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Background: Brucellosis in livestock and its transmission to humans through the consumption of contaminated dairy products is an important issue. The introduction of new approaches using immunogenic proteins against and diagnosing brucellosis is a serious issue in human health. Methods: Brucella abortus contains five proteins including: MOXR family ATPase-α2, T9SS C-terminal target domain-containing protein, Cobyric acid synthase, Hypothetical protein, and VirB11 type IV Secretion protein, which were considered and the designed recombinant polypeptide was produced and evaluated. The pure recombinant protein ABOR with 549aa in combination with chitin as an adjuvant was injected subcutaneously into guinea pigs to evaluate their immunity responses. Results: The results indicated that the ABOR recombinant protein induced Th1 immunity with high levels of specific IgG (IgG2a) as well as Interferon-γ (IFN-γ), Interleukin- 2 (IL-2), IL-12, and Tumor Necrosis Factor-alpha (TNF-α), compared to the control group. Th1/Th2 ratio analysis demonstrated the efficacy of ABOR protein combined with chitin in stimulating cellular immunity in the animals. Conclusion: Designed recombinant polypeptide combined with chitin showed ability for induction of cellular and humoral immunity an guinea pigs compared to RB51 vaccine. [ABSTRACT FROM AUTHOR]

Objective: We aimed to describe the clinical, epidemiological, and laboratory characteristics of patients with Brucella epididymoorchitis (BEO) and reveal the effectiveness of the treatment options and recurrence rates after treatment. Methods: The information of 42 BEO patients who were followed and treated in a tertiary training and research hospital between January 2013 and January 2023 was accessed by scanning the patient files retrospectively. Epididymoorchitis diagnosis was based on physical examination findings (testicular swelling, pain, rash) and/or by ultrasonography in patients with a standard tube agglutination test (STA) ≥1/160 and a positive rose-Bengal (RB) test or Brucella bacteria growth in blood cultures. Results: Forty-two patients with brucellosis-associated epididymoorchitis were included in the study. STA>1/160, and RB tests were positive in all patients. While the incidence of BEO among all patients was 10.9%, the incidence of BEO among male patients was 16.1%. The rate of unilateral testicular involvement in the patients was 92.86%, and the rate of bilateral testicular involvement was 7.14%. Pain accompanied testicular growth in 66.6% of the patients. Most patients (76.19%) were detected during the acute brucellosis period. Doxycycline (DOK) and rifampicin (RIF) combination was given to 13 patients, DOK and streptomycin (SM) combination to 22 patients, DOK and gentamicin (GEN) combination to 5 patients, and DOK, RIF and SM combination to two patients. The relapse rate was 4.76% in the patient group treated with DOK and RIF; relapse was not observed in the group of patients treated with DOK and aminoglycoside (SM or GEN). Conclusion: BEO is a complication of brucellosis. It can be treated successfully through early diagnosis, appropriate antimicrobial treatment for six weeks, and practices that increase patient compliance with treatment. Treatment combinations containing aminoglycosides are statistically superior in preventing relapses than combinations containing RIF. [ABSTRACT FROM AUTHOR]

Copyright of Namık Kemal Tıp Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Brucellosis is one of the most common zoonotic diseases worldwide, posing a significant threat to both human health and the livestock industry, causing substantial economic losses. Today, multi-epitope antigens are widely used in serological diagnostic methods, especially ELISA, due to their high sensitivity and specificity in diagnostic efficiency and lower production costs compared to single antigens. Therefore, this study aimed to design a bioinformatic multi-epitope antigen for the diagnosis of human brucellosis. Methods: To design the multi-epitope antigen, Omp16, Omp25, and BP26 antigens were utilized. After identifying epitopes with high antigenic properties from each antigen, the epitopes were linked using an appropriate linker (EAAAK). The physicochemical properties and antigenicity of the designed antigen were then assessed. Subsequently, the three-dimensional (3D) structure was predicted and validated. The amino acid sequence of the multiepitope antigen was converted to a nucleotide sequence, optimized, and inserted into the pET23a (+) vector. Results: Bioinformatic analyses indicated that the designed multi-epitope antigen is stable, soluble, and possesses significant antigenicity. Conclusion: Our findings suggest that the designed multi-epitope antigen could be a promising candidate for the diagnosis of brucellosis. However, further validation through laboratory methods is necessary to confirm its diagnostic efficacy. [ABSTRACT FROM AUTHOR]

A 68-year-old male with a history of persistent lower back discomfort visited our orthopedic department. Based on magnetic resonance imaging that was compatible with infective spondylodiscitis at a medical facility close to his home, spinal tuberculosis (TB) was suspected, and the patient was transferred to our hospital for further therapy. The patient was treated appropriately after investigations revealed that he had an unusual diagnosis of Brucellar spondylodiscitis. Therefore, it must be taken into consideration as a differential diagnosis when a patient presents with lower back discomfort (especially in the elderly) and symptoms of a persistent infection. Brucellar spondylodiscitis may clinically mimic spinal TB. Serological screening is essential for the early diagnosis and treatment of spinal brucellosis. [ABSTRACT FROM AUTHOR]

Brucellosis is one of the most common zoonotic infections in the world. Human infections are the result of direct exposure to infected animals or ingestion of unprocessed dairy products. While Brucella sp. infection has largely been eliminated from commercial cattle and swine with aggressive vaccination, there is a significant prevalence of Brucella sp. infection in the expanding population of feral swine in the US. We report the surgical treatment of a ruptured mycotic aneurysm of the abdominal aorta due to Brucella suis in a woman living in a rural community with a large population of feral swine. Vascular surgeons should be aware that brucellosis can result in arterial infection and should be considered in the differential diagnosis in patients with a history of exposure to feral swine or the ingestion of unprocessed dairy products. [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate the epidemiological, clinical features, laboratory findings, and treatment regimens of patients with brucellosis in the Tokat region. Methods: In this cross-sectional study, the data of 236 adult patients followed with brucellosis in Tokat Gaziosmanpaşa University Medical Faculty Hospital between January 2016 and December 2021 were evaluated retrospectively. Diagnostic criteria of brucellosis were determined as culture positivity, or positivity in the Wright test at ≥ 1/160 titration, or a 4-fold increase in titer of the Wright test repeated at 2 - 3 week intervals. Demographic data, symptoms, physical examination findings, and laboratory results of the patients were evaluated. Results: 72% (n=170) of the patients were male, and the mean age was 44.47±16.64. 53% (n=125) were engaged in animal husbandry, 21.6% (n=51) consumed unpasteurized dairy products, and 13.1% (n=31) had a family member with brucellosis. Seven (2.9%) patients with a prediagnosis of Crimean-Congo hemorrhagic fever (CCHF) were diagnosed with acute brucellosis. The most common symptoms were muscle-joint pain (70.3%), fever (50.8%), and sweating (43.2%). Spondylodiscitis was observed in 13.6%, epididymal-orchitis in 8.2%, and neurobrucellosis in 0.4% of the patients. Blood culture positivity was detected in 7.2% of the cases. 91.5% had elevated C-reactive protein (CRP) levels, and 48.3% had elevated erythrocyte sedimentation rates. The most common hematological findings were anemia (28%), leukopenia (10.6%), and thrombocytopenia (8.5%). As a therapy doxycycline + rifampicin combination was started at 36%, doxycycline + gentamicin to 5.8%, doxycycline + streptomycin to 5.4%, and doxycycline + rifampicin + gentamicin to 29.7% of the patients. Alternative treatment regimens were given to 22.9% (n=54) of the patients. Conclusion: Brucellosis is still a critical zoonotic disease in our region. It should be kept in mind when diagnosing patients with fever, muscle-joint pain, and sweating, with epidemiological histories, have elevated acute phase reactants and cytopenia. It should also be remembered that brucellosis can be confused with CCHF in endemic areas. [ABSTRACT FROM AUTHOR]

