Risk factors for human brucellosis in northern Tanzania

Little is known about the epidemiology of human brucellosis in sub-Saharan Africa. This hampers prevention and control efforts at the individual and population levels. To evaluate risk factors for brucellosis in northern Tanzania, we conducted a study of patients presenting with fever to two hospitals in Moshi, Tanzania. Serum taken at enrollment and at 4–6 week follow-up was tested by Brucella microagglutination test. Among participants with a clinically compatible illness, confirmed brucellosis cases were defined as having a ≥ 4-fold rise in agglutination titer between paired sera or a blood culture positive for Brucella spp., and probable brucellosis cases were defined as having a single reciprocal titer ≥ 160. Controls had reciprocal titers < 20 in paired sera. We collected demographic and clinical information and administered a risk factor questionnaire. Of 562 participants in the analysis, 50 (8.9%) had confirmed or probable brucellosis. Multivariable analysis showed that risk factors for brucellosis included assisting goat or sheep births (Odds ratio [OR] 5.9, 95% confidence interval [CI] 1.4, 24.6) and having contact with cattle (OR 1.2, 95% CI 1.0, 1.4). Consuming boiled or pasteurized dairy products was protective against brucellosis (OR 0.12, 95% CI 0.02, 0.93). No participants received a clinical diagnosis of brucellosis from their healthcare providers. The under-recognition of brucellosis by healthcare workers could be addressed with clinician education and better access to brucellosis diagnostic tests. Interventions focused on protecting livestock keepers, especially those who assist goat or sheep births, are needed

Clinical manifestations of human brucellosis : a systematic review and meta-analysis

BACKGROUND: The objectives of this systematic review, commissioned by WHO, were to assess the frequency and severity of clinical manifestations of human brucellosis, in view of specifying a disability weight for a DALY calculation. METHODS/PRINCIPAL FINDINGS: Thirty three databases were searched, with 2,385 articles published between January 1990-June 2010 identified as relating to human brucellosis. Fifty-seven studies were of sufficient quality for data extraction. Pooled proportions of cases with specific clinical manifestations were stratified by age category and sex and analysed using generalized linear mixed models. Data relating to duration of illness and risk factors were also extracted. Severe complications of brucellosis infection were not rare, with 1 case of endocarditis and 4 neurological cases per 100 patients. One in 10 men suffered from epididymo-orchitis. Debilitating conditions such as arthralgia, myalgia and back pain affected around half of the patients (65%, 47% and 45%, respectively). Given that 78% patients had fever, brucellosis poses a diagnostic challenge in malaria-endemic areas. Significant delays in appropriate diagnosis and treatment were the result of health service inadequacies and socioeconomic factors. Based on disability weights from the 2004 Global Burden of Disease Study, a disability weight of 0.150 is proposed as the first informed estimate for chronic, localised brucellosis and 0.190 for acute brucellosis. CONCLUSIONS: This systematic review adds to the understanding of the global burden of brucellosis, one of the most common zoonoses worldwide. The severe, debilitating, and chronic impact of brucellosis is highlighted. Well designed epidemiological studies from regions lacking in data would allow a more complete understanding of the clinical manifestations of disease and exposure risks, and provide further evidence for policy-makers. As this is the first informed estimate of a disability weight for brucellosis, there need for further debate amongst brucellosis experts and a consensus to be reache

Incidence of human brucellosis in the Kilimanjaro Region of Tanzania in the periods 2007-2008 and 2012-2014

Background: Brucellosis causes substantial morbidity among humans and their livestock. There are few robust estimates of the incidence of brucellosis in sub-Saharan Africa. Using cases identified through sentinel hospital surveillance and health care utilization data, we estimated the incidence of brucellosis in Moshi Urban and Moshi Rural Districts, Kilimanjaro Region, Tanzania, for the periods 2007–2008 and 2012–2014. Methods: Cases were identified among febrile patients at two sentinel hospitals and were defined as having either a 4-fold increase in Brucella microscopic agglutination test titres between acute and convalescent serum or a blood culture positive for Brucella spp. Findings from a health care utilization survey were used to estimate multipliers to account for cases not seen at sentinel hospitals. Results: Of 585 patients enrolled in the period 2007–2008, 13 (2.2%) had brucellosis. Among 1095 patients enrolled in the period 2012–2014, 32 (2.9%) had brucellosis. We estimated an incidence (range based on sensitivity analysis) of brucellosis of 35 (range 32–93) cases per 100 000 persons annually in the period 2007–2008 and 33 (range 30–89) cases per 100 000 persons annually in the period 2012–2014. Conclusions: We found a moderate incidence of brucellosis in northern Tanzania, suggesting that the disease is endemic and an important human health problem in this area

Antigen-specific acquired immunity in human brucellosis: implications for diagnosis, prognosis, and vaccine development.

