Diagnosis of Brucella Melitensis Infection by Percutaneous Needle Biopsy of the Liver

Fogel, Richard I.; Lewis, Sanford M.

doi:10.7326/0003-4819-53-1-204

Cited by 17 publications

(2 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Up to the advent of novel generations of automated blood culture instruments in the mid-1990s, the recovery of Brucella organisms from peripheral blood samples was frequently suboptimal. In order to improve detection, it was advised to culture alternate sources such as bone marrow aspirates (27,40,41,(87)(88)(89), liver biopsy specimens (90,91), or lymph nodes (92). The rationale behind obtaining these specimens was that Brucella organisms multiply and concentrate inside the reticuloendothelial system, and thus, culturing of these macrophage-rich tissues may increase bacterial recovery (16).…”

Section: (Vi) Is the Traditional Recommendation Of Prolonged Incubatimentioning

confidence: 99%

Laboratory Diagnosis of Human Brucellosis

2019

View full text Add to dashboard Cite

SUMMARY The clinical presentation of brucellosis in humans is variable and unspecific, and thus, laboratory corroboration of the diagnosis is essential for the patient’s proper treatment. The diagnosis of brucellar infections can be made by culture, serological tests, and nucleic acid amplification assays. Modern automated blood culture systems enable detection of acute cases of brucellosis within the routine 5- to 7-day incubation protocol employed in clinical microbiology laboratories, although a longer incubation and performance of blind subcultures may be needed for protracted cases. Serological tests, though they lack specificity and provide results that may be difficult to interpret in individuals repeatedly exposed to Brucella organisms, nevertheless remain a diagnostic cornerstone in resource-poor countries. Nucleic acid amplification assays combine exquisite sensitivity, specificity, and safety and enable rapid diagnosis of the disease. However, long-term persistence of positive molecular test results in patients that have apparently fully recovered is common and has unclear clinical significance and therapeutic implications. Therefore, as long as there are no sufficiently validated commercial tests or studies that demonstrate an adequate interlaboratory reproducibility of the different homemade PCR assays, cultures and serological methods will remain the primary tools for the diagnosis and posttherapeutic follow-up of human brucellosis.

show abstract

Section: (Vi) Is the Traditional Recommendation Of Prolonged Incubatimentioning

confidence: 99%

Laboratory Diagnosis of Human Brucellosis

2019

View full text Add to dashboard Cite

show abstract

“…After the initial hematogenous spread, in 25-35% of patients, brucellae can move towards remote organs with the development of focal infections. This allows for the isolation of brucellae from specimens in other sites other than blood, such as bone marrow, urines, bone tissue, pleural and synovial fluid aspirates, liver biopsy specimens, lymph nodes, cerebrospinal fluid, and abscesses after an incubation up to 14 days in a 5% CO 2enriched atmosphere at 35 • C or by inoculation of specimens into broth media (usually those used for blood cultures) [23][24][25][26][27][28][29][30].…”

Section: Culturementioning

confidence: 99%

Microbiological Laboratory Diagnosis of Human Brucellosis: An Overview

et al. 2021

View full text Add to dashboard Cite

Brucella spp. are Gram-negative, non-motile, non-spore-forming, slow-growing, facultative intracellular bacteria causing brucellosis. Brucellosis is an endemic of specific geographic areas and, although underreported, represents the most common zoonotic infection, with an annual global incidence of 500,000 cases among humans. Humans represent an occasional host where the infection is mainly caused by B. melitensis, which is the most virulent; B. abortus; B. suis; and B. canis. A microbiological analysis is crucial to identifying human cases because clinical symptoms of human brucellosis are variable and aspecific. The laboratory diagnosis is based on three different microbiological approaches: (i) direct diagnosis by culture, (ii) indirect diagnosis by serological tests, and (iii) direct rapid diagnosis by molecular PCR-based methods. Despite the established experience with serological tests and highly sensitive nucleic acid amplification tests (NAATs), a culture is still considered the “gold standard” in the laboratory diagnosis of brucellosis due to its clinical and epidemiological relevance. Moreover, the automated BC systems now available have increased the sensitivity of BCs and shortened the time to detection of Brucella species. The main limitations of serological tests are the lack of common interpretative criteria, the suboptimal specificity due to interspecies cross-reactivity, and the low sensitivity during the early stage of disease. Despite that, serological tests remain the main diagnostic tool, especially in endemic areas because they are inexpensive, user friendly, and have high negative predictive value. Promising serological tests based on new synthetic antigens have been recently developed together with novel point-of-care tests without the need for dedicated equipment and expertise. NAATs are rapid tests that can help diagnose brucellosis in a few hours with high sensitivity and specificity. Nevertheless, the interpretation of NAAT-positive results requires attention because it may not necessarily indicate an active infection but rather a low bacterial inoculum, DNA from dead bacteria, or a patient that has recovered. Refined NAATs should be developed, and their performances should be compared with those of commercial and home-made molecular tests before being commercialized for the diagnosis of brucellosis. Here, we review and report the most common and updated microbiological diagnostic methods currently available for the laboratory diagnosis of brucellosis.

show abstract