Brucella is a global cause of zoonotic infection and is mostly transmitted to humans through unpasteurized milk and dairy products. Brucella can affect many organs focally or systemically and cause different symptoms. However, brucella has a specific affinity for the musculoskeletal system. The most common symptoms in brucella patients are related to musculoskeletal involvement. Musculoskeletal involvements are generally in the form of spondylodiscitis (usually in the lumbar region), sacroiliitis, bursitis, and osteomyelitis. Brucella most commonly causes unilateral epididymoorchitis in the genitourinary system. In brucella epididymoorchitis, if the diagnosis is delayed or wrong treatment options are applied, serious complications such as necrotizing orchitis and testicular abscess may result, and orchiectomy may be required. Ultrasound plays an important role in diagnosis and patient follow-up in brucella epididymoorchitis. MRI, on the other hand, is an effective imaging method in revealing the relationship of the lesion with the testis and the correct localization, thanks to its higher contrast resolution and multi-plane techniques. In countries where brucella is endemic, brucella infection should be considered in cases of epididymoorchitis that does not respond to treatment or in cases of accompanying sacroiliitis and spondylodiscitis. [ABSTRACT FROM AUTHOR]

Although brucellosis is very common in the world and Turkiye, there are no evidence-based guidelines to guide the diagnosis and treatment of the disease. This guide has been prepared by the Turkish Society of Clinical Microbiology and Infectious Diseases to provide evidence-based recommendations to physicians from different specialties interested in the diagnosis and treatment of brucellosis. The recommendations of the Clinical Practice Guide Development Guide of the Infectious Diseases Society of America (IDSA) were taken as the basis for preparing this guide. The guideline preparation group determined 20 questions considered to be important in the diagnosis and treatment of brucellosis, and the publications that could answer these questions prepared in PICO (Population/Patient [P], Intervention [I], Comparison [C], Outcome [O]) format, were searched in ULAKBİM Tr Dizin, PubMed, Cochrane databases without date restrictions. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group method was used to rank the evidence and determine the strength of the recommendations for each PICO question and for each individual outcome. Meta-analyses of comparative clinical studies were performed to answer the PICO questions. Individual participant data (IPD) meta-analyses with data obtained from case reports and case series were conducted in the absence of comparative clinical studies. It is planned to update the recommendations at regular intervals in line with the results of new studies. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Physical Medicine & Rehabilitation Sciences is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Brucellosis is a contagious zoonotic disease that affects domestic animals, wildlife and humans with socio-economic and public health significance. Objectives: To determine seroprevalence of brucellosis in domestic ruminants and associated risk factors in Nandi County, Kenya. Design: Cross-sectional study. Setting: Sampling sites were six wards, each from the six Sub-Counties. Subjects: Cattle, sheep and goats of all sex and breeds above 12 months of age. Interventions: Assess prevalence and risk factors of brucellosis in domestic ruminants. Main outcome measures: Improved health of domestic ruminants and humans. Results: A total of 1,140 blood samples were collected from cattle 63.6% (n=725), sheep 24.8% (n=283) and goats 11.6% (n=132) from 366 households. This was multistage random sampling. Sera were screened for brucella antibodies with Rose Bengal Plate Test (RBPT) and confirmed with indirect Enzyme-Linked Immunosorbent Assay (iELISA). Results showed an overall animal seroprevalence of 0.088%(1/1140) for brucellosis. In cattle, seroprevalence was 0.138%(1/725) and 0% seropositivity in both sheep and goats on iELISA, despite recording 0.414%(3/725), 3.180%(9/283) and 1.515%(2/132) on screening using RBPT in cattle, sheep and goats respectively. The significant potential predictors for sero-positivity of brucellosis were species (p-value 0.00, CI95%), age (p-value 0.042, CI95%) and breed (p-value 0.037, CI95%). Conclusions: Results demonstrated low seroprevalence of brucellosis in domestic ruminants in Nandi County, which implied minimum risk of animals contracting the disease and by extension humans. Confirmation of brucellosis was recommended to minimize misdiagnosis hence unnecessary treatment in addition to enhanced surveillance, awareness and preventive measures to maintain this favourable situation. [ABSTRACT FROM AUTHOR]

Coronavirus disease-2019 (COVID-19) is a serious health problem that started in China in December 2019 and spread worldwide as a pandemic. Due to the fact that COVID-19 is a pandemic, it can be associated with many diseases. In particular, high rates of co-infection with other respiratory pathogens, including influenza virus, Legionella pneumophila, Mycoplasma pneumoniae, have been described. Brucellosis is a bacterial zoonosis caused by Brucella spp. that can be transmitted through direct contact with infected animals or ingestion of unpasteurized milk or milk products. Brucellosis is endemic in our country, and is still increasing in people who are engaged in animal husbandry and consuming raw milk or milk products. Clinical findings are of brucellosis similar to COVID-19 infection and diagnosis is difficult. In this presentation, a case diagnosed with brucellosis while being followed up in the intensive care unit due to COVID-19. [ABSTRACT FROM AUTHOR]

