized and misdiagnosed, resulting in delayed diagnosis, underdiagnosis, and underreporting. Although rapid and affordable point-of-care tests, such as the Rose Bengal test (RBT), are available, acceptance and adoption of these tests at the national level are hindered by a lack of local diagnostic performance data. To address this need, evidence on the diagnostic performance of RBT as a human brucellosis point-of-care test was reviewed. The review was initially focused on studies conducted in Tanzania but was later extended to worldwide because few relevant studies from Tanzania were identified. Databases including Web of Science, Embase, MEDLINE, and World Health Organization Global Index Medicus were searched for studies assessing the diagnostic performance of RBT (sensitivity and specificity) for detection of human brucellosis, in comparison to the reference standard culture. Sixteen eligible studies were identified and reviewed following screening. The diagnostic sensitivity (DSe) and specificity (DSp) of RBT compared to culture as the gold standard were 87.5% and 100%, respectively, in studies that used suitable "true positive" and "true negative" patient comparison groups and were considered to be of high scientific quality. Diagnostic DSe and DSp of RBT compared to culture in studies that also used suitable "true positive" and "true negative" patient comparison groups but were considered to be of moderate scientific quality varied from 92.5% to 100% and 94.3 to 99.9%, respectively. The good diagnostic performance of RBT combined with its simplicity, quickness, and affordability makes RBT an ideal (or close to) stand-alone point-of-care test for early clinical diagnosis and management of human brucellosis and nonmalarial fevers in small and understaffed health facilities and laboratories in endemic areas in Africa and elsewhere.

Primer caso confirmado de brucelosis humana por Brucella melitensis, una zoonosis presente en Colombia

La brucelosis, principal zoonosis a nivel mundial tiene alta prevalencia en varios países de Latinoamérica. Se asocia con la exposición a ganado infectado por distintas especies del género Brucella. B. melitensis la más virulenta para el humano, causa con frecuencia complicaciones de predominio osteoarticular. En Colombia se cree que la infección por B. melitensis es una entidad ausente, a pesar de su plausibilidad biológica en nuestro contexto; sin embargo, son escasos los estudios sobre su ocurrencia y mínimo el índice de sospecha de la enfermedad, por lo cual creemos está subdiagnosticada. Presentamos el primer caso confirmado de brucelosis por B. melitensis en Colombia en una joven embarazada, con diagnóstico incidental, en quien el análisis retrospectivo de su cuadro clínico alertó sobre puntos clave que pueden impactar en el diagnóstico y tratamiento oportuno de la enfermedad. Se plantean preguntas de prevalencia real de esta entidad en Colombia.

Immunochromatographic System for Serodiagnostics of Cattle Brucellosis Using Gold Nanoparticles and Signal Amplification with Quantum Dots

In this article, we describe an immunochromatographic test system developed for rapid serodiagnostics of cattle brucellosis using two markers: Gold nanoparticles (GNPs) and quantum dots (QDs). The test system was compared with immunochromatographic serodiagnostics systems that use only one marker. The approbation of the test system was conducted on samples of cattle sera with low, but diagnostically significant titers of specific antibodies. We show that when two conjugates are used, the intensity of the detectable signal increases by 2–3 times compared with the test system using the QD conjugate and by more than nine times compared with the system using the GNP conjugate.

Nanoniosome-encapsulated levoflaxicin as an antibacterial agent against Brucella

A study was conducted to examine the prevalence of brucellosis (in animal farms) in the vicinity of Islamabad and Rawalpindi. A total of 170 milk samples were collected randomly from several farmhouses. The collected milk samples were initially screened by a Brucella selective medium. The bacterial isolates grown on the selective medium were subjected to biochemical identification for further confirmation of Brucella species. Among the tested samples, 28 (16.4%) were found positive for selective medium and 14 (8.2%) were found positive after biochemical confirmation. The antimicrobial susceptibility of several antibiotics performed by the disc-diffusion method did not yield any significant findings. Encapsulating antimicrobial drugs in unilamellar niosomes is an effective approach to treat the endemic infection. In this study, the antimicrobial activity of niosome-encapsulated levofloxacin is compared with free drug. The drug-encapsulating and empty niosomes were synthesized by using two surfactants Tween 80 and Span 40. Niosomal characterization included electron microscopy, dynamic light scattering, and zeta potential. The encapsulation efficiency was found to be 78% and 74% for Span 40 and Tween 80 niosomes, respectively. The antibacterial activity of niosomal levofloxacin was evaluated against the identified Brucella species and the antimicrobial activity of the free drug was increased many folds after encapsulation. In this study, levofloxacin niosomes were successfully synthesized against Brucellosis.

