A prospective study was carried out to elucidate the clinical, epidemiological and laboratory features of human brucellosis. A total of 26 948 blood samples (from adults aged 15 years and above) were screened for serological evidence of brucellosis over a period of 16 years. The slide agglutination/Rose Bengal plate agglutination test gave positive results in 517 patients, of which 509 had detectable titres by the standard tube agglutination test (SAT). The diagnosis of brucellosis was documented in 495 (1?8 %) patients based on diagnostic titres (¢1 : 160, 490 cases) and rising titres from insignificant titres (four cases) by serology and for one case by blood-culture isolation alone. Blood cultures were carried out in 345 cases, of which 191 cases (55?3 %) yielded Brucella melitensis. In 77/79 cases undertaken for follow up, there was a steady fall in 2-mercaptoethanol (2ME) agglutination titres along with clinical improvement (P <0?01). SAT titres remained detectable in most cases for a longer period in spite of an effective antimicrobial therapy and clinical recovery. A substantial number of patients (84?2 %) presented with fever, this being the only complaint in 51?1 % of the cases. Complications were present in 8?8 % of the patients (arthritis excluded): this included the unusual complications of hydrocele (two cases), Stevens-Johnson syndrome (one case) and urinary tract infection (one case). Brucella agglutinins were demonstrated in synovial, testicular, hydrocele and cerebrospinal fluids. There was no clinical suspicion of brucellosis in 439 cases (88?7 %) and the diagnosis was made only by routine serology. A two-drug regimen for 42-84 days with a follow-up 2ME test resulted in lower levels of relapse. These results suggest that, in endemic areas of the world, it should be mandatory to screen routinely for brucellosis due to protean clinical manifestations. INTRODUCTIONBrucellosis is a worldwide zoonotic disease caused by Brucella spp. The genus Brucella comprises Gram-negative, facultative, intracellular pathogens (Alton et al., 1975). Currently, there are six recognized species of Brucella based on phenotypic characteristics, antigenic variation and prevalence of infection in different animal hosts: Brucella abortus (cattle), Brucella canis (dogs), Brucella melitensis (goats, sheep), Brucella neotomae (desert wood rats), Brucella ovis (sheep) and Brucella suis (pigs, reindeer and hares) (Corbel, 1997;Moreno et al., 2002). Recently, two Brucella strains from marine mammals have been reported (Bricker et al., 2000;Cloeckaert et al., 2000) and the names Brucella pinnipediae (seal/otter) and Brucella cetaceae (porpoise/ whale) have been proposed (Cloeckaert et al., 2003). There has also been a report of human infection with marine brucellae (Sohn et al., 2003). Although each species of Brucella has a preferred host, all can infect a wide range of animals, including humans. Brucellosis is a worldwide reemerging zoonosis causing high economic losses and severe human disease. It has areas of high endemicity...

A total of 5726 blood specimens (from children aged 14 years and younger) were studied for the serological evidence of brucellosis. Ninety-three (1.6 per cent) showed diagnostic agglutinin titres with a geometric mean titre of 403 (SD +/- 547). Forty-three (59.7 per cent) blood specimens yielded the growth of Brucella melitensis. Thirty-nine patients (41.93 per cent) were shepherds, who constituted the major occupational group affected in the present series. More than 60 per cent of the patients had a history of both consumption of fresh goat's milk and close animal contact. The habit of consuming fresh goat's milk to obtain relief from chronic ailments was noted in nine patients. Seventy-three (78.49 per cent) were males and 20 (21.51 per cent) were females, with a male to female ratio of 3:1. The disease occurred mainly in the school age group (mean age 10.3 years). All the patients had an acute history of less than 2 months. Forty-nine (52.68 per cent) patients presented with persistent fever, 19 (20.43 per cent) with joint pain, and the rest with a combination of fever and joint pain with and without low backache, fever being the commonest complaint. One case presented with involuntary movements of limbs alone and the other with burning feet only. Pityriasis alba was the consistent physical finding, with fever in the majority of the patients. The major joint found to be involved was the knee (52.77 per cent). The synovial fluid obtained from the knee joint of five patients demonstrated Brucella agglutinins and also three grew B. melitensis. Eight patients presented with complications that included skin lesions (3), carditis (2), neurobrucellosis such as chorea (1), peripheral neuritis (1), and meningitis (1). Brucella melitensis biotype 1 was successfully isolated from the papular eruption of one out of three cases who presented with skin lesions. To our knowledge this is the fourth confirmed isolation of B. melitensis from skin lesions with brucellosis, reported in the literature. The cerebrospinal fluid obtained from the meningitis patient was positive for B. agglutinins. To our knowledge chorea of brucellar origin appears to be the first case reported in the literature. In 15 cases (16.13 per cent) brucellosis was suspected clinically whereas 78 (83.87 per cent) cases, only serological evidence of brucellosis confirmed the diagnosis. None of the cases relapsed. In our experience an initial combination therapy with a three-drug regimen followed by a two-drug regimen for a minimum of 6 weeks has been found to be effective in the prevention of a relapse.

