Zoonotic Pathogen Seroprevalence in Cattle in a Wildlife-Livestock Interface, Kenya

A cross-sectional study was conducted to determine the seroprevalence of Brucella spp. and Leptospira spp. and risk factors of exposure in cattle in three zones with varying land use types and wildlife-livestock interactions. Five villages were selected purposively; two in areas with intensive livestock-wildlife interactions (zone 1), another two in areas with moderate livestock-wildlife interactions (zone 2) and one in areas where wildlife-livestock interactions are rarer (zone 3). Sera samples were collected from 1170 cattle belonging to 390 herds in all the zones and tested for antibodies against Brucella abortus and Leptospira interrogans serovar hardjo using ELISA kits. Data on putative risk factors for seropositivity of these pathogens in cattle were collected using a questionnaire. The overall apparent animal-level seroprevalence of brucellosis and leptospirosis was, respectively, 36.9% (95% CI 34.1-39.8) and 23.5% (95% CI 21.1-26.0). Brucella spp. seroprevalence was higher in zone 1 than in zones 2 and 3 (χ2 = 25.1, df = 2, P < 0.001). Zones 1 and 2 had significantly higher Leptospira spp. seroprevalence than zone 3 (χ2 = 7.0, df = 2, P = 0.029). Results of multivariable analyses identified animal sex (female) and zones (high interface area) as significant predictors (P < 0.05) of animal-level seropositivity of Brucella spp. For Leptospira spp., important predictors of animal-level seropositivity were animal sex (female), zones (moderate interface area) and herds utilizing a communal grazing reserve. The seroprevalences of Brucella spp. and Leptospira spp. in cattle were higher in areas with moderate to high wildlife-livestock interactions than those with rare interactions.

Brucella melitensis Rev.1 vaccination generates a higher shedding risk of the vaccine strain in Alpine ibex (Capra ibex) compared to the domestic goat (Capra hircus)

Epidemiological investigations implemented in wild and domestic ruminants evidenced a reservoir for Brucella in Capra ibex in the French Alps. Vaccination was considered as a possible way to control Brucella infection in this wildlife population. Twelve ibexes and twelve goats were allocated into four groups housed separately, each including six males or six non-pregnant females. Four to five animals were vaccinated and one or two animals were contact animals. Half of the animals were necropsied 45 days post-vaccination (pv), and the remaining ones at 90 days pv. Additional samples were collected 20 and 68 days pv to explore bacterial distribution in organs and humoral immunity. Neither clinical signs nor Brucella-specific lesions were observed and all vaccinated animals seroconverted. Brucella distribution and antibody profiles were highly contrasted between both species. Proportion of infected samples was significantly higher in ibex compared to goats and decreased between 45 and 90 days pv. Two male ibex presented urogenital excretion at 20 or 45 days pv. The bacterial load was higher 45 days in ibexes compared to goats, whereas it remained moderate to low 90 days pv in both species with large variability between animals. In this experiment, differences between species remained the main source of variation, with low impact of other individual factors. To conclude, multiplicative and shedding capacity of Rev.1 was much higher in ibex compared to goats within 90 days. These results provide initial information on the potential use in natura of a commercial vaccine.

The Pattern of Tpeak-Tend Interval and QTdis, and Pdis in Children with Brucellosis

OBJECTIVE

To investigate the effect of inflammation on the conducting system of the heart in patients diagnosed with brucellosis.

METHODS

A total of 42 patients diagnosed with brucellosis and 39 age and sex-matched healthy children were enrolled into the study. Pre- and post-treatment electrocardiographic parameters in brucellosis and control group were recorded from an electrocardiogram for each patient.

RESULTS

The results indicated that the parameters including Pmax, Pdis, QTmax, QTdis, QTcdis, Tp-edis interval and Tp-emax/QTmax and Tp-emax/QTcmax ratios, which are known to be key indicators for the prediction of severe atrial or ventricular arrhythmia and sudden cardiac death and also important parameters used as the indicators for the non-invasive evaluation of the transmural heterogeneity were significantly longer in the study group compared with the control group (p < 0.05).

CONCLUSION

In this study, it was determined that the brucella disease had more cardiac involvement than thought, and this was more in the subclinical form of cardiac involvement.

Asymptotic analysis of endemic equilibrium to a brucellosis model

Brucellosis is one of the worlds major infectious and contagious bacterial disease. In order to study different types of brucellosis transmission models among sheep, we propose a deterministic model to investigate the transmission dynamics of brucellosis with the flock of sheep divided into basic ewes and other sheep. The global dynamical behavior of this model is given: including the basic repro-duction number, the existence and uniqueness of positive equilibrium, the global asymptotic stability of the equilibrium. We prove the uniqueness of positive endemic equilibrium through using proof by contradiction, and the global stability of endemic equilibrium by using Lyapunov function. Especially, we give the specific coefficients of global Lyapunov function, and show the calculation method of these specific coefficients. By running numerical simulations for the cases with the basic reproduction number to demonstrate the global stability of the equilibria and the unique endemic equilibrium, re-spectively. By some sensitivity analysis of the basic reproduction number on parameters, we find that vaccination rate of sheep and seropositive detection rate of recessive infected sheep are very important factor for brucellosis.

Clinical features of 2041 human brucellosis cases in China

BACKGROUND

Human brucellosis has become a major public health problem in China. However, the available clinical data on brucellosis cases are limited.

METHODS

We retrospectively reviewed medical charts of 2041 patients with confirmed human brucellosis and prospectively recorded their outcomes by telephone interview. These patients were admitted to the Sixth People's Hospital of the Xinjiang Uygur Autonomous region between 1st January and 31st December 2014. Data on these patients were collected from hospital medical records.

RESULTS

Many patients presented with fatigue (67%), fever (64%), arthralgia (63%) and sweating (54%). High erythrocyte sedimentation rate (ESR) (69%), high C-reactive protein (CRP) (39%), high alanine aminotransferase (ALT) (33%) and high aspartate aminotransferase (AST) (20%) were the most common laboratory findings, especially in acute patients. There was evidence of focal involvement in 90% of patients. A total of 61.5% of brucellosis patients recovered. Multivariate logistic regression analyses suggested that the risk factors key to unfavorable prognosis were: age≥45 years (OR = 1.75, 95% CI 1.36-2.24), back pain (OR = 1.50, 95% CI 1.16-1.94) and joint tenderness (OR = 1.73, 95% CI 1.13-2.65). The increasing duration of the illness increased the risk of poor prognosis.

