Investigation of the Sensitivity and Specificity of Laboratory Tests Used in Differential Diagnosis of Childhood Brucellosis

Comprehensive epidemiological evaluation of ruminant brucellosis and associated risk factors in some Egyptian Governorates

Background and Aim

Brucellosis contributes to significant economic losses due to abortion, weak newborns, infertility, and up to 20% reductions in milk yield in carrier animals. This study aimed to estimate the prevalence of ruminant brucellosis in six Egyptian governorates. This study aimed to estimate the prevalence of ruminant brucellosis and evaluate the risk factors regarding the epidemiological status, highlighting the importance of early carrier detection for the success of control programs.

Materials and Methods

A total of 3000 ruminants were investigated. Blood and serum samples were collected for routine hemato-biochemical analysis (complete blood picture and metabolic panel). In addition, genotoxicity analysis was performed, whereas tissue samples were collected for histopathological analysis. The buffered acidified plate antigen test (BAPAT), Rose Bengal plate test (RBPT), and complement fixation test (CFT) were used for serological diagnosis of brucellosis. The obtained bacterial colonies were typed using Brucella abortus-, melitensis-, ovis-, and suis-polymerase chain reaction (AMOS-PCR), depending on the variability of the IS711 fragment among Brucella spp. Serum trace elements, oxidative stress, and acute phase proteins were compared according to body condition score (BCS) and clinical condition images within the study population.

Results

Mastitis and abortion were the key recorded symptoms (9.966%, 299/3000 and 6%, 180/3000, respectively); however, symptomless individuals were predominant (82.9%, 2487/3000). Blood lymphocytosis was prominent even in asymptomatic animals. Nutritional and food conversion conditions were defined as low, moderate, or high BCS. Brucella overall seropositivity by BAPAT, RBPT, and CFT was 6.1% (182/3000), 5.6% (168/3000), and 5.1% (154/3000) in ruminant species within the included governorates, respectively. Upon diagnosis, 154 seropositive cases developed 93 bacterial isolates and a 731-bp PCR fragment whose sequences confirmed Brucella melitensis biovar 3. Serum metabolic and biochemical profiles, acute phase proteins, trace elements, and oxidative stress concentrations were indicative of loss of functionality in the liver and kidneys, malnutrition and malabsorption syndrome, and DNA damage, particularly in the low-BCS groups (p < 0.0001). Granulomatous lesions were most prominent in the lymph nodes, spleen, uterus, and udder of the dams, while placental multifocal necrosis with thrombosis was recorded in aborted fetuses. There were 8 types of chromosomal aberrations detected in peripheral white blood cells. The highest frequency was for dicentric aberrations 0.025% (25/1000), whereas the lowest 0.009% (9/1000) was for acentric, ring, fusion, and polyploidy. The difference between species was significant for BCS; 14.2% in low-BCS cattle and camels and 8.4% in high-BCS buffaloes.

Conclusion

B. melitensis biovar 3 is prevalent in Egypt. Mixed-rearing systems are the main risk factors for interspecies transmission among ruminants. The difficulty in accurately diagnosing all infected animals, particularly carriers, is a major limitation of eradication and control programs. Different biomarkers could be indicators and/or sensors for performance and/or infectivity conditions in animal herds; however, they require further optimization. Early detection using molecular technologies, highly descriptive, quantitative, sensitive, and specific methods, as alternatives to serological diagnosis (CFT, BAPAT, and RBT), is urgently needed to enhance the efficiency of brucellosis-specific prophylaxis. Such a comprehensive procedure is the World Organization for Animal Health dependent decision.

Case report: A case of brucellosis misdiagnosed as coronavirus disease 2019/influenza in China

Brucellosis is an important zoonosis and a multisystem disease. The signs and symptoms of brucellosis are not specific. In the clinical, brucellosis is often ignored and misdiagnosed. We report a case of brucellosis who was misdiagnosed as coronavirus disease 2019 (COVID-19)/influenza and received delayed treatment during strict COVID-19 control. The neglect of other diseases due to COVID-19 and empirical diagnosis and treatment by medical staff are part of the reasons for misdiagnosis. Otherwise, the normal erythrocyte sedimentation rate (ESR), increased white blood cell count (WBC), and increased neutrophil count (NEUT) of this patient was also a cause of misdiagnosis, which is an important reminder for diagnosis. For patients with the unknown origin of fever and other symptoms related to brucellosis, especially those from endemic areas of brucellosis, brucellosis screening is a priority item, and grassroots doctors should be vigilant and standardize the diagnosis and treatment based on epidemiology history, clinical manifestation, and laboratory tests according to the diagnostic criteria of brucellosis.

Gold Nanobiosensor Based on the Localized Surface Plasmon Resonance is Able to Diagnose Human Brucellosis, Introducing a Rapid and Affordable Method

Brucellosis is considered as the most common bacterial zoonosis in the world. Although the laboratory findings are the most reliable diagnosis today, the current laboratory methods have many limitations. This research aimed to design and evaluate the performance of a novel technique based on the localized surface plasmon resonance (LSPR) to eliminate or reduce existing shortcomings. For this purpose, smooth lipopolysaccharides were extracted from Brucella melitensis and Brucella abortus and fixed on the surface of the gold nanoparticles through covalent interactions. After some optimizing processes, dynamic light scattering was used to characterize the probe. The detection of captured anti-Brucella antibody was performed by measuring the redshift on LSPR peak followed by the determination of cutoff value, which indicated a significant difference between controls and true positive patients (P value < 0.01). Furthermore, 40 sera from true negative samples and positive patients were used to evaluate the performance of this method by comparing its outcomes with the gold standard (culture), standard tube agglutination test, and anti-brucellosis IgM and IgG levels (ELISA). The sensitivity, specificity, positive predictive value, and negative predictive value showed an appropriate performance of the LSPR-based method (85%, 100%, 100%, and 86%, respectively). The current research results provide a promising fast, convenient, and inexpensive method for detecting the anti-Brucella antibodies in human sera, which can be widely used in medical laboratories to diagnose brucellosis quickly and effectively.

Clinical and laboratory characteristics of childhood brucellosis in high-risk area of Western China

Childhood brucellosis present various non-specific clinical symptoms, and limited laboratory data exist for clinical diagnosis. A better understanding of these clinical and laboratory characteristics can avoid clinical misdiagnosis and mistreatment. In this case-series study, a total of 78 children with confirmed diagnosis of brucellosis were evaluated retrospectively. We observed that the incidence rate was higher in the first two quarters every year. The most common symptom was fever. Osteoarticular involvement was found in 44.87% of the patients. Laboratory tests showed that the values of erythrocyte sedimentation rate(ESR), C-reactive protein(CRP), Hemoglobin(Hb), Neutrophils(NEU), Alanine aminotransfease(ALT) and Ferritin in childhood brucellosis with osteoarticular involvement had significant differences than those without osteoarticular involvement or control group (P<0.05). Childhood brucellosis without osteoarticular involvement often accompanied by decrease of NEU , increase of CRP and ALT compared with that control group (P<0.05). The Receiver Operating Curves (ROC) analysis revealed that NEU, CRP and ALT can be used as adjunct parameters in the differential diagnosis of childhood brucellosis. These data suggest that clinical and laboratory characteristics are very important for every clinician, which may have a complementary role in diagnosis of childhood brucellosis.