Secondary Serological Response of Patients with Chronic Hepatosplenic Suppurative Brucellosis

Díaz, Ramón; Ariza, Javier; Alberola, I.; Casanova, Aurora; Rubio, M.

doi:10.1128/cvi.00086-06

Cited by 16 publications

(13 citation statements)

References 20 publications

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“…However, IgM antibodies cannot be reliably detected in all patients suffering from brucellosis. False-negative IgM results might be obtained due to an excess of IgG antibodies, and false-positive results due to the presence of rheumatoid factor [65,72]. Hence, rheumatoid factor should be eliminated by absorption routinely before testing for anti-Brucella IgM antibodies to rule out a false-positive result [72].…”

Section: Reviewmentioning

confidence: 99%

“…False-negative IgM results might be obtained due to an excess of IgG antibodies, and false-positive results due to the presence of rheumatoid factor [65,72]. Hence, rheumatoid factor should be eliminated by absorption routinely before testing for anti-Brucella IgM antibodies to rule out a false-positive result [72]. If only a single subgroup of immunoglobulins is quantified using ELISA, many patients will be tested false-negative [68].…”

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confidence: 99%

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Implications of laboratory diagnosis on brucellosis therapy

Dahouk

Nöckler

2011

Expert Review of Anti-infective Therapy

167

131

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Brucellosis is one of the world's most widespread bacterial zoonoses, leading to tremendous economic losses in endemic regions and serious complaints in affected patients. The infection may be transmitted by direct animal contact, but is usually acquired through the consumption of contaminated food products of animal origin, mainly via unpasteurized goat's milk and cheese. Furthermore, brucellosis is the most common bacterial laboratory-acquired infection worldwide [1].Although many national and international programs have been established to eradicate the pathogen and control its spreading in animal husbandry, brucellosis is still a re-emerging disease. The surveillance of animal brucellosis is difficult due to bacterial persistence in wildlife and environmental reservoirs, with consecutive spill-over to domestic animals [2].Brucellosis is caused by members of the genus Brucella (B.), which are gram-negative, facultative intracellular coccobacilli that were historically differentiated by their preferred animal host, varying pathogenicity and a few selected phenotypic traits. The genus comprises six classical species: B. melitensis bv 1-3 (primarily isolated from sheep and goats); B. abortus bv 1-6 and 9 (from cattle and other Bovidae); B. suis bv 1-3 (from pigs), bv 4 (from reindeer), bv 5 (from small rodents); B. canis (from dogs); B. ovis (from sheep); and B. neotomae (from desert wood rats). Recently, two novel species of marine origin, B. pinnipedialis (isolated from seals) and B. ceti (from dolphins and whales) [3], B. microti isolated from the common vole (Microtus arvalis) [4], red foxes (Vulpes vulpes) [5] and from soil [6], and B. inopinata isolated from a breast implant wound of a 71-year-old female patient [7] have been described. In the past, a lot of atypical Brucella strains arose. These could represent novel species or lineages of already described species, for example various Brucella strains originating from wild native rodent species in North Queensland, Australia [8], a novel Brucella isolate in association with two cases of stillbirth in nonhuman primates [9], and a B. inopinata-like strain (BO2), which was isolated from a lung biopsy of a 52-year-old Australian patient suffering from chronic destructive pneumonia [10].Physicians' awareness of the infection is very poor in many countries, and most cases correctly identified are clinically advanced. Because of its protean clinical manifestations, human brucellosis can be easily confused with other infectious and noninfectious diseases, leading to diagnostic delays and late onset of therapy. The isolation of the fastidious organisms is often unsuccessful or takes a long time, which is why the presumptive clinical diagnosis is usually confirmed by Brucellosis is a worldwide zoonosis with a huge economic impact on animal husbandry and public health. The diagnosis of human brucellosis can be protracted because the disease primarily presents as fever of unknown origin with unspecific clinical signs and symptoms. The isolation rate of the fastidiou...

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Section: Reviewmentioning

confidence: 99%

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confidence: 99%

Implications of laboratory diagnosis on brucellosis therapy

Dahouk

Nöckler

2011

Expert Review of Anti-infective Therapy

167

131

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“…Isolation of Brucella species requires strict biosafety measures (level 3), as these species are the predominant cause of laboratory-acquired infections ( Singh, 2009 ). Brucellosis often remains undiagnosed by culture-based analysis of clinical specimens such as blood ( Yagupsky, 1999 ), hepatic abscess ( Agostinelli et al, 2012 ), or infected heart valves ( Moter et al, 2002 ), but may be detected by serological tests, which, in some cases, can also be difficult to interpret ( Díaz et al, 2006 ). Molecular methods based on the polymerase chain reaction (PCR), including quantitative PCR (qPCR) assays, have been developed to increase the sensitivity and specificity of the detection of Brucella in bacterial cultures, sera, blood, and other tissues ( Yu and Nielsen, 2010 ).…”

