Associated factors in distinguishing patients with brucellosis from suspected cases

Brucella-infected abdominal aortic aneurysm: management strategies for an uncommon aneurysm

Objective

The occurrence of Brucella-induced abdominal aortic aneurysms is an exceedingly rare phenomenon, yet it stands as one of the most severe complications within this context. The combined utilization of serological testing and imaging diagnostics has been validated as an effective approach for the identification of Brucella-induced abdominal aortic aneurysms. Presently, the predominant therapeutic strategies encompass antibiotic treatment and surgical intervention. Nonetheless, ongoing controversies persist concerning the establishment of diagnostic criteria, the optimal timing and selection of antibiotic regimens, and the nuanced decision between open surgical procedures and endovascular interventions. Through a meticulous analysis of cases originating from our institution as well as a comprehensive review of previously documented instances, we aim to engage in a detailed discourse on the salient diagnostic and therapeutic facets surrounding Brucella-induced abdominal aortic aneurysms.

Methods

We conducted a retrospective summary of three cases involving Brucella-induced abdominal aortic aneurysms treated within our institution. Furthermore, we performed a comprehensive PubMed search, without imposing restrictions on language or publication year, to identify pertinent literature pertaining to Brucella-induced abdominal aortic aneurysms. The selection criteria primarily focused on case reports delineating occurrences of abdominal aortic aneurysms attributed to Brucella infection.

Results

We present three distinct cases of Brucella-induced abdominal aortic aneurysms managed at our institution, providing comprehensive insights into the employed diagnostic and therapeutic approaches. Additionally, over the past five decades, a total of 24 cases in 23 publications of Brucella-induced abdominal aortic aneurysms have been reported on PubMed. The earliest report dates back to 1976.

Conclusion

Our analysis suggests that Brucella-induced abdominal aortic aneurysm is characterized by a remarkably low incidence but is associated with a substantial risk of life-threatening complications. The integration of serological and imaging assessments assumes pivotal importance in facilitating prompt diagnosis of this condition. The prompt initiation of targeted antibiotic therapy is recommended, and the selection of appropriate surgical strategies should be guided by considerations including aneurysm dimensions and morphological attributes. The timely identification and intervention carry utmost significance in retarding disease advancement and ameliorating unfavorable clinical outcomes.

Serodiagnosis of human brucellosis by an indirect ELISA test using recombinant outer membrane protein 19 kDa (rOMP19) as an antigen

BACKGROUND

Brucellosis remains one of the global health concerns that reemerges in recent years. Delayed or inaccurate diagnosis end to a long treatment duration and financial burden; therefore, finding a good antigen for detection of specific anti-Brucella antibodies is crucial. We intended to evaluate the serodiagnosis value of recombinant Brucella outer membrane protein 19 kDa (rOMP19) using indirect ELISA system compared with Rose Bengal test.

RESULTS

The OMP19 sequence was successfully cloned into pET-28a and produced in E. coli cells (DE3). After extraction and purification of rOMP19, this protein was used for designing indirect ELISA to detect anti-Brucella antibodies in 73 human sera, including 6 brucellosis-positive and 67 brucellosis-negative samples. The accuracy of rOMP19 ELISA was evaluated by receiver operating characteristic (ROC) curve and then compared with Rose Bengal plate test and a commercial anti-IgG Brucella ELISA kit. In comparison with Rose Bengal plate test, the area under the ROC curve was 0.985 (95% CI, 0.96-1.00). From coordinates of the curve, the optimal cut-off value was selected at 0.147, in which the diagnostic sensitivity was 100%, and the specificity was 94%. At this cut-off point, 10 samples were diagnosed as positive (6 true positives and 4 false positives), while negative samples were all correctly diagnosed. The results of our designed rOMP19 ELISA was the same as data obtained from commercial ELISA kit, which applied LPS as an antigen.

CONCLUSIONS

We concluded that OMP19 is an efficient antigen for the serodiagnosis of human brucellosis.