Epidemiology of brucellosis in Iran: A comprehensive systematic review and meta-analysis study

Improving human brucellosis susceptibility mapping using effective and simultaneously metaheuristic-based feature selection and hyperparameter tuning

Human Brucellosis, a neglected zoonotic disease, affects 1.6 to 2.1 million people globally each year. In Iran, it has become a significant health concern, with an average annual incidence rate of 19.91 cases per 100,000 people. This study aims to create a reliable Human Brucellosis Susceptibility Map (HBSM) for Mazandaran Province using a hybrid machine learning approach that enhances performance through metaheuristic algorithms for feature and hyperparameter optimization. A transformation function is integrated into these algorithms to reduce computational and time complexities while simultaneously executing feature selection and hyperparameter tuning. Additionally, a two-phase mutation operator is employed to improve the performance of feature selection. The results indicate that the hybrid model of Support Vector Regression-Transformation Mutation Grey Wolf Optimizer (SVR-TMGWO) outperformed other models, achieving RMSE=0.7723, MAE=0.614, MdAE=0.473, and R = 0.536. The predicted HBSM for 2018 identified 68 rural districts in Mazandaran Province as being in the High and Very High susceptibility classes. The susceptibility map can help decision-makers more effectively prevent, control, and manage Human Brucellosis in Mazandaran Province.

Some zoonotic infectious diseases are prevalent among children under 15 years of age in Ardabil Province, northern Iran

BACKGROUND

This study sought to investigate the seroprevalence of visceral leishmaniasis (VL), toxocariasis, brucellosis, and salmonellosis, as well as their co-infection and potential cross-reaction, in children under 15 years referred to health centers in Ardabil province, Iran, from 2019 to 2021.

METHODS

The current study examined 1,550 serum samples using direct agglutination test (DAT), Toxocara canis ELISA, Wright, and Widal tests to detect antibodies against Leishmania, Toxocara, Brucella, and Salmonella, respectively. We also compared the test results to determine the possibility of cross-reactivity or simultaneous seropositivity in the tested samples.

RESULTS

In general, anti-Leishmania antibodies were positive in 78 samples (5%) at titers of ≥ 1:800, while only 8 cases had titers of ≥ 1:3200, which was considered as positive result. Therefore, the seroprevalence of VL was estimated to be at 5.16 per 1,000 at-risk populations. Meshkin-Shahr city had the highest seroprevalence (7 cases, 87.5%), followed by Ardabil (1 case, 12.5%) (p = 0.03). The highest and lowest seropositivity rates were observed in children aged 1-5 (6 samples, 75%) and 5-15 (2 samples, 25%) years old, respectively (p = 0.02). Anti-Toxocara antibodies were positive in 249 samples, (16.1%, 95% CI: 13.2-18.8), which were primarily males. There was a significant difference in seropositivity to Toxocara infection by city (p = 0.04), and age (p = 0.00). The results of Wright test showed seropositivity of 7.5% (117 samples) with the highest rate in individuals aged ≥ 10 years, males, and urban areas. No significant differences existed between the seropositivity rate and age, sex, residency, or symptoms (p > 0.05). Widal test was positive in 6% (94 samples) of children, with most cases being females (p < 0.05), particularly in those aged ≥ 10 years. Of the 78 DAT-positive sera, only 2 samples with a low titer (1:800) tested positive for anti-Toxocara antibodies, while none of the high titer samples were positive. In addition, samples with a DAT titer of 1:800 were positive for anti-Brucella (1:40: 10.2%, 1:80: 2.5%) and Salmonella (1:40: 3.8%) antibodies. The titers were (1:40: 5.1%, 1:80: 1.3%) for Brucella and (1:40: 2.5%) for Salmonella at a 1:1600 DAT titer. Wright's test on Toxocara-positive sera showed that 1.2% and 0.4% of samples had titers of 1:40 and 1:80, respectively. Furthermore, 2%, 2.8%, and 0.8% of Toxocara-positive samples exhibited anti-Salmonella antibodies at titers of 1:40, 1:40, and 1:80 corresponding to OA and OD antigens, respectively. The Wright (OR:1.099; 95% CI:1.080-1.118) and Widal (OR: 1.078; 95% CI: 1.062-1.094) tests showed cross-reactivity at low titers and minimal co-infection at high titers. Of Widal-positive sera, 11.4% with a titer of 1:40, and 2.7% with a titer of 1:80 were positive for anti-Brucella antibodies (OR:1.078; 95% CI:1.056-1.085).

CONCLUSION

Given the prevalence of bacterial and parasitic febrile infections among children in the region, and their symptomatic similarity to VL, it is crucial to recognize clinical manifestations, accurately diagnose co-infections, and account for cross-reactivity in serological tests.

Spatio-temporal analysis of human brucellosis distribution in Neyshabur, Iran from 2015 to 2022, a cross-sectional study

BACKGROUND

Human brucellosis is a global endemic disease and a significant public health concern. This cross-sectional study aims to explore the characteristics of human brucellosis, as well as its spatial and temporal clustering.

METHODS

This cross-sectional study analyzed the population infected with human brucellosis in Neyshabur, Iran from 2015 to 2022. Data were obtained from the Neyshabur health center. Spatial analysis was conducted using Anselin Local Moran's I and Global Moran's I with ArcGIS 10.8.2. Descriptive statistical analyses were performed using SPSS 26.

RESULTS

During the study period, a total of 4568 brucellosis patients were reported. The incidence of disease was higher in men with 55.37%. The majority of patients belonged to the 30 to 39-year-old age group. Temporal clustering analysis revealed a peak incidence between March and June. The highest incidence rates were observed in spring and summer, with 34.76% and 33.84% of cases, respectively. Spatial clustering analysis indicated a higher prevalence in the southern and southeast districts of Neyshabur. The results of Global Moran's I analysis indicated that the distribution of brucellosis was not clustered in Neyshabur (P-value > 0.05).

CONCLUSION

The findings of this study highlight the importance of educational programs for mothers and animal vaccination strategies, particularly in the months leading up to the peak brucellosis season in high-incidence areas. Further research is needed to assess the coverage of livestock vaccination and its impact on human brucellosis rates.

The Prevalence of Brucella spp. in Dairy Products in Iran: A Systematic Review and Meta-Analysis

Brucellosis, a significant zoonotic disease, threatens food safety substantially, particularly in developing nations such as the Middle East. This study aimed to comprehensively assess the prevalence of Brucella spp. in Iranian milk and dairy products through a systematic review and meta-analysis. A thorough search of international and domestic databases from January 2008 to October 2023 identified 38 relevant studies encompassing 11,130 samples for meta-analysis. The overall prevalence of Brucella spp. in Iranian dairy products was 22% (95% CI: 16-28%). The highest and lowest overall prevalence of Brucella spp. in milk were found in raw goat milk 27% (95% CI: 11-42%) and raw camel milk 15% (95% CI: -0.42 to 72%), respectively. The overall prevalence of traditional cheese, ice cream, and cream is estimated to be 9% (95% CI: -16 to 35%), 2% (95% CI: -2.78 to 2.82%), and 9% (95% CI: -0.94 to 1.12%). Geographical disparities were evident, with Zanjan province reporting the highest contamination rate, 53%, while Razavi Khorasan province had the lowest, 1%. However, the prevalence of Brucella spp. in Iranian dairy products has fluctuated over time, with a significant association between the study year and sample size. Comprehensive planning, robust policy implementation, and rigorous monitoring are imperative to mitigate and ultimately eliminate Brucella contamination in dairy products effectively. Further research is essential to refine prevalence estimates and develop targeted prevention strategies to safeguard public health.