Brucellosis is a well-known and harmful zoonotic disease that poses a severe threat to public health and wild and dairy animals. Due to a lack of monitoring and awareness, disease incidence has increased. Therefore, this study was conducted for the first time to ascertain the status of seroprevalence of brucellosis, hematological, oxidative stress, and antioxidant enzymes in different breeds of cattle reared under tropical-desert conditions in Pakistan. This study comprised 570 cattle of different breeds. We recorded some epidemiological traits, including age and gender. The blood samples were obtained from all the cattle, screened with RBPT, and then confirmed by ELISA and PCR. The results recorded an overall 11.75%, 10.7%, and 9.64% prevalence of brucellosis based on RBPT, ELISA, and PCR. We obtained nonsignificant results in different age and sex groups of cattle. The results showed significantly (P ≤ 0.05) lower values of erythrocyte counts, hemoglobin quantity, hematocrit, lymphocytes, and monocytes in infected cases. The results showed that the total leukocyte and neutrophil cells significantly (P ≤ 0.05) increased. The lipid peroxidation parameters (MDA- and NO-scavenging activity of erythrocyte) increased significantly (P ≤ 0.05) in infected cattle, whereas significantly reduced antioxidant enzymes like SOD, RGSH, and CAT were. Similarly, significantly lower serum albumin levels and total serum proteins were recorded in infected cattle. [ABSTRACT FROM AUTHOR]

Serum agglutination test plus exposure history were used to diagnose most cases of human brucellosis in 2 China provinces. After appropriate treatment, 13.3% of acute brucellosis cases progressed to chronic disease; arthritis was an early predictor. Seropositivity can persist after symptoms disappear, which might cause physicians to subjectively extend therapeutic regimens. [ABSTRACT FROM AUTHOR]

Background and Aim: As the most important human food source, milk and dairy products may lead to infectious diseases due to non-compliance with health standards. Brucellosis is one of the critical zoonotic diseases that affect the human population. Humans are usually infected by Brucella spp. via contaminated milk and dairy products and direct contact with infected animals. Materials and Methods: This study was conducted to determine the Brucella spp. contamination rate of milk and dairy products in the rural and urban areas in the city of Hamadan, west of Iran, in 2018-2019. In this descriptive-analytical study, 291 samples of nonboiling milk (227), fresh cheese (43), and cream (21) were collected from dairy products suppliers in the urban (No=103), rural areas (No=162), and industrial regions (No=26). We collected 72 samples from sheep and goats and 219 specimens from cattle. Samples were randomly selected from the target centers. Results: The overall contamination rate of collected samples with Brucella spp. found to be 4.1%. The milk and dairy products contamination in urban areas was 0.9%, rural 6.6%, and industrial regions 0%. Furthermore, the contamination rate varied from 9.7% to 2.5% for small ruminants and large ruminants, respectively, which was significant (P=0.01). Conclusion: Given the importance of dairy consumption in the human diet and higher contamination of milk and dairy products taken from cattle, sheep, and goats with Brucella species, it is recommended that control and prevention programs in sheep and goats must be taken more seriously. [ABSTRACT FROM AUTHOR]

Introduction: Human brucellosis is one of the most common zoonotic infections in the world. The definitive diagnosis of brucellosis is based on cultured Brucella organisms from blood or other tissue samples. We aimed to compare bacteremic and nonbacteremic brucellosis patients with demographical, epidemiological, clinical and laboratory features and determine the predictive factors affecting blood culture positivity.Materials and Methods: Children aged 1 month to 18 years who were followed up with the diagnosis of brucellosis between January 2005 and March 2021 were included in this retrospective study. According to the isolation of Brucella melitensis in blood culture, the patients were divided into two groups as bacteremic and nonbacteremic and compared in terms of demographic, clinical and laboratory characteristics.Results: One hundred eighty-nine (116 male, 61.4%) patients diagnosed with brucellosis were included in the study. There were 76 (40.2%) bacteremic and 113 (59.8%) nonbacteremic patients. Bacteremic patients were younger than nonbacteremic patients. Fever, arthralgia, hepatomegaly and splenomegaly were significantly higher in the culture positive group. High levels of C-reactive protein (CRP), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were found to be significant in the bacteremic group.Conclusion: In our study, history of fever and arthralgia, hepatomegaly and splenomegaly in physical examination and high CRP, ALT and AST levels in the biochemical analysis were important factors determining blood culture positivity. [ABSTRACT FROM AUTHOR]

A patient was diagnosed with Brucella canis following exposure to infected dogs in her breeding facility. Transboundary spread of B. canis through (illegal) import of infected dogs to non-endemic countries in Europe suggest that B. canis infection should be considered in European patients with occupational exposure to dogs. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to compare the new serological tests "immuncapture agglutination" (Brucellacapt, Vircell, Granada, Spain), enzyme-linked immunosorbent assay (ELISA) and the classical tests for diagnosis of acute, subacute or chronic brucellosis. Methods: Forty-nine samples of patients who presented with fever and clinical suspicion of brucellosis and who were admitted to Infectious Disease Department of Erciyes University Hospital with agglutination (SAT) titers ≥1/10 were collected during 2010 and 2012. And 30 healthy volunteers were enrolled in the study. All samples were subjected to the Brucella spp. Spesific culture, STA test, Brucellacapt test and ELISA for detection of IgM, IgA, and IgG. Coombs test was performed for 28 samples with titers <1/160 as measured by STA. Cohen's kappa test was used to evaluate the correlation between the tests. Results: Blood culture was positive in 6 (12, 2%), joint fluid culture in 2 (4%), STA test in 21 (42, 8%), Brucellacapt test in 36 (73.4%), ELISA IgG in 33 (67.3%), ELISA IgM in 33 (67.3%), ELISA IgA in 31 (61.2%) of 49 patients. While STA, brucellacapt ve ELISA IgA tests were negative in all of the control group (n=30), in four individuals (%13.3) ELISA IgG, three individuals (%10) ELISA IgM were found low positive. When STA test was taken as the reference method, the sensitivities were found to be 100% in brucellacapt test, 85.7%, 90.4%, 90.% in ELISA IgG, IgM, IgA respectively and 23.8% in blood culture. Specifities were 74.1%, 67.2%, 67.2%, 79.3% and 98.2% respectively. When presence of clinical findings are taken as a reference, brucellacapt test was found to be most compatible (=0,66). Conclusions: STA was found to be unsatisfactory in the diagnosis of brucellosis in patients. Brucellacapt and/or ELISA tests are suggested to be used to verify results of STA. [ABSTRACT FROM AUTHOR]

