Acute brucellosis: presentation, diagnosis, and treatment of 144 cases

Imaging of spinal and central nervous system brucellosis: a review

Brucellosis is a zoonotic disease caused by Gram-negative bacteria of the Brucella genus that can be acquired through contact with a contaminated animal or its secretions. The course of the disease can be acute, chronic, or persistent. Axial skeleton and central nervous system (CNS) are among the most common affected locations and may be involved in each of the forms. Due to the varying clinical picture of the disease, diagnosis is made mainly on the basis of laboratory examinations that detect specific IgM and IgG antibodies in blood or other biological material and/or cultures. Imaging methods, especially magnetic resonance imaging, can aid in establishing proper diagnosis, monitoring of the disease and, to some extent, enable differential diagnosis before obtaining the laboratory tests results. The aim of this review is to present imaging features of Brucella infection of the spine and CNS and provide the recent advancements in the field.

Bovine brucellosis in dual-purpose cattle herds and its potential economic impact in the Colombian Caribbean region

Bovine brucellosis (BB) is a cosmopolitan zoonotic disease caused by certain bacteria of the genus Brucella. It has negative health implications for the cattle, economic implications for the owners and is present in numerous cattle and wildlife populations worldwide. To determine the seroprevalence of BB in dual-purpose herds and assess its impact in the southern part of the Department of Atlántico, northern Colombia. 1,000 female cattle were tested for brucellosis, using the Rose Bengal Plate Test (RBPT) and indirect ELISA (iELISA) as screening and confirmatory tests, respectively. Of these, 100 animals tested positive by RBPT and 204 were inconclusive, while 38 positive animals were identified by iELISA. Consequently, the apparent seroprevalence was 3.8%, and the estimated true prevalence was 4.4%. Based on estimates of the economic losses caused by BB, the cost was calculated at $2,496,364 COP ($822 USD) per animal. The costs identified in this study include medication costs, loss of lactation, and others. It highlights the significant impact of BB on food security, particularly concerning the availability of and access to bovine food products, as well as on the economy of livestock farmers in the region.

Selection of treatment strategies for lumbar Brucella spondylitis: a retrospective clinical study

Objective

This study aims to investigate the treatment strategies for lumbar brucellar spondylitis by comparing the outcomes of pure pharmacological treatment with diseased intervertebral fixation fusion, with or without lesion clearance.

Methods

A total of 157 patients with lumbar brucellar spondylitis were categorized into three groups: Group A (52 cases) received pure pharmacological treatment, Group B (53 cases) underwent posterior vertebral fixation fusion, and Group C (52 cases) received posterior (or anterior) lesion clearance followed by posterior vertebral fixation fusion. Clinical data were analyzed, and the efficacy of the three treatment methods was evaluated.

Results

The surgical groups showed better outcomes at various time points compared to the pharmacological treatment group (P < 0.05). The pure fixation group outperformed the lesion clearance fusion group during the perioperative period (P < 0.05). The ESR, CRP, ODI scores, imaging evaluation and complications of the lesion clearance followed by fixation group were all better than those of the other two groups (P < 0.05). Surgical treatment groups showed no statistically significant difference in VAS scores (P > 0.05), and both were superior to the pharmacological treatment group. There were no statistically significant differences in clinical efficacy among the three groups at the last follow-up.

Conclusion

Surgical treatment achieves early recovery goals compared to pharmacological treatment for brucellar spondylitis. However, individualized treatment principles should guide surgical decisions to select the most suitable approach for patients.

Hepatobiliary Brucellosis: Brucella Bacteremia Presenting with Refractory Hepatobiliary Infection

Brucellosis often presents with common and nonspecific symptoms such as fever, malaise, and arthralgia but can also involve primary organs. Intra-abdominal involvement is rare. We report a case of hepatobiliary brucellosis presenting as a refractory hepatobiliary infection in a healthy young adult with no underlying rheumatologic disease or history of exposure to risk factors. Detection of Brucella in the blood led to a shift in the patient's management and consequently her recovery.

Osteoarticular Involvement in Childhood Brucellosis: Evaluation of Clinical, Laboratory and Radiologic Features of 185 Cases

BACKGROUNDS

Brucellosis is a systemic zoonotic disease. Osteoarticular (OA) system involvement is a common complication and the predominant manifestation of brucellosis in children. We aimed to evaluate the epidemiologic, demographic, clinical characteristics, and laboratory and radiologic findings of children with brucellosis and how these related to OA involvement.

METHODS

This retrospective cohort study consisted of all consecutive children and adolescents diagnosed as having brucellosis who were admitted to the pediatric infectious disease department of University of Health Sciences Van Research and Training Hospital between August 1, 2017, and December 31, 2018, in Turkey.

RESULTS

A total of 185 patients diagnosed as having brucellosis were evaluated, 50.8% had OA involvement (n = 94). Seventy-two patients (76.6%) exhibited peripheral arthritis involvement, among of them, hip arthritis (63.9%; n = 46) was the most common manifestation, followed by arthritis of knee (30.6%; n = 22), shoulder (4.2%; n = 3) and elbow (4.2%; n = 3). A total of 31 patients (33.0%) had sacroiliac joint involvement. Seven patients (7.4%) had spinal brucellosis. Erythrocyte sedimentation rate level above 20 mm/h at admission and age were independent predictor of OA involvement (respectively odds ratio [OR] = 2.82; 95% confidential interval [CI] = 1.41-5.64, OR peryear = 1.10; 95% CI: 1.01-1.19). Increasing age was associated types of OA involvement.

CONCLUSION

A half of brucellosis cases had OA involvement. These results can help physicians to make early identification and diagnosis of childhood OA brucellosis who present with arthritis and arthralgia to enable the disease to be treated in time.

Bifurcation analysis of a sheep brucellosis model with testing and saturated culling rate

Testing-culling is a very effective measure for the prevention and control of animal diseases. In this paper, based on sheep brucellosis control policies and animal testing characteristics and considering the limitation of culling resources, a dynamic model is established to study the impact of testing-culling measure. Theoretical analysis reveals that the model may have one or three positive equilibria. The equilibrium in the middle is always unstable, and the model shows saddle-node bifurcation, generalized Hopf bifurcation and Bogdanov-Takens bifurcation. Moreover, the theoretical results are verified via numerical analysis. These results reveal that testing and culling strategies can induce complex transmission dynamics that can help us develop appropriate prevention and control measures for animal brucellosis.

Increased serum piwi-interacting RNAs as a novel potential diagnostic tool for brucellosis

Background

Piwi-interacting RNAs (piRNAs) have emerged as potential novel indicators for various diseases; however, their diagnostic value for brucellosis remains unclear. This study aimed to evaluate the diagnostic potential of altered serum piRNAs in patients with brucellosis.

Methods

Illumina sequencing via synthesis (SBS) technology was used to screen the serum piRNA profile in brucellosis patients, and markedly dysregulated piRNAs were confirmed by quantitative real-time polymerase chain reaction (qRT-PCR) assay in two sets from a cohort of 73 brucellosis patients and 65 controls.

