Epidemiology and the agreement rate of serological tests in human brucellosis in North East of Iran

Abstract

Background: Brucellosis still remains a major health problem with different symptoms and various diagnostic methods. Diagnostic methods of brucellosis are usually based on detecting specific antibodies in the patient’s serum. Nowadays, many serological tests are applied for the diagnosis of human brucellosis. Most routine tests are serum agglutination tests based on Wright and 2-Mercaptoethanol (2-ME). Objectives: The aim of this study (cross sectional study) was to evaluate the prevalence of brucellosis and assess the degree of agreement among serum samples of suspected brucellosis serological tests routinely performed in Mashhad, Iran. Patients and Methods: This study was conducted in Mashhad from August 2011 to September 2012. Sera (2 - 3 mL) were collected from 83 cases suspected of brucellosis among 594 patients. Ten serum samples were collected from healthy subjects as control sera. Rose Bengal test for initial screening and Wright and 2 ME as standard tests were conducted to determine antibody titers. Thereafter, IgG and IgM levels were determined by the Enzyme Linked Immunosorbent Assay (ELISA) method. Results: Among 83 serum samples, Rose Bengal test was able to identify 20 (12%) positive specimens; the standard tube agglutination test was able to detect 30 (18%) positive samples, and the ELISA IgG and ELISA IgM were able to trace 42 (21%) and 13 (6.5%) positive samples, respectively. Ten control samples had negative results for the ELISA method. The results were calculated by the Kappa formula. The highest level of agreement was among 1 = KRB-SAT tests and the lowest level of agreement was among tests K ELISA IgM-IgG = 0.30. Conclusions: According to the results, brucellosis has remained endemic in this region. Most cases were detected by ELISA IgG. The highest kappa agreements were between tests KRB-SAT, KRB-IgG and KSAT-IgG, while the lowest levels of agreement were between tests SAT-IgM and ELISA IgM-IgG. Considering that ELISA IgM results are covered by SAT and ELISA IgG test results, applications of this test do not seem necessary. © 2015, Infectious Diseases and Tropical Medicine Research Center