CONCLUSION

Patients with brucellosis showed different characteristics in different clinical stages. In China, the chronicity rate of human brucellosis is high. The risk of poor prognosis is increased in patients aged 45 years or older, patients who have had brucellosis for a substantial period of time, and patients with back pain or joint tenderness. The clinical management of brucellosis should be improved to include sensitive diagnostic methods for subacute and chronic brucellosis.

Brucellosis Causes Alteration in Trace Elements and Oxidative Stress Factors

Brucellosis is regarded as one of the most common diseases among humans and livestock. In the present study, we aimed to assess the effect of this disease on the level of various cations including copper (Cu), manganese (Mn), zinc (Zn), and magnesium (Mg) as well as oxidative stress status in the serum of people suffering from brucellosis. The present case-study was carried out on 40 patients with brucellosis (case) and 20 healthy people (control). Blood specimens were taken from all the people and the level of essential trace elements and oxidative stress status were measured. The serum level of copper in the case group (165.39 ± 43.19 μg/dl) was significantly higher compared with that in the control group (122.12 ± 28.88 μg/dl). Whereas the serum level of zinc was significantly lower in the case group compared with that in the control group (76.47 ± 28.88 vs. 92.85 ± 23.16 μg/dl). The manganese and magnesium serum levels did not differ significantly between the two groups. Furthermore, total antioxidant capacity level was significantly lower in the case group (122.12 ± 28.22 μmol/ml) than that in the control group (3.08 ± 0.12 μmol/ml) and the level of serum malondialdehyde was significantly higher in the case group (7.20 ± 0.23 mmol/ml) than that in the control group (4.0 ± 0.19 mmol/ml). Brucellosis can cause alteration in the serum level of essential trace elements. Moreover, the present study indicated that brucellosis produces oxidative stress in patients.

Childhood brucellosis in Babol, Iran

This prospective study was conducted on 111 children with brucellosis, who attended the Department of Infectious Diseases, Babol, Iran, from September 1999 to March 2003. Fever (73.9%), sweating (67.6%), artheralgia (49.5%) and splenomegaly (18%) were common findings. The disease was acute and sub-acute in 97.3% and chronic in 2.7% of cases. Peripheral arthritis was seen in 35 (31.5%) of cases, which was monoarticular in 29 patients, most involving the knees and hips. Sacroilitis was seen in six (5.4%) cases.

ASSOCIATION OF MEAN PLATELET VOLUME AND THE MONOCYTE/LYMPHOCYTE RATIO WITH BRUCELLA-CAUSED EPIDIDYMO-ORCHITIS

We evaluated the association between the mean platelet volume (MPV) and monocyte/lymphocyte ratio (MLR) with brucella-caused epididymo-orchitis to determine if they could be used to differentiate between brucella and non-brucella epididymo-orchitis. The charts of 88 patients with non-brucella and 14 patients with brucella epididymo-orchitis were retrospectively reviewed. Brucellosis was diagnosed by isolating Brucella spp from a blood culture or from a serum agglutination titer ≥ 1:160 along with accompanying clinical findings. The patients with brucella epididymo-orchitis were significantly more likely to have a lower MPV and a higher MLR than those with non-brucella epididymo-orchitis. Using a MPV cut-off level of less than 9.25 fl to differentiate brucella from non-brucella epididymo-orchitis gives a sensitivity of 78.6%, a specifity of 78.4%, a positive predictive value of 36.7% and a negative predictive value of 95.8%. Using a MLR cut-off level of greater than 0.265 to differentiate brucella from non-brucella epididymo-orchitis gives a sensitivity of 71.4%, a specifity of 65.9%, a positive predictive value of 25% and a negative predictive value of 93.5.%. MPV and MLR values may assist in differentiating between brucella and non-brucella epididymo-orchitis.

[BRUCELLA MELITENSIS (BM) BACTEREMIA IN HOSPITALIZED ADULT PATIENTS IN SOUTHERN ISRAEL]

BACKGROUND

Southern Israel is endemic for Brucella melitensis (BM) infection.

AIMS

This study aims to describe clinical manifestations and laboratory abnormalities in hospitalized adults with BM-bacteremia and to assess the relationship between various laboratory parameters, outcomes and complications of brucellosis.

METHODS

This is a retrospective study. All BM bacteremic patients hospitalized in the Soroka University Medical Center (SUMC) during 2006-2011 were included. Demographic, clinical data and laboratory results were collected from the medical records.

RESULTS

A total of 114 patients were included in the study, mostly of Bedouin-Arab origin (92%). The average age was 44 years (±18.4) and included 62 females (54%) of whom 11 were pregnant. Most of the subjects were exposed to sheep or their milk or meat products. The main symptoms included fever, arthralgia, myalgia, headache, and low back pain. Complications were present in 22 patients (19%): arthritis and osteomyelitis (59%), spontaneous abortion (36% of pregnant woman), endocarditis and epididymitis. The incidence of complications was correlated to anemia and leukopenia (p=0.03) and to a low neutrophil count (p=0.009). A decrease of albumin by one unit correlated with an increased hospitalization length by 1.9 days; older age also correlated with a prolonged stay. Complications were present in 45% of pregnant women vs. 10% in non-pregnant women (p=0.011. Relapse occurred in nine patients (8%); only one of these received adequate antibiotic treatment.

CONCLUSIONS

MB-bacteremia in southern Israel occurs mainly in Bedouin-Arabs after exposure to sheep or their products. Older age and low albumin levels increase hospitalization. Leukopenia, mainly low neutrophil count, and low thrombocyte count can predict complications. Pregnant women have a higher incidence of complications. Relapse is rare under adequate antibiotic treatment.

First report of a Brucella suis infection in roe deer (Capreolus capreolus)

In the present case report the detection of Brucella (B.) suis biovar 2 in roe deer (Capreolus capreolus) is described for the first time. The roe deer fawn was found emaciated and moribund in a hunting ground in the district Hohenlohe in Baden-Württemberg, Germany, in February 2013. A post-mortem examination revealed particularly a high-grade fibrinous pleurisy caused by the pathogen which could be multiplied in a dense growth on sheep blood agar and confirmed and differentiated subsequently by PCR.