Background: Brucellosis is a common zoonotic disease that is prevalent in many areas worldwide. This infectious disease can occasionally affect the central nervous system but intracranial arteries are rarely involved.Case Presentation: A 17-year-old female who had a history of recurrent fever for 1 month was admitted for subarachnoid hemorrhage due to cerebral aneurysm rupture. Surgery was performed to fix the aneurysm, but the patient had persistent fever after the surgery. Cerebrospinal fluid testing showed a high white blood cell count and elevated protein level but no pathogen was identified in the first two tests. Brucella melitensis was identified in the third cerebrospinal fluid culture, and a diagnosis of brucellosis was finally rendered. The patient was subsequently treated with anti-Brucella medications and her symptoms improved significantly at the last follow-up.Conclusion: Although extremely rare, Brucella-induced cerebral aneurysms can occur and this should be considered in the differential diagnosis of cerebrovascular accidents, especially in Brucella epidemic areas. [ABSTRACT FROM AUTHOR]

Aim: Brucellosis is a zoonotic infection caused by bacteria of the genus Brucella. The disease causes genitourinary system involvement and abortion, which is the most critical complication of the disease, in cattle. Although it is known to cause spontaneous abortion, preterm birth and intrauterine death in humans, the number of systematic studies on the subject is limited. This study compared the patients who experienced pregnancy loss and women who carried their pregnancy to term without any problems in terms of serology for brucellosis in our region which is an endemic region. Materials and Methods: The study was conducted in the Clinic of the Department of Obstetrics and Gynecology in Gaziantep University Hospital between August 2012-June 2013. The study was conducted with 71 patients who experienced intrauterine pregnancy loss and 109 women who carried their pregnancy to term without any problems as the control group, wherein all subjects were aged between 18 and 40. These two groups were in a similar age group and had a similar gestational age. Results: There were 4 (5,6%) subjects who were brucella-positive in the patient group and 1 (0,9%) subjects who were brucellapositive in the control group according to the serology for brucellosis. C-reactive protein, erythrocyte sedimentation rate, aspartate aminotransferase, abortus, and parity were significantly high in women who experienced pregnancy loss (p<0.05). The rate of living in rural areas as well as the frequency of fever, chills, shivering and lower back pain was significantly high in the patient group. When the patient group was divided into two subgroups according to the serology for brucella, patients with positive serology had a significantly higher rate of joint pain and animal contact (livestock farming) history. Although there was no significant relationship between brucella agglutination titration and pregnancy loss, the number of the brucellosis patients and agglutination titrations were higher particularly in the group of women who experienced pregnancy loss. Conclusion: Prospective studies that will be conducted with larger patient groups are required to better reveal the relationship between pregnancy and brucellosis. Moreover, serology for brucella can be used as a screening method to provide early treatment and prevent complications associated with brucellosis during pregnancy follow-up especially in endemic region. [ABSTRACT FROM AUTHOR]

Highlights: (1) Blood culture is the gold standard for the diagnosis of bacterial infections. (2) Bone marrow culture is more sensitive than blood culture even in patients with enteric fever receiving antibiotics. (3) Microscopic agglutination test is considered the gold standard for diagnosing leptospirosis; however, now IgM ELISA and polymerase chain reaction (PCR) are more frequently used for diagnosis. (4) Tuberculosis is diagnosed with the help of nucleic acid amplification tests like Xpert MTB/RIF Ultra which also detects rifampicin resistance. Other tests include microscopy, Lowenstein-Jensen and mycobacteria growth indicator tube culture, line probe assay. (5) Tropical rickettsial infections are diagnosed by serological reactions (Weil-Felix, ELISA for antibodies) and PCR. (6) For Brucellosis culture from blood, bone marrow or tissue specimens remain the mainstay in diagnosis. (7) Dengue, Zika, Crimean-Congo hemorrhagic fever, Ebola, hantavirus, rabies are diagnosed with reverse transcriptase-polymerase chain reaction. Serological tests like IgM ELISA or paired sera samples for IgG are also used for diagnosis. [ABSTRACT FROM AUTHOR]

We report the first case of brucellosis caused by an isolate whose genome is identical that of a frog isolate from Texas, demonstrating the zoonotic potential of amphibian-type Brucella. Importantly, with such atypical Brucella , correct diagnosis cannot be performed using routine serological tests or identification methods. [ABSTRACT FROM AUTHOR]

Brucellosis, caused by several species of the genus Brucella, is a zoonotic disease that affects humans and animal species worldwide. Information on the Brucella species circulating in different hosts in Kenya is largely unknown, thus limiting the adoption of targeted control strategies. This study was conducted in multi-host livestock populations in Kenya to detect the circulating Brucella species and assess evidence of host–pathogen associations. Serum samples were collected from 228 cattle, 162 goats, 158 sheep, 49 camels, and 257 humans from Narok and Marsabit counties in Kenya. Information on age, location and history of abortion or retained placenta were obtained for sampled livestock. Data on age, gender and location of residence were also collected for human participants. All samples were tested using genus level real-time PCR assays with primers specific for IS711 and bcsp31 targets for the detection of Brucella. All genus positive samples (positive for both targets) were further tested with a speciation assay for AlkB and BMEI1162 targets, specific for B. abortus and B. melitensis, respectively. Samples with adequate quantities aggregating to 577 were also tested with the Rose Bengal Test (RBT). A total of 199 (33.3%) livestock and 99 (38.5%) human samples tested positive for genus Brucella. Animal Brucella PCR positive status was positively predicted by RBT positive results (OR = 8.3, 95% CI 4.0–17.1). Humans aged 21–40 years had higher odds (OR = 2.8, 95% CI 1.2–6.6) of being Brucella PCR positive compared to the other age categories. The data on detection of different Brucella species indicates that B. abortus was detected more often in cattle (OR = 2.3, 95% CI 1.1–4.6) and camels (OR = 2.9, 95% CI 1.3–6.3), while B. melitensis was detected more in sheep (OR = 3.6, 95% CI 2.0–6.7) and goats (OR = 1.7, 95% CI 1.0–3.1). Both B. abortus and B. melitensis DNA were detected in humans and in multiple livestock host species, suggesting cross-transmission of these species among the different hosts. The detection of these two zoonotic Brucella species in humans further underpins the importance of One Health prevention strategies that target multiple host species, especially in the multi-host livestock populations. [ABSTRACT FROM AUTHOR]

Brucellosis is the most common zoonosis and is due to Brucella species, which are facultative intracellular bacteria. Animals who serve as carriers include goats, sheep, cattle and swine. This discussion considers various features of this disease, its pathogenesis, transmission, epidemiology, clinical features, diagnostic aspects, treatment and prognosis. Concepts of prevention are also considered. [ABSTRACT FROM AUTHOR]

