Inmunopatología de la brucelosis osteoarticular / Immunopathology of osteoarticular brucelosis

La brucelosis es una de las enfermedades zoonóticas más importantes a nivel mundial capaz de producir enfermedad crónica en los seres humanos. La localización osteoarticular es la presentación más común de la enfermedad activa en el hombre. Sin embargo, algunos de los mecanismos moleculares implicados en la enfermedad osteoarticular han comenzado a dilucidarse recientemente. Brucella abortus induce daño óseo a través de diversos mecanismos en los cuales están implicados TNF-α y RANKL. En estos procesos participan células inflamatorias que incluyen monocitos/macrófagos, neutrófilos, linfocitos T del tipo Th17 y linfocitos B. Además, B. abortus puede afectar directamente las células osteoarticulares. La bacteria inhibe la deposición de la matriz ósea por los osteoblastos y modifica el fenotipo de estas células para producir metaloproteinasas de matriz (MMPs) y la secreción de citoquinas que contribuyen a la degradación del hueso. Por otro lado, la infección por B. abortus induce un aumento en la osteoclastogénesis, lo que aumenta la resorción de la matriz ósea orgánica y mineral y contribuye al daño óseo. Dado que la patología inducida por Brucella afecta el tejido articular, se estudió el efecto de la infección sobre los sinoviocitos. Estos estudios revelaron que, además de inducir la activación de estas células para secretar quemoquinas, citoquinas proinflamatorias y MMPs, la infección inhibe la muerte por apoptosis de los sinoviocitos. Brucella es una bacteria intracelular que se replica en el retículo endoplásmico de los macrófagos. El análisis de los sinoviocitos infectados con B. abortus indicó que las bacterias también se multiplican en el retículo endoplasmático, lo que sugiere que la bacteria podría usar este tipo celular para la multiplicación intracelular durante la localización osteoarticular de la enfermedad. Los hallazgos presentados en esta revisión intentan responder a preguntas sobre los mediadores inflamatorios implicados en el daño osteoarticular causado por Brucella. (AU)

Brucellosis is one of the most important zoonotic diseases that can produce chronic disease in humans worldwide. Osteoarticular involvement is the most common presentation of human active disease. The molecular mechanisms implicated in bone damage have started to be elucidated. B. abortus induces bone damage through diverse mechanisms in which TNF-α and RANKL are implicated. These processes are driven by inflammatory cells, including monocytes/macrophages, neutrophils, Th17 lymphocytes and B cells. Also, Brucella abortus (B. abortus) can directly affect osteoarticular cells. The bacterium inhibits bone matrix deposition by osteoblast and modifies the phenotype of these cells to produce matrix methalloproteinases (MMPs) and cytokine secretion that contribute to bone matrix degradation. B. abortus also affects osteoclast increasing mineral and organic bone matrix resorption and contributing to bone damage. Since the pathology induced by Brucella species involves joint tissue, experiments conducted in sinoviocytes revealed that besides inducing the activation of these cells to secrete chemokines, proinflammatory cytokines and MMPS, the infection also inhibits sinoviocyte apoptosis. Brucella is an intracellular bacterium that replicate in the endoplasmic reticulum of macrophages. The analysis of B. abortus infected sinoviocytes indicated that bacteria also replicate in their reticulum suggesting that the bacterium could use this cell type for intracellular replication during the osteoarticular localization of the disease. The findings presented in this review try to answer key questions about the inflammatory mediators involved in osteoarticular damage caused by Brucella. (AU)

Brucelosis en Chile: descripción de una serie de 13 casos / Brucellosis in Chile: description of a series of 13 cases

Introduction: Brucellosis is a zoonosis caused by Brucella spp. It may be acquired by consuming unpasteurized dairy products. Brucellosis has a low incidence in Chile, thus, we have a scarce data. Aim: To report and to characterize the first series of clinical cases of adult patients diagnosed with brucellosis in Chile. Methods: We describe a series of 13 clinical cases in patients diagnosed between 2000 and 2016 in three different centers in the Metropolitan Region, Chile. A retrospective analysis was performed on clinical presentation, laboratory, antibiotic treatment, morbidity and mortality. Results: The mean age was 50 years old. Eight cases had a record of consumption of unpasteurized dairy products. The most frequently reported complaints were fever. The most frequent focal point involved was the spine. Only one patient had a positive blood culture, while the diagnosis was made using serological techniques in the other part of the group. The most indicated antibiotic regimens were doxycycline-rifampicin and doxycycline-gentamicin. The hospital stay was 20 days approximately as an average. Clinical cure was achieved in all cases. Conclusions: Brucellosis is an infrequent zoonosis in Chile, and it produces a nonspecific clinical picture, so it is necessary to have high suspicion to make the diagnosis based in the antecedent of consumption of unpasteurized dairy or raw meat.

