Accuracy of molecular diagnostic methods for the detection of bovine brucellosis: A systematic review and meta-analysis

Background and Aim:

Bovine brucellosis is a disease of global socio-economic importance caused by Brucella abortus. Diagnosis is mainly based on bacterial culture and serology. However, these methods often lack sensitivity and specificity. A range of molecular diagnostic methods has been developed to address these challenges. Therefore, this study aims to investigate the diagnostic accuracy of molecular tools, in comparison to gold standard bacterial isolation and serological assays for the diagnosis of bovine brucellosis.

Materials and Methods:

The systematic review and meta-analysis were conducted based on analyses of peer-reviewed journal articles published between January 1, 1990, and June 6, 2020, in the PubMed, Science Direct, Scopus, and Springer Link databases. Data were extracted from studies reporting the use of molecular diagnostic methods for the detection of B. abortus infections in animals according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The quality of included journal articles was assessed using the quality assessment of diagnostic-accuracy studies assessment tool and meta-analysis was carried out using Review Manager.

Results:

From a total of 177 studies, only 26 articles met the inclusion criteria based on PRISMA guidelines. Data from 35 complete studies were included in the meta-analysis and used to construct 2 × 2 contingency tables. Improved diagnostic performance was observed when tissue (sensitivity 92.7% [95% confidence interval (CI) 82.0–98.0%]) and serum samples (sensitivity 91.3% [95% CI 86.0–95.0%]) were used, while the BruAb2_0168 locus was the gene of preference for optimal assay performance (sensitivity 92.3% [95% CI 87.0–96.0%] and specificity 99.3% [95% CI 98.0–100.0%]). Loop-mediated isothermal amplification (LAMP) had a higher diagnostic accuracy than polymerase chain reaction (PCR) and real-time quantitative PCR with sensitivity of 92.0% (95% CI 78.0–98.0%) and specificity of 100.0% (95% CI 97.0–100.0%).

Conclusion:

The findings of this study assign superior diagnostic performance in the detection of B. abortus to LAMP. However, due to limitations associated with decreased specificity and a limited number of published articles on LAMP, the alternative use of PCR-based assays including those reported in literature is recommended while the use of LAMP for the detection of bovine brucellosis gains traction and should be evaluated more comprehensively in future.

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.

Brucella spp. Contamination in Artisanal Unpasteurized Dairy Products: An Emerging Foodborne Threat in Tunisia

Brucellosis is a worldwide zoonotic disease transmitted to humans, predominantly by the consumption of contaminated raw milk and dairy products. This study aimed to investigate the occurrence of Brucella spp. in 200 raw milk, ricotta, and artisan fresh cheese samples, collected from individual marketing points in four districts in Tunisia. Samples were analyzed for the presence of Brucella spp. by IS711-based real-time PCR assay. Positive samples were further analyzed by qPCR for B. melitensis and B. abortus species differentiation. The DNA of Brucella spp. was detected in 75% of the samples, B. abortus was detected in 31.3%, and B. melitensis was detected in 5.3% of positive samples. A percentage of 49.3% of samples co-harbored both species, while 14% of the Brucella spp. positive samples were not identified either as B. abortus or B. melitensis. High contamination rates were found in ricotta (86.2%), cheese (69.6%), and raw milk (72.5%) samples. The study is the first in Tunisia to assess the occurrence of Brucella spp. contamination in artisanal unpasteurized dairy products and showed high contamination rates. The detection of both B. abortus and B. melitensis highlights that zoonotic high-pathogen agent control remains a challenge for food safety and consumer health protection and could represent a serious emerging foodborne disease in Tunisia.

Importance of brucellosis control programs of livestock on the improvement of one health

Brucellosis not only represents an important health restraint on livestock but also causes high economic losses in many developing countries worldwide. Despite considerable efforts made for the control of brucellosis, the disease is still spreading in many regions (such as the Middle East) where it represents one of the most important health hazards impacting both animals and humans. The present review aims to investigate the efficacy of veterinary control programs regarding brucellosis, with a special focus on current prevention, control, and eradication approaches. The reasons for unsuccessful control programs such as the absence of highly effective vaccines and non-certified bulls are also debated, to understand why the prevalence of brucellosis in livestock is not decreasing in many areas despite considerable efforts taken to date. The importance of governmental and regional investment in brucellosis control remains one of the main limiting factors owing to the limited budget allocated to tackle this disease. In this context, one health concept has generated novel comprehensive approaches with multiple economic implications across the livestock industry and public health. However, the implementation of such global preventive strategies appears to be a key issue for many endemic and low-income countries. According to the collected data, epidemiological contexts including management and trade systems along with well-defined agro-ecological zones should be evaluated in brucellosis endemic countries to improve milk production and to enhance the sustainability of the livestock sector at both national and regional levels.