Comprehensive study on human brucellosis seroprevalence and Brucella species distribution in Iran (1970-2023)

Brucellosis is a zoonotic bacterial disease that causes enormous economic losses in livestock populations and severe debilitation in humans globally. This study analyzes the seroprevalence of human brucellosis in Iran from 1970 to 2023, revealing key epidemiological trends based on data from 20,046 individuals. Through serological, culture, and molecular tests, it identifies the Brucella species affecting humans over five decades. The findings emphasize the need for ongoing monitoring and improved disease control efforts. Subsequently, we cultured specimens from seropositive individuals who exhibited suspected symptoms of brucellosis. The specimens included blood (n = 9017), placentas (n = 203), bone marrow (n = 221), aborted fetuses (n = 70), cerebrospinal fluid (CSF) (n = 62), synovial fluid (n = 5), urine (n = 4), sperm (n = 3), lumbar discs (n = 3), abscesses (n = 2), milk (n = 2), and vertebral bodies (n = 1). The overall seroprevalence of brucellosis in Iran was 44.9 % based on RBPT, 20.7 % by SAT, and 8.7 % by 2-ME tests. The highest SAT prevalence occurred in the 2000s (25.8 %), followed by the 1990s (23.8 %), 1980s (22.2 %), 1970s (14.8 %), and 2010s (10.4 %). Two main Brucella species were identified in infected humans as Brucella melitensis and Brucella abortus. Positive culture rates varied by sample type, with 9.9 % for blood, 10.4 % for bone marrow, and up to 100 % for fluids like urine and milk. The most common strain was B. melitensis biovar 1 (89.2 %), while B. abortus biovar 1 had a much lower incidence (0.3 %). This investigation showed that the highest rates of culture positivity were in samples of urine, synovial fluid, abscess, and milk. These findings suggest that B. melitensis continues to be an important public health concern and that recent years of decline may be due to better control measures of the disease. The combined use of serology and culture is recommended for diagnosing brucellosis. Increased awareness among farmers and consumers of raw dairy products, coupled with nationwide control measures, is crucial for combating zoonotic brucellosis.

Bovine Brucellosis: First Comprehensive Evaluation from Hamedan, an Endemic Area in Iran

Brucellosis is an infectious zoonotic disease. The disease is one of the major concerns in developing societies due to its great importance for public health and economic losses in the animal industry. The principal target of the study was to detect the prevalence of brucellosis and associated risk factors in cattle from Hamedan (western Iran) using different laboratory techniques. In 2020, blood samples from 900 cattle were obtained to detect brucellosis prevalence in the region. After screening by the modified Rose Bengal plate test, the positive samples were reevaluated using the Wright standard tube agglutination test (SAT), 2-Mercaptoethanol (2-ME), and Enzyme-linked immunosorbent assay. Serology-positive samples were confirmed by culturing bacteria from the lymph nodes and detecting Brucella DNA using specific primers, the BCSP31 target gene, and the IS711 locus. Brucellosis was detected in 1.88% (17/900, 95% CI 1-2.76%) of animals. The high prevalence of brucellosis was observed in female animals (2.77%, p = 0.947), 2-4 years old animals (2.88%, p = 0.994), Holsteins (5.69%, p = 0.989), farm animals (6.49%, p = 0.999), and animals with a history of vaccination against brucellosis (3.04%, p = 0.915). In addition, there was no positive sample in October and December, and also the highest prevalence rate was found in September (5.33%, p = 0.970). There was no statistically significant relationship between the variables and the rate of brucellosis. There were similar results between the different applied laboratory methods. The minimum and maximum levels of titer in the SAT method were + 2/80 and + 2/320, respectively. The rates for 2-ME were + 2/40 and + 4/160. Out of 17 positive samples, 2 were confirmed for B. melitensis and 15 for B. abortus. Notably, no sample showed co-infection of both B. abortus and B. melitensis. This study represents the first comprehensive evaluation of cattle brucellosis in Hamedan. Through molecular evaluation, the presence of Brucella spp. was identified in the seropositive samples. Among the cattle samples, the primary species isolated and confirmed was B. abortus. This finding shed light on the prevalence and distribution of Brucella species in the region, providing crucial insights for future disease management and control efforts. Considering the specificity of the used genes to detect bacteria, molecular biology can be a safe and rapid technique for diagnosing brucellosis, especially in cases without conclusive results. Regular screening of animals and culling seropositive animals are highly recommended; these affect the control of disease at the herd level.

Bovine brucellosis, associated risk factors and preventive measures in industrial cattle farms

Effective management of brucellosis in human populations is closely tied to controlling the disease in domestic livestock. This study focused on identifying determinants of brucellosis prevalence in mixed industrial dairy and beef cattle farms within Isfahan Province, Iran. Employing a case control design, we compared 32 ranches with documented brucellosis within the previous year (12 months) to 38 farms with no brucellosis during the same timeframe. The comparison examined the farms' adherence to health protocols for raising cattle. Utilizing multivariable logistic regression, the study identified several significant risk factors linked to brucellosis prevalence. These included cleaning milking accessories with a water and chlorine solution (OR 0.25, 95%CI 0.06 to 0.99), cleaning water troughs daily (OR 0.20, 95%CI 0.04 to 0.89), the cows' density per square meter (OR 0.14, 95%CI 0.03 to 0.75), being within 2000 m of another cattle ranch with brucellosis (OR 4.02, 95%CI 1.09 to 14.84) and ovine farms situated within a 500-m radius (OR 8.43, 95%CI 1.66 to 42.70). No meaningful difference was observed in vaccination frequency between infected and non-infected farms (P = 0.645). While vaccination is essential for preventing bovine brucellosis, robust biosecurity measures are crucial for effective disease management.

Brucellosis Prevention Questionnaire (BPQ): Adaptation to Turkish Culture, Validity and Reliability Study

BACKGROUND

Brucellosis is the most common zoonosis worldwide. Prevention of brucellosis is based on surveillance and prevention of risk factors.

AIM

The aim of this methodological study, conducted with breeders living in Kütahya, was to perform the Turkish adaptation, validity and reliability study of the Brucellosis Prevention Questionnaire (BPQ).

METHODS

This methodological study was conducted on breeders living in the villages of Kütahya in Türkiye between May and November 2021. Cultural adaptation-language validity and construct (concept) validity of the scale were evaluated. Item total score correlation, internal consistency, and test-retest correlation was used to evaluate the reliability of the scale.

RESULTS

According to factor analysis, the variance explained in the five-dimensional structure was 61.8%. A positive correlation was found between the mean BPQ score and Health Perception Scale scores (r = 0.170; P = 0.005). Cronbach's alpha coefficient of the BPQ was found to be 0.944.

CONCLUSION

Findings from validity and reliability studies show that the Turkish version of the BPQ is a valid and reliable scale in Turkish society and culture.

Molecular examination for Coxiella burnetii and Brucella spp. infections in Iranian women experiencing spontaneous miscarriage

BACKGROUND

Spontaneous miscarriage, a leading health concern globally, often occurs due to various factors, including infections. Among these, Coxiella burnetii and Brucella spp. may have adverse effects on pregnancy outcomes. While previous research has established a link between infections and spontaneous miscarriage, our study aimed specifically to investigate the presence of these two pathogens in abortion samples from women who experienced spontaneous miscarriages in Iran. Our study can add to the existing knowledge by focusing on Iran, a region with a high prevalence of C. burnetii and Brucella spp. As a result, it could provide a better understanding and unique insights into the relationship of these pathogens with spontaneous miscarriages in endemic regions.

METHODS

From March 2021 to March 2022, a total of 728 abortion samples (including placenta and cotyledon) were collected from 409 women who had experienced spontaneous miscarriages in the provinces of Tehran, Fars, and West Azerbaijan in Iran. The specimens included 467 Formalin-Fixed Paraffin-Embedded (FFPE) and 261 fresh frozen samples. After DNA extraction from abortion samples, the quantitative real-time PCR (qPCR) assay targeted a specific fragment of the IS1111 and IS711 elements for molecular identification of C. burnetii and Brucella spp., respectively. Furthermore, the qPCR assay employing specific primers for different species was used to determine the species of Brucella.

RESULTS

Among the studied women, 1 out of 409 (0.24%) samples tested positive for Brucella spp., specifically Brucella melitensis. There were no positive specimens for C. burnetii.

CONCLUSIONS

Our study contributes to understanding the potential involvement of Brucella species in spontaneous infectious abortion within endemic regions. The identification of B. melitensis in this study highlights the need for further research in this area. However, while our results suggest a relatively low or zero identification of these pathogens in our sample population, this does not rule out the possibility of undetected infections. Therefore, it is critical to acknowledge the limitations of the molecular techniques used (qPCR), which may have potential limitations such as sensitivity and specificity. Moreover, because 64.15% of our samples were FFPE, the sensitivity of the qPCR test may be reduced. These raise concerns about the accuracy of the reported prevalence rates and the potential for false positives or negatives.

