Serologic diagnosis of human brucellosis: analysis of 214 cases by agglutination tests and review of the literature

The serum agglutination test (SAT) and 2-mercaptoethanol (2ME) agglutination were used in studies of the sera of 214 patients in whom brucellosis was suspected. On the basis of historical, epidemiologic, clinical, and serologic data, four groups were identified: group I (108 cases) had negative agglutination reactions, and brucellosis was considered unlikely; group II (57 cases) had positive agglutination reactions, and active brucellosis was diagnosed; group III (37 cases) had positive agglutination reactions, but other factors--notably, a history of prior infection--made inactive brucellosis likely; and group IV (12 cases) had positive agglutination reactions, but insufficient data were available for further classification. Most patients with active brucellosis had agglutinin titers of greater than or equal to 160; however, no single titer was always diagnostic. Although more sensitive tests are available, agglutination reactions provide data sufficient to differentiate active from inactive disease when other factors are considered and follow-up sera are tested. This article discusses individual cases and reviews the literature on the diagnosis of brucellosis.     

Diagnosis and treatment of 106 cases of human brucellosis

During the year 1987, 106 cases of human brucellosis were studied prospectively at the Jordan University Hospital. The disease was more often diagnosed among adults (73.6%) than children (26.4%). Serious clinical complications were observed in 5.7% patients. An initial Brucella antibody titre greater than or equal to 160 proved to be reliable in confirming suspected cases of acute and subacute brucellosis. Culture of blood was found to be more sensitive (44.4%) and significant (P less than 0.02) than bone marrow culture (27.7%) for detecting Brucella melitensis. All patients treated with rifampicin plus tetracycline or co-trimoxazole were considered to be clinically cured by disappearance of all major clinical features of brucellosis. By contrast, 2/10 patients treated with rifampicin alone, as well as 1/56 patients treated with tetracycline and streptomycin, clinically relapsed. It is evident from this study that the treatment with rifampicin alone is not as effective in brucellosis as it is when given with another appropriate drug.     

2007～2008年淄博市布鲁氏菌病检测结果分析

目的统计分析淄博市2007～2008年布鲁氏菌病实验室检测结果。方法利用试管凝集试验（SAT）法对淄博市可疑布鲁氏菌病病人血清进行检测。结果SAT法检测淄博市布鲁氏菌病可疑病例398例,阳性112例,阳性率为28.14%;其中2008年阳性率（39.02%）明显高于2007年（20.51%）;男性阳性率高于女性;30～50岁男性阳性率最高;职业分布以畜牧兽医为最高（31.53%）;发病时间集中在3～6月份。结论淄博市存在布鲁氏菌病流行。     

Effect of D-penicillamine and 2-mercaptoethanol on human IgM in normal serum]

Serum from healthy blood donors (O Rh+) was fractionated on a Sephadex-G-200 column before and after incubation with equal volumes of either 0.2 m 2-Mercaptoethanol or D-Penicillamine. Immunoelectrophoretic analyses revealed that addition of these two sulphhydryl-containing compounds resulted in disappearance of the typical IgM-precipitate within the first peak. A new precipitate specific for M-chains appeared within the second peak. The data indicate that the smaller subunits with M-chain specificity result from splitting of disulphide bonds of the IgM molecules by the D-Penicillamine and the 2-Mercaptoethanol.     

208例布鲁氏菌病高危从业人员感染现况调查

目的 了解职业人群布鲁氏菌病的感染现况和可能的影响因素,为制定布鲁氏菌病防治对策提供科学依据。方法 对羊交易市场内的从业人员开展流行病学调查和血清学检查,探讨布鲁氏菌病感染的影响因素。结果 共调查208例从业人员,以本地中年男性为主,文化程度较低,个人防护不到位,涉及多个高危岗位。检查发现布鲁氏菌感染阳性11例,总感染率为5.29%。影响因素关联性分析结果显示,屠宰是可能的危险因素(OR=4.07, 95%CI: 1.05~15.81),工作中戴手套是可能的保护因素(OR=0.25, 95%CI: 0.07~0.85)。结论 建议开展通俗易懂的宣传教育,引导从业人员做好自身防护,改正不良行为,加强布病防控力度。     

Diagnosis of recent and relapsed cases of human brucellosis by PCR assay

Background

Brucellosis affects human populations in many developing countries including the Middle East, and Latin America where it is still endemic. It has been prevalent in Jordan for years, where 7842 cases of human brucellosis were registered at the Ministry of Health during 10 year-period. This study was initiated by the recent increase in the number of human cases diagnosed in a rural area in the Northern Jordan to help assess the status of the disease in that area. For this purpose blood specimens from brucellosis suspected cases were tested by serology, culture and PCR.

