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

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

The Effect of Hepatitis B Vaccination at Birth on Reducing the Prevalence of Hepatitis B Surface Antigen among Rural Pregnant Women in Babol, Iran

BACKGROUND AND OBJECTIVE: Hepatitis B virus infection is regarded as a major factor for chronic liver disease and cirrhosis, worldwide. Hepatitis B is most commonly transmitted from mother to child at birth (perinatal transmission). In this study, we aimed to determine the prevalence of hepatitis B surface antigen (HBsAg) among rural pregnant women, who had received vaccination at birth, based on the national hepatitis B vaccination program, implemented in Iran in 1994. METHODS: This cross-sectional study was performed on all rural women, born in years 1993-1999, who had received hepatitis B vaccination according to the national program and had become pregnant during 2007-2014. In order to diagnose the disease, the status of HBsAg marker was recorded and evaluated by reviewing the subjects' health records. FINDINGS:Among 1065 pregnant women, only 2(0.18%) cases were HBsAg-positive; The mother of one of these two cases was diagnosed with hepatitis B infection CONCLUSION: The results of this study indicated that the national vaccination program had a considerable impact on reducing the prevalence of hepatitis B virus infection among women of reproductive age. Continuous vaccination of newborns and high-risk groups and screening programs for pregnant mothers should be also prioritized in the national program

CLINICAL PROFILE AND MANAGEMENT OF BRUCELLOSIS IN TEHRAN – IRAN

Background- Brucetiosis is one of the most frequent infectious diseases in many regions of Iran. The purpose of this study was to evaluate different clinical, laboratory and therapeutic aspects of this disease. Method- This retrospective descriptive study was performed on patients referred to two teaching hospitals in Tehran/Iran with brucellosis diagnosis during the years 1998 - 2005. Patients' signs and symptoms, laboratory findings and clinical responses were evaluated during the study period. Results- More than half of the 415 patients enrolled in this study were female. The duration of the symptoms was reported to be less than 2 months in 83.85% of the patients prior to being examined in our centre. While sweating and fever were the most common symptoms, peripheral arthritis, sacroiliitis and spienomegaly were the most frequently reported signs. Rifampin plus cotrimoxazole was the most common regimen administered in these cases (32%) and relapse was also more frequently seen in this group of patients (13.8%), whitst doxycycline and cotrimoxazole led to the least number of relapses (2.5%). Conclusion- Brucellosis is known to have various manifestations, so it should be considered as one of the differential diagnoses of any patient referred with different organs involvement accompanied with or without fever. Relapse is one of the complications reported even following an appropriate treatment