First detection of Brucella canis infections in a breeding kennel in Austria

Brucella canis occurs almost worldwide and is a potential danger to the health of dogs and humans. The pathogen was detected in the placenta and fetuses of a Standard Poodle by direct culture and immunohistochemistry. Further, Brucellae were also isolated from the blood samples of two asymptomatic female Medium Poodles. The isolates were identified as B. canis by conventional microbiological methods and a novel Bruce-ladder multiplex PCR. Genotyping was performed by multiple locus variable number tandem repeats analysis (MLVA).

[Effectiveness of cycloferon in complex treatment of brucellosis patients with lesions of the scrotum]

The article presents the results of urological examination (spermograms and data of ultrasound examination) of 22 patients with chronic brucellosis and diseases of the scrotum (6 patients with orchitis, 16 with orchiepididymitis) before and after conventional therapy (10 patients) and combined treatment with the inclusion of cycloferon (2 courses of 5 intramuscular injection [0.25 g] with an interval of 10 days)--12 patients. It is shown that the administration of cycloferon leads to more effective relief of intoxication symptoms and inflammation in the testes and appendages (reduction of scrotal wall thickness, size of testes and/or adjuncts, and the incidence and severity of hydrocele), and has a positive effect on spermatogenesis (reduction of semen viscosity, the number of white blood cells in semen, sperm agglutination associated with the formation of sperm antibodies in most patients after treatment), as well as reduces the number of exacerbations of chronic orchitis/orchiepididymitis by 2.4 times.

Bone marrow biopsy findings in brucellosis patients with hematologic abnormalities

BACKGROUND

Brucellosis can mimic various multisytem diseases, showing wide clinical polymorphism that frequently leads to misdiagnosis and treatment delay, further increasing the complication rates. In this study, we aimed to examine bone marrow biopsy findings in brucellosis cases presenting with hematologic abnormalities.

METHODS

Forty-eight brucellosis cases were prospectively investigated. Complaints and physical examination findings of patients were recorded. Patients' complete blood count, routine biochemical tests, erythrocyte sedimentation rate, C-reactive protein and serological screenings were performed. Bone marrow biopsy and aspiration was performed in patients with cytopenia, for bone marrow examination and brucella culture, in accordance with the standard procedures from spina iliaca posterior superior region of pelvic bone.

RESULTS

Of the 48 patients, 35 (73%) were female and 13 (27%) were male. Mean age was (34.8 ± 15.4) years (age range: 15 - 70 years). Anemia, leukopenia, thrombocytopenia and pancytopenia were found in 39 (81%), 28 (58%), 22 (46%) and 10 patients (21%), respectively. In the examination of bone marrow, hypercellularity was found in 35 (73%) patients. Increased megacariocytic, erythroid and granulocytic series were found in 28 (58%), 15 (31%) and 5 (10%) patients, respectively. In addition, hemophagocytosis was observed in 15 (31%) patients, granuloma observed in 12 (25%) and increased eosinophil and plasma cells observed in 9 (19%) patients.

CONCLUSION

According to the results of our series, hemophagocytosis, microgranuloma formation and hypersplenism may be responsible for hematologic complications of brucellosis.

What have we learned from brucellosis in the mouse model?

Brucellosis is a zoonosis caused by Brucella species. Brucellosis research in natural hosts is often precluded by practical, economical and ethical reasons and mice are widely used. However, mice are not natural Brucella hosts and the course of murine brucellosis depends on bacterial strain virulence, dose and inoculation route as well as breed, genetic background, age, sex and physiological statu of mice. Therefore, meaningful experiments require a definition of these variables. Brucella spleen replication profiles are highly reproducible and course in four phases: i), onset or spleen colonization (first 48 h); ii), acute phase, from the third day to the time when bacteria reach maximal numbers; iii), chronic steady phase, where bacterial numbers plateaus; and iv), chronic declining phase, during which brucellae are eliminated. This pattern displays clear physiopathological signs and is sensitive to small virulence variations, making possible to assess attenuation when fully virulent bacteria are used as controls. Similarly, immunity studies using mice with known defects are possible. Mutations affecting INF-γ, TLR9, Myd88, Tγδ and TNF-β favor Brucella replication; whereas IL-1β, IL-18, TLR4, TLR5, TLR2, NOD1, NOD2, GM-CSF, IL/17r, Rip2, TRIF, NK or Nramp1 deficiencies have no noticeable effects. Splenomegaly development is also useful: it correlates with IFN-γ and IL-12 levels and with Brucella strain virulence. The genetic background is also important: Brucella-resistant mice (C57BL) yield lower splenic bacterial replication and less splenomegaly than susceptible breeds. When inoculum is increased, a saturating dose above which bacterial numbers per organ do not augment, is reached. Unlike many gram-negative bacteria, lethal doses are large (≥ 108 bacteria/mouse) and normally higher than the saturating dose. Persistence is a useful virulence/attenuation index and is used in vaccine (Residual Virulence) quality control. Vaccine candidates are also often tested in mice by determining splenic Brucella numbers after challenging with appropriate virulent brucellae doses at precise post-vaccination times. Since most live or killed Brucella vaccines provide some protection in mice, controls immunized with reference vaccines (S19 or Rev1) are critical. Finally, mice have been successfully used to evaluate brucellosis therapies. It is concluded that, when used properly, the mouse is a valuable brucellosis model.

Pulmonary involvement of Brucellosis: a report of six cases

BACKGROUND

Pulmonary involvement of brucellosis rarely occurs due to inhalation of infected aerosol or hematogenous overspreading.

OBJECTIVE

The study aimed to reveal the pulmonary manifestations of brucellosis that occur rarely in Brucella infections in the context of six cases in this report.

METHODS

Between 1998-2008, 82 patients with brucellosis treated and followed up at infectious diseases clinic have been retrospectively studied in relation to their clinical and laboratory findings and treatment results.