Results

Illumina SBS technology results showed that seven piRNAs were markedly elevated in brucellosis patients compared to normal controls. The seven upregulated piRNAs were further validated individually by qRT-PCR, of which three piRNAs (piR-000753, piR-001312, and piR-016742) were confirmed to be significantly and steadily increased in the patients (> 2-fold, P < 0.01). The area under the receiver operating characteristic (ROC) curve (AUCs) for the three piRNAs ranged from 0.698 to 0.783. The AUC for the three piRNAs combination was 0.772, with a specificity of 86% and a positive predictive value of 90%, respectively.

Conclusions

The three-piRNA panel identified in this study has potential as a novel blood-based auxiliary tool for brucellosis detection.

Brucella pleurisy: An extremely rare complication of brucellosis

Brucella is a rare pathogen of the lung. This intracellular organism can involve pleura in the sub-acute and chronic course of the disease. Here, we introduce an infrequent case of brucella pleurisy that presented to our hospital with chest pain.

Seroprevalence of brucellosis and Q fever infections amongst pastoralists and their cattle herds in Sokoto State, Nigeria

Brucellosis and Q fever are neglected zoonoses of global health importance, with unknown true prevalence in occupationally vulnerable settings, partly due to misdiagnosis for other febrile conditions and poor access to primary health care. We examined the seroprevalence of these diseases and associated factors amongst pastoralists and their cattle in Sokoto State, a hub of cattle and pastoral populations in Nigeria. Serum samples randomly collected from 137 pastoralists and 366 cattle from 27 herds in three selected Local Government Areas (LGAs) in the state were analysed for antibodies to Brucella abortus using Rose Bengal Plate Test (RBT) and competitive Enzyme-Linked Immunosorbent Assay (cELISA) as well as antibodies to Coxiella burnetti using indirect ELISA. Consenting pastoralists' knowledge, perception and practices about the diseases were assessed using a semi-structured questionnaire. Data were analysed using descriptive statistics and bivariate analysis at p ≤ 0.05 level of significance. Brucellosis adjusted individual seroprevalence were 0.83% (95%CI: 0.04-4.59%) and 0% among pastoralists; 2.28% (95%CI: 1.16-4.43%) and 5.70% (95%CI: 3.68-8.74%) in cattle by RBT and cELISA, respectively. Adjusted herd-level seroprevalence for brucellosis were 23.20% (95%CI: 11.07-42.54%) and 42.00% (95%CI: 25.27-61.11%) by RBT and cELISA, respectively. For Q fever, higher seroprevalence of 62.57% (95%CI: 54.04-70.46%) and 2.98% (95%CI: 1.57-5.58%) were recorded amongst the pastoralists and their cattle, respectively. with adjusted herd-level seroprevalence of 40.36% (95%CI: 22.57-63.17%). The LGAs of sampling were significantly (OR: 0.2; 95%CI: 0.02-1.00) associated with Q fever infection, though marginal. The majority of the pastoralists had poor knowledge, perception and practices towards the diseases. This is the first study establishing the presence of brucellosis and Q fever at the human-animal interface in Sokoto State, Nigeria. The pastoralists' poor knowledge, perception and practices about these diseases are worrisome and are important factors for consideration in disease control.

Complicated Brucellosis With Multisystem Involvement: Two Case Reports

Brucellosis is a zoonotic infection caused by facultative intracellular bacteria of the genus Brucella. The ability of the organism to invade both phagocytic and non-phagocytic cells and survive in the intracellular environment makes brucellosis a systemic infection that can affect various organs of the body. Complications of brucellosis occur when the infection involves one or more focal body sites. Early identification of complications of brucellosis and initiation of appropriate treatment is the key to a better outcome.

Here we present two cases of complicated brucellosis, both having multiple body site involvement.

Epidemiological assessment of 5598 brucellosis inpatients in Spain (1997-2015)

Brucellosis remains one of the main zoonoses worldwide. Epidemiological data on human brucellosis in Spain are scarce. The objective of this study was to assess the epidemiological characteristics of inpatient brucellosis in Spain between 1997 and 2015. A retrospective longitudinal descriptive study was performed. Data were requested from the Health Information Institute of the Ministry of Health and Equality, which provided us with the Minimum Basic Data Set of patients admitted to the National Health System. We also obtained data published in the System of Obligatory Notifiable Diseases. A total of 5598 cases were registered. The period incidence rate was 0.67 (95% CI 0.65-0.68) cases per 100 000 person-years. We observed a progressive decrease in the number of cases and annual incidence rates. A total of 3187 cases (56.9%) came from urban areas. The group most at risk comprised men around the fifth decade of life. The average (±s.d.) hospital stay was 12.6 days (±13.1). The overall lethality rate of the cohort was 1.5%. The number of inpatients diagnosed with brucellosis decreased exponentially. The group of patients with the highest risk of brucellosis in our study was males under 45 years of age and of urban origin. The lethality rate has reduced to minimum values. It is probable that hospital discharge records could be a good database for the epidemiological analysis of the hospital management of brucellosis and offer a better information collection system than the notifiable diseases system (EDO in Spanish).

Factors Associated With Single and Recurrent Bacteremia in Childhood Brucellosis

BACKGROUND

Data regarding risk factors of bacteremic brucellosis, and specifically recurrent bacteremia, are scarce. We assessed patients with childhood brucellosis, differentiating between those having culture-negative, single-bacteremic, and recurrent-bacteremic episodes.

METHODS

The medical files of pediatric brucellosis patients, from 2005 through 2014, were reviewed retrospectively. Univariate and multivariate analyses were performed to compare demographic and clinical characteristics of culture-negative, single-bacteremic, and recurrent-bacteremic (≥30 days between positive cultures) episodes.

RESULTS

Of all 436 brucellosis cases, 22% were culture-negative, 72% were single-bacteremic, and 6% were recurrent-bacteremic. In a univariate analysis, single-bacteremic episodes were associated with fever (90% vs 65% and 40% in culture-negative and recurrent bacteremia, respectively) and elevated glutamic oxaloacetic transaminase (GOT) levels. Recurrent-bacteremic episodes were associated with anemia (26% vs 14% and 9% in single bacteremia and culture negative, respectively), elevated GOT, low immunoglobulin M (IgM) titers (56% vs 89% and 99%, respectively), and lower levels of adequate treatment (74% vs 94% and 86%, respectively). In multivariate analyses, single bacteremia was associated with fever (odds ratio [OR], 3.595, compared with culture negative), while recurrent bacteremia was inversely associated with IgM titers ≥1:160 (OR, 0.022 and 0.226 compared with culture negative and single bacteremia, respectively) and fever (OR, 0.108 compared with single bacteremia).

CONCLUSIONS

Brucellosis episodes are commonly complicated with bacteremia. Single-bacteremic episodes were associated with high-grade fever and elevated liver enzymes, possibly indicating high bacterial virulence. Recurrent-bacteremic episodes were associated with poor treatment at initial diagnosis, along with low rates of fever, low IgM titers, and high anemia rates, possibly indicating impaired host response. Physicians should consider treatment modifications for suspected recurrent-bacteremic brucellosis, including monitoring treatment adherence, and possibly administering prolonged treatment.