Introducción: La brucelosis es una zoonosis provocada por Brucella spp, cuyo principal mecanismo de transmisión es mediante el consumo de lácteos no pasteurizados. Es de baja ocurrencia en Chile, por lo que los datos locales son escasos. Objetivo: Reportar y caracterizar la primera serie de casos clínicos de pacientes adultos con diagnóstico de brucelosis en Chile. Material y Método: Se describe una serie de 13 casos clínicos en pacientes diagnosticados entre el año 2000 y el 2016 en tres centros de la Región Metropolitana, Chile. Se realizó un análisis retrospectivo acerca de la presentación clínica, laboratorio, tratamiento antimicrobiano y morbi-mortalidad. Resultados: El promedio de edad fue 50 años. Ocho casos tenían antecedente de consumo de lácteos no pasteurizados. El motivo de consulta más frecuente fue sensación febril. El compromiso focal más frecuente fue el de columna vertebral. Sólo en un paciente se encontró hemocultivo positivo; en el resto el diagnóstico se hizo mediante técnicas serológicas. Los esquemas antimicrobianos más indicados fueron doxiciclina-rifampicina y doxiciclina-gentamicina. La estadía hospitalaria fue en promedio de 20 días. En todos los casos se logró curación clínica. Conclusiones: La brucelosis es una zoonosis infrecuente en Chile, produce un cuadro clínico inespecífico, por lo que se debe tener una alta sospecha para realizar el diagnóstico, basada en el antecedente del consumo de productos lácteos no pasteurizados o de carne mal cocida.

Prevalence and factors associated with human brucellosis in livestock professionals / Prevalência e factores associados à brucelose humana em profissionais da pecuária

ABSTRACT OBJECTIVE The objective of this study is to estimate the seroprevalence of human brucellosis in livestock professionals and analyze the factors associated with brucellosis focusing on sociodemographic variables and the variables of knowledge and practices related to the characteristics of the activities carried out in livestock. METHODS This is a cross-sectional seroepidemiological study with a population of 131 workers of butchers, slaughter rooms, and slaughterhouse and 192 breeders sampled randomly in Namibe province, Angola. The data were obtained from the collection of blood and use of questionnaires. The laboratory tests used were rose bengal and slow agglutination. The questionnaire allowed us to collect sociodemographic information and, specifically on brucellosis, it incorporated questions about knowledge, attitudes, and behaviors of livestock professionals. In addition to the descriptive statistical approach, we used the Chi-square test of independence, Fisher’s test, and logistic regression models, using a significance level of 10%. RESULTS The general weighted prevalence of brucellosis was 15.6% (95%CI 13.61–17.50), being it 5.3% in workers and 16.7% (95%CI 11.39–21.93) in breeders. The statistical significance was observed between human seroprevalence and category (worker and breeder) (p < 0.001) and education level (p = 0.032), start of activity (p = 0079), and service location (p = 0.055). In a multivariate context, the positive factor associated with brucellosis in professionals was the professional category (OR = 3.54; 95%CI 1.57–8.30, related to breeders in relation to workers). CONCLUSIONS Human brucellosis in livestock professionals is prevalent in Namibe province (15.6%), where the professional category was the most important factor. The seroprevalence levels detected are high when compared with those found in similar studies.

RESUMO OBJECTIVO Estimar a seroprevalência da brucelose humana em profissionais da pecuária e analisar os factores associados à brucelose com foco em variáveis sociodemográficas, de conhecimento e práticas relativas às características das actividades desenvolvidas na pecuária. MÉTODOS Estudo transversal seroepidemiológico em população de 131 trabalhadores de talhos, salas de abate e matadouro e 192 criadores amostrados aleatoriamente na província do Namibe, Angola. Os dados foram obtidos por meio de colheita de sangue e aplicação de questionário. Os testes laboratoriais utilizados foram o Rosa de Bengala e a aglutinação lenta em tubos. O questionário permitiu recolher informação sociodemográfica e, especificamente sobre a brucelose, incorporou questões sobre conhecimento, atitudes e comportamentos dos profissionais da pecuária. Além da abordagem estatística descritiva, foram utilizados os testes de Independência do Qui-quadrado, Fisher e modelos de regressão logística, utilizando um nível de significância de 10%. RESULTADOS A prevalência geral ponderada da brucelose foi de 15.6% (IC95% 13.61–17.50), sendo 5.3% em trabalhadores e 16.7% (IC95% 11.39–21.93) em criadores. A significância estatística foi observada entre a seroprevalência humana e a categoria (trabalhador e criador) (p < 0.001) e o nível de instrução (p = 0.032), início de actividade (p = 0.079) e local de serviço (p = 0.055). Em um contexto multivariado, o factor positivamente associado à brucelose em profissionais foi a categoria profissional (OR = 3.54; IC95% 1.57–8.30, relativo aos criadores em relação a trabalhadores). CONCLUSÕES A brucelose humana em profissionais da pecuária é prevalente na província do Namibe (15.6%), onde a categoria profissional foi o factor mais relevante. Os níveis de seroprevalência detectados são elevados se comparados com outros encontrados em estudos semelhantes.