Spinal brucellosis is the most common osteoarticular complication of brucellosis. It can affect any part of the spine with or without neural involvement. The objective of this study was to identify the clinical ministrations, diagnostic measures and treatment modalities of adult patients with spinal brucellosis. The data were collected from medical records of spinal brucellosis. In three years, 107 patients were treated for brucellosis, of which 28 (26.17%) patients had spinal brucellosis. Backache (p=0.0001), feeling of mass or lump along the spine (p=0.0335), pain while walking (p=0.0204) and altered sensation of lower limb (p=0.0011) were the significant clinical manifestations. Other symptoms were fever (75%), weight loss (42.86%) and night sweats (35.71%). Type 2 Diabetes mellitus was identified as a co-morbidity (p=0.0187). Nineteen patients had abnormal magnetic resonance imaging and lumbar (L4-L5) vertebrae were the most commonly infected area. Patients have received symptomatic management along with appropriate antibiotics. [ABSTRACT FROM AUTHOR]

Copyright of Croatian Journal of Infection / Infektoloski Glasnik is the property of Croatian Society for Infectious Diseases and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The control of brucellosis across sub-Saharan Africa is hampered by the lack of standardized testing and the use of tests with poor performance. This study evaluated the performance and costs of serological assays for human brucellosis in a pastoralist community in northern Tanzania. Serum collected from 218 febrile hospital patients was used to evaluate the performance of seven index tests, selected based on international recommendation or current use. We evaluated the Rose Bengal test (RBT) using two protocols, four commercial agglutination tests and a competitive enzyme-linked immunosorbent assay (cELISA). The sensitivity, specificity, positive predictive value, negative predictive value, Youden's index, diagnostic accuracy, and per-sample cost of each index test were estimated. The diagnostic accuracy estimates ranged from 95.9 to 97.7% for the RBT, 55.0 to 72.0% for the commercial plate tests, and 89.4% for the cELISA. The per-sample cost range was $0.69–$0.79 for the RBT, $1.03–$1.14 for the commercial plate tests, and $2.51 for the cELISA. The widely used commercial plate tests performed poorly and cost more than the RBT. These findings provide evidence for the public health value of discontinuing the use of commercial agglutination tests for human brucellosis in Tanzania. [ABSTRACT FROM AUTHOR]

Aim: Brucellosis is the most common bacterial zoonosis in the world and in our country. The definitive diagnosis of the disease is the isolation of the agent in culture, but in routine diagnosis serologic tests are mostly used. In the routine serological diagnosis of brucellosis, rose bengal, standard tube agglutination (STA) and coombs tube agglutination (CTA) tests were used. The aim of this study was to determine the effectiveness of Brucellacapt (BCAP) and Coombs Gel (CJ) tests by comparing with STA and CTA tests. Materials and Methods: A total of 100 samples (47 positive and 53 negative by CTA test) were included in the study between June 2018 and July 2019. Titters detected as ≥1 / 160 in STA, CTA, BCAP (METSER Brucella test with Coombs, Savas Medical, Istanbul), CJ (ODAK Brucella Coombs Gel test, Toprak Medical, Istanbul) tests were accepted as positive. Cohen kappa (κ) analysis was used to evaluate the consistency between the tests. Results: Out of 100 samples included in the study were found positive, 20 with STA, 48 with CAP and 53 with CJ tests, respectively. Among the 47 patients who were positive with CTA test, 44 were positive with BCAP and CJ tests, also 2 of them were negative with BCAP and 1 with CJ test. Among the samples found negative with the CTA test, 3 were found positive with BCAP and 7 with the CJ test. STA test was negative in 27 samples that were positive by CTA test. κ = 0.900 for CTA and BCAP, κ = 0.841 for CTA and CJ, κ = 0.860 for BCAP and CJ; showed a high level of agreement. The STA test showed a very low level of agreement with all three methods (κ = 0.440 for CTA with STA, κ = 0.426 for BCAP with STA, κ = 0.363 for CJ with STA). Conclusion: Compared to CTA testing, the applicability of BCAP and CJ tests is easier. Among the three tests, the CJ test gives the fastest results. In the serologic diagnosis of brucellosis, BCAP and CJ test can be used because of high compatibility with CTA test, and it is thought that the compatibility between the tests should be evaluated with more comprehensive studies. [ABSTRACT FROM AUTHOR]

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Introduction: The term spinal infections or spinal column infections usually include processes localized in various parts of spinal column, parts of vertebrae as well as in intervertebral disc. There are three main types of spondylodiscitis. Bacterial spondylodiscitis (vertebral osteomyelitis) is inflammatory process usually involving two (neighboring) vertebrae and intervertebral disc causing the space for the disc between the vertebrae to be narrowed down. The aim of this paper is to present the frequency of various forms of spondylodiscitis on spinal column segments following laboratory, microbiological and radiological diagnostic procedures. Patients and methods: Descriptive research method was used in the work, as it was deemed appropriate for this type of research analysis. Diagnostic procedures used include: laboratory tests, microbiological analysis, MRI scans of cervical spine, MRI scans of thoracic spine, MRI scans of L/S spinal column. Results: Out of 307 patients included in the research, in 109 occurrences spondylodiscitis was verified on various parts of spinal column. Brucellosis spondylodiscitis represents the most frequent form (in 86% of patients), and the majority of occurrences was localized at lumbosacral part of spinal column. During the research, quite unusually, there was also one occurrence of spondylodiscitis with paravertebral abscess on cervical part of spinal column. It is also a type of brucellosis spondylodiscitis. The use of magnetic resonance imaging appears to be gold standard in diagnostics of spondylodiscitis, especially following the application of contrast agent and the use of T1 FS (fat saturation) sequences along with standard tomograms in times T1 and T2. The majority, up to 262 (85.3%) of Elisa tests were related to brucellosis. In 245 out of 307 cases, the result was positive, that is in direct relation to the fact that various forms of brucellosis are present in the areas being examined. Conclusion: Research results indicated that spondylodiscitis was diagnosed in all segments of spinal column. The most frequent occurrences are on L/S part of spinal column and the most frequent form of brucellosis is spondylodiscitis. [ABSTRACT FROM AUTHOR]