Enhancing Therapeutic Efficacy against Brucella canis Infection in a Murine Model Using Rifampicin-Loaded PLGA Nanoparticles

The in vivo efficacy of rifampicin encapsulated in poly(lactic-co-glycolic acid) (PLGA) nanoparticles was evaluated for the treatment of BALB/c mice experimentally infected with Brucella canis. The PLGA nanoparticles loaded with rifampicin (RNP) were prepared using the single emulsification-solvent evaporation technique, resulting in nanoparticles with a hydrodynamic diameter of 138 ± 6 nm. The zeta potential and polydispersity index values indicated that the system was relatively stable with a narrow size distribution. The release of rifampicin from the nanoparticles was studied in phosphate buffer at pH 7.4 and 37 °C. The release profile showed an initial burst phase, followed by a slower release stage attributed to nanoparticle degradation and relaxation, which continued for approximately 30 days until complete drug release. A combined model of rifampicin release, accounting for both the initial burst and the degradation-relaxation of the nanoparticles, effectively described the experimental data. The efficacy of RNP was studied in vivo; infected mice were treated with free rifampicin at concentrations of 2 mg per kilogram of mice per day (C1) and 4 mg per kilogram of mice per day (C2), as well as equivalent doses of RNP. Administration of four doses of the nanoparticles significantly reduced the B. canis load in the spleen of infected BALB/c mice. RNP demonstrated superior effectiveness compared to the free drug in the spleen, achieving reductions of 85.4 and 49.4%, respectively, when using C1 and 93.3 and 61.8%, respectively, when using C2. These results highlight the improved efficacy of the antibiotic when delivered through nanoparticles in experimentally infected mice. Therefore, the RNP holds promise as a potential alternative for the treatment of B. canis.

Massive cardiac vegetation and cardiomyopathy in a 23-year-old rancher with brucellosis

Key clinical massage

A 23-year-old rancher was admitted with the diagnosis of brucellosis. In evaluations, a massive vegetation in the aortic valve was seen. A combination of antibiotic therapy and cardiac surgery were performed, it seems this approach reduces mortality and complications.

Abstract

Brucellosis (also known as "undulant fever," "Mediterranean fever," or "Malta fever") is a zoonotic infection transmitted to humans from infected animals (cattle, sheep, goats, camels, pigs, or other animals) by ingestion of food products (such as unpasteurized dairy products) or by contact with tissue or fluids. It is the most frequent zoonosis globally and a major public health issue in many resource-poor nations. Endocarditis is one of the rarest and most dangerous consequences of brucellosis. Additionally, the combination of endocarditis with cardiomyopathy increases its rarity. This condition is usually treated with a high level of suspicion Serological, clinical, and epidemiological data can all be used to make a diagnosis. The use of echocardiography aids in the early diagnosis. Due to the high risk of recurrence and the extent of tissue destruction brought on by Brucella, the majority of experts advise an early surgical intervention; nevertheless, other writers assert that low-risk patients also require cautious therapy. In this article, we discuss the situation of a patient who underwent surgery and had Brucella endocarditis and heart failure. In conclusion, a combination of antibiotic therapy and cardiac surgery, reduces mortality and complications associated with Brucella endocarditis and improves patient quality of life.

Unravelling potential biomarkers for acute and chronic brucellosis through proteomic and bioinformatic approaches

Introduction

This study aimed to identify biomarkers for acute and chronic brucellosis using advanced proteomic and bioinformatic methods.

Methods

Blood samples from individuals with acute brucellosis, chronic brucellosis, and healthy controls were analyzed. Proteomic techniques and differential expression analysis were used to identify differentially expressed proteins. Co-expression modules associated with brucellosis traits were identified using weighted gene co-expression network analysis (WGCNA).

Results

763 differentially expressed proteins were identified, and two co-expression modules were found to be significantly associated with brucellosis traits. 25 proteins were differentially expressed in all three comparisons, and 20 hub proteins were identified. Nine proteins were found to be both differentially expressed and hub proteins, indicating their potential significance. A random forest model based on these nine proteins showed good classification performance.

Discussion

The identified proteins are involved in processes such as inflammation, coagulation, extracellular matrix regulation, and immune response. They provide insights into potential therapeutic targets and diagnostic biomarkers for brucellosis. This study improves our understanding of brucellosis at the molecular level and paves the way for further research in targeted therapies and diagnostics.

Determination of seroprevalence of brucellosis in livestock and high-risk population in Kurdistan, Western Iran

BACKGROUND

Brucellosis is one of the most prevalent zoonotic diseases. Using serological tests are valid and rapid methods that could be used in the detection of the history of getting brucellosis. Considering that Iran is an endemic country for brucellosis, we aimed to investigate the rate of seroprevalence of brucellosis among livestock and human in Kurdistan province.

MATERIAL AND METHOD

Serum sampling was performed from 51 slaughterhouse workers, veterinarians, and husbandry workers, along with 260 livestock (80 cattle, 120 sheep, and 60 goats). Rose Bengal plate test (RBPT), and Enzyme-linked immunosorbent assay (ELISA) were used for livestock and the anti-Brucella IgG antibody was evaluated in human participants.

RESULTS

The seroprevalence (based on ELISA assay) in sheep, goats, and cows was 5.8%, 5%, and 1.2%, respectively. Also, the rate of anti-Brucella IgG was 3.9% among human participants.

DISCUSSION

the current study, provided some valuable information on the seroprevalence of brucellosis in animal and human participants from the west of Iran. Considering the effects of brucellosis on causing reproductive disorders, including abortion, placental retention, andendometritis controlling the infection could have a significant impact on terms of economy.

A bioconjugate vaccine against Brucella abortus produced by engineered Escherichia coli

Brucellosis, mainly caused by Brucella, is a widespread zoonotic disease worldwide, with no available effective vaccine for human use. Recently, bioconjugate vaccines against Brucella have been prepared in Yersinia enterocolitica O:9 (YeO9), whose O-antigen structure is similar to that of Brucella abortus. However, the pathogenicity of YeO9 still hinders the large-scale production of these bioconjugate vaccines. Here, an attractive system for the preparation of bioconjugate vaccines against Brucella was established in engineered E. coli. Briefly, the OPS gene cluster of YeO9 was modularized into five individual fragments and reassembled using synthetic biological methods through standardized interfaces, then introduced into E. coli. After confirming the synthesis of targeted antigenic polysaccharides, the exogenous protein glycosylation system (PglL system) was used to prepare the bioconjugate vaccines. A series of experiments were conducted to demonstrate that the bioconjugate vaccine could effectively evoke humoral immune responses and induce the production of specific antibodies against B. abortus A19 lipopolysaccharide. Furthermore, the bioconjugate vaccines provide protective roles in both lethal and non-lethal challenge of B. abortus A19 strain. Using the engineered E. coli as a safer chassis to prepare bioconjugate vaccines against B. abortus paves the way for future industrial applications.

Brucellosis with rare complications and review of diagnostic tests: a case report

BACKGROUND

Brucellosis is one of the most common zoonotic diseases in the world. Osteoarticular complications, especially vertebral system involvement, are most commonly reported. However, reports and coreports of pulmonary complications and thoracal spondylodiscitis and epidural abscess are rare.

CASE PRESENTATION

Spondylodiscitis was detected at the T11-12 vertebral level, followed by epidural and paravertebral abscess, and then empyema was detected in a 17-year-old Asian female patient without any additional disease. The patient had used various antibiotics and the disease could not be proven bacteriologically. Also, the Rose Bengal test was negative. However, serologically high titer Brucella positivity was detected in the blood and pleural fluid sample. Drainage was required for bilateral empyema. Disease duration prolonged due to multiple complications. The patient was cured with combined long-term treatment for brucellosis.

CONCLUSIONS

Although some are rare, brucellosis is a zoonotic disease that can cause many complications. The gold standard for diagnosis is the growth of bacteria in blood culture or tissue culture. However, isolation of the microorganism can be very difficult. Clinical suspicion and serological tests are important guides.