Research Progress on Brucellosis

Brucellosis is a debilitating febrile illness caused by an intracellular Brucella. The disease is distributed in humans and animals widely, especially in developing countries. Ten species are included in the genus Brucella nowadays; four species of them are pathogenic to humans, which make brucellosis a zoonosis with more than 500,000 new cases reported annually. For human brucellosis, the most pathogenic species is B. melitensis followed by B. suis, while B. abortus is the mildest type of brucellosis. The infection mechanism of Brucella is complicated and mostly relies on its virulence factors. The therapy of the disease contains vaccination and antibiotic. However, there are some defects in currently available vaccines such as the lower protective level and safety. Thus, safe and efficient vaccines for brucellosis are still awaited. The dual therapy of antibacterial is effective in the treatment of brucellosis if a rapid and exact detection method is found.

Comprehensive analysis of differentially expressed serum microRNAs in humans responding to Brucella infection

Background

MicroRNAs (miRNAs), a subset of small non-coding RNA molecules, play crucial roles in various pathophysiological processes. Studies increasingly indicate that dysregulated miRNAs are associated with bacterial infection. Nevertheless, little is known about miRNAs that respond to Brucella infection and their potential clinical value. Our research aimed to identify the serum miRNAs altered during Brucella infection.

Methods

We enrolled serum samples from 73 patients diagnosed with brucellosis and 65 age- and sex-matched control individuals. Illumina sequencing via synthesis (SBS) technology was performed for an initial screen of miRNAs expression profile in serum samples pooled from 29 patients and 29 controls, respectively. A quantitative real-time polymerase chain reaction (qRT-PCR) assay was conducted in the training and validation sets to confirm the concentrations of differentially expressed miRNAs in individual serum samples from 73 patients and 65 controls.

Results

The Illumina SBS technology identified 1,372 known miRNAs and 1,893 novel miRNAs in brucellosis patients. The three markedly upregulated miRNAs (miR-15a-3p, miR-7-2-3p, miR-103b) in brucellosis patients were subsequently validated by qRT-PCR assay, of which miR-103b was confirmed to be significantly and steadily increased in the brucellosis patients compared with the controls (>2-fold, P<0.001). The area under the receiver operating characteristic (ROC) curve (AUC) for miR-103b was 0.714 (95% CI, 0.624-0.804). Bioinformatics analysis predicted that some putative target genes of miR-103b are involved in immune regulation or the processes of apoptosis and autophagy in humans.

Conclusions

The serum miR-103b level markedly increases after Brucella infection and has the potential to serve as an auxiliary diagnostic indicator for Brucella infection that deserves further investigation.

Osteoarticular manifestations of human brucellosis: A review

Brucellosis is a common global zoonotic disease, which is responsible for a range of clinical manifestations. Fever, sweating and musculoskeletal pains are observed in most patients. The most frequent complication of brucellosis is osteoarticular involvement, with 10% to 85% of patients affected. The sacroiliac (up to 80%) and spinal joints (up to 54%) are the most common affected sites. Spondylitis and spondylodiscitis are the most frequent complications of brucellar spinal involvement. Peripheral arthritis, osteomyelitis, discitis, bursitis and tenosynovitis are other osteoarticular manifestations, but with a lower prevalence. Spinal brucellosis has two forms: focal and diffuse. Epidural abscess is a rare complication of spinal brucellosis but can lead to permanent neurological deficits or even death if not treated promptly. Spondylodiscitis is the most severe form of osteoarticular involvement by brucellosis, and can have single- or multi-focal involvement. Early and appropriate diagnosis and treatment of the disease is important in order to have a successful management of the patients with osteoarticular brucellosis. Brucellosis should be considered as a differential diagnosis for sciatic and back pain, especially in endemic regions. Patients with septic arthritis living in endemic areas also need to be evaluated in terms of brucellosis. Physical examination, laboratory tests and imaging techniques are needed to diagnose the disease. Radiography, computed tomography, magnetic resonance imaging (MRI) and bone scintigraphy are imaging techniques for the diagnosis of osteoarticular brucellosis. MRI is helpful to differentiate between pyogenic spondylitis and brucellar spondylitis. Drug medications (antibiotics) and surgery are the only two options for the treatment and cure of osteoarticular brucellosis.

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.

Predominance of Brucella abortus antibodies among women with spontaneous abortion in the city of Mwanza: unrecognized link or coincidence?

OBJECTIVE

This study investigated the association of Brucella seropositivity and spontaneous abortions in human population in the city of Mwanza, Tanzania.

RESULTS

A comparative cross sectional study which used 148 sera from women with spontaneous abortion and 250 sera from full-term delivered women was conducted in July 2017. Detection of Brucella abortus and Brucella melitensis antibodies was done using slide agglutination test. Data were analyzed using STATA version 13 software. The median age of the study participants was 25 (interquartile range 21-30) years. The overall seropositivity of Brucella antibodies was significantly higher among sera from women with spontaneous abortion than full term delivered women; (86/148, 58.1%: 95% CI 50-66 vs. 65/250, 26%: 95% CI 18-33, P < 0.001). Seropositivity of B. abortus was significantly higher among sera from women with spontaneous abortion than full-term delivered women (31.8% vs. 10.8%, P < 0.001). Women with abortion had 3.59 odds of being brucella seropositive compared to full term women (OR: 3.59, 95% CI; 2.25-5.74, P < 0.001). Seropositivity of Brucella antibodies is significantly higher among women with spontaneous abortion than full-term delivered women necessitating a need to investigate the relationship between Brucellosis and adverse pregnancy outcomes.

Prevalence and risk factors of brucellosis among febrile patients attending a community hospital in south western Uganda

Human brucellosis, a chronic disease contracted through contact with animals and consuption of unpasteurized dairy products is underreported in limited-resource countries. This cross-sectional study aimed to determine the prevalence and risk factors of brucellosis among febrile patients attending a community hospital in South western Uganda. A questionnaire that captured socio-demographic, occupational and clinical data was administered. Blood samples were tested for Brucella antibodies using Rose Bengal Plate Test (RBPT) and blood culture with standard aerobic BACTEC bottle was done. Of 235 patients enrolled, prevalence of brucellosis (RBPT or culture confirmed) was 14.9% (95% CI 10.6-20.1) with a culture confrmation in 4.3% of the participants. The factors independently associated with brucellosis were consumption of raw milk (aOR 406.15, 95% CI 47.67-3461.69); history of brucellosis in the family (aOR 9.19, 95% CI 1.98-42.54); and selling hides and skins (aOR 162.56, 95% CI 2.86-9256.31). Hepatomegaly (p < 0.001), splenomegaly (p = 0.018) and low body mass index (p = 0.032) were more common in patients with brucellosis compared to others. Our findings reveal a high prevalence of brucellosis among febrile patients and highlight a need for implementing appropiate tests, public awareness activities and vaccination of animals to control and eliminate the disease.

