Brucellosis in children: clinical observations in 115 cases.

OBJECTIVE: Brucellosis is endemic in Saudi Arabia. This report summarizes the epidemiology of brucellosis in children. METHOD: A retrospective review was made of medical records of all patients admitted to King Fahad National Guard Hospital with brucellosis during the period from 1984 to 1995. RESULTS: Children < or =12 years constituted 115/545 (21%) of the total brucellosis admissions. The mean age was 5.8 years and 64% of the patients were males. Consumption of unpasteurized milk (often from camel) was the main source of infection. In 70% the clinical picture was dominated by arthritis, 20% of patients presented with a non-specific febrile illness without localizing signs, and 10% had a febrile illness with uncommon presentations. Brucella serology was most helpful in making an early diagnosis. Initial titers of >1:640 were found in 90% of the cases. Bacteremia was observed in 45% and of the isolates speciated, 96% were Brucella melitensis. No increase in resistance to commonly used antimicrobials was noted during the 12-year study period. A combination of rifampin plus co-trimoxazole with or without streptomycin was used in two thirds of the patients. The overall rate of relapse was 9% and one patient died from neurobrucellosis. CONCLUSION: Brucellosis presents in various ways and should be included in the differential diagnosis of arthritis in endemic countries. Prevention should rely on education including on boiling raw milk.     

Screening for brucellosis in pregnant women

During a period of 6 months, 537 pregnant women from a rural area in Saudi Arabia were tested serologically for brucellosis. Of the 513 women who were tested routinely, 18 were found to have a positive titre (3.5%). Of 24 patients in whom the test was carried out because of symptoms suggestive of brucellosis, all were positive. Thirty of the 42 positive cases had titres exceeding 1:160. The incidence of abortion among pregnant women with Brucella titres less than 1:160 was 7.7% contrasting with 17.6% among those with titres above 1:160 (P less than 0.04). This observation calls for further study of the incidence of brucellosis in pregnant women in infected areas, and the connection between elevated Brucella titre and abortion.     

Brucella meningitis

Infection with Brucella melitensis is endemic in Saudi Arabia but involvement of the central nervous system (CNS) is rare. We report on three patients with acute brucella meningitis, all of whom had a history of exposure to a possible source of infection. Diagnosis was confirmed by isolation of Brucella species from blood cultures. Examination of cerebrospinal fluid revealed lymphocytic pleocytosis with a high concentration of protein and low concentration of glucose. The patients were treated by combinations of co-trimoxazole, doxycycline or rifampicin. All responded well without recurrences. A combination of two of the three drugs was effective in treating brucellosis of the CNS when given for a period of 6-8 weeks.     

Characteristics of B. melitensis versus B. abortus bacteraemias

OBJECTIVE: To determine the epidemiological and the clinical characteristics of bacteremic brucellosis. METHODS: A prospective study, performed in the First Infectious Diseases Clinic of Ankara Numune Education and Research Hospital. All the patients had positive culture result for Brucella spp. RESULTS: Fifty-four acute bacteremic brucellosis cases were included. The majority of patients (76%) were from rural Anatolia. Brucella melitensis serotypes were more common than Brucella abortus (83% versus 17%). Fever and arthralgia were the most common symptoms. The number of patients with back pain and arthralgia was higher in B. abortus infected group (p = 0.014 and p = 0.009). CONCLUSIONS: B. melitensis is the most common subtype of Brucella infection in Turkey. The infections with B. abortus spp. are not less severe than the infections with B. melitensis.     