Objective: Brucellosis is a zoonosis that affects more than 500 000 people a year, according to World Health Organization data. Brucellosis is endemic in Turkey, and it has a high morbidity. Community-based studies should be performed to detect brucellosis cases, to treat them, and to control the infection. The aim of this study was to determine the prevalence of brucellosis and the associated risks in adults aged 18 years and older living in Izmir. Methods: The study was carried out between January 2011 and December 2012 in 26 358 people living in Izmir. Sociodemographic characteristics, epidemiological characteristics and complaints specific for brucellosis were questioned, and the questionnaire was applied face to face with each participant. After application of the questionnaire, 5 ml venous blood was taken from everyone. Serum samples were tested with rose- Bengal test and standard tube agglutination (STA) test which was repeated by adding Coombs serum if necessary. Χ² test and Mann-Whitney U test were used to analyze the data. Statistically, p<0.05 was considered significant. Results: Rose-Bengal test was positive in 239 (0.91%) of 26 358 serum samples. STA test was positive with 1/160 and higher titers in 35 (14.6%) of them. STA test was repeated in 9 samples by adding Coombs serum, and 4 were found positive with 1/160 and higher titers. There was no statistically significant difference in age and sex distribution among seropositive persons (p>0.5). The most consumed product (n=23, 58.9%) was fresh cheese made from unpasteurized milk among these people. Their most common complaints were muscle and joint pain (n=15, 38.5%). Conclusions: Since our country is an endemic country in terms of brucellosis, it remains a disease that should be taken into consideration in the differential diagnosis of patients admitted to the hospital. We believe that it is important to manage the disease under the one health concept to control the disease. Also, we suggest that current and multicenter prevalence studies are necessary. [ABSTRACT FROM AUTHOR]

Brucellosis is an infectious disease seen particularly in developing countries with a high rate of morbidity. It can affect any system in the body and lead to different clinical presentations. The patients presented here draw attention because they were different presentations of rarely encountered central nervous system involvement. Case 1, a 17-year-old male patient was referred to our hospital with symptoms including sudden-onset fever, headache, vomiting, and being unable to speak and walk. On physical examination, the patient had a fever of 37.5 °C, he was lethargic and had no orientation and cooperation. Lumbar puncture was performed. Cerebrospinal fluid (CSF) findings were consistent with purulent meningitis. Case 2, it was learned that a 34-year-old male patient went to a physician two weeks ago due to a decrease in hearing. He was brought to the emergency room because of the deterioration in his time and place orientation and his symptoms of agitation gradually increased after a headache that started in the morning. It was learned from his relatives that similar symptoms happened again about a month ago, but he did not consult a physician because it resolved spontaneously within a few hours and he had been using depression treatment for more than a year. In the physical examination, his temperature was 37.2 °C, the patient was unconscious, his orientation and cooperation were limited. There was no neck stiffness, and Brudzinski's neck phenomenon and Kernig's sign were negative. Both patients were diagnosed as having neurobrucellosis through blood and CSF examinations and they both recovered with appropriate treatment. Here, we report and discuss two patients with neurobrucellosis with different clinical features. [ABSTRACT FROM AUTHOR]

Background: Human brucellosis is an important zoonotic disease of public health and often remains neglected owing to lack of sensitive and efficient diagnostic methods. This study evaluates diagnostic utility of in-house designed enzyme-linked immunosorbent assay (ELISA) using whole-cell antigens of Brucella abortus (B. abortus) S19 against the commercially available kits. Methods: A prospective cohort study involving different populations within the Vidarbha regions of Maharashtra, India was conducted through camps organised from May 2009 to October 2015. A total of 568 serum samples were collected from high-risk people recruited as study cohorts based on inclusion criteria, additional risk factors and clinical symptoms. Samples were evaluated by indirect ELISA using the whole-cell antigens of B. abortus. The results were compared with the commercially available IgG detection ELISA kit to ascertain the specificity and sensitivity of the developed test. Results: Fever, body ache, joint pain, lower back pain, loss of appetite and weight loss were major symptoms associated with the disease. With the cut-off of > 0.8, the positivity of brucellosis infection was at 12.32% (70/568) compared to 9.33% (53/568) as detected by the commercial kit. The in-house developed ELISA method yielded a sensitivity of 87.5% and specificity of 99.18% as compared to the commercial kits (sensitivity -80.30% and specificity -99.6%). Discussion: The B. abortus Sl9-derived whole-cell protein-based ELISA is rapid and cost- effective and can be used for screening brucellosis infection in lieu of the commercially available ELISA kits. [ABSTRACT FROM AUTHOR]

Antecedentes: La brucelosis tras 133 años de estudio es una zoonosis reemergente. Objetivo. Analizar aspectos limitantes para una aproximación real a la brucelosis, con énfasis en las cabras como reservorios. Desarrollo: Se revisaron 126 fuentes especializadas (118 artículos y 8 libros). Fueron seleccionadas 50 referencias para cumplir el objetivo de la reseña y las exigencias de las normas editoriales de la revista. Aunque B. melitensis es la especie más virulenta para los humanos y las cabras, sus reservorios naturales, las dos publicaciones nacionales que investigan la zoonosis desde una óptica veterinaria se enfocan a B. abortus en bovinos. No ocurre igual en las foráneas, con predominio de las correspondientes a países en vías de desarrollo. Los lácteos son una vía importante de transmisión de la enfermedad. Cinco artículos extranjeros valoran el fenotipo bacteriano biofilm como factor de virulencia y causa de cronicidad, solo dos valoran a Brucella. Aunque existen técnicas de diagnóstico fiables, algunas de manufactura cubana, la visibilidad del comportamiento de la brucelosis en el país es limitado, particularmente en animales domésticos. Conclusiones: La aproximación real a la brucelosis está sesgada por: errónea subvaloración como zoonosis; lo propio en cuanto las cabras y sus productos como fuentes de transmisión; no incluir la variable biofilm en las investigaciones realizadas y pobre divulgación de los resultados de las pesquisas nacionales. [ABSTRACT FROM AUTHOR]

Occupational brucellosis is caused by contact with infected animal tissues during work. Workers who are working in veterinary services, occupations with products derived from animals and close contact to waste of animals, processing or keeping or trading animal products and laboratories are under the risk of occupational brucellosis. In this study, 9 cases of occupational brucellosis who were diagnosed between 1 January 2012 -31 December 2017 in the occupational disease hospital were evaluated. Two thirds of the cases (n=6) worked for the same company that works in dairy cattle farming and raw milk production. When all cases were evaluated, it was seen that the necessary occupational health and safety measures were not taken in the workplaces, proper personal protective equipment (PPE) was not used, and there were problems in diagnosis, notification and return to work. It should be keep in mind that these cases are just the tip of the iceberg. [ABSTRACT FROM AUTHOR]