Untargeted accurate identification of highly pathogenic bacteria directly from blood culture flasks

To improve the preparedness against exposure to highly pathogenic bacteria and to anticipate the wide variety of bacteria that can cause bloodstream infections (BSIs), a safe, unbiased and highly accurate identification method was developed. Our liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based method can identify highly pathogenic bacteria, their near-neighbors and bacteria that are common causes of BSIs directly from positive blood culture flasks. The developed Peptide-Based Microbe Detection Engine (http://proteome2pathogen.com) relies on a two-step workflow: a genus-level search followed by a species-level search. This strategy enables the rapid identification of microorganisms based on the analyzed proteome. This method was successfully used to identify strains of Bacillus anthracis, Brucella abortus, Brucella melitensis, Brucella suis, Burkholderia pseudomallei, Burkholderia mallei, Francisella tularensis, Yersinia pestis and closely related species from simulated blood culture flasks. This newly developed LC-MS/MS method is a safe and rapid method for accurately identifying bacteria directly from positive blood culture flasks.

A Cellular Model of Infection with Brucella melitensis in Ovine Macrophages: Novel Insights for Intracellular Bacterial Detection

Intracellular bacteria provoking zoonoses, such as those of the genus Brucella, present a host cell tropism mostly limited to the monocyte/macrophage lineage, leading to chronic inflammatory reactions, difficult-to-eradicate-infections, and widespread prevalence among ruminants. Eradication of brucellosis has been based on programs that translate into a substantial financial burden for both the authorities and stockbreeders, if not strictly followed. To this end, we sought to create an in vitro cell model that could be utilized as future reference for adequately measuring the number of engulfed brucellae/cell, using peripheral blood-derived sheep macrophages infected with B. melitensis at decimal multiplicities of infection (MOI = 5000-5), to simulate the host cell/microorganism interaction and monitor bacterial loads up to 6 days post-infection. We show that the MOI = 5000 leads to high numbers of engulfed bacteria without affecting macrophages’ viability and that the minimum detection limit of our Real-Time PCR assay was 3.97 ± 5.58 brucellae/cell. Moreover, we observed a time-associated, significant gradual reduction in bacterial loads from Day 2 to Day 6 post-infection (p = 0.0013), as part of the natural bactericidal properties of macrophages. Overall, the work presented here constitutes a reliable in vitro cell model of Brucella melitensis for research purposes that can be utilized to adequately measure the number of engulfed brucellae/cell and provides insights towards future utilization of molecular biology-based methods for detection of Brucella.

Genetic Diversity of Brucella melitensis in Kazakhstan in Relation to World-Wide Diversity

We describe the genetic diversity of 1327 Brucella strains from human patients in Kazakhstan using multiple-locus variable-number tandem repeat (VNTR) analysis (MLVA). All strains were assigned to the Brucella melitensis East Mediterranean group and clustered into 16 MLVA11 genotypes, nine of which are reported for the first time. MLVA11 genotype 116 predominates (86.8%) and is present all over Kazakhstan indicating existence and temporary preservation of a “founder effect” among B. melitensis strains circulating in Central Eurasia. The diversity pattern observed in humans is highly similar to the pattern previously reported in animals. The diversity observed by MLVA suggested that the epidemiological status of brucellosis in Kazakhstan is the result of the introduction of a few lineages, which have subsequently diversified at the most unstable tandem repeat loci. This investigation will allow to select the most relevant strains for testing these hypotheses via whole genome sequencing and to subsequently adjust the genotyping scheme to the Kazakhstan epidemiological situation.