RESULTS

Patients' (n=6) age ranged from 48 to 59 years and they showed equal gender distribution. All patients presented with fever and cough. Radiological examination showed pneumonic patches and consolidation in two cases, bilateral glass round opacity in four cases, perivascular and peribronchial thickness increase in two cases, pleural effusion in two cases, sentri-acinar emphysematous images in one patient, and athelectasis in one patient. Blood cultures of three patients grew Brucella spp. All patients responded to treatment containing doxycycline, rifampicin and streptomycin (for only one patient) within seven to 10 days and were treated for six weeks except for one patient for who was treated eight weeks due to hepatosplenic brucellosis.

CONCLUSION

Pulmonary involvement of brucellosis has good prognosis with combined antimicrobial therapy.

[Efficacy of cycloferon in the treatment of brucellosis]

Therapeutic potential of cyclopheron was evaluated as exemplified by the treatment of patients with chronic brucellosis. Positive clinical dynamics during combined treatment including cyclopheron is apparent as reduced duration of intoxication and inflammation, improved quality of life, decreased frequency of exacerbation of the infectious process and development of intercurrent diseases. These effects are shown to be due to immunomodulating activity of cyclopheron and suppression of lipid peroxidation. Also, the drug increases activity of antioxidants, decreases the levels of proinflammatory (and to a lesser degree of anti-inflammatory) cytokines.

[Clinical and laboratory indicators of systemic inflammation and endotoxicosis in the evaluation of the activity of an infectious process]

Patients with chronic brucellosis underwent a complex clinical and laboratory studies to determine the indicators reflecting the degree of systemic inflammation and endotoxicosis. On the basis of an analysis of the findings, an integral quantitative approach was applied to describing the associations between various pathophysiological processes and clinical manifestations; criteria for the activity of the infectious process were objectivized, and the form of chronic brucellosis was defined. The mathematical simulation method was shown to be an adequate tool to objectivized the differential diagnosis of the clinical forms of the disease.

EVALUATION OF BRAINSTEM AUDITORY POTENTIAL IN BRUCELLOSIS PATIENTS WITH AND WITHOUT NEUROLOGICAL INVOLVEMENT

This study investigated the changes in brainstem auditory evoked potentials (BAEPs) in acute phase of brucellosis. Twenty-two patients with brucellosis without neurologic involvement and seven patients with neurobrucellosis were included. BAEPs were evaluated before treatment. No patient had a symptom of hearing loss. Patients who had neurologic involvement did not show any abnormalities in their BAEPs recording. This study suggests that patients with brucellosis who are in the acute phase of the disease with or without neurological involvement may have normal BAEPs. BAEPs do not seem to be a sensitive method for central nervous system involvement of brucella patients in the acute phase of the disease.

Brucellosis mimicking enteric fever

Brucellosis is a systemic infection with multiple presentations. Despite its oral transmission and gastrointestinal pathogenesis, systemic symptoms are usually more prominent than gastrointestinal complaints. We report a patient with enteric fever caused by Brucella melitensis.

[Abnormal liver function in brucellosis]

We assessed the prevalence of impaired liver function in 47 patients suffering from brucellosis consecutively admitted to our department over the last five years. Parameters of liver function and ultrasound of the upper abdomen were performed at entry and at the end of treatment. On admission, mean transaminase values were elevated and significantly higher than at recovery (p 0.001): 38 percent and 53 percent of patients had elevated baseline values of GOT and GPT vs 13 and 19% at the end of treatment, respectively. Mean serum values of alkaline phosphatase (AP) were within normal limits on admission, although in 12 of them serum values were elevated. The same proportion was seen for gamma-glutamyltranspeptidase. Both transaminases and AP were elevated in 8 patients (17 percent). There were no significant differences in serum values of albumin and bilirubin before and after therapy. The platelet count slightly decreased, but not significantly, during the acute phase of disease. At ultrasound one third of the patients showed hepatomegaly with a hepatitis-like pattern and 40 percent of patients had splenomegaly. In conclusion, this study confirms data in the literature showing a high frequency of liver impairment during the course of brucellosis, which is usually mild-moderate.

Evaluation of different serological techniques in laboratory diagnosis of brucellosis

Diagnosis of brucellosis is vital for early institution of proper therapy as untreated cases may progress to chronic stage. Though the demonstration of the causative agent in blood is considered as the most conclusive test in the diagnosis of brucellosis, isolation of brucella organism by blood culture is relatively low. Hence a number of sensitive and rapid serological tests have been introduced for the diagnosis of brucellosis. In the present study, an attempt was made to compare the efficacies of existing serological tests such as agglutination reaction with newer rapid tests which help in the detection of either specific antigen or antibody. The study included specimens from 80 patients clinically suspected to be suffering from brucellosis and 20 apparently healthy controls. All serum samples were subjected for evidence of brucellosis by five serological tests viz, standard tube agglutination test, 2-mercaptoethanol test, modified antiglobulin test, counter immuno-electrophoresis and passive haemagglutination test for antibody detection and two serological tests viz, counter immunoelectrophoresis and latex agglutination test for antigen detection. Eighty blood samples were processed for microbiological evidence of brucellosis and yielded only 8 isolates of Brucella melitensis of biotype 1. By standard tube agglutination test, 25 sera showed titre of brucella agglutinins equal to more than the diagnostic titre (i.e., more than or equal to 160 IU). Counter immuno-electrophoresis test and latex agglutination showed presence of antigen in 3 and 4 blood culture negative cases respectively.

Brainstem auditory evoked potential (BAEP) in brucellosis

BACKGROUND

Brucellosis is a zoonosis still endemic in many parts of the world including coastal countries of Mediterranean Sea, Middle East regions and Central and South America. Now in this study we surveyed whether patients with systemic brucellosis, BAEP differ from healthy persons or not. This will help us later, when the patients with brucellosis refer to perform BAEP to prevent misdiagnosis.

MATERIALS AND METHODS

Fifteen patients with acute systemic brucellosis without neurological involvement and 15 apparently healthy persons underwent a brainstem auditory evoked potentials (BAEP) study.

RESULTS

Comparison of pooled data between the systemic brucellosis and healthy groups showed no significant differences in all BAEP parameters.

