Performance characteristics of the Euroimmun enzyme-linked immunosorbent assay kits for Brucella IgG and IgM

Brucella Seroprevalence in a High-Risk Population in Greece: A Cross-Sectional Study

Introduction

Brucellosis is a zoonosis with high occupational risk. However, seroprevalence of Brucella antibodies among occupational groups is not known, since studies in endemic countries are rare.

Methods

A cross-sectional seroprevalence study was conducted among livestock farmers in an endemic region in Greece. A low-risk group of individuals that just moved in the region was used as controls. Rose Bengal, Wright standard tube agglutination (STA) tests, and specific IgG and IgM antibodies using ELISA were evaluated; differences and odds ratios were calculated. Results were compared with studies from other endemic regions.

Results

100 livestock farmers and family members and 34 first-year students were enrolled. Rose Bengal results were 18% positive versus 0% (p=0.007); Wright STAs for Brucella melitensis were 8% versus 2.9% (p=0.448) and for Brucella abortus they were 2% versus 2.9% (p=0.588). ELISA IgG was positive in 8% of farmers versus 2.9% of students (p=0.448). Parallel testing with Rose Bengal and ELISA IgG was positive in 3% versus 0% (p=0.571). No significant odds ratios were calculated for Wright STAs and ELISA IgG.

Conclusions

Healthy livestock farmers may present with positive Rose Bengal test but this translates to true seroprevalence in only a small proportion. Livestock farmers have no significant seroprevalence that may obscure diagnosis of acute brucellosis in clinical settings.

A high percentage of serum samples that test reactive by enzyme immunoassay for anti-Brucella antibodies are not confirmed by the standard tube agglutination test

We describe a retrospective analysis of Brucella enzyme immunoassay (EIA) IgM and IgG results compared to those of the standard tube agglutination test (SAT). Among 1,091 samples tested, 104 (9.5%) and 24 (2.2%) sera were positive by IgM and IgG EIA, respectively. Supplemental testing by SAT showed that 82.7% (86/104) of IgM EIA-reactive samples and 54.2% (13/24) of IgG EIA-reactive samples were negative by SAT. Testing all EIA screen-reactive samples by SAT is required when evaluating patients for potential brucellosis. Due to the limitations of serology, culture remains the gold standard for detecting Brucella infection.

Implications of laboratory diagnosis on brucellosis therapy

Brucellosis is a worldwide zoonosis with a huge economic impact on animal husbandry and public health. The diagnosis of human brucellosis can be protracted because the disease primarily presents as fever of unknown origin with unspecific clinical signs and symptoms. The isolation rate of the fastidious etiologic agent from blood cultures is low, and therefore laboratory diagnosis is mainly based on serologic and molecular testing. However, seronegative brucellosis patients have been described, and antibody titers of diagnostic significance are difficult to define. Whether the molecular detection of Brucella DNA in clinical samples should be followed by long-term antibiotic treatment or not is also a matter of debate. The aim of this article is to review and discuss the implications of laboratory test results in the diagnosis of human brucellosis on disease therapy.