Diagnostic Testing in Central Nervous System Infection

Patients with central nervous system (CNS) infection experience very high levels of morbidity and mortality, in part because of the many challenges inherent to the diagnosis of CNS infection and identification of a causative pathogen. The clinical presentation of CNS infection is nonspecific, so clinicians must often order and interpret many diagnostic tests in parallel. This can be a daunting task given the large number of potential pathogens and the availability of different testing modalities. Here, we review traditional diagnostic techniques including Gram stain and culture, serology, and polymerase chain reaction (PCR). We highlight which of these are recommended for the pathogens most commonly tested among U.S. patients with suspected CNS infection. Finally, we describe the newer broad-range diagnostic approaches, multiplex PCR and metagenomic sequencing, which are increasingly used in clinical practice.

When brucellosis met the Assessment of SpondyloArthritis international Society classification criteria for spondyloarthritis: a comparative study

OBJECTIVES

To distinguish brucellosis patients fulfilling the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for spondyloarthritis (SpA) from SpA patients.

METHODS

Brucellosis patients diagnosed from September 2012 to December 2017 who met the ASAS classification criteria for SpA were analyzed with clinical characteristics and laboratory and imaging examinations. Axial or peripheral SpA patients were respectively included into the comparative analysis with a 4:1 ratio.

RESULTS

Twenty-two brucellosis (10 axial and 12 peripheral) patients (male, 16 cases; 72.72%; mean (S.D.) age, 40.23 (16.49) years) and 88 SpA patients were included. All brucellosis patients had been misdiagnosed or considered as SpA before admission to our center. The brucellosis patients had shorter disease duration (axial, P = 0.001; peripheral, P = 0.108). More than half (59.09%) of the patients had contact history with livestock. The low back pain (LBP) of brucellosis patients was generally less improved with exercise (axial, P = 0.001; peripheral, P = 0.008). More brucellosis patients had myalgia (axial, P < 0.001; peripheral, P = 0.071) or fever (axial, P < 0.001; peripheral, P = 0.107). None of them had positive HLA-B27. Blood culture tests were performed in all brucellosis patients and only 4 (18.18%) were positive. Twenty (90.91%) brucellosis patients were gold-immunochromatographic assay (GICA) positive. Bone marrow edema and bone erosion in sacroiliac joints were respectively detected in 100% (10/10) and 90% (9/10) axial brucellosis patients by MRI. Adjacent muscle involvement was found in 80% (8/10) of the patients.

CONCLUSIONS

Indicators including disease duration, contact history of livestock, features of LBP, myalgia, fever, and HLA-B27 can help the differential diagnosis of brucellosis and SpA. GICA test and sacroiliac joints MRI can furtherly confirm the diagnosis of brucellosis.

A review of the immunopathogenesis of Brucellosis

Brucellosis, caused by the intracellular pathogens Brucella, is one of the major zoonotic infections. Considering the economic burden, its prevalence has been a health concern especially in endemic regions. Brucella is able to survive and replicate within host cells by expressing different virulence factors and using various strategies to avoid the host's immune response. This leads to progression of the disease from an acute phase to chronic brucellosis. Exploration of genetic variations has confirmed the expected influence of gene polymorphisms on susceptibility and resistance to brucellosis of humans. Since there is no approved human vaccine and treatment is uncertain with risk of relapse, it is important to increase knowledge about pathogenesis, diagnosis and treatment of brucellosis in order to manage and control this infection, especially in endemic regions.

Clinical and serological approach to patients with brucellosis: A common diagnostic dilemma and a worldwide perspective

According to the WHO factsheet, although approximately half a million brucellosis cases are reported annually, the true incidence is always 10-25 times higher than the reported number of cases. Therefore, we face a common yet uncommonly recognized entity of brucellosis, which highlights the importance of providing precise and understandable guidelines for physician to recognize and manage the disease. Up to now, there is no distinct and clear guideline for brucellosis diagnosis. Hence, this article presents for the first time an algorithm based on our 30 years clinical experiences for brucellosis diagnosis. There are several serological patterns of brucellosis due to the insidious nature and serologic response of this disease. In contrast to most infectious diseases, the IgM response to brucellosis remains after the acute phase, IgG responses often fade after improvement and there is no lifelong positivity for IgG antibody. This diversity of serological pattern leads to seven clinical subtypes of the disease; three of those do not need any medical intervention. In endemic regions, this issue makes a challenging diagnostic puzzle for clinicians, which may consequently lead to national and international over- or underestimation of brucellosis incidence. On one hand, this may change the epidemiological landscape of brucellosis. On the other hand, drugs used in therapy are often accompanied by serious or sometimes irreversible side effects. Accordingly, we attempt to create a unique template to better identify these seven serological patterns and give a comprehensive insight into the diagnostic approach to brucellosis. Moreover, we describe in detail the appropriate use of wright, 2 ME, Coomb's WRIGHT, and ELISA tests.