CONCLUSION

In conclusion, BAEP parameters in brucellosis group did not differ from healthy persons. Thus in interpretation of BAEP in patients that referred for another reason and have systemic brucellosis, it is not necessary to consider about the effect of brucellosis on BAEP.

Novel Brucella strain (BO1) associated with a prosthetic breast implant infection

We report the microbiological, biochemical, and molecular characterization of an unusual Brucella strain (BO1) isolated from a breast implant wound in a 71-year-old woman with clinical symptoms consistent with brucellosis. Initial phenotypic analysis, including biochemical and antimicrobial susceptibility testing, cellular fatty acid analysis, and molecular analysis based on DNA-DNA reassociation and the presence of multiple copies of IS711 element suggested that the isolate was a Brucella-like organism, but species determination using microbiological algorithms was unsuccessful. Furthermore, molecular data based on 16S rRNA gene sequencing and multilocus sequence analysis demonstrated that BO1 was an unusual Brucella strain and not closely related to any currently described Brucella species. However, comparison with equivalent sequences in Ochrobactrum spp. confirms that the isolate is much more closely related to Brucella than to Ochrobactrum spp., and thus the isolate likely represents an atypical and novel strain within the genus Brucella.

Acquired progressive spastic paraparesis due to neurobrucellosis: a case report

A 39-year-old man with a 4-month history of transient pins and needles sensations occurring below the waist while walking and difficulty walking presented to our outpatient clinic. He had an approximate 1-year history of bilateral hearing loss, the etiology of which was unknown. His symptoms had been progressive, and there was no significant family history. He demonstrated a spastic gait and required assistance for walking. Deep tendon reflexes were hypertonic; a sensation deficit was defined as originating from the 12th thoracic vertebra. Babinski's sign was positive bilaterally. Sphincter abnormalities were seen in the patient's bladder and bowel functions. Cerebral and spinal magnetic resonance images with contrast media were unremarkable. An analysis of the patient's cerebrospinal fluid was consistent with neurobrucellosis. Owing to spastic paraparesis and hearing loss, the diagnosis of neurobrucellosis was made. Combined antimicrobial therapy was started and continued 6 months. His neurologic condition improved, and he was able to walk without help after 3 months' treatment. Our case illustrates that acquired progressive spastic paraparesis may occur during the course of neurobrucellosis. Neurobrucellosis should be borne in mind when patients present with spastic paraparesis.

Epidemiological and clinical aspects of human brucellosis in Central Greece

The confirmed cases of human brucellosis in the area of Larissa in Central Greece from 2003 to 2005 were analyzed to assess the features of the affected population and to determine the factors influencing the acquisition of infection. Data of patients infected by Brucella spp. concerning age, gender, occupation, date of diagnosis and the observed symptoms were collected from regional hospitals, health centres and private practitioners. The incidence of human brucellosis in the area was 32.49 cases/100,000 inhabitants. Males, due to their professions, were affected more often by brucellosis than females. The majority of the cases were attributed to direct contact with animals or their products. Only in 8.49% of the cases was the infection attributed to the consumption of dairy products. The urban population is not at potential risk for acquiring brucellosis because all commercialized dairy products in Greece are produced from pasteurized milk. The occurrence of human brucellosis shows seasonality, with the majority of the cases diagnosed from December to May. Direct contact with animals, the season of the year and gender were the risk factors influencing the acquisition of infection. Fever, arthralgia, profuse sweating and anorexia were the symptoms most often observed.

PCR confirmation of cutaneous manifestation due to Brucella melitensis

Human brucellosis, a zoonotic disease, is endemic in the Belgaum district, Karnataka, India. A male patient presented with a generalized itchy rash. Blood was sent for venereal disease research laboratory testing. Screening was carried out for Brucella antibodies following hospital policy and diagnosis was confirmed by PCR.

Cervical spinal brucellosis causing epidural and prevertebral abscesses and spinal cord compression: a case report

BACKGROUND CONTEXT

Cervical involvement due to spinal brucellosis is quite rare. Although surgery usually is not necessary in spinal brucellosis, most of the patients with cervical involvement require surgical treatment because of the high rate of neurological involvement and spinal cord compression.

PURPOSE

To present a unique case with cervical spinal brucellosis with epidural and paravertebral abscesses and to discuss the treatment alternatives of this disease.

STUDY DESIGN

A case report.

METHODS

A 61-year-old patient with spinal cord compression syndrome due to cervical spinal brucellosis was reported. He was treated by triplet antibiotherapy for 24 weeks. On magnetic resonance imaging, spinal cord compression caused by epidural abscess and granulation tissue, and prevertebral abscess were seen.

RESULTS

At the end of the treatment, there were no complaints, neurological findings, or positive infection markers. There was not epidural compression on control magnetic resonance imaging.

CONCLUSIONS

Surgery may not be required in all cervical spinal brucellosis cases with epidural compression and neurological involvement. Conservative treatment with close observation may be sufficient in these patients who are usually older people.

Medically treated paravertebral Brucella abscess presenting with acute torticollis: case report

BACKGROUND

Atlantoaxial subluxation secondary to a paravertebral (retropharyngeal) abscess is a well known but rare event in children.

CASE DESCRIPTION

The authors describe the clinical and radiologic findings of a case of 6-year-old child who presented with acute torticollis (duration, 4 days). Type 2 atlantoaxial rotatory fixation and upper cervical paravertebral (retropharyngeal) abscess were diagnosed on radiologic examination. Laboratory test results showed positive agglutination titer for Brucella melitensis, in the rate of 1/640 dilution. This is the first reported case of Brucella-related atlantoaxial subluxation in a child in the pediatric literature. The patient was treated successfully with anti-inflammatory drugs, Brucella-specific antibiotic regimen, and Philadelphia collar application. Possibly, effusion of the atlantoaxial joint, due to Brucella infection, led to the laxity of the ligaments and contributed to subluxation.

CONCLUSIONS

Brucella abscess should be kept in mind for the differential diagnosis of retropharyngeal mass, and the torticollis may be the only presenting sign. The authors recommend a trial of medical treatment with adequate dosages for a reasonable length of time and immobilization before considering surgical intervention for the spinal paravertebral Brucella abscess and related atlantoaxial subluxation.