Bovine brucellosis - a comprehensive review

Brucellosis is a zoonotic disease of great animal welfare and economic implications worldwide known since ancient times. The emergence of brucellosis in new areas as well as transmission of brucellosis from wild and domestic animals is of great significance in terms of new epidemiological dimensions. Brucellosis poses a major public health threat by the consumption of non-pasteurized milk and milk products produced by unhygienic dairy farms in endemic areas. Regular and meticulous surveillance is essentially required to determine the true picture of brucellosis especially in areas with continuous high prevalence. Additionally, international migration of humans, animals and trade of animal products has created a challenge for disease spread and diagnosis in non-endemic areas. Isolation and identification remain the gold standard test, which requires expertise. The advancement in diagnostic strategies coupled with screening of newly introduced animals is warranted to control the disease. Of note, the diagnostic value of miRNAs for appropriate detection of B. abortus infection has been shown. The most widely used vaccine strains to protect against Brucella infection and related abortions in cattle are strain 19 and RB51. Moreover, it is very important to note that no vaccine, which is highly protective, safe and effective is available either for bovines or human beings. Research results encourage the use of bacteriophage lysates in treatment of bovine brucellosis. One Health approach can aid in control of this disease, both in animals and man.

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.

Xyloglucan based mucosal nanovaccine for immunological protection against brucellosis developed by supercritical fluid technology

Vaccines delivered via the mucosal route have logistic benefits over parenteral or intramuscular vaccines as they offer patient compliance. This study presents the first intranasal, controlled release, subunit nanovaccine comprising mucoadhesive tamarind seed polymer (xyloglucan) based nanoparticles produced using an efficient, environmentally compatible, and industrially scalable technique: rapid expansion of supercritical solution. The nanovaccine formulation aimed against brucellosis comprised xyloglucan nanoparticles loaded separately with antigenic acellular lipopolysaccharides from B. abortus (S19) and the immunoadjuvant quillaja saponin. The nanovaccine elicited prolonged humoral and cell-mediated immunity in female Balb/c mice. Nasal vaccination with the nanovaccine resulted in higher levels of mucosal IgA and IgG than with an aqueous solution of soluble lipopolysaccharides and quillaja saponin. Systemic immunity triggered by the nanovaccine was evidenced by higher IgG levels in sera post priming and boosting. The nanovaccine induced a mixed Th1/Th2 type of immunity with higher IgG2a levels and thus a polarized Th1 response. The results suggest that the nanovaccine administered by homologous nasal route can prime the immune system via the mucosal and systemic pathways and is a good candidate for vaccine delivery.

Use of touch-down polymerase chain reaction to enhance the sensitivity of Brucella melitensis detection in raw milk

Brucellosis is a highly contagious bacterial zoonotic infectious disease severely affecting the public health and economic features of endemic and non-endemic countries. The present study assessed the potentials of using the touch-down polymerase chain reaction (TD-PCR) compared to the conventional PCR and culture methods in order to detect Brucella melitensis in raw milk samples of 55 sheep and 45 goats through deriving the primers from the omp31 element of the Brucella genome. In addition, nine isolates of B. melitensis were identified using the culture method. No positive cases were found in sediment samples, while the fatty tap layer test by conventional PCR and TD-PCR revealed 6 and 16 positive samples, respectively. Based on the survey of the limits of detection by TD-PCR and conventional PCR, TD protocol had a detection threshold of three logs higher than the conventional protocol under the experimental condition. The developed protocol of this study was highly sensitive and extremely fast. Therefore, this TD-PCR protocol could detect even a very low number of bacteria in milk samples. To our best knowledge, this is the first report on the use of the TD-PCR method to identify B. melitensis in milk.

The prevalence of Brucella spp. in dairy products in the Middle East region: A systematic review and meta-analysis

Brucellosis, known as Malta fever or Mediterranean fever, is one of the most common bacterial zoonotic diseases caused by Brucella spp. which can result in serious health issues. The objective of the present study was to systematically review and summarize the studies regarding the prevalence of Brucella spp. in milk and milk products in the Middle East region. Some international databases (PubMed, Web of Science, Scopus, Science Direct, and Google Scholar) were searched to retrieve relevant reports published between 1 January 2008 and 30th October 2018. After assessing for eligibility, 30 articles containing 9281 samples, were included in the current study. The highest number of publications were found in Iran and Turkey (n = 12 and 7, respectively), while Saudi Arabia, Kuwait, and Syria had the lowest number of publications (n = 1). Besides, the highest and lowest prevalence was observed in Kuwait (62%) and Egypt (15%), respectively. The highest and lowest overall prevalence of Brucella spp. in milk was found in raw cow milk 36% (95%CI: 28-54%) and raw buffalo milk 13% (95%CI: -22-48%), respectively. The overall prevalence in cheese estimated to be 9% (95%CI: -16-35%). The overall prevalence of Brucella spp. in dairy products in the Middle East was estimated to be 29% (95%CI: 23-35%). The results indicate that more risk management plans are needed to reduce the incidence of Brucella spp. in dairy products in the Middle East, especially in cow milk.