Section: Introductionmentioning

confidence: 99%

When Bacterial Culture Fails, Metagenomics Can Help: A Case of Chronic Hepatic Brucelloma Assessed by Next-Generation Sequencing

et al. 2018

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Here, we sequenced DNA extracted from a necrotic hepatic lesion from a patient with suspected chronic hepatic brucelloma but negative culture results. Although most of the taxonomically classified sequencing reads corresponded to human genome sequences, our data suggest that whole-metagenome shotgun sequencing may be used together with other tests to strengthen the diagnosis of hepatic brucelloma.

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“…The fact that an increase in these titers was detected only in exceptional cases in the group of patients without relapse confers a high specific value on the increase in the Coombs titer as a marker of relapse. Thus, the sensitivity of the Coombs test could be higher than that of the BCAP test, because the Coombs test detects agglutinating and nonagglutinating antibodies, including those with high and low affinities (4,11,21). Taken together, these findings seem to indicate that a movement of low-affinity antibodies alone may be detected in some patients with active disease; in this regard, we recently reported similar findings in the setting of late hepatosplenic reactivated brucellosis (4,11).…”

Section: Discussionmentioning

confidence: 99%

BrucellaCapt versus Classical Tests in the Serological Diagnosis and Management of Human Brucellosis

Casanova

Ariza

Rubio

et al. 2009

Clin Vaccine Immunol

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The BrucellaCapt test is an immunocapture agglutination test suggested as a possible substitute for the Coombs test in the diagnosis of human brucellosis. Here it is compared with classical tests using 321 samples from 48 patients with brucellosis (6.9 ؎ 1.7 samples per patient), including 20 patients with focal disease and 8 patients with a total of 9 relapse episodes (mean follow-up, 18 months). The BrucellaCapt test was used according to the manufacturer's instructions, and we also used a variant of the BrucellaCapt test in which the microtiter plates were not coated with antibodies against total human immunoglobulin ( Human brucellosis continues to be a major health problem worldwide. Although the endemicity of this disease is limited to some areas of the Mediterranean basin and developing countries in Asia, Africa, and Latin America, sporadic cases may develop in any area where the disease is not endemic. Thus, the illness is currently included among travelers' diseases (20).The definite diagnosis of the disease is based on the isolation of Brucella spp. in blood cultures (12, 32), but under certain clinical conditions the microorganism cannot be finally recovered. In the past decade, PCR has emerged as a promising alternative method to confirm the presence of the microorganism (16, 23), although its use has not been standardized. Thus, serological tests continue to play a relevant role in the diagnosis and management of patients with brucellosis (12, 31). Most classical tests used, along with the enzyme-linked immunosorbent assay method, offer good detection of anti-lipopolysaccharide agglutinating and/or nonagglutinating antibodies. However, problems in serological diagnosis continue, mainly in chronic forms of the disease and in the course of follow-up, when the meaning of persistent titers could be difficult to interpret, especially since no definite criteria of cure have yet been established (2,12,13,18,24,25).In recent years, the new immunocapture agglutination antiBrucella (BrucellaCapt [BCAP]) test has been reported to detect agglutinating and nonagglutinating antibodies with very high sensitivity (1,5,6,8,10,15,17,18,27,29). It has been suggested as a possible substitute for the anti-human immunoglobulin (Coombs) test and, perhaps, as a better marker of disease activity (1,17,27,29). The aim of the present study was to investigate the basis and mechanisms of the high sensitivity of the BCAP test and to conduct an accurate evaluation of its performance in comparison with those of classical tests for a large group of brucellosis patients with several forms of the disease over a prolonged follow-up period. MATERIALS AND METHODSPatients and serum samples. Serum samples from 48 patients diagnosed with brucellosis at Bellvitge Hospital, a tertiary teaching hospital in Barcelona, Spain, were included. These patients were part of a series of patients with brucellosis who were treated and prospectively followed up in our hospital over a period of years, as reported elsewhere (2, 3). For all patients with po...

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Secondary Serological Response of Patients with Chronic Hepatosplenic Suppurative Brucellosis

Cited by 16 publications

References 20 publications

Implications of laboratory diagnosis on brucellosis therapy

Implications of laboratory diagnosis on brucellosis therapy

When Bacterial Culture Fails, Metagenomics Can Help: A Case of Chronic Hepatic Brucelloma Assessed by Next-Generation Sequencing

BrucellaCapt versus Classical Tests in the Serological Diagnosis and Management of Human Brucellosis

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