Future trends in human brucellosis treatment

The global burden of human brucellosis remains enormous. Existing treatment options, largely based on experience gained > 30 years ago, are adequate but not optimal. The evolving understanding of the pathophysiology of the disease may augment in designing and evaluating alternative approaches that may prove to be superior. Current alternative approaches such as co-trimoxazole-containing regimens, should be widely evaluated as being more cost-effective. New methods of delivery such as gentamicin-loaded microparticles, neutralisation of the environment where Brucella resides and use of novel antibiotics such as tigecycline may be of importance in the future. The role of immunomodulation, widely but inconsistently applied in 'chronic' brucellosis, should be further evaluated in all disease stages to define if it is of any use. The development of a subcellular vaccine would be an important step forward although one has to take into account the multiple interactions between Brucella and the immune system, various technical problems and the lack of funds. Reviewing existing attempts at the development of such a vaccine, the authors conclude that a trivalent subcellular vaccine may be needed for adequate efficacy.

Cognitive and emotional changes in neurobrucellosis

OBJECTIVE

To determine cognitive and emotional changes among neurobrucellosis patients.

METHODS

The patients with neurobrucellosis and controls with brucellosis without neurologic involvement were included in the study. Neurobrucellosis was diagnosed by the following criteria: (i) symptoms or clinical findings compatible with neurobrucellosis, including headache, confusion, mental and emotional changes; (ii) isolation of Brucella spp. from CSF and/or demonstration of antibodies to Brucella > or = 1/4 in the CSF; (iii) the presence of lymphocytosis, increased protein and decreased glucose levels in the CSF; and (iv) clinical improvement with appropriate treatment. Two psychiatrists interviewed the patients, and performed the Hamilton Depression Rating Scale (HDRS) tests and Mini-Mental State Examination (MMSE) tests.

RESULTS

Thirty-four neurobrucellosis cases and 30 patients with brucellosis without neurological involvement were studied. The mean age was 41 years, 12 (41%) patients were female, 13 (46%) patients were farmers, and 7 (25%) patients were housewives. Among the neurobrucellosis cases, before the antibiotic therapy, the mean MMSE test score was 21.6, one week after the therapy 22.7, and two weeks after the therapy 24.3 (p=0.024, and p<0.001, respectively). At the day of admission before therapy, the mean of HDRS test was 9.9, one week after therapy it was 7.8, and two weeks after therapy it was 5 (p=0.014, and p<0.001, respectively).

CONCLUSION

The cognitive and emotional disturbances among neurobrucellosis patients were documented by MMSE and HDRS tests. These disorders improve by antibiotic therapy, without any anti-depressive or anti-psychotic therapy.

Diminished percentage of CD4+ T-lymphocytes expressing interleukine-2 receptor alpha in chronic brucellosis

OBJECTIVES AND METHODS

Despite the treatment, a considerable proportion of brucellosis patients develop chronic disease, characterized by atypical clinical picture and/or relapses. Th1 cytokines are critical for the clearance of Brucella infection and diminished production of IL-2 in response to PHA, has been described in chronic brucellosis. In order to investigate the role of IL-2R alpha (CD25) in disease outcome, we evaluated the ex vivo and PHA-induced percentage of peripheral CD4+ T-lymphocytes expressing CD25 in 13 acute brucellosis patients (AB), 22 chronic brucellosis patients (CB), 11 "clinically cured" subjects and 15 healthy volunteers (controls). Simultaneously, CD3+, CD4+ and CD8+ T-lymphocytes subsets were measured.

RESULTS

The ex vivo percentage of CD4+/CD25+ T-cells was significantly higher in AB patients compared to "clinically cured" subjects (p=0.005) and controls (p=0.006). By contrast, CD4+/CD25+ T-cells were significantly lower in CB patients (p=0.001). T-lymphocytes subsets did not significantly differ between the groups. After PHA stimulation, CD4+/CD25+ T-cells remained significantly lower in CB and specifically in the relapsing form of chronic disease compared to AB (p=0.044, 0.023). Additionally, CD8+ T-lymphocytes were found to be significantly increased in CB and mainly in the relapsing subgroup of CB patients compared to AB (p=0.044, 0.011).

CONCLUSION

Diminished percentage of peripheral CD4+ T-lymphocytes expressing IL-2R alpha is associated with chronic relapsing brucellosis.

Noncontiguous dual segment thoracic brucellosis with neurological deficit

BACKGROUND CONTEXT

Brucellosis can affect the musculoskeletal system, and bony involvement ranges from 2% to 70% in the literature. Spinal brucellosis is generally localized to the sacroiliac region; thoracic brucellosis is rarely seen.

PURPOSE

To present a case with noncontiguous multilevel thoracic brucellosis with spinal cord compression.

STUDY DESIGN

Case report.

METHODS

The patient underwent aggressive surgical debridement (posterior decompression, fusion and stabilization, and two noncontiguous level anterior corpectomy and fusion procedures with titanium mesh cages).

RESULTS

At the latest follow-up of 2 years, her clinical, radiological, and laboratory examination showed no recurrence of infection. The neurological examination was completely normal.

CONCLUSION

Early aggressive debridement and stabilization together with medical treatment, especially in the elderly and immunocompromised patients, would be the most beneficial treatment for eradication of pathology.

Clinical and laboratory features of brucellosis in two university hospitals in Southeast Turkey

This prospective study was carried out in two university hospitals between January 2000 and December 2002. The diagnosis of brucellosis was made with compatible clinical findings, positive Brucella agglutination > or =1/160 titres, and/or the isolation of Brucella species. The patients were followed up without intervention. One hundred and thirty-eight patients with active brucellosis were evaluated. Of the participants, 79 (57.2%) cases were acute, 23 (16.7%) sub-acute and 36 (26.1%) chronic. Brucella melitensis was isolated in the specimens of 24 (26.9%) out of 89 patients. The most frequent symptoms were fever (78.3%), arthralgia (77.5%) and sweating (72.5%). The most common physical findings were fever (40.6%), splenomegaly (36.2%), and hepatomegaly (26.8%). The osteoarticular involvement was found in 64 patients (46.4%). Ten (7.5%) patients had orchiepididymitis. Meningitis, pulmonary involvement, endocarditis, and hepatitis were found in five (3.6%), three (2.1%), two (1.5%) and one (0.7%) patient, respectively. Relative lymphomonocytosis was found in 80 cases (58.8%), anaemia in 46 (33.3%) and leucopoenia in 30 cases (21.7%). Clinical relapse was observed in 14 patients (10.1%).