An Interesting Case of Neurobrucellosis Mimicking Neuropsychiatric Lupus

This case describes a patient presenting with acute onset papilledema, subacute strokes resulting in upper extremity weakness and numbness, arthritis, maculopapular rash, depressed C4 and CH50, and a high titer anti-double-stranded DNA antibody. The patient was given the diagnosis of probable systemic lupus erythematosus, which was supported by the Systemic Lupus International Collaborating Clinics (SLICC) criteria. He was aggressively treated for neuropsychiatric lupus (NPSLE) with pulse dose steroids and a dose of intravenous cyclophosphamide. Blood cultures drawn on admission later grew out 2/4 bottles of Gram-variable bacteria, speciated as Brucella melitensis by PCR. Serum Brucella serologies were also positive. On further evaluation, the patient noted a history of eating unpasteurized cheese in Mexico. Given these additional findings, the patient's presentation was most consistent with a diagnosis of neurobrucellosis. Steroids were tapered off, no further doses of cyclophosphamide were given, and a prolonged course of intravenous and oral antibiotic therapy was administered, resulting in complete resolution of the patient's presenting symptoms.

First case of cervical epidural abscess caused by brucellosis in Saudi Arabia: A case report and literature review

Spinal epidural abscess (SEA) is an extremely rare and disastrous musculoskeletal complication of spondylodiscitis and sacroilitis secondary to brucellosis infection. Few case reports and retrospective studies have been published reporting patients with epidural abscesses mainly lumbar, and thoracic while cervical abscess are rare. Management of spinal epidural abscess due to Brucella species is not standard and remains controversial. To the best of our knowledge this is the first case of brucellar cervical epidural abscess reported in Saudi Arabia. In this paper, we review the literature and report a case of a 67-year-old Saudi gentleman, who presented with fever and back pain. Further evaluation revealed cervical epidural abscess and a positive serology for brucellosis. Following 6 months of antibiotic therapy alone against brucellosis, he showed significant clinical and radiological improvement. Spinal epidural abscess caused by brucellosis is a rare condition, difficult to diagnose, and can be complicated by disastrous neurological or vascular complication if left untreated. Brucellosis must be considered as a possible cause of spinal epidural abscess in patients from endemic area. Hence, early detection and initiation of appropriate medical treatment alone is crucial in preventing permanent neurological complication, and possibly avoid surgical intervention.

Pattern of childhood brucellosis in Najran, south Saudi Arabia in 2013-2017

Background

With more than 500,000 new cases annually, human brucellosis is the commonest zoonotic disease worldwide. In some endemic countries, its prevalence is more than 10 per 100,000 population.

Objective

The aim of this study was to determine the magnitude of the problem and the clinical features, laboratory findings, treatment given and complications seen in children with brucellosis in Najran City, Kingdom of Saudi Arabia.

Methods

This is a case-series study by analysis of data of children known or diagnosed to have brucellosis for the last 4 years in Najran City. Data was obtained by reviewing the hospital records of the Maternity and Children Hospital and Najran Armed Forces Hospital in Najran during the period from 2013 to 2017. The statistical analysis was carried out using SPSS version 16.0. Since it was the first report of brucellosis on the study population, we used descriptive statistics (frequency, proportion, mean, and standard deviation) for presenting the findings.

Results

We studied 57 diagnosed cases of child brucellosis throughout the past 4 years in Najran, south Saudi Arabia with an average number of about 12 cases per year. Of the cases, 15.8% reported a history of ingestion of raw milk and dairy product and only 1.8% of them reported a history of animal contact while 82.4% confirmed unknown mode of transmission. Fever was the only finding in 36.8%, fever and arthralgia 21.1%, and fever and myalgia 19.3%. Two thirds of the cases were diagnosed by standard agglutination test (SAT). Hepatosplenomegaly was found in 10.5%. Rifampicin was the antibiotic of choice and 70.2% of cases have been cured but 3.5% relapsed and 1.8% died from complications.

Conclusions

Results suggest brucellosis be considered in every child living in an endemic area, showing symptoms of fever and having a history of ingestion of raw milk and dairy product and/or animal contact.

Prevention should rely on health education of the public about different issues of the disease including boiling raw milk.

Effect of hydroxychloroquine on treatment and recurrence of acute brucellosis: a single-blind, randomized clinical trial

Brucellosis is associated with a high recurrence rate and requires more than one course of standard treatment; therefore, more research is required to find more effective treatments that lead to prompt recovery, and reduce the relapse of disease. This single-blind, randomized study was designed to evaluate the effect of the standard treatment for brucellosis in combination with hydroxychloroquine. A total of 177 patients with acute brucellosis were randomly assigned to one of two treatment groups: doxycycline-streptomycin (DS) and doxycycline-streptomycin-hydroxychloroquine (DSH). Clinical symptoms and signs, serological tests, and side effects of therapy were compared between the two groups during the treatment course and at three and six months after the end of drug therapy. Of the 177 patients, with a mean age of 40.5 ± 16.9 years, 66.1% were males. The mean duration of clinical signs prior to admission was 43.4 ± 41.1 days. Appropriate clinical responses, relapse, treatment failure, and adverse drug reactions were seen in 98.9%, 1.2%, 0.0%, and 12.6% of patients, respectively, in the DSH group vs. 86.7%, 11.6%, 2.3%, and 19.8% of patients, respectively, in the DS group. There were significant differences in clinical response and relapse rates between the two groups. The addition of hydroxychloroquine to a doxycycline-streptomycin regimen appears to increase the efficacy of treatment, accelerate improvement of clinical symptoms, and significantly reduce the rate of relapse of brucellosis.

[Dermato-urology: Male genital lesions urologist should know]

This article aimed to gather male genital dermatoses that may lead to consult a urologist, except pre-neoplastic or neoplastic lesion.

METHOD

This review is based on a research on Pubmed and EM-consult database, in English and in French, using the following key terms "male genital dermatoses", "male genital lesions", "balanitis", "balanoposthitis", "dermatoses des organes génitaux externes masculines", "lésions des organes génitaux externes de l'homme", "balanoposthites".

RESULTS

It highlights normal morphological aspects, acute balanoposthitis (nonspecific, infectious, allergic, irritative and traumatic), common skin disease localized to male genital and male genital specific dermatoses.

CONCLUSION

Any suspicious, fixed, must lead to a skin biopsy.

Differential study of DCE-MRI parameters in spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis

Objective

In the present study, spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis were quantitatively analyzed using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to assess the value of DCE-MRI in the differential diagnosis of these diseases.

Methods

Patients with brucellar spondylitis, spinal tuberculosis or a spinal metastatic tumor (30 cases of each) received conventional MRI and DCE-MRI examination. The volume transfer constant (K^trans), rate constant (K_ep), extravascular extracellular volume fraction (V_e) and plasma volume fraction (V_p) of the diseased vertebral bodies were measured on the perfusion parameter map, and the differences in these parameters between the patients were compared.