Prevalence, diagnosis, and manifestations of brucellosis: A systematic review and meta-analysis

Objectives

Brucellosis is one of the most prevalent zoonotic diseases common between humans and animals. Despite eradication efforts, the burden of the disease is well-known in endemic countries and in countries where brucellosis has not been an important health issue until recently. The aim of this study was to evaluate the prevalence, diagnosis, and manifestations of brucellosis.

Methods

In this study, PubMed, Web of Science, Scopus, Embase, and Google scholar databases were systematically searched to find studies published from 2011 to 2021. The search was conducted using text words and Medical Subject Headings (MeSH) Terms on the prevalence of brucellosis. Stata software 14.0 was used for all analyses.

Results

Based on the results, the pooled prevalence of brucellosis was 15.27% (95% CI: 9.68-21.86; heterogeneity I 2 index: 97.43; p < 0.001) for man and 15.33% (95% CI: 7.19-25.75; heterogeneity I 2 index: 98.19; p < 0.001) for woman. Age (coefficient: 0.240; p = 0.480), gender (coefficient: -0.017; p = 0.800), and publication year (coefficient: 0.114; p = 0.861) showed no significant effect on heterogeneity among studies. Egger's test indicated a significant publication bias for the prevalence of brucellosis (coefficient 3.894; p < 0.001). Moreover, the trim-and-fill method exhibited that the adjusted prevalence of brucellosis (18.30%, 95% CI: 14.10-22.52) was not significantly different from the original prevalence of brucellosis.

Conclusion

The pooled estimate for brucellosis prevalence was estimated as 15.53%. To better understand the epidemiology of brucellosis globally, more extensive studies are needed to be conducted throughout the world, especially in developing and low-income countries.

COVID-19 co-infection in a patient with brucellosis

An 89-year-old male case was hospitalized in the COVID-19 department. His CT scan showed nodular opacities, also a variable low P O2, elevated transaminases, and a high D-dimer concentration. The patient diagnosed with active brucellosis. Finally, he treated by combination of doxycycline and rifampicin in addition to anti-COVID-19 treatment.

Brucellosis in livestock: First study on seroepidemiology, risk factors, and preventive strategies to manage the disease in Famenin, Iran

Background and Aim:

Brucellosis is an infectious disease in humans and livestock. The disease is endemic in many regions of Iran, for example, Hamedan Province. Knowledge of infection rate and associated risk factors is essential to control and prevent the disease. The study aimed to estimate the prevalence of brucellosis and associated risk factors in cattle, sheep, and goats in Famenin, Hamedan Province, West of Iran.

Materials and Methods:

Blood samples of 1758 animals (1470 sheep, 190 goats, and 98 cattle) were obtained in different rural regions of Famenin. The samples were evaluated to detect of Brucella-antibodies using rose Bengal plate test (RBPT), Wright standard tube agglutination test (SAT), and 2-Mercapto-Ethanol (2-ME) techniques. The risk factors associated with brucellosis such as age, gender, history of vaccination against brucellosis, and abortion history in animals were evaluated. In the sampling process, the critical gaps related to the distribution of brucellosis in the herds and regions are identified for designing the strategies to prevent and control the disease.

Results:

About 6.88% and 89.31% of animals had a history of abortion and vaccination against brucellosis, respectively. Most of the animals were female (92.49%) and in the range of 2–3 age old (39.8%). The antibodies to the Brucella-infection in animals were 2.73% with RBPT and 1.30% with SAT and 2-ME. The prevalence of brucellosis was detected 1.3% among individual animals and 11% among herds. This rate was 1.43% for sheep and 1.05% for goats, with no significant statistical difference. No seropositive case was detected in cattle samples using RBPT, STAT, and 2-ME. The highest rate of brucellosis (6.25%) was detected in Emamzadeh-Pirnahan region (22.2% goats and 5.6% sheep). In sheep, most cases of the disease were in 3–4 age-old group (1.92%), animals without a history of abortion (1.58%), and without a history of vaccination against brucellosis (2.80%). Furthermore, 5.94% of males and 1.11% of females were detected positive for brucellosis (p < 0.001). The chance of brucellosis in rams was 5.6 folds higher than in others (odds ratio = 5.64). Brucellosis in goats was detected 2.94% and 1.89% in the age groups <1 and 2–3 year-old. Furthermore, 1.22% of females and 1.34% of animals without a history of abortion were positive. Brucellosis was found in 0.61% of vaccinated and 3.85% of non-vaccinated goats. Except for gender in sheep, no significant statistical correlation (p > 0.05) was observed between prevalence of brucellosis and risk factors. In farmers, low level of information about the transmission and also control and preventive methods of the disease was dominant. Consumption of traditional and unpasteurized dairy products is also very common in the studied regions.

Conclusion:

This is a comprehensive evaluation of animal brucellosis parallel to humans’ cohort study in the Famenin region for the first time. Although the rate of brucellosis in animals is low in the region, explaining the risk factors to farmers, mass vaccination, regular screening of animals, and culling the positive animals are very important for controlling and reducing the disease in the region.

The Effects of Probiotics Supplementation on Clinical Status and Biomarkers of Oxidative Damage and Inflammation in Children with Brucellosis: A Randomized, Double-Blind, and Placebo-Controlled Trial

Background

Increased levels of inflammatory cytokines and oxidative damage may play crucial roles in the pathogenesis of brucellosis. The purpose of this trial was to evaluate the impact of probiotics administration on clinical status and biomarkers of oxidative damage and inflammation in pediatric patients diagnosed with brucellosis.

Methods

This randomized, double-blind, and placebo-controlled trial was performed by recruiting 40 patients, 8–15 years of age, who had been diagnosed with brucellosis. Study participants were randomly allocated into two groups to receive either probiotics supplement or placebo (n = 20 each group) for 8 weeks. Blood samples were collected at the onset and after 8 weeks of intervention to quantify biochemical parameters. Clinical status was examined by a pediatric infectious disease specialist.

Results

Following 8-week intervention, probiotics supplementation substantially improved total antioxidant capacity (P < 0.001) and malondialdehyde (P=0.002). Furthermore, the difference between probiotics group and placebo group for the duration of fever (P=0.02) and musculoskeletal pain (P=0.001) was statistically significant, though probiotics administration had no significant effects on high-sensitivity C-reactive protein, total glutathione, and other clinical outcomes compared with placebo.

Conclusion

Overall, probiotics intake had beneficial impact on clinical status and body antioxidative defense system in pediatric patients with brucellosis.

Facing the Human and Animal Brucellosis Conundrums: The Forgotten Lessons

Brucellosis is a major zoonotic disease caused by Brucella species. Historically, the disease received over fifty names until it was recognized as a single entity, illustrating its protean manifestations and intricacies, traits that generated conundrums that have remained or re-emerged since they were first described. Here, we examine confusions concerning the clinical picture, serological diagnosis, and incidence of human brucellosis. We also discuss knowledge gaps and prevalent confusions about animal brucellosis, including brucellosis control strategies, the so-called confirmatory tests, and assumptions about the primary-binding assays and DNA detection methods. We describe how doubtfully characterized vaccines have failed to control brucellosis and emphasize how the requisites of controlled safety and protection experiments are generally overlooked. Finally, we briefly discuss the experience demonstrating that S19 remains the best cattle vaccine, while RB51 fails to validate its claimed properties (protection, differentiating infected and vaccinated animals (DIVA), and safety), offering a strong argument against its current widespread use. These conundrums show that knowledge dealing with brucellosis is lost, and previous experience is overlooked or misinterpreted, as illustrated in a significant number of misguided meta-analyses. In a global context of intensifying livestock breeding, such recurrent oversights threaten to increase the impact of brucellosis.

Changing Patterns in Epidemiology of Brucellosis in the South of Iran (2015–2020): Based on Cochrane-Armitage Trend Test

Background:

Objective:

Methods:

Results:

Conclusion:

Application of the PRECEDE -PROCEED model in prevention of brucellosis focused on livestock vaccination process

BACKGROUND

This article reports the steps of an educational intervention, which is designed to change livestock breeders' preventive behavior in terms of vaccinating their livestock against brucellosis. The study has been conducted in a rural area in a country with the second highest brucellosis prevalence in the world.