Vertebral osteomyelitis: long-term disability assessment and prognostic factors

In the present study, we quantified the long-term sequelae of a series of patients diagnosed with vertebral osteomyelitis during the period 1990-2002 in Albacete (Spain), using two validated questionnaires of spinal dysfunction and also one pain and one global health assessment. It was possible to interview 69 (78%) patients diagnosed with vertebral osteomyelitis, and an additional 90 "normal" people were recruited as controls to establish normal values. We also carried out a multivariate analysis to identify independent risk factors. We found only a 33% rate of spinal disability, only 3% severe, assessed by the Oswestry and HAQ for ankylosing spondylitis questionnaires, a median of 5.4 years after treatment. Pain and global health assessment did not correlate with spinal function questionnaires. Independent predictors of long-term disability were the followings: neurological impairment at the time of diagnosis (RR=7.1, 95% CI 1.3-10.2), time to diagnosis > or = 8 weeks (RR=4.4, 95% CI 1.5-7.9) and debilitating disease (RR=3.9, 95% CI 1.2-7.5). Standardized spinal function questionnaires are useful measures to assess long-term outcome of vertebral osteomyelitis that facilitates comparison between case series and identification of risk factors.

A complication of brucellosis: epididymoorchitis

BACKGROUND

Epididymoorchitis is the most frequent genitourinary complication of brucellosis.

METHODS

This prospective study was conducted between February 2001 and January 2004, prospectively. Male patients diagnosed with brucellosis were included in this study and evaluated for testicular involvement.

RESULTS

Epididymoorchitis was detected in 17 out of 134 (12.7%) male patients with brucellosis. Mean age of the patients was 36.9+/-7.1 years. Twelve patients (70.6%) had acute, four patients (23.5%) had subacute, and one patient (5.9%) had chronic brucellosis. The most common symptoms were scrotal pain (94%) and swelling (82%). Eleven patients had unilateral epididymoorchitis, four had unilateral orchitis and two had unilateral epididymitis. A testicular abscess was detected in one patient. Sperm analysis was performed on 14 patients. Five patients had aspermia and eight had oligospermia. Combined antibiotic therapy was started and continued for 6-8 weeks. Orchiectomy was required for two patients and granulomatous orchitis was detected in the resected specimens. Relapse occurred in only one patient. Three patients had permanent oligospermia and one patient had permanent aspermia after the antibiotic therapy. Younger age, high C-reactive protein level and blood culture positivity were statistically significant differences between the patients with and without epididymoorchitis.

CONCLUSIONS

Brucellosis should be considered in the diagnosis of scrotal diseases in endemic areas. A conservative approach is usually adequate for managing brucellar epididymoorchitis. However, infertility problems may develop in these patients. Well-designed further investigations are needed to explain the relationship between brucellar epididymoorchitis and infertility in man.

[Neurobrucellosis: four case reports]

INTRODUCTION

Brucellosis is a form of anthropozoonosis that is found the world over. It has a particularly high incidence rate in Spain, above all in rural areas such as Extremadura, Castile and Leon, Castile-La Mancha and Aragon, largely due to the consumption of non-pasteurised milk and cheese. Neurobrucellosis can be defined as a set of either early or late neurological complications caused by Brucella. It is difficult to determine its frequency, although it oscillates between 2-18% of all cases of brucellosis.

CASE REPORTS

We report the cases of four patients diagnosed as having neurobrucellosis. The different presenting clinical symptoms, the complementary explorations, treatment and duration are all described.

CONCLUSIONS

The clinical features of neurobrucellosis vary greatly and, in general, tend to be chronic. Many of the laboratory procedures usually employed in the diagnosis of brucellosis frequently give negative results. For these reasons, and because it is a disease that is both treatable and curable, the degree of suspicion must be high, especially in endemic areas, so that an early diagnosis can be made to allow suitable treatment to be established.

Lipid peroxidation levels in patients with acute brucellosis

The purpose of this study was to investigate levels of lipid peroxidation, indicated by plasma malondialdehyde (MDA), with consideration of clinical status and treatment outcomes in patients with acute brucellosis. Plasma MDA levels were measured in patients with acute brucellosis and healthy subjects. Significantly higher MDA levels were detected in plasma of patients with acute brucellosis compared to controls (P<0.01). Plasma levels of MDA were significantly decreased after the brucellosis treatment (P<0.01). The results of the present study indicate for the first time that a considerable level of lipid peroxidation is involved in acute brucellosis cases and this may be of importance with respect to the understanding of disease pathogenesis and may serve as a target for treatment regime.

Human brucellosis in a nonendemic country: a report from Germany, 2002 and 2003

Human brucellosis has become a rare disease in Germany since the eradication of bovine and ovine/caprine brucellosis in this country. Therefore, most physicians are unfamiliar with the illnesses clinical presentation, diagnostic tools, and therapeutic strategies. This retrospective study was carried out to evaluate the epidemiological, clinical, and laboratory features of human brucellosis in Germany in the years 2002 and 2003. Thirty-one bacterial isolates from 30 patients sent to the German national reference laboratory were characterized using the genus-specific bcsp31 real-time PCR, the species-specific AMOS-PCR, and standard microbiological methods for the detection and identification of Brucella spp. The medical records of all patients with bacteriologically confirmed brucellosis were evaluated. All 31 isolates proved to be Brucella (30 Brucella melitensis and 1 Brucella suis). Most of the brucellosis patients were infected in endemic countries while visiting friends and relatives during their summer holidays. One case of laboratory-acquired infection was identified. Brucellosis was transmitted mainly by the consumption of contaminated unpasteurized milk or cheese from goats and sheep. The patients presented primarily with flu-like symptoms, i.e. fever, chills, sweating, headaches, arthralgia, and myalgia. In most cases, however, symptoms and signs of focal complications, e.g. spondylitis, endocarditis, and meningoencephalitis, predominated. The rate of complications was much higher than that in endemic countries, presumably as a result of diagnostic delay due to a low index of suspicion. In summary, physicians in nonendemic countries such as Germany must be aware of brucellosis being a possible cause of fever of unknown origin in immigrants and tourists travelling from endemic countries.