Brucella bacteraemia: clinical and laboratory observations in 160 patients

OBJECTIVES: To describe the clinical, serological, and prognostic features of bacteraemic brucellosis in an endemic region. METHODS: Retrospective case series of 160 patients admitted from 1983 to 1995 to a hospital providing secondary and tertiary level medical care in Saudi Arabia. All patients had positive blood cultures for Brucella species, predominantly Brucella melitensis. RESULTS: Bacteraemia was documented in 38% of 545 cases of brucellosis admitted to our institution during the study period. The main clinical syndromes were febrile illness alone (44%) or fever with arthritis (42%). Of 68 isolates that were speciated, 93% were Brucella melitensis. Initial agglutinating antibody titre was > or =1:320 in 96% of the patients. Antimicrobial resistance of B.melitensis isolates was: co-trimoxazole, 29%; rifampicin, 3.5%; streptomycin, 0.6%; and tetracycline, 0.6%. No increase in resistance was noted over the 13-year study period. Commonly used antimicrobial regimens consisted of streptomycin plus tetracycline or rifampicin plus doxycycline given for 6 weeks. Seven patients (5%) had relapse of their symptoms after antimicrobial therapy. Three of these had infective endocarditis with repeated bacteraemia. These patients required aortic valve replacement and recovered after surgery. The remaining four patients responded to a second course of therapy. CONCLUSIONS: Brucella bacteraemia is an acute febrile disease often associated with rheumatologic complaints. Most patients have an agglutinating antibody titre > or =1:320 and respond well to standard chemotherapy regimens with low mortality.     

2020年陕西省一起布鲁氏菌病暴发疫情的调查分析

目的 调查2020年陕西省泾阳县一起家庭布鲁氏菌病(布病)暴发疫情的原因,明确传染源和传播途径,为阻断疫情传播提供科学依据。方法 对报告病例开展布病流行病学调查,并对病例和牲畜进行布病检测和布鲁氏菌分离培养鉴定种型,对结果进行描述和分析。结果 共发现7例确诊病例和6例隐性感染者;确诊病例发病时间为3月18日至5月7日,临床表现以发热为主;经分析,病例发病与食用牛肉无关联(OR=0.48,95%CI:0.08~2.85),与去过首发病例家有关(OR=141.00, 95%CI:17.15~1 159.28);13例病例、2只羊和2只公犬布鲁氏菌抗体检测阳性,血清抗体滴度从1∶100(++)到1∶800(++++)以上;从2例病例、2只羊和1只公犬血液中共分离到5株布鲁氏菌,均为羊种3型,MLVA-16基因型均为(1-5-3-13-2-2-3-2-4-41-8-6-4-3-4-5)。结论 该起布病家庭暴发疫情的原因为公犬叼食了布病阳性羊只的流产物而感染布病,继而人通过与病犬直接接触以及接触被病犬污染的水等生活物质而发病。     

Brucellosis in spouses and the possibility of interhuman infection

This paper deals with a Brucella infection in a laboratory worker and his wife. The diagnosis of brucellosis was proved by isolating Brucella melitensis, biotype 2, from blood cultures and by the standard serum agglutination test. In the absence of any alternative epidemiologic information, the authors consider this case to be an example of interhuman infection.     

Polymorphism in the First Intron of Interferon-Gamma Gene (+874T→A) in Iranian Patients with Brucellosis

Background: Brucella is a gram-negative bacterium, causing acute and chronic infection in humans and animals. Cell-mediated immunity is the main protective immune response against Brucella spp. Activation of macrophages by IFN-γ and generation of reactive oxygen intermediates and nitric oxide are the main immunologic mechanisms responsible for control of Brucella infection. Objective: To investigate the correlation between IFN-γ gene polymorphism and brucellosis. Methods: 195 patients with brucellosis, 186 healthy patients' family members and 82 healthy farmers who kept infected animals and consumed their contaminated dairy products were selected to take part in the study. IFN-γ genotyping at position +874 (T→A) was carried out by allele specific polymerase chain reaction (AS-PCR) method. Results: The frequency of AT and TT genotypes significantly increased in farmers compared to patients with brucellosis (P=0.03) while there was no significant difference in genotype distribution between patients and their healthy family members. Conclusion: IFN-γ (+874) AA genotype is probably a genetic factor that contributes to the susceptibility of the individuals to brucellosis.     