Contamination of milk and dairy products by Brucella species: A global systematic review and meta-analysis

Brucellosis is known as an influential zoonosis in different regions worldwide, with significant effects on the reproductive performance of livestock. Considering the high incidence of brucellosis in dairy products and further negative impacts on food safety, the present study was aimed to systematically investigate prevalence worldwide among published data regarding the identification of Brucella spp. in dairy products. In this regard, some databases, i.e., Scopus, PubMed, Embase, and Web of Science have been searched to retrieve all related articles regarding the incidence of Brucella contaminations in dairy products from 1 January 1983 to 1 April 2019. The prevalence of Brucella spp. in unpasteurized dairy products based on countries, WHO regions, and dairy product subgroups were evaluated and statistically compared. Based on the findings, the prevalence of Brucella spp. in dairy products increased while the GDP (C = 0.17, P-value < 0.001) and HDI (C = 0.19, P-value < 0.001) ranking decreased. Also, the highest prevalence of Brucella contamination in dairy products was noted in buffalo (25.91%) and goat (17.90%), respectively. The lowest and highest prevalence of Brucella spp. were observed in the Western Pacific (15.32%) and the Southeast Asia region (25.55%), respectively. Also, the rank order of WHO regions based on odds ratio (OR) was Southeast Asia region (2.84) > Eastern Mediterranean (2.41) > Region of America (1.65) > European Region (1.54) > Africa region (1.46) > Western Pacific (reference). The results of this study showed that decreasing poverty and an increase in the level of education in societies could reduce the prevalence of Brucella spp. in dairy products. The outcome of the current investigation can be used for the implementation of sustainable intervention and prevention strategies in affected regions.

Human brucellosis caused by raw dairy products: A review on the occurrence, major risk factors and prevention

Despite considerable efforts made to address the issue of brucellosis worldwide, its prevalence in dairy products remains difficult to estimate and represents an important public health issue in many areas of the globe today. This is partly explained by the increasing tendency for consumption of raw dairy products, making the prevention and control of this zoonosis even more critical. This review summarizes reports published since the early 2000s on human brucellosis caused by contaminated dairy products and the systems of evaluation and assessment which are used to improve the diagnosis, surveillance, control and prevention of the disease. For this purpose, five comprehensive electronic databases were investigated and relevant studies were identified for systematic review. The design and quality of the studies revealed notable variation, especially in the methods used for the detection and characterization of Brucella spp. This report provides helpful information about the health risk associated with the consumption of raw milk and relevant preventive strategies.

Direct diagnosis of Brucella species through multiplex PCR formed by a new method

This study aimed to develop direct PCR methods, which enable the diagnosis of brucellosis agents from ruminant aborted fetus samples at species and genus levels, and determine the applicability of the newly developed methods. For this purpose, 137 lung, 137 liver, and 52 fetal stomach fluid samples belonging to 166 ruminant aborted fetuses (326 samples in total) were examined. Firstly, agent isolation and identification were performed and species-specific multiplex PCR (m-PCR) from the culture was applied to the samples. In addition, the Mayer-Scholl m-PCR method was modified and termed 'modified Mayer-Scholl', and genus specific Bcsp31 PCR was also modified with minor changes. Four different methods were applied to direct examination samples and the obtained results were compared. The conventional culture method was set as the standard method to which sensitivities and specificities of the molecular methods were calculated. According to the assessments on the basis of fetus (n = 166), sensitivity and specificity values for modified Mayer-Scholl m-PCR method were 94.11% and 98.76%, and the same indicators for the modified Bcsp31 PCR were 95.29% and 98.76%, respectively. When all organ samples were taken into account (n = 326), sensitivity and specificity values for the modified Mayer-Scholl m-PCR method were 85.38% and 98.06%, and for the modified Bcsp31 PCR, they were 83.62% and 98.06%, respectively. As a result, it was found that the diagnostic power of the tests were 'high' when results were evaluated at fetus level. On the other hand, it was found to be 'clinically useful' when evaluated at organ level. We concluded that species level identifications can be made through the modified Mayer-Scholl method, which is a direct m-PCR method, with a high diagnostic power by specifying DNAs belonging to Brucella species directly from clinical samples.