Health-seeking behaviour of human brucellosis cases in rural Tanzania

<p>Abstract</p> <p>Background</p> <p>Brucellosis is known to cause debilitating conditions if not promptly treated. In some rural areas of Tanzania however, practitioners give evidence of seeing brucellosis cases with symptoms of long duration. The purpose of this study was to establish health-seeking behaviour of human brucellosis cases in rural Tanzania and explore the most feasible ways to improve it.</p> <p>Methods</p> <p>This was designed as a longitudinal study. Socio-demographic, clinical and laboratory data were collected from patients who reported to selected hospitals in rural northern Tanzania between June 2002 and April 2003. All patients with conditions suspicious of brucellosis on the basis of preliminary clinical examination and history were enrolled into the study as brucellosis suspects. Blood samples were taken and tested for brucellosis using the Rose-Bengal Plate Test (RBPT) and other agglutination tests available at the health facilities and the competitive ELISA (c-ELISA) test at the Veterinary Laboratory Agencies (VLA) in the UK. All suspects who tested positive with the c-ELISA test were regarded as brucellosis cases. A follow-up of 49 cases was made to collect data on health-seeking behaviour of human brucellosis cases.</p> <p>Results</p> <p>The majority of cases 87.7% gave a history of going to hospital as the first point of care, 10.2% purchased drugs from a nearby drug shop before going to hospital and 2% went to a local traditional healer first. Brucellosis cases delayed going to hospital with a median delay time of 90 days, and with 20% of the cases presenting to hospitals more than a year after the onset of symptoms. Distance to the hospital, keeping animals and knowledge of brucellosis were significantly associated with patient delay to present to hospital.</p> <p>Conclusion</p> <p>More efforts need to be put on improving the accessibility of health facilities to the rural poor people who succumb to most of the diseases including zoonoses. Health education on brucellosis in Tanzania should also stress the importance of early presentation to hospitals for prompt treatment.</p

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

Poor performance of the rapid test for human brucellosis in health facilities in Kenya

Human brucellosis is considered to be an important but typically under-diagnosed cause of febrile illness in many low and middle-income countries. In Kenya, and throughout East Africa, laboratory diagnosis for the disease is based primarily on the febrile antigen Brucella agglutination test (FBAT), yet few studies of the diagnostic accuracy of this test exist. Assessment of the performance of the FBAT is essential for its appropriate clinical use, as well as for evaluating surveillance data reported by public health systems. To assess FBAT performance, we collected sera from people with symptoms compatible with brucellosis attending two health facilities in Busia County, Kenya. Sera were tested using the FBAT and results compared with those from the Rose Bengal Test (RBT), an assay with well-known performance characteristics. Positives on either test were confirmed using the classical serum agglutination test (SAT)-Coombs test combination and a rapid IgM/IgG lateral flow immunochromatography assay (LFA). A questionnaire focussing on known risk factors for exposure to Brucella spp. was also conducted, and relationships with FBAT positivity examined using logistic regression. Out of 825 recruited individuals, 162 (19.6%) were classified as positive using the FBAT. In contrast, only eight (1.0%) were positive using the RBT. Of the 162 FBAT positives, one (0.62%) had an atypical agglutination in SAT and three (1.9%) showed low Coombs titres. Out of 148 FBAT positive individuals tested using the LFA, five (3.4%) were IgM positive and none were IgG positive. Poor or no correlation was observed between FBAT results and most established risk factors for Brucella infection. We observed substantial disagreement between the FBAT and a number of well-known serological tests, with the majority of reactive FBAT results appearing to be false positives. Poor FBAT specificity, combined with a lack of confirmatory testing, strongly suggests overdiagnosis of brucellosis is common in this low prevalence setting. This is expected to have important economic impacts on affected patients subjected to the long and likely unnecessary courses of multiple antibiotics required for treatment of the disease

Brucellosis in Sub-Saharan Africa:Current challenges for management, diagnosis and control

Brucellosis is a highly contagious zoonosis caused by bacteria of the genus Brucella and affecting domestic and wild mammals. In this paper, the bacteriological and serological evidence of brucellosis in Sub-Saharan Africa (SSA) and its epidemiological characteristics are discussed. The tools available for the diagnosis and treatment of human brucellosis and for the diagnosis and control of animal brucellosis and their applicability in the context of SSA are presented and gaps identified. These gaps concern mostly the need for simpler and more affordable antimicrobial treatments against human brucellosis, the development of a B. melitensis vaccine that could circumvent the drawbacks of the currently available Rev 1 vaccine, and the investigation of serological diagnostic tests for camel brucellosis and wildlife. Strategies for the implementation of animal vaccination are also discussed.Publishe

Prevalence of bovine mastitis and multi-antibiotic resistant Staphylococcus and Streptococcus species in a research centre farm at Naivasha, Kenya

A cross-sectional study was conducted on prevalence of mastitis, its bacterial causes, their antibiotic sensitivities and management practices of sahiwal and dairy cattle kept at a centre of Kenya Agricultural &amp; Livestock Research Organization (KALRO) in Naivasha, Kenya. Clinical mastitis was diagnosed through physical examination of cows’ udders and milk. California Mastitis Test (CMT) was used to detect subclinical mastitis (SCM). Bacterial causes were determined by culture and their antibiotic sensitivities investigated by subjecting them to the commonly used antibiotics. Fifty cows were randomly selected from each herd giving a total of 100 cows. Prevalence of clinical mastitis in sahiwals at cow level was 6% (3/50) and subclinical mastitis (SCM) was 54% (27/50). Dairy herd had only SCM with a cow level prevalence of 36%. Prevalence of SCM was significantly different (p&lt;0.05) between the herds. Sahiwal herd had 93.8% bacterial recovery rate with Staphylococcus species as the predominant bacteria (86.7%) (n=30). Other isolates included Streptococcus 6.3%, Corynebacterium 3.3%, and Escherichia coli. Mixed infection of Staphylococcus and Streptococcus was found in one case. Milk samples from dairy herd had a bacterial recovery rate of 85.7% with Staphylococcus species as the predominant (55.6%) bacteria. Other isolates included Streptococcus species (38.9%) and Corynebacterium (5.6%). Mixed infection consisting of Staphylococcus and Corynebacterium (5.6%) was also detected. Staphylococcus isolates had highest sensitivity to Gentamycin of 100% while Streptococci had the highest sensitivity for Ampicillin and Gentamycin of 100%, respectively. The isolates showed resistance to some commonly used antibiotics such as sulphamethoxazole, streptomycin and tetracycline. Bovine mastitis is prevalent among cows at KALRONaivasha and appropriate control methods needs to be applied to lower this prevalence. Further, this study has shown that Gentamycin and ampicillin are the drugs of choice for treating bovine mastitis in this institute. In fact, knowledge on prevalence of mastitis causing organisms and their antibiotic sensitivities will boost efficacy of therapy and cow productivity.Key words: antibiotic sensitivity, bacterial causes, dairy herd, mastitis prevalence, Sahiwal her

Draft genome sequences of Enterococcus faecium, Enterococcus gallinarum, and Lactococcus lactis strains isolated from a mastitis-infected camel in Isiolo County, Kenya

We report the draft genome sequences and annotation of Enterococcus faecium, Enterococcus gallinarum, and Lactococcus lactis isolates that were recovered from a mastitis-infected camel in Isiolo County, Kenya. Collectively, these data provide an invaluable repository for data mining to support the development of a potential multicomponent mastitis subunit vaccine