Human Brucellosis in Khartoum State: a Commonly Underdiagnosed Disease

Back ground: Human brucellosis is a major debilitating zoonotic disease. It is caused by bacteria of the genus Brucella Methods: The serum antibody titres to Brucella melitensis and Brucella abortus of one thousand febrile patients; randomly selected from Khartoum; Khartoum North and Omdurman Teaching Hospitals; were estimated by the STAT. Results: Eighty nine (8.9) of the febrile patients had brucellosis. The average age of brucellosis patient was 43.9 years. Sixty three (70.8) of the brucellosis patients were males; and 26 (29.2) were females. Fifty four (60.7) of them had significant titres to Brucella melitensis while 23 (25.8) patients had significant titres to Brucella abortus. Twelve (13.5) patients had significant titres to both Brucella melitensis and Brucella abortus. The average diagnostic delay of brucellosis in this study was 88.6 days. Conclusion: Brucellosis was found to be misdiagnosed as malaria or typhoid fever. Animal contact was found to be a significant risk factor

Brucellosis in a high risk occupational group: seroprevalence and analysis of risk factors

To estimate Brucella seropositivity among slaughterhouse workers of Lahore district and to elucidate risk factors associated with seropositivity to Brucella. During the year 2008, a cross-sectional study was conducted in four slaughterhouses of Lahore district. A sample of 360 workers was selected from these slaughterhouses through stratified random sampling on proportional basis. Workers were interviewed using a structured questionnaire to obtain risk factor information and their blood samples were collected to be screened for the presence of anti-Brucella IgG using Enzyme Linked Immunosorbent Assay [ELISA] technique. Data management and analysis were performed using SPSS [statistical package for social sciences] version 16. Risk factors associated with seropositivity to anti-Brucella IgG were identified by constructing a logistic regression model. Of the 360 serum samples tested, 21.7% [95% Cl 17.44% - 25.96%] were positive by ELISA test. The logistic regression model identified age [OR 0.96, 95% Cl 0.94-0.99], assistance in parturition of animal [OR 0.47, 95% Cl 0.23-0.96], consuming raw milk [OR 2.25, 95% Cl 1.04-4.87] and handling sheep [OR 0.30, 95% Cl 0.09- 0.92] as risk factors for Brucella seropositivity among slaughterhouse workers of Lahore district. To reduce the burden of brucellosis, a national brucellosis control programme should be initiated with special emphasis on the high risk population of slaughterhouse workers

brucellosis a common infectious cause of Pyrexia of unknown origin in Kuwait?

To investigate the prevalence of brucellosis and to compare it with other causes of pyrexia of unknown origin [PUO] in Kuwait Retrospective study Infectious Disease Hospital, Kuwait All patients admitted to Infectious Disease Hospital with a diagnosis of PUO between January 2001 and December 2004 were included in this study. Age, gender, nationality, occupation, residence and laboratory investigations One hundred thirty six patients were admitted with PUO to the hospital. Their mean age was 36.7 +/- 11.69 years [range: 14-80 years]. The mean duration of hospitalization was 8.7 +/- 7.8 days. Infectious diseases were the most common causes of PUO. Brucellosis was diagnosed in 80 [58.8%] patients, respiratory tract infection in 10 [7.4%], gastrointestinal diseases in 14 [10.3%] and HIV was diagnosed in three patients. Other diseases such as thyroiditis and glaucomatous hepatitis were diagnosed in 15 [11%] patients. Brucellosis patients had high alanine amino transferase [ALT] level and lower white blood cell [WBC] count than other PUO patients [56.9 +/- 40.6 Vs. 38 +/- 31.4, p < 0.003 and 7.1 +/- 3.9 Vs. 8.5 +/- 4.04, p < 0.01 respectively]. Brucellosis was common among Asian population [58.8% compared to Gulf residents 31.3% and other nationals 10%, p = 0.022]. Brucellosis is common among patients in high-risk occupations [62.5% compared to non-high risk occupations 37.5%, p < 0.0001]. Brucellosis is the common infectious cause of PUO among Asian and patients in high-risk occupations in Kuwait