METHODS

In a quasi-experimental study and applying PRECEDE-PROCEED model, 45 livestock breeders were trained through basket method, accompanied with constructive feedback from researchers and peers and a brief interactive lecture at the end. The livestock breeders' awareness, attitude and practice level in the intervention group was compared with those of other 45 livestock breeders in a control group, 1 and 6 months after the intervention. According to the results of the Rose Bengal tests (RBTs), as a rapid and simple screening test, the presence or absence of Brucella antibodies in the animals' serum was investigated.

RESULTS

Immediately and 1 month after the intervention, the mean scores of knowledge, awareness and practice of livestock breeders in the intervention group were significantly higher. Six months after the intervention, the results of the RBTs were positive in more livestock in the intervention group compared to the animals in the control group. The positive result of RBT after educational intervention, in livestock whose test results were negative immediately before intervention, accompanying the results of observation indicating a good general condition of livestock was considered as a probable evidence of the success of the educational intervention.

CONCLUSION

The model-driven educational intervention could significantly increase livestock breeders' awareness, attitude and practice regarding prevention of brucellosis and vaccination of their livestock against brucellosis; however, a period of non-continuous reinforcement and gradual reduction of the number of the reinforcements by health educator workers is recommended in order to increase the maintenance of the learnt behavior.

TRIAL REGISTRATION

Conducting this study was registered at Iranian Registry of Clinical Trials ( IRCT20180304038945N1 ). Registered 24 December 2018. The proposal was registered before enrollment of the first participant.

Epidemiological Characteristics and Trend in the Incidence of Human Brucellosis in Iran from 2009 to 2017

BACKGROUND

The development of preventive measures and promotion of healthcare delivery systems for disease management is dependent on detecting the incidence rates of the diseases and important risk factors. The current study aimed to determine some epidemiological indices and trends of the human brucellosis incidence in Iran between 2009 and 2017.

STUDY DESIGN

A descriptive cross-sectional study.

METHODS

In the current study, online data were gathered from all cases of brucellosis who were potentially or definitely diagnosed and registered in medical centers, hospitals, laboratories, and private clinics in all districts of Iran. Epidemiologic questionnaires were used to collect data on demographic and background characteristics, risk factors, high-risk behaviors, and lab test results, respectively, based on the national brucellosis control plan.

RESULTS

A total of 138,448 cases of brucellosis have been studied in Iran from 2009 to 2017. The highest (25.89) and the lowest (12.07) incidence rates were observed in 2014 and 2009, respectively. In this nine-year study, the highest incidences were reported in the Hamedan, Lorestan, Kordestan, and Kermanshah provinces. The cumulative percentages of the disease were estimated for different variables at the following rates: by gender: 57.9% for males; by age groups: 36.2% and 16.7% for the 25-44 and16-24 years age groups, respectively; by occupation: 33.2% for housewives; and by residential area: 75.7% for rural residents.

CONCLUSIONS

Based on the obtained results, although the incidence of human brucellosis in Iran has declined since 2015, the number of cases has remained high.

Clinical Effect of Doxycycline Combined with Compound Sulfamethoxazole and Rifampicin in the Treatment of Brucellosis Spondylitis

Objective

The purpose of this study was to determine the clinical value of triple antibiotic therapy consisting of doxycycline, compound sulfamethoxazole and rifampicin in the treatment of brucellosis spondylitis.

Methods

A retrospective analysis was performed on 100 patients with brucellosis spondylitis admitted to the First Affiliated Hospital of Hebei North University from March 2016 to June 2019. Patients were divided into the following two groups: the control group (n = 50) treated with dual antibiotic therapy (rifampicin + compound sulfamethoxazole), and the observation group (n = 50) treated with triple antibiotic therapy (rifampicin + doxycycline + compound sulfamethoxazole). The treatment effect, low back pain relief, levels of erythrocyte sedimentation rate (ESR), procalcitonin (PCT) and C-reactive protein (CRP), as well as the adverse reactions were compared between the two groups.

Results

The response rate of the observation group was significantly higher than that of the control group (P < 0.05). Before treatment, there was no significant difference in the low back pain assessed by the visual analogue scale (VAS), or levels of ESR, PCT and CRP between the two groups (P > 0.05). But after treatment, the VAS score and the levels of ESR, PCT and CRP in observation group were lower than those in the control group (P < 0.05). No significant difference was found in the incidence of adverse reactions (P > 0.05).

Conclusion

The triple antibiotic therapy of doxycycline, compound sulfamethoxazole and rifampicin is effective in the treatment of brucellosis spondylitis. It can significantly alleviate patients’ back pain and inflammation with a high safety profile, which is worthy of clinical application.

Vector-borne and zoonotic infections and their relationships with regional and socioeconomic statuses: An ID-IRI survey in 24 countries of Europe, Africa and Asia

BACKGROUND

In this cross-sectional, international study, we aimed to analyze vector-borne and zoonotic infections (VBZI), which are significant global threats.

METHOD

VBZIs' data between May 20-28, 2018 was collected. The 24 Participatingcountries were classified as lower-middle, upper-middle, and high-income.

RESULTS

382 patients were included. 175(45.8%) were hospitalized, most commonly in Croatia, Egypt, and Romania(P = 0.001). There was a significant difference between distributions of VBZIs according to geographical regions(P < 0.001). Amebiasis, Ancylostomiasis, Blastocystosis, Cryptosporidiosis, Giardiasis, Toxoplasmosis were significantly more common in the Middle-East while Bartonellosis, Borreliosis, Cat Scratch Disease, Hantavirus syndrome, Rickettsiosis, Campylobacteriosis, Salmonellosis in Central/East/South-East Europe; Brucellosis and Echinococcosis in Central/West Asia; Campylobacteriosis, Chikungunya, Tick-borne encephalitis, Visceral Leishmaniasis, Salmonellosis, Toxoplasmosis in the North-Mediterranean; CCHF, Cutaneous Leishmaniasis, Dengue, Malaria, Taeniasis, Salmonellosis in Indian Subcontinent; Lassa Fever in West Africa. There were significant regional differences for viral hemorrhagic fevers(P < 0.001) and tick-borne infections(P < 0.001), and according to economic status for VBZIs(P < 0.001). The prevalences of VBZIs were significantly higher in lower-middle income countries(P = 0.001). The most similar regions were the Indian Subcontinent and the Middle-East, the Indian Subcontinent and the North-Mediterranean, and the Middle-East and North-Mediterranean regions.

CONCLUSIONS

Regional and socioeconomic heterogeneity still exists for VBZIs. Control and eradication of VBZIs require evidence-based surveillance data, and multidisciplinary efforts.

Establishment of brucellosis relapse and complications registry: a study protocol

Brucellosis is an endemic bacterial zoonotic disease in developing countries; that is a serious public health problem in Iran. Brucellosis is a life-threatening multi-system disease in human with different clinical manifestations, complications and relapse. The incidence of brucellosis in Hamadan province, west of Iran is high. In addition, there is few reliable and population-based studies regarding relapse and complications of brucellosis in developing countries, therefore establishment of the registry system in areas with adequate occurrence of cases is needed to better understand the predictors of brucellosis relapse and complications and management of the disease. Detecting occurrence of relapse and complications over time and by geographical area provide information for further investigations and identification of health system deficiencies in the management of patients.

Seroepidemiological survey of brucellosis and Q fever among high-risk occupations in northeast of Iran for first time

Background and Objectives:

Brucellosis and Q fever are considered as occupational hazards to people in contact with domestic animals or their carcasses. The present cross-sectional study was carried out to determine the seroprevalence of brucellosis and Q fever among professions at risk in the North Khorasan Province, northeastern Iran during 2020.

Materials and Methods:

In this study, 185 sera samples were collected from butchers, slaughterhouse workers, farmers, and veterinarians in different counties of the province. The collected sera were tested by ELISA test for the detection of IgG antibodies against Coxiella burnetii and Brucella spp. A questionnaire was filled for each participant to investigate demographic characteristics information (i.e., age, gender, educational status, occupation, years of occupational experience, and location), and any exposure to risk factors (animals Keeping, consumption of unpasteurized dairy products, exposure to ill or dead animals, tick bite, splashing animal fluids, travel history, and use of personal protective equipment) that could be associated with these infections.