Successful treatment of brucella melitensis endocarditis

Brucella endocarditis is a rare, but often fatal, complication of brucellosis. A 32 year old man acquired brucellosis while on a visit to his former home in Greece and presented six months later with malaise, fever and aortic regurgitation. Blood cultures grew Brucella melitensis biotype 1. Combined chemotherapy with streptomycin, tetracycline and rifampin sterilized his blood; however, his aortic valve was replaced owing to recurrent emboli and cardiac failure. Over the next 18 months the patient's antibody titer to Brucella fell and his blood remained sterile. Cure was achieved by resection of the infected aortic valve and 10 weeks of bactericidal therapy for B. melitensis.     

布鲁菌病血清DNA定量检测的临床意义

目的：分析布鲁菌病血清DNA定量检测与布鲁菌病临床表现的相关性,从而探讨其对布鲁菌病的诊断价值。方法选择2010年5月-2011年6月内蒙古自治区100例布鲁菌血清凝集试验阳性（玻片凝集试验＋~＋＋＋＋）的患者。采用荧光定量PCR法测定血清布鲁菌DNA含量,分析血清布鲁菌DNA检测结果与临床表现的相关性。结果100例布鲁菌血清凝集试验阳性患者中,23例有明显的临床症状,包括发热（91.3%）、全身关节疼痛（78.3%）、乏力（87.0%）、多汗（65.2%）等全身不适症状,其中的20例血清布鲁菌DNA定量值明显升高[范围（1.30～9.27）×106 copies/ml,平均（2.00±7.87）×106 copies/ml],检测时间仅3 h,灵敏度、特异度和准确度分别达到86.96%、97.40%和95.00%。结论血清布鲁菌DNA定量检测可以为布鲁菌病的诊断提供准确、快速和可靠的实验室确诊依据,用以区分布鲁菌现症感染和既往感染,为布鲁菌病的及时治疗提供客观依据。     

Current understanding and management of chronic hepatosplenic suppurative brucellosis.

To outline the characteristics and define appropriate management of chronic hepatosplenic suppurative brucellosis (CHSB), 905 patients with brucellosis were analyzed. Sixteen episodes of CHSB (14 in the liver and 2 in the spleen) were found in 15 patients. Six patients had had previous remote brucellosis. Twelve patients presented with systemic symptoms, and 12 with local symptoms. Cultures of blood samples yielded negative results in all cases except 1, and the results of cultures of pus specimens were positive for Brucella melitensis in only 2 cases. All patients showed calcium deposits surrounded by a hypodense area on computed tomography. Patients often had low titers of agglutinating antibody. In patients who were receiving conservative management, early response was successful in 50% and late response was successful in 33.3%. In the patients who underwent surgery and concomitant antibiotic therapy, early and late response was successful in 100%. Thus, CHSB mainly represents a local reactivation of previous brucellosis. Its diagnosis may be difficult to establish and surgery may be required to cure many patients.     

Late-onset herpes simplex virus-associated interstitial pneumonia after allogeneic bone marrow transplantation

We report a unique case of brucellosis transmitted by BMT. An 8-year-old boy with the diagnosis of Fanconi's anemia received an allogeneic BMT from his HLA-identical sibling. Routine culture from the infused marrow suspension grew Brucella abortus on day +4 post BMT. Spiking fevers occurred on days +2 and +16. The first febrile episode responded to broad-spectrum antibiotic therapy. However, the second episode did not. B. abortus was isolated from blood cultures taken during the second febrile episode. The Brucella agglutination titer was negative. Antibiotic therapy with oral doxycycline and i.v. gentamycin was successful with no recurrence of infection during 13 months of follow-up. The donor's blood culture was also positive for B. abortus and Brucella antibodies were detectable at 1:320 titer when he presented with fever and hepatosplenomegaly on day +32. We emphasize the need to consider brucellosis in patients undergoing BMT. We suggest that donor and recipient be evaluated for brucellosis especially in countries where the incidence of this infection is relatively high.     