Background: Brucellosis is a neglected underdiagnosed zoonotic disease of worldwide distribution with varying symptoms similar to those occurring in other febrile illnesses. A recent screening survey conducted among butchers in Bauchi state reported a high prevalence of human brucellosis; however, its burden among patients with other febrile illnesses is unknown. We determine the seroprevalence and factors associated with risk of brucellosis among febrile patients attending health-care facilities (HCFs) in Bauchi metropolis, North-Eastern Nigeria. Methodology: We conducted a hospital-based descriptive cross-sectional study of 382 participants using a multistage sampling technique. Brucella antibodies were detected using Rose Bengal plate test, and a questionnaire was used to identify risk factors associated with human brucellosis. Data analyses were conducted using Epi Info version 7.0. Bivariate and multivariate analyses were conducted at P â?¤ 0.05. Results: Fifty-seven (14.9%) of the 382 febrile patients tested had Brucella antibodies. Males: female ratio was 1.1:1, and the mean age was 29.9 (standard deviation ± 12.03). Age, sex, occupational status, keeping animals, having ever milked an animal, handling animals during birth, and consuming unpasteurized milk or meat were found to be significantly associated with brucellosis on bivariate analysis. Conclusions: Up to 14.9% of the febrile patients attending HCFs in Bauchi metropolis had Brucella antibodies. Age, occupational status, consuming unpasteurized milk or meat, handling animals during birth, and lack of awareness on zoonosis remained independent predictors for brucellosis. Therefore, conducting routine serological screening tests for Brucella antibodies in all febrile patients presenting to HCFs will assist in its diagnosis and proper management. [ABSTRACT FROM AUTHOR]

Background: Brucellosis is endemic in many areas in China. The current diagnosis of Brucellosis predominantly relies on the traditional bacterial culture and serum agglutination test. In this study, we aimed to explore the value of ELISA in the diagnosis of Brucellosis in Chinese population.Methods: We recruited 235 patients with a diagnosis of Brucellosis at different clinical stages: 117 in acute, 78 in subacute, and 40 in chronic. We also recruited 248 control patients who presented with similar clinical symptoms but with a different diagnosis other than Brucellosis. In addition, 90 healthy volunteers were also recruited. Bacterial culture, agglutination test and ELISA assay were performed to detect Brucella spp.Results: Among 235 patients with Brucellosis, 51 (21.7%) was positive for bacterial culture, 150 (63.8%) were positive by agglutination test, and 232 (98.7%) were positive by ELISA (IgG and/or IgM). When we stratified the patients based on the disease stages (acute, subacute and chronic), ELISA was the most sensitive method and showed a highest positive rate in all stages. By Receiver Operating Characteristic Curve analysis of ELISA results, we found that measurement of IgG level was superior to measurement of IgM level (AUC, 0.993 versus 0.877). Since the measurement of IgG itself missed rare cases in acute phase, we recommended measuring IgG and IgM simultaneously by ELISA for the diagnosis of Brucellosis. In term of the specificity of ELISA in the diagnosis of Brucellosis, our study showed that only 1.6% (4/248) non-Brucellosis patients were positive by ELISA; all positive cases were IgM only and none showed positive IgG. Similar results were found in healthy volunteers. In summary, our study concluded that ELISA is the most sensitive and specific method to detect Brucellosis in Chinese population.Conclusions: ELISA assay is sensitive, fast, and convenient to detect Brucellosis. It shows the high sensitivity and specifity and should be used as a routine lab test when Brucellosis is suspected in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: The goal of treatment in brucellosis is to control symptoms to prevent the development of complications and relapse of infection. The aim of this study was to evaluate the risk factors for relapse in brucellosis patients, including those with complications. Materials and Methods: Our study was performed retrospectively with data from three centers. Complication of brucellosis was defined as the involvement of specific anatomical regions in the disease. Recurrence of symptoms and signs of brucellosis six months after termination of treatment and increased standard tube agglutination titer under treatment or isolation of Brucella spp. in sterile body fluids was defined as relapse. Inadequate treatment duration was defined as a treatment duration of less than eight weeks in patients with osteoarticular complications and less than six weeks in other brucellosis involvement. A multivariate logistic regression model was built with the variables determined to be effective in relapse development. The logistic regression model included gender, the presence of osteoarticular complications, inadequate treatment duration, treatment combinations, and leukocyte count. The SPSS 20 statistical package program was used for statistical analysis. Results: A total of 1,296 patients were enrolled in the study. Their median age was 42 (31-54) years and 631 (48.7%) were female. One or more complications were detected in 448 (34.6%) cases. A two-drug antibiotic combination was given to 1,125 (86.8%) patients and 171 (13.2%) were treated with a three-drug antibiotic combination regimen. Three hundred sixteen (24.4%) of the patients were treated with combination therapies that included an aminoglycoside. Relapse occurred in 110 (8.5%) patients, and treatment was inadequate for 105 (8.1%) cases. Osteoarticular complications were more frequent in patients with relapse than in those without relapse (33.6% vs 18.5%, p<0.001). The presence of osteoarticular complications [odds ratio (OR): 2.413, 95% confidence interval (CI): 1.550-3.756] and inadequate treatment duration (OR: 2.861, 95% CI: 1.645-4.974) were associated with a higher rate of brucellosis relapse, while combination therapies including an aminoglycoside (OR: 0.432, 95% CI: 0.249-0.752) was associated witha lower relapse rate. Conclusion: Our results indicate that in patients with osteoarticular complications, treatment should be administered for the recommended optimal duration, and combination therapies including aminoglycosides should be chosen preferentially in order to prevent a relapse of infection. [ABSTRACT FROM AUTHOR]

Background: It is important to identify new biomarkers for early detection of complications and treatment success in patients with brucellosis. Methods: A total of 187 brucellosis patients in the Department of Infectious Diseases of Izmir Katip Celebi University Ataturk Training and Research Hospital were evaluated retrospectively from January 2010 to January 2016.Complications of brucellosis were hematologic, osteoarticular, genitourinary, neurologic, cardiovascular, gastrointestinal and ocular involvement. Specific organ involvement was defined as the presence of infection signs in any specific anatomic site except hematologic involvement. Neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte-ratio (PLR) were evaluated statistically to predict complications and specific organ involvement of brucellosis. Results: Complications occurred in 125 patients. We found that PLR and erythrocyte sedimentation rate (ESR) were higher in complicated patients (P = 0.007, P < 0.001). The area under curve (AUC) for PLR was 0.622 (95% confidence interval [CI], 0.538- 0.707) with a cutoff value of >119.6 in predicting complications in brucellosis. LMR and NLR were not significant in terms of predicting complications in brucellosis. We also evaluated only specific organ involvement as a complication due to frequent occurrence of hematologic abnormalities in brucellosis. ESR, mean platelet volume (MPV), NLR, PLR and LMR were significantly different in patients with specific organ involvement (P = 0.001, P = 0.011, P = 0.001, P = 0.013 and P = 0.040). The AUC values for NLR and LMR were 0.649 (95% CI 0.570-0.728) and 0.589 (95% Cl 0.507-0.671), respectively. Conclusion: These biomarkers are cost-effective, simple and broadly available parameters for predicting complications and specific organ involvement of brucellosis. [ABSTRACT FROM AUTHOR]

