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Lanza Galvão E, Miranda Souza K, Gonçalves de Freitas M, Souza MRF, Gonçalves MWA, Cota G, Silva SN. Treatment of Childhood Brucellosis: A Systematic Review. Pediatr Infect Dis J 2024; 43:857-866. [PMID: 38754009 DOI: 10.1097/inf.0000000000004389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND Proper treatment for brucellosis is crucial to eradicate the infection and prevent complications, but there is a notable gap in evidence for pediatric treatment. This study aims to address this gap by reviewing current literature, analyzing the efficacy and safety of brucellosis treatment in children, and identifying areas that require further investigation. METHODS A systematic review, following preferred reporting items for systematic reviews and meta-analyses and Cochrane Handbook guidelines, assessed antimicrobial regimens' efficacy and safety for treating human brucellosis in children. Original human studies with clinical outcomes after drug therapy intervention for children up to 10 years were included. Searches were conducted in Medline, Embase, Cochrane Library and LILACS databases for studies indexed until March 6, 2023. Study selection, data extraction, and bias risk assessment were performed by pairs of reviewers. The quality assessment used Joanna Briggs Institute tools and grading of recommendations assessment, development and evaluation system. Data were analyzed using R software. RESULTS A total of 1773 records were reviewed, yielding 11 eligible studies encompassing 1156 children. All included studies presented an observational design. The most reported treatment approaches included sulfamethoxazole-trimethoprim with rifampicin or aminoglycosides, with summarized failure rates of 2% (95% confidence interval: 0.0-0.49) and 13% (95% confidence interval: 0.06-0.29), respectively (very low certainty of evidence). Adverse events and time to defervescence were not reported. CONCLUSIONS Sulfamethoxazole-trimethoprim + rifampicin were the most prescribed antibiotics for brucellosis for pediatrics. The study highlights the need for more research with robust designs, and emphasizes uncertainty regarding the efficacy of antimicrobial regimens, emphasizing the importance of further investigations to guide specific treatment protocols for this population.
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Affiliation(s)
- Endi Lanza Galvão
- From the Núcleo de Avaliação de Tecnologias em Saúde, Fundação Oswaldo Cruz, Belo Horizonte
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina
| | - Kathiaja Miranda Souza
- From the Núcleo de Avaliação de Tecnologias em Saúde, Fundação Oswaldo Cruz, Belo Horizonte
| | - Marina Gonçalves de Freitas
- From the Núcleo de Avaliação de Tecnologias em Saúde, Fundação Oswaldo Cruz, Belo Horizonte
- SCMED, Brazilian Health Regulatory Agency, Brasilia
| | | | | | - Gláucia Cota
- From the Núcleo de Avaliação de Tecnologias em Saúde, Fundação Oswaldo Cruz, Belo Horizonte
| | - Sarah Nascimento Silva
- From the Núcleo de Avaliação de Tecnologias em Saúde, Fundação Oswaldo Cruz, Belo Horizonte
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Maduranga S, Valencia BM, Li X, Moallemi S, Rodrigo C. A systematic review and meta-analysis of comparative clinical studies on antibiotic treatment of brucellosis. Sci Rep 2024; 14:19037. [PMID: 39152180 PMCID: PMC11329684 DOI: 10.1038/s41598-024-69669-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 08/07/2024] [Indexed: 08/19/2024] Open
Abstract
Brucellosis is a difficult to treat infection that requires antibiotic combinations administered over several weeks for clearance of infection and relapse prevention. This systematic review summarizes current evidence for antibiotic treatment of human brucellosis. PubMed, EMBASE, Scopus, CINAHL, Web of Science, and China Academic Journal databases were searched for prospective studies that had compared different antibiotic regimens for treating human brucellosis in the last 25 years. Thirty-four studies recruiting 4182 participants were eligible. Standard dual therapy with doxycycline + rifampicin had a higher risk of treatment failure compared to triple therapy which added streptomycin (RR: 1.98, 95% CI 1.17-3.35, p = 0.01) or levofloxacin (RR: 2.98, 95% CI 1.67-5.32, p = 0.0002), but a similar or lower risk compared to alternative dual antibiotic combinations (p > 0.05). The same combination had a higher risk of relapses compared to triple therapy which added streptomycin (RR: 22.12, 95% CI 3.48-140.52, p = 0.001), or levofloxacin (RR: 4.61, 95% CI 2.20-9.66, p < 0.0001), but a similar or lower risk compared to other dual antibiotic combinations (p > 0.05). Triple antibiotic therapy is more effective than standard dual therapy with rifampicin and doxycycline. However, the latter is also efficacious and suitable for uncomplicated disease.