A case of disseminated intravascular coagulation caused by <Emphasis Type="Italic">Brucella melitensis</Emphasis>

OBJECTIVE: Although the haematological abnormalities were common accompaniments of brucellosis, overt disseminated intravascular coagulopathy was reported only in a case at the literature. We report here a case of Brucella melitensis sepsis which showed an acute onset with clinical and hematological findings disseminated intravascular coagulopathy METHODS: The patient had a physical examination, coagulation screening tests, tests of thrombin generation and fibrinolysis, bone marrow aspirate, serum Brucella agglutination test and blood culture. A case of Brucella infection presenting at the onset as a disseminated intravascular coagulation with gingival bleeding and echimotic lesions on abdomen is reported. A hemogram showed severe thrombocytopenia, anemia, and leukopenia. Anisocytozis, poikilocytozis, shift to the left of the granulocytic series, fragmented red blood cells, toksic granulation, were present in the peripheral smear. Bone marrow aspirate revealed a hypercellular marrow without granulomata or malignant precursors. Prothrombin time: 20 s, activated partial thromboplastin time:53.9 s were found longer than normal. D-dimer: 1056 mug/l (50-228 mug/l) was found. Fibrinogen was too low to detected in serum. Patient had Brucella melitensis isolated from blood cultures. RESULTS: After appropriate antimicrobial therapy, the clinical and hematological status of the patient improved, and 4 days later with disappearance of all hematological abnormalities. Conclusison: Diagnosis of brucellosis may be delayed, particularly if uncommon features such as pancytopenia and disseminated intravascular coagulopathy are present. Hence, brucellosis must be considered in the differential diagnosis of all those conditions leading to pancytopenia and disseminated intravascular coagulopathy in areas endemic for brucellosis.     

Changes in IgM and IgG antibody concentrations in brucellosis over time: importance for diagnosis and follow-up

Changes in concentrations of IgM and IgG antibodies to Brucella were monitored for at least 13 mo by an enzyme-linked immunosorbent assay (ELISA) in 52 patients with culture-positive brucellosis. Two main patterns were observed. After an initial peak, 29 patients (56%) had a steady drop in their IgG levels, whereas 23 (44%) had more than one peak over time. All patients with a chronic form of brucellosis or a relapse were in the second group. In most cases, Brucella antibodies, although falling to low levels, remained measurable. Cutoff levels for IgM and IgG were calculated after considering serum antibody concentrations in people who had recovered from an infection. A separate normal range was established for occupationally exposed workers. On admission, sera from all patients contained Brucella antibody levels greater than established cutoff levels. Our results show that ELISA is an excellent method for diagnosis and follow-up of brucellosis.     

Epidemiological and clinical aspects of human brucellosis in Central Greece

The confirmed cases of human brucellosis in the area of Larissa in Central Greece from 2003 to 2005 were analyzed to assess the features of the affected population and to determine the factors influencing the acquisition of infection. Data of patients infected by Brucella spp. concerning age, gender, occupation, date of diagnosis and the observed symptoms were collected from regional hospitals, health centres and private practitioners. The incidence of human brucellosis in the area was 32.49 cases/100,000 inhabitants. Males, due to their professions, were affected more often by brucellosis than females. The majority of the cases were attributed to direct contact with animals or their products. Only in 8.49% of the cases was the infection attributed to the consumption of dairy products. The urban population is not at potential risk for acquiring brucellosis because all commercialized dairy products in Greece are produced from pasteurized milk. The occurrence of human brucellosis shows seasonality, with the majority of the cases diagnosed from December to May. Direct contact with animals, the season of the year and gender were the risk factors influencing the acquisition of infection. Fever, arthralgia, profuse sweating and anorexia were the symptoms most often observed.     

Epidemiology of needlestick and sharps injuries in a tertiary care center in Saudi Arabia

BACKGROUND: Health care workers (HCWs) are frequently exposed to the danger of infectious agents through needlestick and sharps injury (NSSI). In Saudi Arabia, the hepatitis B and C viruses pose a great threat to the HCW because of their high prevalence rate (8%-10% and 2%-6%, respectively). METHOD: A prospective study on the management of NSSI at King Fahad National Guard Hospital from 1996 to 2000. Data relating to the epidemiology of NSSI were collected with the Exposure Prevention Information Network (EPIN(et)) data collection tool, 1997. RESULTS: The results were compared with data as reported by EPIN(et) 1998. Consistency was demonstrated between King Fahad National Guard Hospital and EPIN(et) 1998 for the occupational categories, locations, and the devices involved. Three anomalies were noted: (1) housekeeping staff injuries ranked third at our facility and eighth as reported by EPIN(et) 1998; (2) injuries caused by devices discarded inappropriately commonly occurred at this facility but were not reported by EPIN(et); and (3) injuries due to unsafe practices ranked third at our hospital but ranked seventh in EPIN(et). To date, only 1 employee in our hospital had a seroconversion to hepatitis C. CONCLUSION: This surveillance highlighted risky practices and demonstrated employees and locations frequently involved in NSSIs. An education program was designed for all staff at risk of exposure, targeting higher-risk employees.     