Brucella spp., are Gram negative bacteria that cause disease by growing within monocyte/macrophage lineage cells. Clinical manifestations of brucellosis are immune mediated, not due to bacterial virulence factors. Acquired immunity to brucellosis has been studied through observations of naturally infected hosts (cattle, goats), mouse models (mice), and human infection. Even though Brucella spp. are known for producing mechanisms that evade the immune system, cell-mediated immune responses drive the clinical manifestations of human disease after exposure to Brucella species, as high antibody responses are not associated with protective immunity. The precise mechanisms by which cell-mediated immune responses confer protection or lead to disease manifestations remain undefined. Descriptive studies of immune responses in human brucellosis show that TH(1) (interferon-γ-producing T cells) are associated with dominant immune responses, findings consistent with animal studies. Whether these T cell responses are protective, or determine the different clinical responses associated with brucellosis is unknown, especially with regard to undulant fever manifestations, relapsing disease, or are associated with responses to distinct sets of Brucella spp. antigens are unknown. Few data regarding T cell responses in terms of specific recognition of Brucella spp. protein antigens and peptidic epitopes, either by CD4+ or CD8+ T cells, have been identified in human brucellosis patients. Additionally because current attenuated Brucella vaccines used in animals cause human disease, there is a true need for a recombinant protein subunit vaccine for human brucellosis, as well as for improved diagnostics in terms of prognosis and identification of unusual forms of brucellosis. This review will focus on current understandings of antigen-specific immune responses induced Brucella peptidic epitopes that has promise for yielding new insights into vaccine and diagnostics development, and for understanding pathogenetic mechanisms of human brucellosis

Il-4 Polymorphism in Patients with Acute Brucellosis in the Republic of Azerbaijan

Currently, there are isolated data on the relationship between IL-4 polymorphism (C-589T) and susceptibility to brucellosis. Therefore, the purpose of the study was to determine the frequency of polymorphism of IL-4 (C-589T) in patients with acute brucellosis.Materials and methods: the article presents the results of surveys of 120 patients with acute brucellosis. The control group consisted of 30 practically healthy persons. The diagnosis of brucellosis was based on complaints, anamnesis, epidemiological and clinical data, and the results of a specific study. The definition of the polymorphism of IL-4 (C-589T) was performed for all patients in the main and control group. A detailed description of patients with brucellosis is presented. Among the observed prevailed men and young people of working age.Results: A mild degree was established in 74 (61.66 %) patients, while severe - only in 11 (9.17 %) patients. It was determined that the genotype CT (65.83 %) was significantly more common among patients with brucellosis than in the control group, where the frequency of this genotype was only 16.66 %. While the CC genotype was 3.2 times more common among healthy individuals than among patients in the main group (76.67 % versus 24.17 %), it was found that the CC genotype of the IL-4 gene was 13 times more common in patients for acute brucellosis with mild progress than with severe.Conclusions: The genotype IL-4 (C-589T) SS is significantly associated with the mild course of brucellosis