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Affiliation(s)
- Sachith Maduranga
- School of Biomedical Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
- Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Braulio Mark Valencia
- Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Xiaoying Li
- Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Samaneh Moallemi
- School of Biomedical Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
- Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Chaturaka Rodrigo
- School of Biomedical Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia.
- Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia.
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Kıran P, Uçku R. Seroprevalence of human brucellosis in Turkey: A comprehensive meta-analysis. Zoonoses Public Health 2024. [PMID: 38978271 DOI: 10.1111/zph.13166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 06/13/2024] [Accepted: 06/21/2024] [Indexed: 07/10/2024]
Abstract
AIMS Brucellosis remains a common zoonotic disease, in developing countries, as well as in Turkey where it is endemic, underdiagnosed, and underreported. The aim of this meta-analysis was to provide a comprehensive estimate of seroprevalence with a large sample size, covering all regions of Turkey, including both grey literature and published studies. METHODS AND RESULTS A systematic search was performed in MEDLINE (via PubMed), TürkMedline (National Health Sciences-Periodicals Database), and YÖKSİS database (Higher Education Council Information System) until May 5th, 2023. The quality of the studies was evaluated independently using Joanna Briggs Institute (JBI) critical assessment tool for prevalence studies. A random-effects model (DerSimion and Laird) was utilized to estimate the overall pooled prevalence. A sensitivity analysis was performed, excluding studies with a high risk of bias. The subgroup analyses and meta-regression were conducted to explore sources of heterogeneity. Egger test and funnel plot were used to assess publication bias. The meta-analysis included 30 studies in total published between 1999 and 2021 with 51,560 individuals. In Turkey, the pooled seroprevalence of human brucellosis was estimated to be 4.5% (95% confidence interval [CI]: 3.8%-5.3%). According to the subgroup analysis, a higher seroprevalence was found in rural areas (8.0%, 95% CI: 5.4%-10.7%), high-risk occupational groups (9.9%, 95% CI: 5.3%-14.6%), and the Central East Anatolia Region (13%, 95% CI: 3.2%-22.8%). The meta-regression analysis identified living in rural areas and certain geographic regions as significant risk factors associated with higher seroprevalence. CONCLUSIONS This meta-analysis revealed a significant burden of human brucellosis in Turkey. The findings highlight the need for public health measures and targeted interventions to reduce the burden of this zoonotic disease, especially in rural areas, high-risk occupational groups, and the East Anatolia Region.
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Affiliation(s)
- Pınar Kıran
- Division of Epidemiology, Department of Public Health, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
| | - Reyhan Uçku
- Division of Epidemiology, Department of Public Health, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
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Alikhani A, Ahmadi N, Frouzanian M, Abdollahi A. Motor polyradiculoneuropathy as an unusual presentation of neurobrucellosis: a case report and literature review. BMC Infect Dis 2024; 24:491. [PMID: 38745172 PMCID: PMC11092037 DOI: 10.1186/s12879-024-09365-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/29/2024] [Indexed: 05/16/2024] Open
Abstract
Brucellosis, a zoonotic disease caused by Brucella species, poses a significant global health concern. Among its diverse clinical manifestations, neurobrucellosis remains an infrequent yet debilitating complication. Here, we present a rare case of neurobrucellosis with unusual presentations in a 45-year-old woman. The patient's clinical course included progressive lower extremity weakness, muscle wasting, and double vision, prompting a comprehensive diagnostic evaluation. Notable findings included polyneuropathy, elevated brucella agglutination titers in both cerebrospinal fluid and blood, abnormal EMG-NCV tests, and resolving symptoms with antibiotic therapy. The clinical presentation, diagnostic challenges, and differentiation from other neurological conditions are discussed. This case underscores the importance of considering neurobrucellosis in regions where brucellosis is prevalent and highlights this rare neurological complication's distinctive clinical and radiological features. Early recognition and appropriate treatment are crucial to mitigate the significant morbidity associated with neurobrucellosis.