Results

For pathological vertebrae in cases of spinal metastatic tumor, brucellar spondylitis and spinal tuberculosis, respectively, the K^trans values (median ± quartile pitch) were 0.989±0.014, 0.720±0.011 and 0.317±0.005 min^–1; the K_ep values were 2.898±0.055, 1.327±0.017 and 0.748±0.006 min^–1; the V_e values were 0.339±0.008, 0.542±0.013 and 0.428±0.018; the V_p values were 0.048±0.008, 0.035±0.004 and 0.028±0.009; the corresponding H values were 50.25 (for K^trans), 52.47 (for K_ep), 48.33 (for V_e) and 46.56 (for V_p), and all differences were statistically significant (two-sided P<0.05).

Conclusions

The quantitative analysis of DCE-MRI has a certain value in the differential diagnosis of spinal metastatic tumor, brucellar spondylitis and spinal tuberculosis.

Brucella pericarditis: A forgotten cause of chest pain

BACKGROUND

Brucellosis pericarditis is an extremely rare involvement of the cardiovascular system with Brucella species that has worldwide distribution and is endemic in many provinces of Iran.

CASE PRESENTATION

The present report describes an exceptional case of pericardial involvement by Brucella melitensis in a 50- year-old woman. The patient presented with night sweats, mild fever, weight loss, and chest pain.

CONCLUSION

Pericarditis occurs during the course of brucellosis as an isolated cardiac symptom and may be asymptomatic or may be manifested with chest pain as ischemic heart disease.

Predictors of specific anti-Brucella antibodies among humans in agro-pastoral communities in Sengerema district, Mwanza, Tanzania: the need for public awareness

Background

Human brucellosis remains to be a neglected zoonotic disease among agro-pastoral communities where livestock rearing is one of the main economic activities. This study was conducted in different agro-pastoral communities in Sengerema district, Mwanza, Tanzania, to determine seroprevalence and predictors of anti-Brucella antibodies, information that may influence public awareness on the risk factors and strategies to improve the diagnosis of brucellosis in developing countries.

Methods

A cross-sectional community-based study was conducted between July and September 2008 in ten villages of Sengerema district. Sociodemographic and other related information were collected using a standardized data collection tool. Detection of Brucella abortus and Brucella melitensis antibodies were done using rapid Brucella serum agglutination test. Data were analysed by using STATA version 11.0. Adjusted odds ratios (AOR) were calculated using multivariate logistic regression analysis.

Results

A total of 382 adults were enrolled with the median age of 30 (interquartile range 15–40) years. Males formed the majority of the participants 234 (61.5 %). Overall, seroprevalence of anti-Brucella antibodies was found to be 14.1 % (54/382, 95 % CI 10.6–17.5). Seroprevalence of B. melitensis was 11 % (42/382) while that of B. abortus was found to be 7 % (26/282), P = 0.0267. Co-infection of B. melitensis and B. abortus was observed in 3.6 % (14/382, 95 % CI 1.7–5.4) of participants. On a multivariate logistic regression analysis, male sex (AOR 3.2, 95 % CI 1.3–7.5, P = 0.007), touching goat placenta (AOR 2.54, 95 % CI 1.05–6.14, P = 0.012) and agro-pastoralist occupation (AOR 2.07, 95 % CI 1.01–4.24, P = 0.04) were found to predict B. melitensis infection. Males (AOR 3.07, 95 % CI 1.45–6.51, P = 0.003) and agro-pastoralists (AOR 2.98, 95 % CI 1.38–6.43, P = 0.005) were found to be predictors for specific anti-Brucella antibodies.

Conclusions

A significant proportion of the agro-pastoralist male population in agro-pastoral communities in Sengerema district is positive for anti-Brucella antibodies. With the decrease incidence of malaria fever, other causes of fever such as Brucella spp. should be considered of public health concern in Tanzania especially in agro-pastoral communities.

Congenital Tick Borne Diseases: Is This An Alternative Route of Transmission of Tick-Borne Pathogens In Mammals?

Tick-borne diseases (TBDs) have become a popular topic in many medical journals. Besides the obvious participation of ticks in the transmission of pathogens that cause TBD, little is written about alternative methods of their spread. An important role is played in this process by mammals, which serve as reservoirs. Transplacental transfer also plays important role in the spread of some TBD etiological agents. Reservoir species take part in the spread of pathogens, a phenomenon that has extreme importance in synanthropic environments. Animals that accompany humans and animals migrating from wild lands to urban areas increase the probability of pathogen infections by ticks This article provides an overview of TBDs, such as tick-borne encephalitis virus (TBEV), and TBDs caused by spirochetes, α-proteobacteria, γ-proteobacteria, and Apicomplexa, with particular attention to reports about their potential to cross the maternal placenta. For each disease, the method of propagation, symptoms of acute and chronic phase, and complications of their course in adults, children, and animals are described in detail. Additional information about transplacental transfer of these pathogens, effects of congenital diseases caused by them, and the possible effects of maternal infection to the fetus are also discussed. The problem of vertical transmission of pathogens presents a new challenge for medicine. Transfer of pathogens through the placenta may lead not only to propagation of diseases in the population, but also constitute a direct threat to health and fetal development. For this reason, the problem of vertical transmission requires more attention and an estimation of the impact of placental transfer for each of listed pathogens.

Testicular infection in brucellosis: Report of 34 cases

BACKGROUND/PURPOSE

To present clinical and laboratory features, treatment options, and outcome in patients with brucellar testicular infection and to compare them with analogous in brucellar patients without testicular involvement.

METHODS

Thirty four brucellar patients with testicular infection treated in two general hospitals in the Republic of Macedonia, during the period 1998-2009, were retrospectively analyzed. Their clinical and laboratory characteristics were compared with analogous in 364 male brucellar patients without testicular infection, who were treated at the same hospitals during the same time period.

RESULTS

Brucellar testicular infection was evident in 34 (8.5%) out of 398 male patients with brucellosis. The median age of the patients was 46.5 years. In all patients testicular involvement was presented as an acute form with a median duration of 5 days (range, 2-14 days) prior to diagnosis. Twenty-three of the patients had at least one other simultaneous focal infection. After starting with the treatment testicular infection lasted a median 10 days, range 7-21 days. Brucellar patients with testicular infection when compared with other brucellar patients more frequently manifested fever (97% vs. 61%), concomitant spondylitis (32% vs. 16%), and urinary system involvement (12% vs. 2%). Also, the relapse rate in patients with testicular involvement was significantly higher (24% vs. 9%).

CONCLUSION

In endemic regions brucellosis should be taken into consideration in any patient with testicular infection. Brucellar testicular involvement is usually characterized with a severe acute clinical presentation and a high percentage of relapses which entails the need of timely recognition and proper treatment duration of at least 60 days.

Brucellosis-related acute pancreatitis: A rare complication of a universal disease

OBJECTIVES

To determine the prevalence and determinants of acute pancreatitis in patients with acute brucellosis.