Successful medical treatment of intracranial abscess caused by Brucella spp

An unusual presentation of unilateral cerebellar abscesses due to neurobrucellosis observed in a patient is reported. He gave a history of fever, headache, vomiting and had unilateral cerebellar signs. The abscess was detected on magnetic resonance imaging (MRI) and analysis of cerebrospinal fluid revealed neurobrucellosis. Patient treated by only antibiotics therapy, evolving to complete clinical and radiological resolution, without neurosurgical intervention. We are presenting a case of cerebellar abscess due to neurobrucellosis diagnosed by MRI, treated medically, and had both radiologic and clinical follow-up. We also made a review of the literature concerning the cerebellar abscess due to neurobrucellosis.

The Brucella abortus Cu,Zn superoxide dismutase is required for optimal resistance to oxidative killing by murine macrophages and wild-type virulence in experimentally infected mice

Two-dimensional gel electrophoretic analysis of cell lysates from Brucella abortus 2308 and the isogenic hfq mutant Hfq3 revealed that the RNA binding protein Hfq (also known as host factor I or HF-I) is required for the optimal stationary phase production of the periplasmic Cu,Zn superoxide dismutase SodC. An isogenic sodC mutant, designated MEK2, was constructed from B. abortus 2308 by gene replacement, and the sodC mutant exhibited much greater susceptibility to killing by O(2)(-) generated by pyrogallol and the xanthine oxidase reaction than the parental 2308 strain supporting a role for SodC in protecting this bacterium from O(2)(-) of exogenous origin. The B. abortus sodC mutant was also found to be much more sensitive to killing by cultured resident peritoneal macrophages from C57BL6J mice than 2308, and the attenuation displayed by MEK2 in cultured murine macrophages was enhanced when these phagocytes were treated with gamma interferon (IFN-gamma). The attenuation displayed by the B. abortus sodC mutant in both resting and IFN-gamma-activated macrophages was alleviated, however, when these host cells were treated with the NADPH oxidase inhibitor apocynin. Consistent with its increased susceptibility to killing by cultured murine macrophages, the B. abortus sodC mutant also displayed significant attenuation in experimentally infected C57BL6J mice compared to the parental strain. These experimental findings indicate that SodC protects B. abortus 2308 from the respiratory burst of host macrophages. They also suggest that reduced SodC levels may contribute to the attenuation displayed by the B. abortus hfq mutant Hfq3 in the mouse model.

Investigation of the hypothalamo-pituitary-adrenal axis and changes in the size of adrenal glands in acute brucellosis

The aim of the study was to investigate the hypothalamo-pituitary-adrenal (HPA) axis by ACTH stimulation test and the changes in adrenal size in acute brucellosis before and after therapy in a prospective study. Sixteen patients with acute brucellosis and 15 healthy subjects were included in the study during the last two years. Cortisol levels were assessed before, 30 and 60 minutes after ACTH (250 microg i.v.) injection and the size of the adrenals was measured in both groups. Mean basal cortisol levels in the patients before the therapy and after the therapy were 22.1 +/- 6.9 microg/dL and 11.3 +/- 6.0 microg/dL, respectively. The difference was statistically significant (p<0.001). There was also statistically significant difference for basal cortisol levels between the healthy subjects (12.2 +/- 4.6 microg/dL) and the patients before the therapy (p<0.001). Peak cortisol responses to ACTH were higher before the therapy in the patients with acute brucellosis (39.3 +/- 10.7 microg/dL) than in the healthy subjects (30.4 +/- 4.8 microg/dL, p = 0.014). However, there was no significant difference for peak cortisol levels in the patients before and after the therapy (32.7 +/- 8.0 microg/dL). Mean basal cortisol levels and peak cortisol responses to ACTH between the patients after the therapy and the healthy controls were similar. Both the maximum width of the adrenal glands and the width of the adrenal limbs were significantly greater before the therapy compared to healthy subjects and post-treatment period. We concluded that the HPA axis is activated and the adrenal glands are enlarged in acute brucellosis, which is reduced after appropriate therapy.

Characteristics of B. melitensis versus B. abortus bacteraemias

OBJECTIVE

To determine the epidemiological and the clinical characteristics of bacteremic brucellosis.

METHODS

A prospective study, performed in the First Infectious Diseases Clinic of Ankara Numune Education and Research Hospital. All the patients had positive culture result for Brucella spp.

RESULTS

Fifty-four acute bacteremic brucellosis cases were included. The majority of patients (76%) were from rural Anatolia. Brucella melitensis serotypes were more common than Brucella abortus (83% versus 17%). Fever and arthralgia were the most common symptoms. The number of patients with back pain and arthralgia was higher in B. abortus infected group (p = 0.014 and p = 0.009).

CONCLUSIONS

B. melitensis is the most common subtype of Brucella infection in Turkey. The infections with B. abortus spp. are not less severe than the infections with B. melitensis.

Differential requirements for VirB1 and VirB2 during Brucella abortus infection

The Brucella abortus virB operon, encoding a type IV secretion system (T4SS), is required for intracellular replication and persistent infection in the mouse model. The products of the first two genes of the virB operon, virB1 and virB2, are predicted to be localized at the bacterial surface, where they could potentially interact with host cells. Studies to date have focused on characterization of transposon mutations in these genes, which are expected to exert polar effects on downstream genes in the operon. In order to determine whether VirB1 and VirB2 are required for the function of the T4SS apparatus, we constructed and characterized nonpolar deletion mutations of virB1 and virB2. Both mutants were shown to be nonpolar, as demonstrated by their ability to express the downstream gene virB5 during stationary phase of growth in vitro. Both VirB1 and VirB2 were essential for intracellular replication in J774 macrophages. The nonpolar virB2 mutant was unable to cause persistent infection in the mouse model, demonstrating the essential role of VirB2 in the function of the T4SS apparatus during infection. In contrast, the nonpolar virB1 mutant persisted at wild-type levels, showing that the function of VirB1 is dispensable in the mouse model of persistent infection.