Review of Brucellosis Cases from Laboratory Exposures in the United States in 2008 to 2011 and Improved Strategies for Disease Prevention

Traxler, Rita M.; Guerra, Marta; Morrow, Meredith G.; Haupt, Thomas; Morrison, J.; Saah, J. Royden; Smith, Charles G.; Williams, Carl J.; Fleischauer, Aaron; Lee, P. A.; Stanek, Danielle; Trevino-Garrison, Ingrid; Franklin, P.; Oakes, P.; Hand, Sheryl; Shadomy, Sean V.; Blaney, David D.; Lehman, Mark; Benoit, Tina J.; Stoddard, Robyn A.; Tiller, Rebekah; De, Barun K.; Bower, William A.; Smith, Theresa L.

doi:10.1128/jcm.00813-13

Cited by 49 publications

(59 citation statements)

References 22 publications

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“…However, LAB did not develop in any worker who took antimicrobial PEP. CDC recommends 3 weeks of antimicrobial PEP (17,70), though 6 weeks has also been recommended (67).…”

Section: Discussionmentioning

confidence: 99%

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A Literature Review of Laboratory-Acquired Brucellosis

et al. 2013

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bBrucellosis is a bacterial zoonotic disease which has been associated with laboratory-acquired infections. No recent reviews have addressed the characteristics of laboratory-acquired brucellosis (LAB). English-language literature was reviewed to identify reports of laboratory exposures to Brucella spp. and LAB cases between 1982 and 2007. Evaluation of 28 case reports identified 167 potentially exposed laboratory workers, of whom 71 had LAB. Nine reports were identified that summarized an additional 186 cases of LAB. Only 18 (11%) exposures were due to laboratory accidents, 147 (88%) exposures were due to aerosolization of organisms during routine identification activities, and the circumstances of 2 (1%) exposures were unknown. Brucella melitensis was the causative agent in 80% (135/167) of the exposures. Workers with high-risk exposures were 9.3 times more likely to develop LAB than workers with low-risk exposures (95% confidence interval [CI], 3.0 to 38.6; P < 0.0001); they were also 0.009 times likelier to develop LAB if they took antimicrobial PEP than if they did not (95% CI, 0 to 0.042; P < 0.0001). The median incubation period in case and summary reports was 8 weeks (range 1 to 40 weeks). Antimicrobial PEP is effective in preventing LAB. The incubation period may be used to identify appropriate serological and symptom surveillance time frames for exposed laboratory workers.

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“…However, LAB did not develop in any worker who took antimicrobial PEP. CDC recommends 3 weeks of antimicrobial PEP (17,70), though 6 weeks has also been recommended (67).…”

Section: Discussionmentioning

confidence: 99%

“…If an exposure to Brucella spp. occurs, revised postexposure guidelines are available in the accompanying article (70).…”

Section: Discussionmentioning

confidence: 99%

A Literature Review of Laboratory-Acquired Brucellosis

et al. 2013

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“…In the United States, an estimated 839 new cases of brucellosis illness are reported annually with 55 hospitalization and 1 death [22]. Laboratory acquired cases of brucellosis are increasingly becoming a concern, with up to 5 cases between 2008 and 2011, as it demonstrates violations in safety standards in laboratories or some degree of negligence on the side of laboratory staff [23].…”

Section: North Americamentioning

confidence: 99%

Prevalence and risk factors of brucellosis in man and domestic animals: A review

Bamaiyi

2016

Int J One Health

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Brucellosis is the most common worldwide zoonosis with 500,000 new cases every year in humans and infections in millions of animals. This infection is mainly acquired by humans through consumption of unpasteurized milk and milk products from infected animals. Exposure can also occur occupationally in those who work closely with animals through contact with aborted fetuses and reproductive secretions. Animals acquire the infection from other infected animals through direct contact and vertical transmission. This infection is prevalent in all continents of the world except Antarctica, but its impact is more felt in developing countries where it is endemic in animals and humans. In certain developed countries where the disease was eradicated, there seem to be a re-emergence of the disease as the disease appears to claim more territory. The risk factors of the disease may vary from country to country and region to region, but most risk factors are similar. Consumption of unpasteurized milk and milk products plays a very important role in the transmission of this infection from animals to humans, in addition to direct contact with infected animals and their secretions. The best way to control this ubiquitous infection is through the One Health approach which involves human health, animal health, and environmental health. This paper reviews the prevalence of brucellosis in some countries in various continents of the world and highlights the risk factors responsible for the persistence of this infection in animals and humans with a view to proffering solution to this age-old zoonosis that has defied eradication for many generations in many parts of the world.