METHODS

Adult patients with brucellosis were retrospectively recruited. Brucellosis and acute pancreatitis were diagnosed according to standard criteria. Laboratory analyses included Wright agglutination titre, serum biochemical parameters and blood count.

RESULTS

Patients with acute pancreatitis (n = 21) had significantly higher Wright agglutination titres, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ-glutamyl transpeptidase, amylase, lipase and serum glucose concentrations, and significantly lower haemoglobin concentrations and haematocrit than patients with brucellosis alone (n = 326).

CONCLUSIONS

Hyperglycaemia, anaemia, and liver transaminase and cholestatic enzyme concentrations may represent new approaches for assessing disease severity in patients with brucellosis and acute pancreatitis.

Childhood brucellosis: Review of 317 cases

OBJECTIVE

To describe the main epidemiological, clinical, and laboratory features, treatment options and outcome in children with brucellosis.

METHODS

Retrospectively evaluated data were obtained from 317 pediatric patients with brucellosis that were treated at the University Clinic for Infectious Diseases and Febrile Conditions in Skopje, during the period from 1989 to 2011. The medical records and follow-up protocols were used for evaluation.

RESULTS

Childhood brucellosis composed 317 (18.7%) of 1691 patients with brucellosis. The patients were median 9 years old, ranging from 7 months to 14 years, and 201 (63.4%) were males. Family history was present in 197 (62.1%), and direct contact with animals occurred in 140 (44.2%) of the children. The dominant manifestations were fever in 248 (78.2%), joint pain in 228 (71.9%) and hepatomegaly in 216 (68.1%). Organ affection was present in 206 (65.0%) of the patients. One hundred and six (33.4%) of the patients were treated with combination composed of two, and 211 (66.6%) with three antimicrobial agents. Relapses were registered in 21 (6.6%), and therapeutic failures in 3 (0.9%) of the children.

CONCLUSIONS

In endemic regions childhood brucellosis represents a significant part of human cases. Wide spectrum of clinical manifestations, frequent affection of various organ systems and possibility of relapses show that brucellosis could be a serious disease in this age group. The presence of fever, joint pain, sweating, and affection of various systems in children from endemic regions should alert pediatricians for the possibility of brucellosis.

Epidemiological, diagnostic, clinical, and therapeutic aspects of Brucella bacteremia in children in southern Israel: a 7-year retrospective study (2005-2011)

BACKGROUND

Data on the various aspects of brucellosis in children living in southern Israel are missing.

OBJECTIVES

Our aim was to study the epidemiological, microbiological, diagnostic, clinical, therapeutic and outcome features of brucellosis in children <19 years of age in southern Israel during 2005-2011.

PATIENTS AND METHODS

The study population included all patients hospitalized with a diagnosis of brucellosis, established according to a clinical presentation compatible with brucellosis+presence of Brucella bacteremia (BB).

RESULTS

A total of 128 (50.8%) of 252 patients admitted with a diagnosis of brucellosis had BB (all with Brucella melitensis). All patients were of Muslim Bedouin ethnicity. The mean incidence of BB in southern Israel was 16 cases/100,000 Bedouin, with no significant changes during the study period. Overall duration of symptoms before diagnosis was 10.1±10.9 days. Fever at diagnosis was recorded in <20% of the patients. The most frequent symptoms were arthralgia (61.7%), weakness (32.8%), gastrointestinal disturbances (27.3%), myalgia (25%), and headache (18.8%). The main clinical findings included monoarthritis (36.7%), hepatosplenomegaly (25%), lymphadenopathy (17.2%), heart murmur (11.7%), and skin rash (9.4%), respectively. Anemia, leukopenia, thrombocytopenia, and pancytopenia were reported in 17.6%, 29.6%, 12.8%, and 2.3% of the patients, respectively. Twenty-nine (30.5%) patients with BB had serum agglutinin titers ≤1/160 (13, 13.7%%, had titers <1/160). Twenty-seven (93%) of the 29 patients aged 0-4 years were treated with gentamicin and trimethoprim-sulfamethoxazole; a total of 77 (60.2%) patients received gentamicin and doxycycline.

CONCLUSIONS

Childhood brucellosis remains an important public health problem in southern Israel. BB was diagnosed in >50% of the children with brucellosis, and B. melitensis was identified in all cases. Arthralgia, weakness, and gastrointestinal complaints were the most common symptoms, and monoarthritis, hepatosplenomegaly, and lymphadenopathy were the most common clinical findings. A considerable number of patients with BB had undetectable/low serum agglutinin titers, suggesting insufficient reliability on serology alone in diagnosis of brucellosis.

Human brucellosis: sero-prevalence and associated risk factors in agro-pastoral communities of Kiboga District, Central Uganda

BACKGROUND

Brucellosis remains a neglected zoonotic disease among agro-pastoral communities where unprocessed milk and milk products are consumed. A cross-sectional study was carried out in Kiboga district to determine the seroprevalence and risk factors associated with human brucellosis in communities where livestock rearing in a common practice.

METHODS

A total of 235 participants were involved in the study. Blood samples from the participants were collected and screened for Brucella using Serum Agglutination Test and Rose Bengal Plate Test. A questionnaire was used to collect data on socio-demographic characteristics and human brucellosis related risk factors.

RESULTS

Human Brucella seroprevalence was at 17.0 % (n = 235). The prevalence was highest among males (20.5 %, n = 78) and the elderly - above 60 years (22.2 %, n = 18). Residence in rural areas (OR 3.16, 95 % CI: 1.16-8.56), consuming locally processed milk products (OR 2.54, 95 % CI: 1.12-5.78) and being single (OR 2.44, 95 % CI: 1.05-5.68), were associated with increased risk of brucellosis.

DISCUSSION

Human brucellosis seroprevalence was high at 17 %, this was parallel with animal brucellosis prevalence that has been reported to range from 10.2 % to 25.7 % in cattle in the region. The participants were from communities known to habitually consume raw milk and milk products, know to process milk products using bare hands which are major risk factors for brucellosis in humans. This also explains why consumption of unpasteurized milk products was associated with the occurrence of brucellosis in study area. This strengthened the argument that humans get infected through consumption of contaminated animal products as reported in other earlier studies. Males and elderly being more affected because of traditional roles of these groups they play in livestock care and management. The single were also to be more associated to brucellosis, due to the fact that this group consume milk and milk products more as it is readily available in the informal markets as highly nutritious fast foods in this community as also observed in USA.

CONCLUSIONS

Brucellosis is highly prevalent in Kiboga district, and therefore, an important public health problem. The transmission risk was aggravated by consumption of unpasteurized milk products, residing in rural settings and being single. There is a need to initiate screening, treat infected humans early, and educate the public about risk factors and appropriate preventive measures of brucellosis.