Isolation of Brucella from blood culture of hospitalized brucellosis patients

Brucellosis is a zoonotic disease that is endemic in Iran. Appropriate and rapid diagnosis has a vital role in public health improvement. Low isolation rate of the organism has reported frequently in various reports. The present study was conducted to determine the isolation rate of organism in culture from collected specimens of hospitalized patients who were not under antibiotic therapy. Meanwhile, comparing the direct inoculation to biphasic media with lysis method was also determined. Twenty-five hospitalized brucellosis patients diagnosed on the basis of clinical manifestations and positive serologic tests were included. Blood samples were provided and cultured either as direct inoculation into biphasic media or lysis method by washing with distilled water before culture on solid media. Brucella was isolated in 4 samples [16%]. Further studies revealed all these four cases to be B. melitensis. Washing method did not differ in isolation rate with direct inoculation; however, Brucella was isolated in a shorter period in washing method. Higher isolation rate when compared with prior studies indicates an appropriate sampling time and technique, rapid inoculation to the media, and the lack of antibiotic therapy before sampling. Washing method has the preference of shorter isolation time to direct inoculation; however, it is faced with a higher risk of contamination

Isolation of brucella melitensis and brucella abortus from brucellosis patients by conventional culture method and polymerase chain reaction technique

Isolation of B. melitensis and B. abortus from brucellosis patients by application of conventional culture and PCR methods and comparison of sensitivity of both techniques in diagnosis of human brucellosis. Infectious diseases Ward, Ahwaz University's hospitals over a period of 9 months [September 2003 to May 2004]. A total of 30 peripheral blood samples were collected from patients with brucellosis referred to infectious Diseases Unit of Ahwaz University's hospitals. The samples were inoculated into Castaneda medium and after 7-30 days, the isolated colonies were identified by inoculation into brucella agar containing thionine and fuschin and by performance of biochemical tests. DNA was extracted from colonies and serum samples and examined by PCR involving specific primers for B. melitensis and B. abortus based on IS 711 in the brucella chromosome. We identified 8 isolates of B. melitensis using culture and biochemical methods. When PCR technique was applied to serum samples, 28 cases were positive for B. melitensis and we were able to isolate more cases compared to culture method and the difference was significant [P<0.05]. The sensitivities of culture and PCR in this study were determined as 26.6% and 93.3% respectively. Neither of examined cultures or sera subjected to PCR were positive for B. abortus. The results of present study showed that PCR assay is a rapid and sensitive technique for diagnosis of brucellosis compared to culture method. However it is more valuable when coupled with conventional methods

Seroprevalencia de brucelosis en trabajadores de mataderos de municipios del Tolima(Colombia / Seroprevalence of brucellosis in workers of slaughter houses in the municipalities of Tolima (Colombia)

La brucelosis es una enfermedad que se presenta principalmente en personal que tiene contacto cercano con el ganado o que consume derivados que no se han tratado adecuadamente.Métodos: se realizó un estudio de corte transversal para determinar la seroprevalencia de brucelosis en trabajadores de mataderos de algunos municipios del Departamento del Tolima (Colombia). Se evaluaron 186 trabajadores a quienes se aplicaron las pruebas serológicas indirectas (rosa de bengala, fijación de complemento y Elisa).Resultados: se detectó una prevalencia de anticuerpos antibrucella cercana al 4 por ciento en la población evaluada, con una llamativa correlación entre condiciones de higiene del trabajo y seropositividad.Conclusiones: los trabajadores de mataderos con condiciones técnico-higiénicas desfavorables se encuentran en mayor riesgo de contagio de brucelosis.

