Evaluation of Brucellosis by PCR and Persistence After Treatment in Patients Returning to the Hospital for Follow-Up

Maas, Kathlène S.J.S.M.; Mendez, Melissa; Zavaleta, Milagros; Manrique, Jennie; Franco, María Pía; Mulder, Maximilian; Bonifacio, Nilo; Castañeda, Maria L.; Chacaltana, Jesús; Yagui, Elena; Gilman, Robert H.; Guillén, Alfredo; Blazes, David L.; Espinosa, Benjamin J.; Hall, Eric R.; Abdoel, Theresia H.; Smits, Henk L.

doi:10.4269/ajtmh.2007.76.698

Cited by 41 publications

(33 citation statements)

References 21 publications

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“…Earlier PCR studies indicated that the pathogen may persist in the blood of patients during and after the end of treatment with the standard combination therapies consisting of doxycycline with rifampicin and doxycycline with streptomycin, which have been recommended by the WHO [12][13]25]. In our study, we found that the pathogen persisted more than three months in patients treated with doxycyline and ciprofloxacine.…”

Section: Discussionsupporting

confidence: 62%

“…However, therapeutic failure and the development of persistent diseases as well as the high relapse rate are of concern. Earlier studies using PCR have indicated that the pathogen may persist in the blood of the patient during and following treatment providing a plausible explanation for the suboptimal effect of current treatment regimens [12][13][14]. Other treatment regimens including treatment with doxycycline and ciprofloxacin have not been demonstrated to be more effective than the WHO recommended regimens [15].…”

Section: Introductionmentioning

confidence: 99%

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Laboratory diagnosis of human brucellosis in Egypt and persistence of the pathogen following treatment

Marei

Boghdadi

Abdel-Hamed

et al. 2011

J Infect Dev Ctries

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Introduction: Brucellosis is a major public health problem in Egypt. The Brucella IgM/IgG lateral flow assay was developed as a point-ofcare test for the diagnosis of human brucellosis. The aim of this study was to assess the diagnostic value of the lateral flow assay for use in Egypt. Methodology: Fifty samples of patients who presented with clinical suspicion of brucellosis over a one-year period were collected. All samples were subjected to the Brucella IgM/IgG lateral flow assay, serum agglutination test (SAT), rose bengal RB Test (RB), 2-mercapteoethanol (2-ME), culture and PCR. SAT, 2-ME, culture and PCR were retested after the end of the treatment. Results: Culture and SAT confirmed the diagnosis of brucellosis in twenty patients. While 90% of the samples were positive by SAT, only 30% and 85% were positive by culture and PCR respectively. The sensitivity of the lateral flow assay calculated for the Brucella IgM/IgG was 95% and specificity was 97%. Conclusion: These data show that the lateral flow assay is more suitable for diagnosis of brucellosis in Egypt than culture and SAT. Application of the PCR on serum samples collected during follow-up revealed that the DNA of the pathogen was yet not completely cleared almost 60 days after the start of treatment with doxycycline and ciprofloxacin.

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Section: Discussionsupporting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Laboratory diagnosis of human brucellosis in Egypt and persistence of the pathogen following treatment

Marei

Boghdadi

Abdel-Hamed

et al. 2011

J Infect Dev Ctries

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“…Extensive efforts have been made on the development of molecular diagnostic assays based on amplification of different genomic targets by the polymerase chain reaction (PCR) for the diagnosis of human brucellosis. A recent publication 5 has indicated the persistence of DNA in the serum, even after completion of standard treatment regimen, ranging from weeks to months, thus failing to establish these molecular assays as routine diagnostic methods as yet. Hence, the laboratory diagnosis is often serologically directed to detection of Brucella -specific antibodies.…”

Section: Introductionmentioning

confidence: 99%

ELISA versus Conventional Methods of Diagnosing Endemic Brucellosis

Mantur

Parande²,

Amarnath³

et al. 2010

The American Society of Tropical Medicine and Hygiene

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Abstract. The diagnostic value of enzyme-linked immunosorbent assay (ELISA) was evaluated when blood specimens of 92 patients suspected of brucellosis underwent the ELISA (IgM and IgG), standard tube agglutination (SAT) , and 2-mercaptoethanol (2-ME) tests and blood cultures; 38 sera from non-brucellosis patients and 34 sera from blood donors were also subjected to ELISA, SAT, and 2 -ME tests. SAT was able to pinpoint only 23 (25%), whereas ELISA confirmed the etiology in 56 (60.9%; P < 0.001) patients with brucellosis, including 31 culture-confirmed cases. The sensitivity and specificity of ELISA were 100% and 71.31%, respectively. Because they were confirmed by ELISA, the diagnosis could never be excluded with SAT in 33 cases. ELISA has been found to be more sensitive in acute (28% higher sensitivity; P < 0.02) and chronic (55% higher sensitivity; P < 0.01) cases. For accurate diagnosis in suspected brucellosis cases detection, we recommend both ELISA IgM and IgG tests. ELISA IgG and 2 -ME tests seem to be promising tools in judging prognosis.

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“…However, our group and others have demonstrated the persistence of Brucella sp. DNA for long periods of time after the conclusion of therapy in asymptomatic patients (10,15,24). The practical role of quantitative real-time PCR (Q-PCR) in the laboratory diagnosis of chronic brucellosis and the assessment of clinical manifestations remains to be demonstrated.…”

mentioning

confidence: 99%

Chronic Brucellosis and Persistence of Brucella melitensis DNA

Castaño¹,

Solera

2009

J Clin Microbiol

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After acute brucellosis infection, symptoms persist in a minority of patients for more than 1 year. Such patients are defined as having chronic brucellosis. Since no objective laboratory methods exist to confirm the presence of chronic disease, these patients suffer delays in both diagnosis and treatment. The aim of the current study was to evaluate the usefulness of quantitative real-time PCR (Q-PCR) in the diagnosis and follow-up of these patients. Thirty-five subjects with a well-documented history of brucellosis that had been diagnosed between 2 and 33 years previously were screened by Q-PCR for the presence of Brucella melitensis DNA and by serological tests and blood culture. Subjects were divided into three groups: 8 (23%) focal-disease subjects, 9 (26%) nonfocal-disease subjects with subjective complaints, such as fatigue, malaise, arthralgia, and/or myalgia, and 18 (51%) asymptomatic subjects. All (100%) focal-disease patients and symptomatic nonfocal-disease patients had at least one positive Q-PCR sample. Only six (33%) of the asymptomatic subjects had Q-PCR-positive samples (P < 0.05). Eleven patients (five focal-disease patients and six nonfocal-disease patients with subjective complaints) received therapy during the study. For those patients who completed treatment, six (60%) still had Q-PCR-positive samples at the posttreatment follow-up. The proportion of individuals with B. melitensis DNA was significantly higher for symptomatic nonfocal-disease patients than for asymptomatic subjects. Therefore, Q-PCR appears to be a useful method for identifying chronic brucellosis patients.

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Evaluation of Brucellosis by PCR and Persistence After Treatment in Patients Returning to the Hospital for Follow-Up

Cited by 41 publications

References 21 publications

Laboratory diagnosis of human brucellosis in Egypt and persistence of the pathogen following treatment

Laboratory diagnosis of human brucellosis in Egypt and persistence of the pathogen following treatment

ELISA versus Conventional Methods of Diagnosing Endemic Brucellosis

Chronic Brucellosis and Persistence of Brucella melitensis DNA

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