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

Marei, Ayman; Boghdadi, Ghada; Abdel-Hamed, Nahla; Hessin, Rasha; Abdoel, Theresia H.; Smits, Henk L.; Fathey, Fayza

doi:10.3855/jidc.1538

Cited by 21 publications

(26 citation statements)

References 23 publications

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“…Considering time, cost and cultivation problems, we recommend that, in suspected brucellosis cases, agglutination tests should be considered the first choice; culture and/or ELISA should be used for those cases with negative agglutination results. This recommendation is in agreement with recently published studies [24, 26]. …”

Section: Discussionsupporting

confidence: 93%

Epidemiological and Clinical Features of Brucellosis in the Country of Georgia

et al. 2017

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BackgroundBrucellosis is an endemic disease in the country of Georgia. According to the National Center for Disease Control and Public Health of Georgia (NCDC), the average annual number of brucellosis cases was 161 during 2008–2012. However, the true number of cases is thought to be higher due to underreporting. The aim of this study was to provide current epidemiological and clinical information and evaluate diagnostic methods used for brucellosis in Georgia.MethodologyAdult patients were eligible for participation if they met the suspected or probable case definition for brucellosis. After consent participants were interviewed using a standardized questionnaire to collect information on socio-demographic characteristics, epidemiology, history of present illness, and clinical manifestation. For the diagnosis of brucellosis, culture and serological tests were used.ResultsA total of 81 participants were enrolled, of which 70 (86%) were from rural areas. Seventy-four percent of participants reported consuming unpasteurized milk products and 62% consuming undercooked meat products before symptom onset. Forty-one participants were positive by the Wright test and 33 (41%) were positive by blood culture. There was perfect agreement between the Huddelston and Wright tests (k = 1.0). Compared with blood culture (the diagnostic gold standard), ELISA IgG and total ELISA (IgG + IgM), the Wright test had fair (k = 0.12), fair (k = 0.24), and moderate (k = 0.52) agreement, respectively.ConclusionsConsumption of unpasteurized milk products and undercooked meat were among the most common risk factors in brucellosis cases. We found poor agreement between ELISA tests and culture results. This report also serves as an initial indication that the suspected case definition for brucellosis surveillance purposes needs revision. Further research is needed to characterize the epidemiology and evaluate the performance of the diagnostic methods for brucellosis in Georgia.

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Section: Discussionsupporting

confidence: 93%

Epidemiological and Clinical Features of Brucellosis in the Country of Georgia

et al. 2017

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“…The fact that three cases were undiagnosed by performance of agglutination tests alone emphasizes the need for further laboratory testing for patients with negative agglutination results, especially in cases of high clinical indication and persistence of symptoms. This recommendation is in agreement with those of other studies' findings [6]. Real-time PCR, culture and ELISA IgG were statistically similar in sensitivity, which suggests that applying these tests for patients with uncertain negative agglutination test results should be sought according to other considerations such cost and time.…”

Section: Discussionsupporting

confidence: 81%

“…Therefore, the standard agglutination test (SAT, measures total IgM and IgG) is usually performed as a screening test, followed by Coombs test (which mainly measures IgG) to avoid false negative results [5]. Today, several diagnostic tests are increasingly proposed to improve the diagnosis, such as ELISA, which has a higher sensitivity compared to other serological methods [5], and quantitative molecular testing [6,7].…”

Section: Introductionmentioning

confidence: 99%

Brucellosis laboratory tests in Syria: what are their diagnostic efficacies in different clinical manifestations?

Alsayed

Monem

2012

J Infect Dev Ctries

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Introduction: Diagnosis of brucellosis in Syria is based on the presence of compatible symptoms in addition to positive agglutination results. This study investigated the potential of culture, ELISA and real-time PCR to support the diagnosis in different clinical manifestations of brucellosis. Methodology: Peripheral blood samples from 34 suspected brucellosis patients and 42 probable chronic or relapsed brucellosis patients were tested by agglutination tests, culture, ELISA and real-time PCR. Results: Among 34 samples collected from suspected cases, 18/34 (53%) were agglutination tests positive, 12/34 (35%) were culture positive, 12/34 (35%) were Brucella IgG positive, and 10/34 (29%) were real-time PCR positive. Three out of 34 patients were positive by real-time PCR but not by agglutination tests or culture. Among 42 samples obtained from probable chronic or relapsed patients, 27/42 (64%) were agglutination tests positive, 26/42 (62%) were Brucella IgG positive, 4/42 (10%) were culture positive, and 1/42 (2%) was real-time PCR positive. Conclusion: To rule in or rule out the diagnosis of brucellosis, a combination of several tests should be applied. Agglutination tests should be performed first considering their high sensitivity. If the agglutination test is negative, real-time PCR, and/or ELISA, and/or culture should be performed. When relapse or chronic brucellosis are suspected, agglutination tests and/or ELISA are recommended.

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“…Lateral flow assays do not require extensive laboratory infrastructure or technical expertise, and compared to the standard of SAT and/or culture, the sensitivity and specificity were 92–95 and 97%, respectively, in endemic settings [87,88]. Rapid latex agglutination tests can also be useful in areas with limited laboratory capacity, and one study using culture-confirmed cases and negative controls demonstrated a sensitivity of 89% and a specificity of 98% [89].…”

Section: Clinical Diagnosis and Diagnostic Advancesmentioning

confidence: 99%

Brucellosis in low-income and middle-income countries

Rubach

Halliday

Cleaveland

et al. 2013

Current Opinion in Infectious Diseases

209

176

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Purpose of review Human brucellosis is a neglected, underrecognized infection of widespread geographic distribution. It causes acute febrile illness and a potentially debilitating chronic infection in humans, and livestock infection has substantial socioeconomic impact. This review describes new information regarding the epidemiology of brucellosis in the developing world and advances in diagnosis and treatment. Recent findings The highest recorded incidence of human brucellosis occurs in the Middle East and Central Asia. Fever etiology studies demonstrate brucellosis as a cause of undifferentiated febrile illness in the developing world. Brucellosis is a rare cause of fever among returning travelers, but is more common among travelers returning from the Middle East and North Africa. Sensitive and specific rapid diagnostic tests appropriate for resource-limited settings have been validated. Randomized controlled trials demonstrate that optimal treatment for human brucellosis consists of doxycycline and an aminoglycoside. Decreasing the burden of human brucellosis requires control of animal brucellosis, but evidence to inform the design of control programs in the developing world is needed. Summary Brucellosis causes substantial morbidity in human and animal populations. While improvements in diagnostic options for resource-limited settings and stronger evidence for optimal therapy should enhance identification and treatment of human brucellosis, prevention of human disease through control in animals remains paramount.

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

Cited by 21 publications

References 23 publications

Epidemiological and Clinical Features of Brucellosis in the Country of Georgia

Epidemiological and Clinical Features of Brucellosis in the Country of Georgia

Brucellosis laboratory tests in Syria: what are their diagnostic efficacies in different clinical manifestations?

Brucellosis in low-income and middle-income countries

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