Results:

The seroprevalence of antibodies against C. burnetii and Brucella spp. were 17.2% and 19.4%, respectively. Twelve participants also had Q fever and brucellosis co-infection, with a prevalence of 6.4%.

Conclusion:

Based on the results, it is concluded that brucellosis and Q fever occur among the high-risk populations in this area and it needs more surveillance to control the diseases by public health and veterinary authorities.

Evaluation of Putative Toxin-antitoxins Systems in Clinical Brucella melitensis in Iran

BACKGROUND

Toxin-antitoxin systems (TAs) are two-component elements, which are extensive in the bacterial genome and have a regulatory role in many cellular activities including, growth arrest, survival, biofilm formation, and bacterial persistence.

OBJECTIVE

TAs have not well studied in Brucella spp.

METHODS

We evaluated the presence of different toxin-antitoxin systems, including relE- rhhlike, Fic- Phd, Cog- Rhh, and cogT- cogAT in 40 clinical Brucella melitensis isolates using PCRbased sequencing assay.

RESULTS

Our results showed the high presence of relE-rhh-like, Fic-Phd, Cog-rhh, and cogTcogAT s TAs genes in B. melitensis isolates that were 96.25%, 92.5%, 96.25%, and 95%, respectively.

CONCLUSION

A high presence of TAs genes in clinical B. melitensis isolates revealed that the TA system could be an antibacterial target in B. melitensis but more investigation is necessitated to elucidate the exact roles of these genes.

The Incidence and Geographical Distribution of Brucellosis in Iran Using Geographic Information System and Prediction of its Incidence in 2021

BACKGROUND

Brucellosis is one of the most challenging health issues in many developing countries including Iran. The purpose of this study is to investigate the incidence and geographical distribution of brucellosis using Geographic Information System (GIS) and to predict its incidence in Iran in 2021.

METHOD

This is a descriptive-analytical cross-sectional study, which contains spatial and climatic information along with the prevalence rate of brucellosis in Iran. Disease information was obtained from the National Center for Infectious Diseases Management during 2011-2015. Then, Arc GIS version 9.3 was used to plot the geographical maps for the incidence and frequency of the disease. Using the Raster calculator tool, the disease prediction map for the future was plotted. For proper spatial distribution of hot and cold spots, Getis-Ord-Gi statistic was employed.

FINDINGS

The highest incidence of brucellosis during 2009-2015 was observed in the western provinces of Iran (North Khorasan, South Khorasan and Razavi Khorasan provinces). The incidence of brucellosis in Iran decreased from 2009 to 2011 but it exhibited an increasing trend from 2011 to 2014. The provinces of Kurdistan, Lorestan, Ilam, Zanjan and Kermanshah may be among the hot spots in terms of brucellosis incidence in 2021.

CONCLUSION

We predicted significant variations in brucellosis risk distribution in Iran in the coming years. In the western and northwestern provinces, which are among the high risk areas for the incidence of this disease in the future, this disease can pose a serious health threat to the residents of these areas.

Epidemiology, Clinical and Laboratory Manifestations, and Outcomes of Brucellosis Among 104 Patients in Referral Hospitals of Tehran, Iran

Background: Brucellosis is the most common zoonotic disease in Iran, imposing a significant financial burden on the healthcare system. The diversity of non-specific clinical manifestations of this disease can lead to misdiagnosis or delayed diagnosis. Therefore, it is important to pay attention to other aspects of this disease. Objectives: This study aimed to determine the epidemiology, clinical and laboratory manifestations, and outcomes of brucellosis. Methods: In this cross-sectional study, brucellosis patients, admitted to three hospitals, affiliated to Shahid Beheshti University of Medical Sciences (Tehran, Iran) from April 2015 to September 2020, were examined. The patients' medical records were reviewed for epidemiological, clinical, and laboratory findings. The outcomes of the disease were evaluated by phone calls. Results: Of the 104 patients included in this study, 53.8% were male, and 46.2% were female. The mean age of the patients was 43.07 ± 18.521 years. Unpasteurized dairy consumption and contact with livestock were reported in 60.6 and 27.9% of the patients, respectively. Also, 23.1% of the patients had high-risk occupations. The most common symptoms included fever (80.8%), chills (58.7%), backache (55.8%), and sweating (51%). The most common complication was osteoarticular involvement (21.2%), followed by neurobrucellosis (6.7%). Elevated alkaline phosphatase (89.7%), anemia (67.3%), increased C-reactive protein (57.7%), and increased erythrocyte sedimentation rate (48.1%) were common laboratory findings. The rates of improvement, treatment failure, and relapse were 86.9, 9.1, and 4%, respectively. There was no significant relationship between the rate of improvement and the antibiotic regimen. However, the most common cause of treatment failure was the patient’s poor compliance with treatment. Conclusions: The diversity of non-specific clinical manifestations of brucellosis is a diagnostic challenge. Therefore, physicians must request laboratory tests to evaluate brucellosis after taking a precise epidemiological and clinical history of suspected cases.

Prevalence of Brucella spp. in raw milk and artisanal cheese tested via real-time qPCR and culture assay

Brucellosis is one of the most prevalent zoonotic diseases with worldwide distribution. Although the incidence of brucellosis varies widely in different regions, it is a major concern for public health around the world. This study aimed to determine the prevalence and quantity of Brucella spp. in sheep and goat raw milk, as well as artisanal cheeses produced in the North-west of Iran. To evaluate the intrinsic parameters that may affect the survival of Brucella spp., some of the cheese properties (e.g., pH, salt, moisture, and storage time before selling) were also assessed. A total of 572 samples consisting in 214 sheep raw milk, 92 goat raw milk, and 266 local artisanal cheese samples were collected. The artisanal cheeses were manufactured from a mixture of raw sheep and goat milk. According to the results, using quantitative real-time PCR (qPCR), 17.29%, 15.22%, and 22.93% of the sheep raw milk, goat raw milk, and artisanal cheese samples were found positive for Brucella spp., respectively. In comparison with culture assay, qPCR was 3.5 to 5 times (p < 0.05) more sensitive in the detection of Brucella spp. The results also revealed that the mean values of Brucella spp. load in sheep and goat raw milk and artisanal cheeses were 1.22, 1.55, and 1.43 log cell/ml or g, respectively. A positive correlation was found between Brucella load and successful detection of Brucella spp. by culture assay. Data also suggested a correlation (p < 0.01) between the load of Brucella spp. estimated by qPCR and pH value, salt content, and storage period of the cheese samples. However, Brucella spp. load did not correlate significantly with the moisture content. Based on the results, in any of the cheese samples with a pH value less than 4.5 and a storage period more than five months, no contamination with Brucella spp. was detected.

Pulmonary involvement in brucellosis: A case report and literature review

Although pulmonary involvement is rare in brucellosis it should be considered as a causative agent in patients with prolonged fever and arthritis. Also, it should be presented with manifestations resembling systemic juvenile idiopathic arthritis.

Seroprevalence of Bovine Brucellosis in Ethiopia: Systematic Review and Meta-Analysis

Brucellosis is an infectious and widespread zoonotic disease caused by bacteria of the genus Brucella and can induce considerable human suffering and huge economic losses in animals. Thus, the aim of this study was to conduct a systematic review and meta-analysis on the seroprevalence of bovine brucellosis in Ethiopia. PubMed, Science Direct, African Journals Online, and Google Scholar were used to search the articles. All references were screened and articles, which reported seroprevalence of bovine brucellosis in Ethiopia were included in the study. Meta-analysis using random-effects models was made to calculate the pooled seroprevalence of brucellosis. This review included 15 papers. The estimated pooled seroprevalence of brucellosis was found to be 3.0% (95% CI: 2.0, 4.0). The subgroup analysis showed that there was a statistically significant association between the disease and geographical location, setting, laboratory technique employed and study years. Also, there was some evidence of publication bias (Egger's test, p = 0.0003) on studies reporting the prevalence of brucellosis in Ethiopia. This review proves a high seroprevalence of brucellosis in the country and appropriate control strategies are recommended. Moreover, further study on the risk factors is also required to develop cost-effective preventive strategies.

