Article thumbnail

The Rose Bengal Test in Human Brucellosis: A Neglected Test for the Diagnosis of a Neglected Disease

By Ramón Díaz, Aurora Casanova, Javier Ariza and Ignacio Moriyón


Brucellosis is a highly contagious zoonosis affecting livestock and human beings. The human disease lacks pathognomonic symptoms and laboratory tests are essential for its diagnosis. However, most tests are difficult to implement in the areas and countries were brucellosis is endemic. Here, we compared the simple and cheap Rose Bengal Test (RBT) with serum agglutination, Coombs, competitive ELISA, Brucellacapt, lateral flow immunochromatography for IgM and IgG detection and immunoprecipitation with Brucella proteins. We tested 208 sera from patients with brucellosis proved by bacteriological isolation, 20 contacts with no brucellosis, and 1559 sera of persons with no recent contact or brucellosis symptoms. RBT was highly sensitive in acute and long evolution brucellosis cases and this related to its ability to detect IgM, IgG and IgA, to the absence of prozones, and to the agglutinating activity of blocking IgA at the pH of the test. RBT was also highly specific in the sera of persons with no contact with Brucella. No test in this study outperformed RBT, and none was fully satisfactory in distinguishing contacts from infected patients. When modified to test serum dilutions, a diagnostic titer >4 in RBT resulted in 87.4% sensitivity (infected patients) and 100% specificity (contacts). We discuss the limitations of serological tests in the diagnosis of human brucellosis, particularly in the more chronic forms, and conclude that simplicity and affordability of RBT make it close to the ideal test for small and understaffed hospitals and laboratories

Topics: Research Article
Publisher: Public Library of Science
OAI identifier:
Provided by: PubMed Central

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.

Suggested articles


  1. (1971). A comparison of the tube agglutination and card tests for the diagnosis of Brucella melitensis infection in humans.
  2. (2000). A panel of eight tests in the serodiagnosis and immunological evaluation of acute brucellosis.
  3. (2005). Application of a user-friendly Brucella-specific IgM and IgG antibody assay for the rapid confirmation of Rose Bengal-positive patients in a hospital in Iran.
  4. (1998). Assessment of the Rose-Bengal plate test for the diagnosis of human brucellosis in health facilities in Narok district,
  5. (2001). Bacteriemia por Brucella con serologı ´a convencional negativa.
  6. (2001). Bacteriemia por Brucella sp. con serologı ´a convencional negativa.
  7. (1995). Brucella antibodies and oral cholera vaccination.
  8. (1948). Brucella antibodies following cholera vaccination.
  9. (2009). Brucellacapt vs. classical tests in the serological diagnosis and management of human brucellosis.
  10. (2001). Brucellosis among animals and human contacts in eastern Sudan.
  11. (2006). Brucellosis in human and animals.
  12. (1997). Brucellosis: an overview.
  13. (1995). Characteristics of and risk factors for relapse of brucellosis in humans.
  14. (2003). Comparison of a dipstick assay for detection of Brucella-specific immunoglobulin M antibodies with other tests for serodiagnosis of human brucellosis.
  15. (1999). Competitive enzyme immunoassay for diagnosis of human brucellosis.
  16. (1997). Criteria for better detection of brucellosis in the Narok District of Kenya.
  17. (2001). Current understanding and management of chronic hepatosplenic suppurative brucellosis.
  18. (2003). Dı ´az R
  19. (2008). Effectiveness of rose bengal test and fluorescence polarization assay in the diagnosis of Brucella spp. infections in free range cattle reared in endemic areas in Zambia. Trop Anim Health Prod.
  20. (1994). Efficacy of different rose bengal and complement fixation antigens for the diagnosis of Brucella melitensis infection in sheep and goats.
  21. (1988). ELISA versus routine tests in the diagnosis of patients with systemic and neurobrucellosis.
  22. (1972). Etude de quelques particularites des anticorps bloquants dans la brucellose humaine.
  23. (2007). Evaluation and comparison of fluorescence polarization assay with three of the currently used serological tests in diagnosis of human brucellosis.
  24. (2009). Evaluation and importance of selected microbiological methods in the diagnosis of human brucellosis.
  25. (2008). Evaluation of seven tests for the diagnosis of human brucellosis in an endemic area.
  26. (2007). Human brucellosis.
  27. (1980). Isopol’zovanie kislogo antigen roz-bengal v plastinchatoi reakstii aggliutinatsii pri brutselleze u liudei. Zh Mikrobiol Epidemiol Immunobiol.
  28. (2010). Large scale immune profiling of infected humans and goats reveals differential recognition of Brucella melitensis antigens.
  29. (2005). Martı ´nL ,L o ´pez-Palmero
  30. (1989). Moriyo ´n I
  31. (1970). Nature des anticorps bloquants dans la brucellose humaine.
  32. (2002). Prevalence of antibodies to Brucella spp. and risk factors related to high-risk occupational groups in Eritrea.
  33. (1976). Rivero A
  34. (2006). Secondary serological response of patients with chronic hepatosplenic suppurative brucellosis.
  35. (1998). Selected laboratory tests in febrile patients in
  36. (1964). Some molecular characteristics of blocking antibodies in human brucellosis. Soluble antigen-antibody complexes.
  37. (1992). Specific antibody profile in human brucellosis.
  38. (2000). Study of brucellosis in a pastoral community and evaluation of the usefulness of clinical signs and symptoms in differentiating it from other flu-like diseases.
  39. (1988). Techniques for the brucellosis laboratory.
  40. (2009). The evaluation of a user-friendly lateral flow assay for the serodiagnosis of human brucellosis in Kazakhstan.
  41. (1956). The evolution of the concept that brucellosis is a disease of animals and man. In: The nature of brucellosis.
  42. (1974). The rose bengal plate test in human brucellosis.
  43. (2003). The sensitivity and specificity of Brucella agglutination tests.
  44. (2004). Use of the Brucella IgM and IgG flow assays in the serodiagnosis of human brucellosis in an area endemic for brucellosis.
  45. (1974). Valor de la prueba del rosa de bengala y la demostracio ´n de anticuerpos anti-proteı ´na de Brucella en el diagno ´stico serolo ´gico de brucelosis y yersiniosis.
  46. (2006). Zoonoses in the Mediterranean region. Ann Ist Super Sanita 42: 437–445. 3 . C h a b a s s eD ,R o u r eC ,R h a l yA A ,M a i g aD ,T r a o r eM ,e ta l
  47. (2009). Zoonotic tuberculosis and brucellosis in Africa: neglected zoonoses or minor public-health issues? The outcomes of a multi-disciplinary workshop.