Methods

Peripheral blood specimens from 50 healthy control subjects and 165 seropositive patients having compatible signs and symptoms that were clinically diagnosed to have brucellosis were tested by blood culture, and by PCR. The PCR assay used genus-specific primers from the conserved region of the 16S rRNA sequence, which showed high specificity for the Brucella spp.

Results

Diagnosis of Brucella was established by PCR in 120 cases (72.7%). All of them were seropositive and 20 were positive by culture. Forty-eight of 58 (82.8%) of the relapsed cases two months after completing the treatment with an increase in the previous serological titers were positive by PCR. The assay has 85.7% positive predicative value, 100% sensitivity and specificity since it correctly identified all cases that were positive by blood cultures, 95.8% by serology and none of the control group was positive.

Conclusions

Results showed that PCR assay can be applied with serology for the diagnosis of brucellosis suspected cases and relapses regardless of the duration or type of the disease without relying on the blood cultures, especially in chronic cases.

     

The nature of human brucellosis in Kuwait: study of 379 cases

Three hundred seventy-nine Kuwaiti patients with brucellosis were admitted to Adan General Hospital, Kuwait, during the period 1984-1985. Of these 231 were males and 148 were females. Diagnosis was based on symptoms and signs compatible with the disease and on the detection of significantly elevated antibody titer and/or positive blood culture. The primary means of exposure were the consumption of raw milk and contact with goats, sheep, or camels. Patients most frequently presented with fever (91%), chills (40%), sweats (39%), gastrointestinal symptoms (30%), headache (23%), respiratory symptoms (23%), and musculoskeletal symptoms (22%). The major signs were osteoarticular involvement (37%), hepatosplenomegaly (27%), and lymphadenopathy (9%). Different regimens of treatment were used, but the highest rate of cure was achieved with triple therapy--tetracycline, streptomycin, and rifampin.     

Articular involvement in human brucellosis: a retrospective analysis of 304 cases

Brucellosis is a zoonosis which in humans is caused by one of four species of the Brucella genus: B. melitensis, B. abortus, B. suis and B. canis. B. abortus is the species prevalent in North America and Europe and B. melitensis in most developing countries.Differences in disease manifestations may be accounted for either by differences in the species or by differences in the host. Articular involvement in brucellosis, although recognized since 1904, has been variably emphasized.Three hundred and four cases of human Brucellosis caused by B. melitensis, the prevalent species in Perú, were seen during a 12-yr period in one Lima hospital. Fever, malaise and hepatomegaly were the most frequent findings. Diagnosis was greatly improved when cultures were done in the biphasic Ruiz-Castañeda medium, rather than in trypticase soy broth. Serologie diagnosis is still important, and it should include standard tube testing, detection of IgG blocking antibodies and fractionation with 2-ME in chronic cases.The disease may take one of three courses: acute, (<8 wk), chronic (>8 wk) or undulant (periods of remissions and exacerbations). Four syndromes were recognized in a total of 33.8% of patients with Brucellosis. The most frequent pattern (in ~46.6% of patients with arthritis) was sacroiliitis, usually non-destructive and either uni-or bilateral. The second most frequent articular syndrome was peripheral arthritis (38.8%), manifested either as a single large lower extremity joint or as an asymmetric pauciarthritis. Rarely patients presented with a rheumatoidlike arthritis. Mixed arthritis (7.8%) was a combination of the first two. The above forms occurred in patients with an acute or undulant course. Spondylitis was the least common form of arthritis (6.8%), and differed significantly from the other forms of arthritis in the duration of symptoms (chronic course), age of patients (older individuals) and the paucity of fever and malaise. It also tended to be destructive.The arthritis usually resolved with the combined regimen of tetracycline (2 g p.o. for 21 days) and streptomycin (1 g i.m. for 21 days) without sequelae. Illustrative cases of these syndromes are presented.The relatively benign nature of most of the patients with brucellar arthritis lead us to postulate that they are for the most part reactive arthritides. Host factors are thought to be important in determining the response to the infection, but they are yet to be identified. Our own genetic studies have failed to identify an increased frequenty of B27 or CREG antigens in the patients with sacroiliitis. The demonstrations of circulating immune complexes in these patients however favors an immunopathogenic mechanism as responsible for some of the manifestations of this disease.     