Design and validation of brucellosis prevention questionnaire focused on animal vaccination

BACKGROUND

The inadequate awareness of livestock breeders on brucellosis transmission, as well as their improper knowledge about preventing brucellosis is considered as one of the important barriers to animal vaccination against brucellosis. The present study aimed to design and validate a brucellosis prevention questionnaire focused on animal vaccination. The valid questionnaire was used to design, implement, and evaluate an interventional training program.

METHOD

A brucellosis prevention questionnaire (BPQ) was developed in the exploratory psychometric study. In addition, face-to-face interviews were conducted to formulate its initial items, the results of which were merged with those obtained from literature review. Further, the face, content, and construct validity of the questionnaire were assessed by co-operating livestock breeders, veterinarians, and health educationists. The impact score (IS), and content validity ratio (CVR) and index (CVI) of the items were calculated, and the construct validity of the questionnaire was evaluated through factor analysis. Furthermore, the reliability of the results related to the questionnaire was measured by using Cronbach's alpha, intra-class correlation coefficient (ICC), and composite reliability, as well as the standard error of measurement (SEM).

RESULTS

The questionnaire was finalized with 53 items and its validity was confirmed by CVI (0.90), CVR (0.74), and IS (4.30). Additionally, the items were loaded into three constructs of awareness, attitude, and practice. Further, the predictive power of awareness, attitude, and practice was determined as 43.43, 15.81, and 15.78%, respectively. Furthermore, the fitness of the proposed model among the constructs was confirmed by the root mean square error of approximation (RMSEA) < 0.08, as well as normed chi-square (× 2/ df) < 5.0, comparative fit index (CFI) ≥ 0.90, and Tucker- Lewis index (TLI) ≥ 0.9.

CONCLUSION

The brucellosis prevention questionnaire represented acceptable psychometric properties. The factors influencing the preventive behavior of livestock breeders can be identified by applying the questionnaire, and co-operating veterinarians and educational planners.

Brucella Pneumonia with Systemic Complications and Pancytopenia: A Case Report

Iran, which is regarded as an endemic region for brucellosis, ranks second in brucella prevalence in the world. Pulmonary involvement is a rare complication of brucellosis. In this article, we aimed to report a case of systemic brucellosis complicated with brucella pneumonia. ; Case Presentation: A 39-years-old man was referred to the emergency department with weakness, productive coughs and severe weight loss during 8 months. Agglutination tests for brucellosis showed high titers suggestive for brucella infection. After 6 days of treatment, the patients' clinical state improved significantly. ; Conclusion: The patient had systemic signs and bone marrow suppression with pulmonary involvement that his diagnosis confirmed with delay after one year, but with treatment, he had a very good outcome.

Incidence and Risk Factors of Brucellosis in Kermanshah Province, Iran During 2010-2014

INTRODUCTION

Incidence of brucellosis was growing up in Iran during the past years. Kermanshah province-west of Iran is one of the endemic regions of the disease. The aim of this study was to evaluate the incidence and risk factors of brucellosis in Kermanshah province during a recent five-year period.

METHODS

This study was an observational cross-sectional study performed on registries of the patients with brucellosis at the center for the zoonotic disease of Kermanshah University of medical sciences during 2010-2014. The data was collected using a questionnaire containing demographic data and the risk factor of brucellosis. Collected data were analyzed by SPSS-22 software using descriptive statistic, Chi-square, and student t-test.

RESULTS

The five-years mean incidence of brucellosis in our study was 46.5 in one hundred thousand, and male to female ratio was 1.37/1. The most common risk factors of brucellosis in our patients were unpasteurized dairy products' consumption (47%) and occupational contact with livestock (14.4%). 84% of the patients were rural. The most common diagnostic method was the standard agglutination test within 1/160 and 1/320 titers.

CONCLUSION

Risk factors of brucellosis in our study were like other studies, but in more than onethird of the patients, no risk factor was identified. Lack of livestock vaccination history and incomplete registered data about other possible transmission routes of transmission were the limitations of the study.

Epidemiology of human brucellosis in Nahavand county, Hamadan Province, western Iran: an 8-year (2010-2017) registry-based analysis

Background

Brucellosis is an infectious zoonosis, which greatly afflicts human health and animal productivity.

Objectives

To describe the trends and epidemiological characteristics of human brucellosis in Nahavand county, Hamadan Province, western Iran over 8 years (2010-2017).

Methods

In this registry-based longitudinal study, we analyzed all reported cases of human brucellosis, including 1,130 patients from 2010 to 2017. A checklist including demographic and clinical characteristics of patients with reported cases of brucellosis had been used to gather data. We calculated annual percent changes (APCs) and average annual percent changes (AAPCs) using Joinpoint software to determine the trend of brucellosis using a segmented regression model.

Results

Among the patients, 60.9% were male and 87.3% lived in rural areas. The mean age of the patients was 35.9 ± 18.34 years. Compared with male patients, female patients were more affected when they were elderly (15.6% men vs. 24.2% women for those aged ≥55 years) (P = 0.001). Of patients with brucellosis, 65.2% had consumed unpasteurized dairy products and 82.3% had a history of contact with animals. The incidence of human brucellosis in Nahavand county increased between 2010 and 2014, then decreased in 2015, and thereafter remained steady. Per 100,000 population, the AAPC pertaining to the incidence was 17.4 in the male population (95% CI: 4.4, 31.9), 13.8 in the female population (95% CI: 0.2, 29.3), and 16.1 in rural dwellers (95% CI: 2.2, 31.8) indicating an increasing trend from 2010 to 2017 (P < 0.05).

Conclusion

The incidence of brucellosis in the western part of Iran is high and remains a challenging health problem. In the present study, age, job, sex, and seasonal changes are important risk factors for human brucellosis.

Evaluating the efficiency of TaqMan real-time PCR and serological methods in the detection of Brucella spp. in clinical specimens collected from suspected patients in Ardabil, Iran

BACKGROUND

This study aims to evaluate the efficiency of the TaqMan real-time PCR and serological methods in detecting Brucella spp. in clinical specimens that have been collected from suspected patients in Ardabil, Iran.

METHODS

In this cross-sectional study, a total of 113 consecutive patients suspected of brucellosis who were referred to the three hospitals in Ardabil province were selected. In the first step, the diagnosis of brucellosis was performed by serological methods including the Rose Bengal slide agglutination test, Wright test, 2-ME test, and BrucellaCapt test. In the next step, TaqMan real-time PCR with primer and probe targeting the bcsp31 gene was used for the detection of Brucella spp. Specificity, sensitivity, and positive and negative predictive values of the TaqMan real-time PCR assay were calculated.

RESULTS

Among 113 suspected patients with different clinical manifestations, the Rose Bengal slide agglutination test, Wright test, and 2-ME test were positive in 60 cases; however, the BrucellaCapt test titer was 1:160 for one patient. Six patients had high initial serum antibody titers; 2-ME titers of ≥1:640; STA titers of ≥1:1280; BrucellaCapt titers of ≥ 1:2560. Among positive cases, no correlation was observed among gender, age, and life (residence) in urban or rural areas. The TaqMan real-time PCR was positive in 35% of all 60 positive cases. The comparison of the results of the BrucellaCapt and TaqMan real-time PCR methods revealed that 19 out of 54 (35.2%) and 2 out of 6 (33.4%) BrucellaCapt positive cases with titers of >1:320 and ≤ 1:320 were positive, respectively. The sensitivities and specificities of the TaqMan real-time PCR assay were 49.1% and 100% respectively.

CONCLUSION

The sensitivity of the TaqMan real-time PCR assay was low in the diagnosis of brucellosis, while the BrucellaCapt test turned out to be a very valuable, sensitive, and specific test for the diagnosis of brucellosis in suspected patients and, thus, can provide reliable results in medical laboratories.

Forecasting the monthly incidence rate of brucellosis in west of Iran using time series and data mining from 2010 to 2019

Background

The identification of statistical models for the accurate forecast and timely determination of the outbreak of infectious diseases is very important for the healthcare system. Thus, this study was conducted to assess and compare the performance of four machine-learning methods in modeling and forecasting brucellosis time series data based on climatic parameters.