We investigated the role of the lysis centrifugation blood culture technique over the conventional Castaneda technique for the diagnosis of human brucellosis. The lysis centrifugation technique has been found to be more sensitive in both acute (20% higher sensitivity; P < 0.00001) and chronic (40% higher sensitivity; P ‫؍‬ 0.087) forms of brucellosis. The major advantage of lysis centrifugation was in the mean detection time, which was only 2.4 days in acute and 2.7 days in chronic cases, with 103 out of 110 (93.6%) and 17 out of 20 (85%) cultures from acute and chronic brucellosis, respectively, detected before the conventional culture was positive. Our results confirmed the potential usefulness of the lysis technique in diagnosis and institution of appropriate antibiotic therapy.The spectrum of human brucellosis, a zoonosis, ranges from subclinical infection to acute (less than 2 months), subacute (2 to 12 months), and chronic illness, often manifested by recurrent symptoms over many years (1,10). A definitive diagnosis of this infection is based on culture from different samples, mainly blood. With acute forms produced by Brucella melitensis, the number of positive results from blood cultures by the conventional (Castaneda) technique is usually 70 to 80% (2). This figure is notably reduced for patients with long illness and focal complications; in these cases the percentage of positives rarely exceeds 30 to 50% (3, 6). Although a prior study (4) of the lysis centrifugation technique has demonstrated the possibility of detecting brucellae early along with an increased isolation rate, information concerning the use of this technique in the diagnosis of human brucellosis is scarce, especially for chronic illness. This study compares lysis centrifugation to the conventional blood culture technique for the diagnosis of acute and chronic brucellosis.The study group comprised 121 acute and 27 chronic brucellosis patients. A case of brucellosis was identified if the titers were Ն1:160 (9) by standard tube agglutination testing (Brucella abortus plain antigen; Indian Veterinary Research Institute, Izatnagar, India).Five milliliters of venous blood was inoculated aseptically into the broth phase of Castaneda's biphasic medium consisting of brain heart infusion agar and broth (High Media, Mumbai, India), in duplicate. The media were incubated at 37°C with and without a CO 2 atmosphere for 30 days, and the broth-blood mixtures were tilted over the solid phase every day.A modification of the method described by Etemadi et al. (4) was employed for lysis centrifugation. A 5-ml aliquot of blood drawn simultaneously along with that used for the Castaneda culture was added to a 50-ml screw-cap sterile centrifuge tube containing 20 ml of sterile distilled water and 1.5 ml of 4% sodium citrate. The contents were gently mixed, and the tube was centrifuged (model no. R8C; Remi, Mumbai, India) at 2,000 ϫ g for 30 min. The supernatant was discarded, and the sediment was inoculated onto brain heart infusion agar plates in duplicate. ...

Brucellosis most of the times was missed or misdiagnosed. Regular screenings for brucellosis and awareness programmes to increase KAP levels are necessary to control brucellosis in occupationally exposed groups.

BACKGROUND: Escherichia coli accounts for 70%–95% of urinary tract infections (UTIs). UTI is a serious health problem with respect to antibiotic resistance and biofilms formation being the prime cause for the antibiotic resistance. Biofilm can restrict the diffusion of substances and binding of antimicrobials. In this context, the present study is aimed to perform in vitro detection of biofilm formation among E. coli strains isolated from urine and to correlate their susceptibility pattern with biofilm formation. MATERIALS AND METHODS: A total of 100 E. coli strains isolated from patients suffering from UTI were included in the study. The identification of E. coli was performed by colony morphology, Gram staining, and standard biochemical tests. The detection of biofilm was carried out by Congo Red Agar (CRA) method, tube method (TM), and tissue culture plate (TCP) method. Antimicrobial sensitivity testing was performed by Kirby–Bauer disc diffusion method on Muller–Hinton agar plate. RESULTS: Of the 100 E. coli strains, 49 (49%) and 51 (51%) were from catheterized and noncatheterized patients, respectively. Biofilm production was positive by CRA, TM, and TCP method were 49 (49%), 55 (55%), and 69 (69%), respectively. Biofilm producers showed maximum resistance to co-trimoxazole (73.9%), gentamicin (94.2%), and imipenem (11.6%) when compared to nonbiofilm producers. Significant association was seen between resistance to antibiotic and biofilm formation with a P = 0.01 (<0.05). CONCLUSION: A greater understanding of biofilm detection in E. coli will help in the development of newer and more effective treatment. The detection of biofilm formation and antibiotic susceptibility pattern helps in choosing the correct antibiotic therapy.