Brucellosis is one of the most common zoonotic diseases with widespread distribution. Traditional methods for diagnosis of brucellosis require long determination times with complex instruments that do not meet the needs of rapid, simple, and convenient analysis. Thus, a newly rapid and simple method for the colorimetric diagnosis of brucellosis was developed using a paper-based enzyme-linked immunosorbent assay (p-ELISA). A total of 135 serum samples were analyzed including 33 samples as healthy controls, 77 samples as the positive group with brucellosis, and 25 samples were infected with other bacteria. The major parameters were optimized for the reported protocol. To evaluate the method, receiver operating characteristic analysis and statistical analysis were carried out using these serum samples. In the established p-ELISA system, only 5 ml of serum were required to detect the antibodies of human brucellosis in suspected brucellosis patients in less than 2 hours. The receiver operating characteristic curve was plotted, and the area under the curve of receiver operating characteristic was 0.996 and shown to be a highly accurate diagnostic test. The sensitivity was determined to be 0.961, the specificity 0.983, and the cutoff value 2.260. The gray scale intensity of the human brucellosis patients group was significantly higher than for the healthy and the non-brucellosis patient groups (p 0.001). This newly developed system allows the rapid and easy diagnosis of human brucellosis. [ABSTRACT FROM AUTHOR]

In July 2018, brucellosis was diagnosed in a German patient without a travel history to regions endemic for Brucella. Microbiological analysis, including whole-genome sequencing, revealed Brucella suis biovar 1 as the etiologic agent. Core-genome-based multilocus sequence-typing analysis placed the isolate in close proximity to strains originating from Argentina. Notably, despite a strong IgM response, the patient did not develop Brucella-specific IgG antibodies during infection. Here, we describe the clinical course of infection, the extensive epidemiological investigations, and discuss possible routes of transmission. [ABSTRACT FROM AUTHOR]

Although often underappreciated, a number of bacterial zoonoses are endemic in Africa. Of these, brucellosis, leptospirosis, Q fever, and rickettsioses are responsible for a substantial proportion of febrile illness among patients seeking hospital care. In this paper, we discuss the aetiology, epidemiology, clinical presentation, diagnosis, treatment and prevention of these bacterial zoonoses. To prevent and control bacterial zoonoses, strategies targeting both animals and humans are crucial. These may lead to better outcomes than strategies based exclusively on treatment of human infections. Such strategies are referred to as the 'One Health' approach; the collaborative effort of multiple disciplines to attain optimal health for people, animals and the environment. [ABSTRACT FROM AUTHOR]

Brucellosis is widespread zoonotic disease that afflicts both human and animals and the clinical signs and symptoms of human brucellosis are different and non-specific diagnosis of brucellosis depended on a positive assessment on laboratory based testing, the present study was designed to assess the validity of serological tests [Rose Bengal(RBT) and ELISA tests] and Polymerase Chain Reaction assay for diagnosis of brucellosis. A clinical manifestation of fever cases included symptoms such as a temperature greater than 38°C on several occasion within three weeks. In patients suffering from Malta fever and according to recommendation of Ministry of Health to conduct this problem in Iraq. Blood samples were collected from the 50 patients during November 2017 to April 2018 after inform all patients about the aim of this study as a permission for ethics. Blood sera were prepared to conduct the serological tests (RBT and ELISA) then the Brucella was isolated on selective media such as Brucella agar media, which confirmed molecularly by using Real-time PCR to amplify the primer of 16SrRNA gene and finally the method of gene sequencing was used to detect the species and biovars of Brucella by using the rpoBgene. The results of screening (serological) test by using RBT showed that the occurrence percent of brucellosis in human was 45/50 (90%), while the results of ELISA was 42(84%). On the other hand, the result of bacteria isolation on Brucella agar was 10(20%) and the results of Real-time PCR was 38(76%) as a confirmation test for Brucella melitensis isolates after extraction of DNA and amplification of primer belong to 16SrRNA gene. The results of rpoB gene amplification for Brucella melitensis revealed the appearance of one distinct band after electrophoresis on agarose gel that had a molecular size 1091bp. PCR product of rpoB gene was used for partial sequencing and blotting the phylogenetic tree of local isolates in comparison with some pathogenic standard world strains. Five local isolates were submitted to Gene Bank- NCBI for registration of sequences of rpoB gene. The results of specificity, sensitivity and accuracy values of the used methods in diagnosis revealed that the technique of PCR had a sensitivity 100%, specificity 30% and accuracy 44% in comparison with bacteria culture, sensitivity 97.3%, specifity 33.3% and accuracy 82% when compared with RBT, at the last sensitivity 100%, specifity 66.6% and accuracy 92% in compared with ELISA test. [ABSTRACT FROM AUTHOR]

Non-specific and often misleading clinical presentation of active brucellosis has made it a diagnostic puzzle for treating physicians. Clinicians rely greatly on the detection of IgG and IgM anti-Brucella antibodies by ELISA. Different patterns of positivity have been observed for IgG and IgM anti-Brucella antibodies in different cases, which further increases the risk of an erroneous diagnosis. Detailed herein is our two-years data with varied Brucella serology patterns and their clinical interpretation. Between January 2015 to December 2017, 1102 samples were processed in the Immunology Laboratory of KFHU for Brucella serology. 68 samples were positive for both IgG and IgM, 28 samples were positive for IgG and negative for IgM while 15 samples were positive for IgM and negative for IgG antibodies against Brucella. Electronic medical records, history of exposure, signs, symptoms, laboratory data, and the final diagnosis were recorded for all these patients. None of the patients with only positive IgM antibodies was finally diagnosed with brucellosis, while a diagnosis of brucellosis was established for only one patient with IgG antibodies positive in his serum. All the double-positive (IgG- and IgM-positive) serology patterns were diagnosed as having brucellosis. We concluded that determination of single IgM or IgG anti-Brucella-antibodies by ELISA could both be considered as definite and should ideally be interpreted in the context of appropriate clinical scenario and confirmation by other laboratory assays. [ABSTRACT FROM AUTHOR]