Methods

In this cohort study, human brucellosis cases and climatic parameters were analyzed on a monthly basis for the Qazvin province–located in northwestern Iran- over a period of 9 years (2010–2018). The data were classified into two subsets of education (80%) and testing (20%). Artificial neural network methods (radial basis function and multilayer perceptron), support vector machine and random forest were fitted to each set. Performance analysis of the models were done using the Root Mean Square Error (RMSE), Mean Absolute Error (MAE), Mean Absolute Root Error (MARE), and R² criteria.

Results

The incidence rate of the brucellosis in Qazvin province was 27.43 per 100,000 during 2010–2019. Based on our results, the values of the RMSE (0.22), MAE (0.175), MARE (0.007) criteria were smaller for the multilayer perceptron neural network than their values in the other three models. Moreover, the R² (0.99) value was bigger in this model. Therefore, the multilayer perceptron neural network exhibited better performance in forecasting the studied data. The average wind speed and mean temperature were the most effective climatic parameters in the incidence of this disease.

Conclusions

The multilayer perceptron neural network can be used as an effective method in detecting the behavioral trend of brucellosis over time. Nevertheless, further studies focusing on the application and comparison of these methods are needed to detect the most appropriate forecast method for this disease.

Human Brucellosis: Risks and Prevalence among Iranian Blood Donors Residing in Endemic Areas

Background

Brucellosis is a common zoonotic infection worldwide. Transmission can be occasionally observed via transfusion or transplantation. This study was designed to survey the seroprevalence of anti-Brucella antibody in blood donors in different endemic provinces.

Materials and Methods

A total of 14,706 blood donors from the 5 most prevalent provinces were studied by standard tube agglutination (STA) and any positive subjects were further confirmed by 2-mercaptoethanol agglutination test (2-ME). Significant titres were 80 for STA and 40 for 2-ME.

Result

A total of 63 (0.43%) serum samples were STA-positive. Of these, the 2-ME test was reactive in 42 samples. The 2-ME test was reactive in 31 samples with a low titre. However, concomitant STA ≥80 and the titre of ≥40 for the 2-ME test were found in 11 subjects (0.075%), mostly resident in urban areas. Exposure to manure products was identified as a significant risk factor (p = 0.0128). Conclusion : The observed data show a somewhat noticeable prevalence among Iranian blood donors, bringing attention to the importance of pre-donation screening via a questionnaire which supplies answers about occupational history, and any history of exposure or past infections. Further studies to evaluate the frequency and related risk factors in certain populations, in conjunction with implementing stricter regulations in blood donor selection in endemic areas, may be necessary.

Usefulness of Blood Parameters for Preliminary Diagnosis of Brucellosis

BACKGROUND

Human brucellosis is a multisystem disease with a wide range of clinical signs which often leads to misdiagnosis and treatment delay. Early diagnosis of this disease can prevent the serious complications and mismanagements. This study aimed to evaluate the hematological parameters with predictive value for the diagnosis of brucellosis.

METHODS

In this prospective case-control study which was done during 2015-2017 in Imam Reza Hospital, Kermanshah Province, west Iran, 100 patients with a confirmed diagnosis of brucellosis (brucellosis group) and 100 healthy individuals (control group) were studied. The hematological parameters, including hemoglobin (Hb), red blood cell (RBC), white blood cell (WBC) count, lymphocyte count, neutrophil count, platelet count (PLTs), mean platelet volume (MPV), platelet distribution width (PDW), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) of both groups were recorded. The data were statistically compared between the brucellosis and the control groups.

RESULTS

The mean age of patients and healthy groups was 44.04 ± 23.11 and 37.92 ± 24.80, respectively (P = 0.062). The WBC, CRP and neutrophil counts were significantly higher in the brucellosis group (P < 0.05). Based on the receiver operating characteristic (ROC) analysis, the sensitivity and specificity were 54% and 66% for the WBC, 45% and 71% for the neutrophil and 65% and 72% for the CRP, respectively. There was no statistically significant difference between the two groups in terms of Hb, RBC, WBC, lymphocyte and platelet count, MPV, PDW and ESR (P > 0.05).

CONCLUSION

The results of this study indicate that WBC, CRP and neutrophil count can be used as valuable markers in the preliminary diagnosis of brucellosis. However, further researches are required to standardize these parameters for various forms of brucellosis.

Multiple Myeloma or Brucellosis: A Case Report

BACKGROUND

Brucellosis, a major health problem in developing countries, is a multisystem infection with a broad spectrum of clinical manifestations. Hematological complications, ranging from an intravascular coagulopathy to mild homeostasis disorders (such as gammopathy), have been reported in brucella infection. These signs and symptoms may lead to misdiagnosis of brucellosis with other hematological diseases.

CASE

A 65-year-old male whose occupation was shepherding was referred to our hospital as a known case of multiple myeloma with continuous fever, muscle weakness, and night sweating after taking 2 courses of chemotherapy. The laboratory diagnosis of multiple myeloma had been based on the observation of a high percent of plasma cells in the bone marrow aspiration. At follow- up, the result of patient's fever workup, with 2 sets of blood cultures, was positive for Brucella melitensis. Isolated brucella was confirmed as B. melitensis by 16S rRNA sequencing. Brucellosis serologic test was performed by agglutination test and positive results were obtained. The patient was discharged with the cessation of fever and general improvement after the end of the parental treatment phase of brucella bacteremia.

CONCLUSIONS

Brucella infection may cause a severe disease, mimicking a primary hematological disease, which could complicate the correct diagnosis. In brucellosis cases, due to the wide range of symptoms, in addition to cultivation and serological methods, molecular methods should also be used to prevent inappropriate diagnosis and additional costs.

Molecular identification of Brucella species and biovars associated with animal and human infection in Iran

Brucellosis is a costly contagious disease of human, domestic and wild animals. It is a serious health problem in Iran causing significant economic losses therefore, control approaches to prevent its spread are of great importance. In Iran, the species and biovars of virulent Brucella species are still under-reported due to the inadequate diagnostic protocols and insufficient laboratory facilities. The objective of this study was to characterize Brucella isolates obtained from passive animal and human surveillance in Iran from 2011 to 2018 in order to understand the current epidemiological situation of the disease. A total of 419 samples (milk, blood, cerebrospinal fluid, abomasum content and aborted fetus tissues) were collected from 65 cases/case series (human and animals) and examined bacteriologically. The initially identified Brucella isolates were further characterized using phenotypic and molecular approaches. All recovered isolates were either B. abortus or B. melitensis. The infection in sheep appeared to be exclusively associated with B. melitensis, but both B. abortus and B. melitensis were common in bovine samples. Samples from one sheep and one goat were confirmed to be infected by the B. melitensis vaccine strain Rev1. In spite of B. abortus burden in animals (14 cases in cattle and camel), brucellosis in human was predominantly associated with B. melitensis (15 cases). The results confirmed that B. melitensis biovar 1 and B. abortus biovar 3 remain the most prevalent biovars in Iran. This report builds a picture of the significance of different Brucella species in different hosts in Iran and provides applicable information for the healthcare professionals about the public health risks of brucellosis and relevant preventive strategies.

Time series and trend analysis of brucellosis in Oskou county, East Azerbaijan: 2007-2016

Background: The epidemiology of human brucellosis has drastically changed in recent years. This study aims to assess trend in brucellosis in the Oskou county, East Azerbaijan, Iran.

Methods: This cross-sectional study was conducted on all confirmed brucellosis cases over the period between 2007 and 2016 in Oskuo county. We use crude incidence rate (CIR) per100000 persons and carried out Joinpoint regression analysis to describe brucellosis trend over the study period. Also, we used ARIMA model to predict trend and number of new brucellosis cases for the coming years.

Results: More than 90% (92.5%; 95% CI: 89.9-95.1) of brucellosis cases were in rural areas over the study period. In recorded cases, 60.5% (95% CI: 55.6-65.4) of total cases were men and 39.5% (95% CI: 34.6-44.4) of total cases were women. The mean age of men was 33.85(SD=19.72) years and the mean age of women was 35.88 (SD=17.26) years old. Majority of brucellosis cases occurred in spring. CIRs for the rural and urban areas were 47.62 to132.20 and zero to 18.55, respectively. The CIR for rural area had decreasing trend to 2011 and increasing for 2011-2017.

Conclusion: Based-on time series analysis, the number of new cases in the future years has fixed trend and the most number of incident cases will be occurred between third to fifth months in each years.