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Affiliation(s)
- Ahmad Alikhani
- Infectious Diseases Department and Antimicrobial Resistance Research Center and Transmissible Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Noushin Ahmadi
- Infectious Diseases Department and Antimicrobial Resistance Research Center and Transmissible Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mehran Frouzanian
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amirsaleh Abdollahi
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
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Streva VA, Weinstein J, Jankowski-Romano C, Osakwe N, Duong S, Juretschko S, Lemon JK. The Brief Case: Incidental finding of Brucella abortus bacteremia in a patient with urinary tract infection. J Clin Microbiol 2024; 62:e0138123. [PMID: 38597631 PMCID: PMC11005331 DOI: 10.1128/jcm.01381-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Affiliation(s)
- Vincent A. Streva
- Department of Pathology and Laboratory Medicine, Northwell Health, New York, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Jacqueline Weinstein
- Department of Pathology and Laboratory Medicine, Northwell Health, New York, New York, USA
| | | | - Nonso Osakwe
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
- Department of Medicine, Northern Westchester Hospital, Northwell Health, New York, New York, USA
| | - Scott Duong
- Department of Pathology and Laboratory Medicine, Northwell Health, New York, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Stefan Juretschko
- Department of Pathology and Laboratory Medicine, Northwell Health, New York, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Jamie K. Lemon
- Department of Pathology and Laboratory Medicine, Northwell Health, New York, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
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Samadi A, Amiri M, Hailat N. The Reasons Behind Long-Term Endemicity of Brucellosis in Low and Middle-Income Countries: Challenges and Future Perspectives. Curr Microbiol 2024; 81:82. [PMID: 38289422 DOI: 10.1007/s00284-023-03605-5] [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: 09/20/2023] [Accepted: 12/28/2023] [Indexed: 02/01/2024]
Abstract
Brucellosis is a neglected worldwide zoonotic disease with more than 500,000 new human cases each year. Direct contact with infected animals and consumption of undercooked animal origin foods are the main routes of brucellosis transmission to humans. Although long endeavor has been applied to control and eliminate brucellosis from animal and human populations in developing countries especially in low- and middle-income countries (LMICs), the disease is still endemic in these regions. Many common or unique factors including raw milk consumption, unhygienic slaughter of livestock, extensive husbandry, budgetary limitations, misdiagnosis, and other conditions play a role in long-term endemicity of brucellosis in these locations. It has been shown that One Health is the only practical approach to control brucellosis; however, applying such methods is challenging in low-resource areas. In such conditions, brucellosis is continuously maintained in animals and repeatedly spread to human populations. In this article, factors playing a critical role in brucellosis endemicity, and the real conditions challenging the application of One Health approach in control of brucellosis are highlighted.
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Affiliation(s)
- Assadullah Samadi
- Paraclinic Department, Faculty of Veterinary Science, Kabul University, Kabul, Afghanistan.
| | | | - Nabil Hailat
- Veterinary Pathology, Pathology and Public Health Department, Faculty of Veterinary Medicine, Jordan University of Science and Technology [JUST], Irbid, Jordan
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Alhatou M, Joudeh AI, Alhatou A, Ghamoodi M. Neurobrucellosis complicated by primary pyogenic ventriculitis: a case report. Oxf Med Case Reports 2024; 2024:omad149. [PMID: 38292152 PMCID: PMC10823331 DOI: 10.1093/omcr/omad149] [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: 09/19/2023] [Revised: 11/24/2023] [Accepted: 12/10/2023] [Indexed: 02/01/2024] Open
Abstract
Neurobrucellosis is a serious focal brucella infection. Ventriculitis is a special form of central nervous infection where pyogenic infection of the ependymal linings hinders antibiotics' accessibility to the cerebrospinal fluids and leads to protracted infection. We present a case of a 37-year-old Shepherd who had low-grade fever for 5 months followed by a brief history of vomiting, abdominal pain, and gait imbalance. Investigations showed neutrophilic leukocytosis, high titers of serum anti-brucella antibodies, and lymphocytic pleocytosis. Mycobacterial tuberculosis workup was negative. Magnetic resonance imaging of the brain revealed cervical and spinal meningeal enhancement in addition to mild hydrocephalus. The patient was presumptively diagnosed with neurobrucellosis. He received treatment with ceftriaxone-based combination antibiotics therapy for 6 months with complete resolution of his symptoms. Central nervous infection by brucella is a challenging diagnosis. The possibility of primary ventriculitis due to Brucella infection mandates early recognition and prolonged antimicrobial therapy to achieve full recovery.