虎红平板凝集试验确诊布鲁杆菌病截断值的探讨

目的 探讨虎红平板凝集试验确诊布鲁杆菌病凝集度的截断值.方法 内蒙古地方病防治研究中心门诊部选择2009年5月至2009年6月,进行布鲁杆菌病检查的398人,进行试管凝集试验和虎红平板凝集试验检测,以试管凝集试验为金标准,探讨虎红平板凝集试验诊断布鲁杆菌病的截断值,并对可靠性和真实性进行评价.结果 以阳性预测值100.0％作为筛选标准,虎红平板凝集试验快速确诊布鲁杆菌病的截断值为“++”,以该凝集度强度作为截断值进行布鲁杆菌病诊断,灵敏度为83.3％,特异度为100.0％,约登指数为0.823,符合率为89.9％.结论 以虎红平板凝集试验的“++”作为截断值诊断布鲁杆菌病,值得临床推广.     

20例布氏杆菌病临床分析

目的 探讨呼和浩特地区布氏杆菌病的流行情况、临床症状、体征、化验检查及治疗结果.方法　分析我科2008年3月-2009年12月20例布氏杆菌病住院患者的临床特征及治疗效果.结果　本地区布氏杆菌病以冬春季为高发期;发病人群以从事养殖业及畜牧业的中青年男性为主;临床主要表现为发热、多汗、乏力及关节痛,部分患者查体可出现肝脾...     

Serological diagnosis of human brucellosis: analysis of seven cases with neurological and cardiological manifestations

Serum Tube Agglutination (STA) test was used as routine test to detect antibrucellar antibodies in diagnosis of brucella infection in sera (n = 75) and CSF (n = 14) from 78 patients with neurological (n = 60) and cardiological (n = 15) complaints in whom brucellosis was suspected, over a period of two and a half years from January, 1997 to July 1999. Seven (neurological-six and cardiac-one) serum samples (9.33%) were positive by STA, while none of the CSFs were positive. STA titres ranged from 1:10 to 1:1280. We report the findings of these seven cases with neurological and cardiac manifestations in whom STA were found positive. Treatment was accomplished in two cases (neurological-one and cardiac-one), while remaining five cases either were treated empirically with antitubercular treatment or lost for follow up. However these reported cases should alert clinicians to investigate for Brucella infection in cases of pyrexia of unknown origin and this condition in cases of chronic meningitis with unproven aetiology.     

Evaluation of growth hormone stimulation tests in cured acromegalic patients

We have evaluated the GH peak response to insulin tolerance test (ITT) and to GHRH + arginine in 11 patients cured of acromegaly after treatment with surgery/radiotherapy and compared them to a control group matched for age and sex. GH peak response was significantly higher in the control group than in the patient group (11.21 ± 6.98 vs. 4.46 ± 6.90 ng/ml, p=0.010). Seven patients had a GH peak response of less than 3 ng/ml, compatible with the diagnosis of GH deficiency. Peak GH response after GHRH + arginine was significantly lower in the group of patients with GH peak of less than 3 ng/ml during ITT as compared to the group with GH peak of more than 3 ng/ml, and in all cases the diagnosis of GH deficiency was confirmed. Mean IGF-I level was not different between the patients and controls, as well as between patients with and without GH deficiency diagnosed by the stimulation tests. Conclusion: The incidence of GHD diagnosed by stimulation tests is high in patients cured of acromegaly.     

Epidemiology and diagnosis of human brucellosis in Jordan

In recent reports, brucellosis has emerged as an important public health problem in the east Mediterranean region and Jordan is no exception. In 1986 and 1987, the minimal incidence rates per 100,000 persons in Jordan were 33.2 and 46.2, respectively, with no sex difference. Low incidence rates were confined to those below 4 and over 55 years of age. A seasonal incidence seen in 1986 was repeated in 1987 with maximal rates in the spring and summer months, exhibiting a strong connection with the lambing season. In-vitro sensitivity of 43 isolates of Brucella melitensis is presented. Endemicity in animals is discussed because of its direct relationship with the disease in man.