Acute Brucellosis with Splenic Infarcts: A Case Report from a Tertiary Care Hospital in Saudi Arabia

Splenic infarction is an extremely rare and unique presentation of brucellosis. Only few cases have been reported worldwide. We here report a case of a young man, presenting with acute onset of fever, left hypochondial pain, and vomiting. Further evaluation revealed multiple splenic infarcts and positive blood culture for brucellosis despite negative transesophageal echocardiography for endocarditis. Significant improvement in clinical symptoms and splenic lesions was achieved after six weeks of combination therapy against brucellosis.

Prevalence of Brucella antibodies on a previously acute brucellosis infected population: sensitivity, specificity and predictive values of Rose Bengal and Wright standard tube agglutination tests

PURPOSE

Brucellosis is a zoonosis with worldwide distribution. The presence of antibodies after acute infection and the prevalence of positive serology in endemic area are not well documented.

METHODS

Patients hospitalized with acute brucellosis were relocated 3-13 years after the initial infection. Hospital records of the initial infection were retrieved, and examination of Brucella antibodies using Rose Bengal test (RBT) and Wright standard tube agglutination (STA) test was performed.

RESULTS

Eighty-three patients were hospitalized from 2000 to 2010; 50.6 % were farmers and 37.4 % livestock farmers. All had febrile illness and various focal complications. All had positive serology, and 82.2 % had positive blood cultures; 91.5 % were treated with streptomycin plus doxycycline. Seventy-two (86.7 %) were relocated on follow-up. Nine (12.5 %) had positive RBT and STA up to 1/320. Occupational history was associated with positive serology (p = 0.0172), and 8/9 of the positive individuals were livestock farmers (38.0 % of the livestock farmers checked). Residence, years after the infection, clinical presentation of brucellosis and treatment were not associated with serology results. Both tests had excellent sensitivity (nearly 100 %), specificity 87.5 % and excellent negative predictive value (nearly 100 %); however, positive predictive value was only 11.4 %.

CONCLUSIONS

Rapid and low-cost tests as RBT and STA are still very useful in diagnosing acute brucellosis; however, every positive test must be examined together with clinical symptoms and occupational history. The tests can be used as screening tests in endemic populations to rule out acute brucellosis.

Spinal brucellosis in South of Tunisia: review of 32 cases

BACKGROUND CONTEXT

Brucellosis remains an important economic and public health problem in some parts of the world. The spine is the most common site of musculoskeletal involvement of brucellosis.

PURPOSE

Assess the clinical, laboratory, radiological findings, and outcomes of vertebral involvement in brucellosis.

STUDY DESIGN

A retrospective study.

PATIENT SAMPLE

Thirty-two patients with spinal brucellosis during a period of 21 years (1990-2010) were included.

OUTCOME MEASURES

Clinical and radiological improvement.

METHODS

Diagnosis made on clinical presentation, laboratory findings, radiographic evidence, and the Brucellar etiology was considered when seroagglutination tests were positive at a titer of 1/160 or higher, and/or Brucella spp were isolated in the blood or sample cultures.

RESULTS

The mean age of patients was 51±15.85 years (23 males, 9 females; age range, 19-74 years). The median diagnostic delay was 3 months. Back or neck pain (100% of patients), fever (78%), and sweats (68.6%) were the most common symptoms. Cultures of blood specimens from five patients (15.6%) were positive for Brucella melitensis. Four patients (12.5%) had motor weakness or paralysis. Magnetic resonance imaging was performed in 24 (75%) cases. Paravertebral masses, epidural masses, and psoas abscesses were detected in 65.6%, 59.4%, and 28.1% of patients, respectively. The lumbar vertebra was the most frequently involved region with the rate of 68.7%, followed by thoracal (18.7%), cervical (6.3%), lumbosacral (6.3%), and thoracolumbar (3.1%) segments. The duration of antimicrobial therapy of brucellosis (median, 6 months; range, 3-13 months) varied according to clinical response and the presence of epidural and paravertebral masses. There were no deaths or severe sequelae in this study.

CONCLUSIONS

Brucellar spondylitis should be considered in patients with back pain and fever in endemic areas. A high index of suspicion and clinical, laboratory, and radiological examinations help to confirm the diagnosis of vertebral involvement.

In vitro drug resistance of clinical isolated Brucella against antimicrobial agents

OBJECTIVE

To explore the antibiotic resistance of Brucella melitensis and instruct rational use of antimicrobial agents in clinical treatment of Brucella infection.

METHODS

Bacteria were cultured and identified by BACTEC9120 and VITEK II automicrobic system. E-test was used to detect the minimal inhibitory concentration (MIC) of antimicrobial agents in the drug susceptivity experiment.

RESULTS

A total of 19 brucella strains (all Brucella melitensis) were isolated from 19 patients, who had fever between January 2010 and June 2012, and 17 samples were blood, one was bone marrow, the other sample was cerebrospinal fluid. The MIC range of ceftazidime was 2.0-8.0 mg/L, rifampicin was 0.06-2.0 mg/L, amikacin was 4.0-12.0 mg/L, levofloxacin was 2.0-8.0 mg/L, doxycycline was 8.0-32.0 mg/L, sulfamethoxazole-trimethoprim was 4.0-16.0 mg/L, ampicillin was 1.5-2.0 mg/L and gentamicin was 0.50-0.75 mg/L.

CONCLUSIONS

The drugs used in this experiment cover common drugs for treating Brucella. Meanwhile, the results are consistent with clinical efficacy. It is suggested personalized regimen according to patients' status in treatment of Brucella.

Factors affecting Brucella spp. blood cultures positivity in children

Brucella infections have a wide spectrum of symptoms especially in children, making the diagnosis a complicated process. The gold standard for the final diagnosis for brucellosis is to identify the Brucella spp. isolated from blood or bone marrow cultures. The main purpose of this work was to evaluate the factors affecting the isolation of Brucella spp. from blood cultures. In our study, the ratio of fever, presence of hepatomegaly, and splenomegaly were found to be higher in the bacteremic group. In addition, C-reactive protein levels and liver function enzymes were found to be higher in the bacteremic group. In our opinion, while evaluating the febrile child with suspected Brucella infection, we highly recommend sampling blood cultures regardless of the history of previous antimicrobial therapy and duration of the symptoms.

Brucellosis presenting with pericarditis: case report and literature review

Pericarditis is a rare manifestation during the course of brucellosis. This paper describes a case of pericarditis associated with brucellosis in a 31-year-old veterinary physician with a past medical history of testicular tumor and reviews the cases of pericarditis associated with brucellosis in medical English literature.

Clinical manifestations of human brucellosis: a systematic review and meta-analysis

Background

The objectives of this systematic review, commissioned by WHO, were to assess the frequency and severity of clinical manifestations of human brucellosis, in view of specifying a disability weight for a DALY calculation.