Brucellosis in poultry--an experimental study

Experimental brucellosis with Brucella abortus has been studied in chickens, though antibody response and histopathological changes in the tissues of the birds were conspicuous and noticed consistently, it was not possible to isolate Brucella organisms from lung, liver, spleen and faecal samples of the infected chickens. These observations suggested that birds are resistant to Brucella infection and organisms succumb to death in vivo.     

Deep venous thrombosis associated with acute brucellosis--a case report

Vascular complications, including arteries and veins associated with Brucella infection, have rarely been reported. To date, only three cases of deep venous thrombosis (DVT) of the lower extremities associated with brucellosis have been previously reported. The authors describe another case of DVT of the right leg in association with acute Brucella infection. Since infection with Brucella may be asymptomatic, and the manifestations of acute brucellosis are exceedingly nonspecific, and in view of the potential for Brucella to cause unexplained or unusual illness involving almost any organ including blood vessels, the authors' case and those previously reported suggest that brucellosis should be included among the causes and infections taken into account in patients suffering from DVT, particularly in those coming from Brucella-endemic areas.     

Brucellosis in San Diego: epidemiology and species-related differences in acute clinical presentations

Although aggressive public health measures have greatly reduced the number of brucellosis cases in the United States, there is a resurgence of interest in this worldwide zoonosis because of its potential as a bioweapon and its 8-fold higher incidence in California, Texas, and the other borderlands between the United States and Mexico compared with the national rate. Accordingly, we reviewed the clinical records of 28 patients diagnosed at a university hospital in San Diego, CA, between 1979 and 2002 to look for new epidemiologic trends and to test the hypothesis that there are species-specific differences in clinical presentations. In contrast to the latest California-wide study completed in 1992, Brucella abortus infections were more common (73%) than Brucella melitensis after 1992, and women were more commonly infected (77% compared with 39%) than men. Major risk factors remained Hispanic ethnicity, travel to Mexico, and ingestion of nonpasteurized dairy products. Analysis of diagnostic procedures suggested that the traditional practice of prolonged incubation of blood cultures increased their sensitivity for Brucella, even in automated radiometric systems. Direct comparison of the clinical manifestations of infections with B. abortus and B. melitensis strongly supported differences in acute presentations. B. melitensis presented more acutely as fevers of unknown origin with statistically significant higher rates of abdominal tenderness, hepatomegaly, splenomegaly, thrombocytopenia, pancytopenia, and hepatic dysfunction. These results suggest that the epidemiology of brucellosis in California may be evolving, and they show, to our knowledge for the first time in a single series, that species-specific differences in presentations may account for some of the protean manifestations of brucellosis. Familiarity with manifestations of brucellosis and the optimal laboratory techniques for its diagnosis could help physicians protect the public against this reemerging, under-recognized zoonosis.     

布鲁氏菌TIR结构域蛋白TcpB的研究进展

布鲁氏菌病是由布鲁氏杆菌感染引起的一种人兽共患病,其感染的重要特征是机体的免疫功能受到抑制。布鲁氏菌TIR结构域蛋白TcpB具有多种免疫抑制功能,在逃避宿主免疫应答中具有重要作用。谨就布鲁氏菌TcpB的基本结构、免疫调节功能和分子机制的研究进展综述,以便理解TIR结构域蛋白TcpB在布鲁氏菌致病中介导的免疫抑制机制,有助于更好理解布鲁氏菌的致病机理,为诊治布鲁氏菌病提供新思路。