Evaluation of ELISA and Brucellacapt tests for diagnosis of human Brucellosis

Background and Objectives: Brucellosis is one of the most common zoonotic diseases in Iran and human brucellosis is endemic in all parts of the country. Because of the difficulty in the diagnosis of brucellosis, particularly in endemic areas, the use of new and feasible diagnostic tests seem to be of great importance for resolving the diagnostic obstacles. We evaluated the usefulness of a new serological test based on an immunocapture-agglutination technique in comparison with ELISA test for serological diagnosis of brucellosis. Materials and Methods: A total of 11 patients with brucellosis, who had positive blood cultures for Brucella species, and 47 suspected patients were included in this study. Serum samples collected from these patients were tested by brucellacapt and ELISA and the results were, consequently, compared. Results: In patients with positive blood culture, all the samples gave positive results with brucellacapt test while IgM ELISA, IgG ELISA and (IgG + IgM) ELISA tests were positive in 8, 9 and 11 patients, respectively. Out of the 46 suspected patients, (IgG + IgM) ELISA, Brucellacapt, IgG ELISA and IgM ELISA were positive in 37, 15, 34 and 37 patients, respectively.The best cut-off point of ELISA-IgG was 10.78 IU/ml which produced the maximal sensitivity and specificity for the diagnosis of human brucellosis. Conclusion: Both the (IgG + IgM) ELISA and Brucellacapt tests demonstrate a high specificity in this study. According to the results of the current study, it is found that both tests are valuable tools for diagnosis of brucellosis in Iran as an endemic area of brucellosis. It is strongly suggested that a combination of both tests to be used for the diagnosis of brucellosis

Determination of sensitivity and specificity of PCR in diagnosis of human brucellosis

Background and Objective: Brucellosis is one of the most common zoonotic diseases in Iran and human brucellosis is endemic in all parts of the country. Diagnosis of brucellosis is frequently difficult to establish. This is not only because the disease clinically mimic any infectious and non infectious diseases, but also because the established diagnostic methods are not always successful in isolating the organisms. The aim of this study was to determine the sensitivity and specificity of PCR method for diagnosis of human brucellosis. Material and Methods: 30 serum samples from patients with clinical presentation of brucellosis that had positive wright test and 30 serum samples of healthy people with negative wright test were included in this study. These samples were examined by PCR with F4/R2 primer. Results: In patients, how were positive wright test , 15 samples were positive by PCR. While In healthy persons, 5 samples were positive by PCR. The sensitivity and specificity of PCR was 66.67%, 88.23% respectively. Conclusion: we found that PCR had not high sensitivity and specificity in diagnosis of brucellosis. For this reason, we suggested the use of combination methods for diagnosis of human brucellosis

Bovine tuberculosis and brucellosis prevalence in cattle from selected milk cooperatives in Arsi zone, Oromia region, Ethiopia

Bovine tuberculosis (BTB) and bovine brucellosis are two important milk-borne zoonoses that have been shown to be prevalent to various degrees in Ethiopian cattle. The study was carried out in four Woredas (districts) around Asella town, Arsi Zone between October 2011 and March 2012 and included 318 small-holders in 13 dairy cooperatives that marketed the delivered milk. The aims of the study were i) to assess the prevalence of the two diseases in cattle in a cross-sectional study, ii) to assess potential risk factors of BTB and brucellosis to humans as well as the knowledge-attitude-practice (KAP) among these farmers towards these diseases.; BTB testing using the comparative intradermal skin test (CIDT) was done on 584 milking cows, out of which 417 were serologically tested for brucellosis using the Rose Bengal Plate Test and reactors confirmed with an indirect ELISA test (PrioCHECK®). The individual animal prevalence was 0.3% (95% CI 0.1% to 1.3%) for BTB, 1.7% (95% CI 0.8% to 3.5%) for brucellosis and 8.9% (95% CI 6.8% to 11.5%) for MAC (Mycobacterium avium complex). Of the 13 milk cooperatives, two had at least one positive BTB reactor and five had animals positive for brucellosis. Cross-breeds accounted for 100% and 71.4% of the BTB and brucellosis reactors respectively. For both diseases, there were prevalence variations depending on Woreda. No animal was concomitant reactor for BTB and brucellosis. Raw milk was consumed by 55.4% of the respondents. 79.2% of the respondents reported touching the afterbirth with bare hands. The latter was fed to dogs in 83% of the households. One cow among the herds of the 130 interviewees had aborted in the last 12 months. Among the interviewees, 77% stated knowing tuberculosis in general but 42 out of the 130 respondents (32.3%) did not know that BTB was transmitted by livestock. Less than half (47.7%) of the respondents knew about brucellosis.; Low prevalence of both diseases reflected the potential for the area to compete with the growing milk demand. The authors discussed the possible control strategies for the area