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Affiliation(s)
- Mohammed Alhatou
- Department of Neurology, Al-Khor Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Anwar I Joudeh
- Department of Internal Medicine, Al-Khor Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abraham Alhatou
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Tennessee, USA
| | - Mohamed Ghamoodi
- Department of Neurology, Al-Khor Hospital, Hamad Medical Corporation, Doha, Qatar
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Mohammed A, Ahmed M, Osman Ahmed A, Yousof S, Hamad S, Shuaib Y, Ibrahim N. Seroprevalence and risk factors of brucellosis in dromedary camels ( Camelus dromedarius) in Sudan from 1980 to 2020: a systematic review and meta-analysis. Vet Q 2023; 43:1-15. [DOI: https:/doi.org/10.1080/01652176.2023.2248233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
- Abdullah Mohammed
- Department of Biomedical Sciences, Faculty of Veterinary Sciences, University of Gadarif, Gadarif, Sudan
- Reproductive Health Sciences Program, Pan African University Life and Earth Sciences Institute (PAULESI), University of Ibadan, Ibadan, Nigeria
| | - Musa Ahmed
- Reproductive Health Sciences Program, Pan African University Life and Earth Sciences Institute (PAULESI), University of Ibadan, Ibadan, Nigeria
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, AL-Salam University, West Kordofan, Sudan
| | - Ahmed Osman Ahmed
- Department of Microbiology, Pathology, and Parasitology, Faculty of Veterinary Sciences, University of Gadarif, Gadarif, Sudan
| | - Sadam Yousof
- Department of Animal Production, Faculty of Veterinary Science, University of Gadarif, Gadarif, Sudan
| | - Suad Hamad
- Department of Zoonotic Disease and Disease Control, Ministry of Animal Resources, Al-Hamadi, Sudan
| | - Yassir Shuaib
- College of Veterinary Medicine, Sudan University of Science and Technology, Khartoum North, Sudan
| | - Nasir Ibrahim
- Department of Biology, Faculty of Science, Imam Mohammed Ibn Saud Islamic University, Riyadh, Saudi Arabia
- Department of Biochemistry and Physiology, Faculty of Veterinary Medicine, University of Al-butana, Ruffaa, Sudan
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Mohammed A, Ahmed M, Osman Ahmed A, Yousof S, Hamad S, Shuaib Y, Ibrahim N. Seroprevalence and risk factors of brucellosis in dromedary camels ( Camelus dromedarius) in Sudan from 1980 to 2020: a systematic review and meta-analysis. Vet Q 2023; 43:1-15. [PMID: 37584638 PMCID: PMC10472849 DOI: 10.1080/01652176.2023.2248233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/17/2023] Open
Abstract
Camel brucellosis is a major public health concern in Sudan; however, there is no overall estimation of the prevalence of camel brucellosis in Sudan. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this study aimed to perform a meta-analysis of 30 eligible studies published before December 31, 2022, with a total of 70059 dromedary camels, to estimate the pooled prevalence of camel brucellosis and its risk factors in Sudan. The random effect model was used for the final analysis due to the significantly high heterogeneity among the included studies, and the results showed that the overall pooled prevalence of camel brucellosis was 17%, with a confidence interval (CI) of 12%-21%. The prevalence was higher in males than females (54% vs. 46%) and in adults than youngling (77% vs. 23%). The prevalence also varied by region, with central and northern Sudan having the highest prevalence (24%), compared to other regions of Sudan. Moreover, the prevalence of camel brucellosis appeared to be decreasing over time. The current study concluded that camel brucellosis infection is still endemic in many areas of Sudan, with the disease being especially prevalent in central and northern Sudan. Thus, this study provides valuable information for the prevention and control of camel brucellosis in Sudan. However, the significant heterogeneity among the included studies should be taken into account when interpreting these results. Finally, to provide adequate information, research must be updated, and more research must be conducted in many regions of Sudan.
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Affiliation(s)
- Abdullah Mohammed
- Department of Biomedical Sciences, Faculty of Veterinary Sciences, University of Gadarif, Gadarif, Sudan
- Reproductive Health Sciences Program, Pan African University Life and Earth Sciences Institute (PAULESI), University of Ibadan, Ibadan, Nigeria
| | - Musa Ahmed
- Reproductive Health Sciences Program, Pan African University Life and Earth Sciences Institute (PAULESI), University of Ibadan, Ibadan, Nigeria
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, AL-Salam University, West Kordofan, Sudan
| | - Ahmed Osman Ahmed
- Department of Microbiology, Pathology, and Parasitology, Faculty of Veterinary Sciences, University of Gadarif, Gadarif, Sudan
| | - Sadam Yousof
- Department of Animal Production, Faculty of Veterinary Science, University of Gadarif, Gadarif, Sudan
| | - Suad Hamad
- Department of Zoonotic Disease and Disease Control, Ministry of Animal Resources, Al-Hamadi, Sudan
| | - Yassir Shuaib
- College of Veterinary Medicine, Sudan University of Science and Technology, Khartoum North, Sudan
| | - Nasir Ibrahim
- Department of Biology, Faculty of Science, Imam Mohammed Ibn Saud Islamic University, Riyadh, Saudi Arabia
- Department of Biochemistry and Physiology, Faculty of Veterinary Medicine, University of Al-butana, Ruffaa, Sudan
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