Methods/Principal Findings

Thirty three databases were searched, with 2,385 articles published between January 1990–June 2010 identified as relating to human brucellosis. Fifty-seven studies were of sufficient quality for data extraction. Pooled proportions of cases with specific clinical manifestations were stratified by age category and sex and analysed using generalized linear mixed models. Data relating to duration of illness and risk factors were also extracted. Severe complications of brucellosis infection were not rare, with 1 case of endocarditis and 4 neurological cases per 100 patients. One in 10 men suffered from epididymo-orchitis. Debilitating conditions such as arthralgia, myalgia and back pain affected around half of the patients (65%, 47% and 45%, respectively). Given that 78% patients had fever, brucellosis poses a diagnostic challenge in malaria-endemic areas. Significant delays in appropriate diagnosis and treatment were the result of health service inadequacies and socioeconomic factors. Based on disability weights from the 2004 Global Burden of Disease Study, a disability weight of 0.150 is proposed as the first informed estimate for chronic, localised brucellosis and 0.190 for acute brucellosis.

Conclusions

This systematic review adds to the understanding of the global burden of brucellosis, one of the most common zoonoses worldwide. The severe, debilitating, and chronic impact of brucellosis is highlighted. Well designed epidemiological studies from regions lacking in data would allow a more complete understanding of the clinical manifestations of disease and exposure risks, and provide further evidence for policy-makers. As this is the first informed estimate of a disability weight for brucellosis, there is a need for further debate amongst brucellosis experts and a consensus to be reached.

Brucellosis is a bacterial disease transmitted to humans by consumption of infected, unpasteurised animal milk or through direct contact with infected animals, particularly aborted foetuses. The livestock production losses resulting from these abortions have a major economic impact on individuals and communities. Infected people often suffer from a chronic, debilitating illness. This systematic review on the symptoms of human brucellosis is the first ever conducted. Using strict exclusion criteria, 57 scientific articles published between January 1990–June 2010 which included high quality data were identified. Severe complications of brucellosis infection were not rare, with 1 case of endocarditis and 4 neurological cases per 100 patients. One in 10 men suffered from testicular infection, which can case sterility. Debilitating conditions such as joint, muscle, and back pain affected around half of the patients. Given that most patients had fever, brucellosis poses a diagnostic challenge in malaria-endemic areas where fever is often assumed to be malaria. More high quality data is needed for a more complete understanding of the clinical manifestations of disease and exposure risks, and to provide further evidence for policy-makers.

Brucellosis among hospitalized febrile patients in northern Tanzania

Acute and convalescent serum samples were collected from febrile inpatients identified at two hospitals in Moshi, Tanzania. Confirmed brucellosis was defined as a positive blood culture or a ≥ 4-fold increase in microagglutination test titer, and probable brucellosis was defined as a single reciprocal titer ≥ 160. Among 870 participants enrolled in the study, 455 (52.3%) had paired sera available. Of these, 16 (3.5%) met criteria for confirmed brucellosis. Of 830 participants with ≥ 1 serum sample, 4 (0.5%) met criteria for probable brucellosis. Brucellosis was associated with increased median age (P = 0.024), leukopenia (odds ratio [OR] 7.8, P = 0.005), thrombocytopenia (OR 3.9, P = 0.018), and evidence of other zoonoses (OR 3.2, P = 0.026). Brucellosis was never diagnosed clinically, and although all participants with brucellosis received antibacterials or antimalarials in the hospital, no participant received standard brucellosis treatment. Brucellosis is an underdiagnosed and untreated cause of febrile disease among hospitalized adult and pediatric patients in northern Tanzania.

A rare case of seronegative culture--proven infection with Brucella suis

Brucellosis is a chronic infection produced by members of the Brucella family. Diagnosis of this condition requires either isolation of the organism in culture or positive serological tests.We describe a 27-year-old male admitted as a case of pyrexia of unknown origin (PUO), who tested negative for Brucella IgM ELISA test on preliminary evaluation but was subsequently diagnosed on the strength of positive blood and bone marrow cultures to be a case of brucellosis secondary to Brucella suis infection. In addition to highlighting the pathogenic potential of an unusual organism, this case demonstrates the unreliability of standard serological tests based on the Brucella melitensis antigen for infection with other species of Brucella.

Systematic review and meta-analysis of randomized clinical trials in the treatment of human brucellosis

Background

Brucellosis is a persistent health problem in many developing countries throughout the world, and the search for simple and effective treatment continues to be of great importance.

Methods and Findings

A search was conducted in MEDLINE and in the Cochrane Central Register of Controlled Trials (CENTRAL). Clinical trials published from 1985 to present that assess different antimicrobial regimens in cases of documented acute uncomplicated human brucellosis were included. The primary outcomes were relapse, therapeutic failure, combined variable of relapse and therapeutic failure, and adverse effect rates. A meta-analysis with a fixed effect model was performed and odds ratio with 95% confidence intervals were calculated. A random effect model was used when significant heterogeneity between studies was verified.

Comparison of combined doxycycline and rifampicin with a combination of doxycycline and streptomycin favors the latter regimen (OR = 3.17; CI95% = 2.05–4.91). There were no significant differences between combined doxycycline-streptomycin and combined doxycycline-gentamicin (OR = 1.89; CI95% = 0.81–4.39). Treatment with rifampicin and quinolones was similar to combined doxycycline-rifampicin (OR = 1.23; CI95% = 0.63–2.40). Only one study assessed triple therapy with aminoglycoside-doxycycline-rifampicin and only included patients with uncomplicated brucellosis. Thus this approach cannot be considered the therapy of choice until further studies have been performed. Combined doxycycline/co-trimoxazole or doxycycline monotherapy could represent a cost-effective alternative in certain patient groups, and further studies are needed in the future.

Conclusions

Although the preferred treatment in uncomplicated human brucellosis is doxycycline-aminoglycoside combination, other treatments based on oral regimens or monotherapy should not be rejected until they are better studied. Triple therapy should not be considered the current treatment of choice.

Interactions of the human pathogenic Brucella species with their hosts

Brucellosis is a zoonotic infection caused primarily by the bacterial pathogens Brucella melitensis and B. abortus. It is acquired by consumption of unpasteurized dairy products or by contact with infected animals. Globally, it is one of the most widespread zoonoses, with 500,000 new cases reported each year. In endemic areas, Brucella infections represent a serious public health problem that results in significant morbidity and economic losses. An important feature of the disease is persistent bacterial colonization of the reticuloendothelial system. In this review we discuss recent insights into mechanisms of intracellular survival and immune evasion that contribute to systemic persistence by the pathogenic Brucella species.

The visual impairment and inscrutable disease of Samuel Johnson

Samuel Johnson, the acclaimed author of the Dictionary of the English Language, survived childhood scrofula with impaired sight and hearing. The cause of his scrofula has been attributed to bovine tuberculosis, but mycobacterial infection does not satisfactorily account for the peculiar features of Johnson's eye disorder or his hearing loss. The subject of numerous biographies, Johnson may have the most scrutinized medical history of all time. Medical detectives, hampered by the vagueness of 18(th)-century diagnosis, suspect that phlyctenular eye disease related to tuberculosis was the reason for his visual impairment. Pediatric brucellosis can also explain childhood scrofula associated with visual and auditory disabilities, but it may be difficult to reconcile any single diagnosis given the uncertainties surrounding Johnson's medical and ocular histories.