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

A study of differentials causing flu-like symptoms (malaria; typhoid; streptococcal infections and rheumatoid arthritis) in 488 patients from a pastoralist area is presented. The potential usefulness of clinical signs; symptoms and diagnostic tests in ruling-in or ruling-out these diseases was investigated in the District hospital and three outlying health dispensaries. For each patient a detailed clinical history plus diagnostic test for brucellosis; typhoid; streptococcal infections and rheumatoid arthritis; and for some patients malaria were conducted. Incidence levels of these diseases were estimated using laboratory test results; brucellosis; 13; typhoid; 40: streptococcal infections; 6malaria; 9: and rheumatoid arthritis; 10. Brucellosis could not be differentiated clinically from the other flu-like diseases but rheumatoid arthritis could

Human brucellosis in Gaza Strip, Palestine

The magnitude of the brucellosis problem in the Gaza Strip and the exposure to risk factors among cases were investigated. The incidence of brucellosis in 1996 was 8/100 000. The age-specific incidence rate was approximately equal in all age groups, with a mean age of infection of 20 years. Cases were reported from all districts, with a particularly high incidence in the Mid-zone district and Gaza City, and most cases had onset of illness in spring and summer. The main reported risk factor was consumption of milk and milk products, especially home-made cheese [70.4%], and 22.2% of cases were among animal breeders. The proportion of chronic and relapsing cases was very high [17%]

Brucelose: relato de dois casos / Brucellosis: two cases report

Os autores descrevem dois casos de brucelose humana, ocorridos recentemente no Estado de Pernambuco. O primeiro deles acometeu um vaqueiro, que contaminou-se no exercício de suas atividades profissionais. O outro paciente, um diplomata americano, adquiriu a doença através da ingestäo de queijo de coalho cru. Apesar de pouco notificada na regiäo nordeste do Brasil, a brucelose ainda encontra-se presente, devendo ser lembrada nos pacientes com febre prolongada de origem näo esclarecida

Púrpura trombocitopénica asociada a brucelosis / Thrombocytopenic purpura in human brucellosis

Entre los años 1981 a 1990 se estudiaron las características clínicas de la púrpura trombocitopénica asociada a brucelosis. De 1091 pacientes con brucelosis, 27 presentaron púrpura durante la enfermedad, de éstos, 22 (81.5 por ciento) fueron hospitalizados y 5 (18.5 por ciento) evaluados ambulatoriamente. Veintiuno (77.7 por ciento) fueron mujeres y 6 hombres (22.3 por ciento). El rango de edad fluctuó entre 2 y 77 años, promedio de 28.7 años. Presentaron anemia 23 pacientes (85.1 por ciento), leucopenia 10 (37 por ciento) y trombocitopenia 22 (88 por ciento). Se observó pancitopenia en 10 pacientes (37 por ciento). El estudio de médula ósea en 22 pacientes mostró: hipercelularidad en 16 (72.2 por ciento), hiperplasia megacariocítica en 11 (50 por ciento), histiocitofagocitosis en 8 (36.4 por ciento), ausencia de hierro medular en 13 (59.1 por ciento) y granulomas en el coágulo de la médula ósea en 2 pacientes. Se utilizó corticoterapia en todos los pacientes con trombocitopenia severa observándose remisión completa en el 73 por ciento de los casos. Tres pacientes necesitaron esplenectomía por ser refractarios a la corticoterapia. Dos pacientes fallecieron por hemorragia en el sistema nervioso central

Brucella agglutination titre in febrile versus healthy cases

Brucella tube agglutination test was performed to measure brucella antibody titre in 55 clinically healthy individuals [Controls], and 45 febrile patients due to custom to drink unpasteurised milk. Brucella antibodies were detected in 20 [36.3%] healthy subjects with titre ranging from 1:15 to 1:60, while the rest 35 [63.7%]. had negative titre. From the ferible group, 36 [80%] patient had positive titre. The highest antibody titre [1:960] was observed in two cases who had clinical manifestations suggestive of brucellosis, and their repeated blood cultures were positve for brucella organisms. Out of 7 typhoid fever cases, 5 cases [70.4%] had titres ranging from 1:60 to 1:240, but with no rising titres in subsequent estimations. Fever of other aetiologies were either negative or positive at low levels for brucella agglutination titres, the significance of these results had been discussed

Prevalencia de la brucelosis humana en el matadero y la feria de ganado de Medellin / Prevalence of human brucelosis in the slaughterhouse and livestock market at Medellin city

Se estudiaron 186 empleados del Matadero y Feria de Ganado del Municipio de Medellin (Colombia), buscando la prevalencia de brucelosis. Se baso el diagnostico en la presencia de titulos mayores de 1:50 en la pruebas en placa (Bang), en tubo y 2-Mercaptoetanol, en aquellos pacientes con sintomatologia clinica compatible con un cuadro de brucelosis. Se encontro solo un caso positivo y 3 casos sospechosos. Debido a esto, no se lograron establecer relaciones significativas entre la enfermedad y otros factores como la sintomatologia, el oficio, el tiempo de exposicion o los antecedentes personales. Esta baja ocurrencia en humanos (0.5%) parece fijar la prevalencia de brucelosis en bovinos procedentes de las zonas que tributan a esta ciudad