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“…The recent introduction of matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry (MS) has revolutionized the identification of bacteria and yeasts (8,9). However, the procedures recommended by the manufacturers for non-biosafety level 3 (BSL3) organisms are not adequate for the manipulation of Brucella strains, which are classified as BSL3 (potential bioterrorism pathogens) and represent potential health hazards for laboratory workers (1,10). Any inactivation procedure must allow safe sample handling outside the BSL3 environment and must avoid destruction of the biomarkers used for identification.…”

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confidence: 99%

A Simple and Safe Protocol for Preparing Brucella Samples for Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry Analysis

et al. 2016

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dWe describe a simple protocol to inactivate the biosafety level 3 (BSL3) pathogens Brucella prior to their analysis by matrix-assisted laser desorption ionization-time of flight mass spectrometry. This method is also effective for several other bacterial pathogens and allows storage, and eventually shipping, of inactivated samples; therefore, it might be routinely applied to unidentified bacteria, for the safety of laboratory workers. Brucellosis is a zoonosis caused by bacteria of the genus Brucella, which are transmitted to humans through direct contact, ingestion of contaminated animal products, or aerosolization (1, 2). Brucellosis is endemic in several regions of the world, with more than 500,000 new cases each year (2-5). To date, 10 recognized species of Brucella have been described, with the most pathogenic for humans being Brucella melitensis (2). Diagnoses of clinical brucellosis are made initially using serological tests and are confirmed by isolation of the agent (6, 7). The recent introduction of matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry (MS) has revolutionized the identification of bacteria and yeasts (8, 9). However, the procedures recommended by the manufacturers for non-biosafety level 3 (BSL3) organisms are not adequate for the manipulation of Brucella strains, which are classified as BSL3 (potential bioterrorism pathogens) and represent potential health hazards for laboratory workers (1, 10). Any inactivation procedure must allow safe sample handling outside the BSL3 environment and must avoid destruction of the biomarkers used for identification. Therefore, we developed a simple, safe, and efficient sample preparation method for Brucella isolates that is compatible with their analysis by the current MALDI-TOF MS platforms.Solvent inactivation of Brucella. We first applied the direct transfer procedure recommended by the manufacturer to a panel of Brucella strains, working in class II microbiological safety cabinets in a BSL3 laboratory (Table 1). The target plate (Vitek MS DS slide; bioMérieux) was inoculated by picking a portion of a colony from a plate with a 1-l disposable loop (Sarsted), and the deposit was overlaid with 1 l of ␣-cyano-4-hydroxycinnamic acid (CHCA) matrix solution (saturated solution of CHCA in a solvent mixture composed of 33% acetonitrile, 33% absolute ethanol, 3% trifluoroacetic acid, and 31% water) and then air dried for 2 min at room temperature. The dried material was recovered with a sterile swab and spread on culture plates, which were then incubated for up to 3 weeks under the optimal growth conditions for the corresponding bacteria indicated in Table 1. Viable bacteria were recovered for most strains, showing that this protocol does not kill all Brucella strains, possibly because the bacterial deposit was not completely covered with the matrix solution. This risk is not acceptable for BSL3 pathogens. To overcome this problem, different liquid-phase inactivation protocols were tested in 1.5-ml Eppendorf tubes (see F...

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Review of Brucellosis Cases from Laboratory Exposures in the United States in 2008 to 2011 and Improved Strategies for Disease Prevention

Cited by 49 publications

References 22 publications

A Literature Review of Laboratory-Acquired Brucellosis

A Literature Review of Laboratory-Acquired Brucellosis

Prevalence and risk factors of brucellosis in man and domestic animals: A review

A Simple and Safe Protocol for Preparing Brucella Samples for Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry Analysis

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