A systematic review and meta-analysis of the prevalence of osteoarticular brucellosis

BACKGROUND

Infection of bones and joints remains one of the most commonly described complications of brucellosis in humans and is predominantly reported in all ages and sexes in high-risk regions, such as the Middle East, Asia, South and Central America, and Africa. We aimed to systematically review the literature and perform a meta-analysis to estimate the global prevalence of osteoarticular brucellosis (OAB).

METHODOLOGY

Major bibliographic databases were searched using keywords and suitable combinations. All studies reporting the incidence and clinical manifestations of osteoarticular brucellosis in humans, and demonstrated by two or more diagnostic methods (bacteriological, molecular, serological, and/or radiographic) were included. Random model was used, and statistical significance was set at 0.05.

PRINCIPAL FINDINGS

A total of 56 studies met the inclusion criteria and were included in the systematic review and meta-analysis. There was an evidence of geographical variation in the prevalence of osteoarticular disease with estimates ranging from 27% in low-risk regions to 36% in high-risk regions. However, the difference was not significant. Thus, brucellosis patients have at least a 27% chance of developing osteoarticular disease.

CONCLUSIONS

The prevalence of OAB is not dependent on the endemicity of brucellosis in a particular region. Hence, further research should investigate the potential mechanisms of OAB, as well as the influence of age, gender, and other socioeconomic factor variations in its global prevalence, as this may provide insight into associated exposure risks and management of the disease.

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

OBJECTIVE

To determine the frequency of therapeutic failure among patients with acute and subacute brucellosis and to explore the predictors of failure.

METHODS

The study included 213 consecutive, naïve patients with acute and subacute brucellosis. All participants underwent clinical evaluation, chest radiography, stool microscopic examination and interferon-gamma release assay. Patients received the WHO-recommended therapy of doxycycline 200 mg/day and rifampin 900 mg/day, for 6 weeks.

RESULTS

Mean age of the study population was 39.8 ± 12.2 years; 64.8% of them were males. The therapeutic failure rate was 16.4%. Adverse effects were reported by 13.1%. Multivariate analysis of factors associated with therapeutic failure revealed latent tuberculosis infection (LTBI) (OR 3.1, 95% CI, 1.9-24.6, P: 0.009), ascariasis (OR 2.6, 95% CI 1.5-17.9, P: 0.012), and the use of acid suppressive therapy (OR 2.1, 95% CI 1.2-19.5, P: 0.037) as the predictors of therapeutic failure.

CONCLUSIONS

The prevalence of therapeutic failure among the Egyptian patients with acute/subacute brucellosis is increasing. Predictors of therapeutic failure are LTBI, ascariasis, and the use of acid suppressive therapy.

Human brucellosis: Experience from a tertiary care hospital in southern India

The aim of our study was to examine and compare the clinical presentations, complications, laboratory findings, treatment and outcome of patients with acute, subacute and chronic forms of brucellosis in a tertiary care setting. This hospital-based observational study was undertaken between April 2015 and March 2017. Patients diagnosed with brucellosis, either by blood culture and/or serology, were recruited. A total of 94 cases of brucellosis of acute, subacute and chronic forms were observed in 78.7%, 15.9% and 5.3%, respectively. Blood culture grew Brucella spp. in 70.2% cases. Serological tests showed positivity in 96.8% of the patients. Using multivariate logistic regression analysis, fever and upper back pain were significant predictors for both acute and chronic forms of the disease, respectively. There is a need to increase awareness and understand the local sero-epidemiological pattern of brucellosis as it is still little known.