Spatiotemporal distribution and ecological factors of brucellosis among children from 2016 to 2020 in Inner Mongolia, China.

OBJECTIVE: In recent years, the increasing incidence of brucellosis in children has become more serious. However, relatively few studies have been conducted to characterize the spatialtemporal distribution of brucellosis in children. This study aimed to analyze the spatiotemporal distribution characteristics and ecological influencing factors of brucellosis incidence among children in Inner Mongolia. METHODS: This study used data on brucellosis incidence in children aged 0-14 years reported in Inner Mongolia from 2016 to 2020. A Bayesian model was used to analyze the spatial and temporal distribution of brucellosis in children from 2016 to 2020 in Inner Mongolia. Geographical weighted regression model was used to analyze the ecological factors related to the incidence of brucellosis in children. RESULT: Bayesian spatiotemporal analysis indicated that the highest brucellosis risk and increased disease incidence were observed in Hinggan, Inner Mongolia, in children aged 0-14 years. Alxa had the lowest risk but the incidence rate increased rapidly. The incidence of childhood brucellosis was positively associated with the number of sheep at the year-end (ß: 2.5909 ~ 2.5926, P < 0.01), average temperature (ß: 2.8978 ~ 2.9030, P < 0.05), and precipitation level (ß: 3.3261 ~ 3.3268, P < 0.01). CONCLUSION: From 2016 to 2020, the overall incidence of brucellosis in children in Inner Mongolia showed an upward trend, with cases exhibiting spatial aggregation. We should focus on areas where the incidence of brucellosis in children is rising rapidly. The incidence of childhood brucellosis was associated with the number of sheep at the year-end, average temperature and precipitation level. IMPLICATIONS AND CONTRIBUTION: The findings suggest that brucellosis in children is not to be taken lightly. For children should also focus on protection, take corresponding protective measures. While we focus on high-risk areas, we must also monitor areas where the risk of disease is low, but the incidence is rising fast, to prevent outbreaks in low-risk areas from becoming high-risk areas.

Seroprevalence of Brucellosis in Sheep and Goats With Owners' Knowledge, Attitudes and Practices in Garowe District, Nugal region, Somalia.

Brucellosis is an important neglected bacterial zoonotic disease in sub-Saharan Africa, including Somalia. A cross-sectional study was conducted in the Garowe district, Nugal region, Somalia, from May 2022 to January 2023 to estimate the seroprevalence of small ruminant brucellosis and assess owners' knowledge, attitudes, and practices toward brucellosis. A total of 384 sheep and goats were selected using a simple random sampling technique and screened for Brucella antibodies by the Modified Rose Bengal Plate Test, and positive samples were then further confirmed using an indirect enzyme-linked immunosorbent assay. For the questionnaire survey, 384 households were selected randomly, and a structured questionnaire was used to assess owners' knowledge, attitudes, and practices toward brucellosis. The overall brucellosis seroprevalence was 4.7% in small ruminants (95% CI: 2.8-7.3), and the true seroprevalence was calculated as 5.2%. According to the multivariable logistic regression analysis, sex was found to be a potential risk factor for small ruminant brucellosis (P < .05). More specifically, female sheep and goats were 9.13 times (aOR 9.13, 95% CI: 1.18-70.33) more likely to become seropositive than males. The owners' knowledge, attitudes, and practices toward brucellosis were found to be low, and education level was associated with owners' knowledge (χ2 = 16.78; P < .001), attitudes (χ2 = 19.4; P < .001) and practices (χ2 = 34.0; P < .001). There is also a significant association between owner knowledge, attitudes, and practices and seropositivity of brucellosis in sheep and goats. Moderate seroprevalence, together with insufficient knowledge, attitudes, and practices of owners, makes brucellosis a threat to animals and the entire community. Hence, raising community awareness of the disease is essential to reduce the impact on small ruminant productivity and the risks to public health.

Vitrectomy Combined with Repeated Intravitreal Injection of Ceftazidime for the Treatment of Brucellosis Endophthalmitis: A Case Report and Literature Review.

PURPOSE: To present a treatment regimen for Brucellosis endophthalmitis that resulted in a good visual outcome. Additionally, we conducted a literature review on the treatment and visual prognosis of related cases. CASE PRESENTATION: A 49-year-old woman with the chief complaint of decreased vision and redness in the right eye was initially diagnosed with noninfectious uveitis and prescribed high-dose steroids which led to transient improvement followed by a decline in vision. An infectious cause was suspected. Metagenomic next-generation sequencing of vitreous fluid and serological testing confirmed Brucella melitensis infection. The patient underwent vitrectomy combined with six intravitreal injections of ceftazidime in the right eye in addition to systemic antibiotic treatment. The intraocular inflammation was completely resolved, and the visual acuity recovered to 20/25, which is the best-documented recovery in Brucella endophthalmitis cases, as revealed by the literature review. CONCLUSION: Vitrectomy combined with repeated intravitreal injections of ceftazidime can enhance the treatment for brucellosis endophthalmitis and achieve a better visual prognosis.

Epidemiology of brucellosis in Mazandaran, North of Iran in a nine-year period (2009-2017).

Background: Brucellosis is a common disease between humans and animals that still exists in most parts of Iran. This study investigated the epidemiology of brucellosis in Mazandaran province, Iran, during a nine-year period from the beginning of 2009 until the end of 2017. Methods: This descriptive-analytical study was conducted based on the guidelines of Iran's Ministry of Health and Medical Education on the data of 3732 brucellosis patients. The data were retrieved from the private and public laboratories gathered in a Ministry's database. We used the generalized estimating equation (GEE) for the Poisson regression model (Poisson GEE) to examine the disease incidence based on the studied variables. Results: The age-standardized incidence rate has been 13.2 per 100,000 people (15.6 in men and 21.3 in rural areas). The highest rate (17.2) was in 2012 and the lowest (10.6) was in 2014. The cities of Galugah (35.0) and Qaemshahr and Fereydunkenar (3.0) had the highest and lowest incidence rates. The patients' professions had been 30% housewives, 14.9% ranchers, and 14.4% livestock-related professions. The highest standard incidence was in people older than 55 years old. The results of the Poisson GEE regression model showed that the disease incidence has been higher in men compared to women and in rural compared to urban areas (risk ratio = 1.5, 3.4, P = 0.001). Conclusion: Mazandaran faces the risk of increased brucellosis incidence rate. Taking preventive measures, including educating people, are recommended for the near future.

A rare case of necrotizing pneumonia due to brucellosis with blood and urine culture positivity.

Brucellosis is a zoonotic infectious disease widely seen worldwide, especially in developing countries and endemic regions where livestock farming is common. Brucella primarily affects the reticuloendothelial system and joints but can also localize in the central nervous, cardiovascular, and genitourinary systems. Pulmonary and urinary involvements are very rarely reported in the literature. This article presents a 24-year-old male patient who was admitted with syncope. Initially admitted with a preliminary diagnosis of Crimean-Congo hemorrhagic fever, the first thoracic computed tomography findings of the patient were considered alveolar hemorrhage. However, due to the growth of Brucella spp. in blood and urine cultures, the patient was diagnosed with necrotizing pneumonia due to brucellosis.

Clinical characterization of brucellosis in children from non-pastoral areas: a report of five cases.

BACKGROUND: Brucellosis is a global public health concern and occurs mainly in young adults and the elderly, with children having a lower incidence, thus often leading to delayed treatment. This study aimed to describe the epidemiologic features and clinical characteristics of brucellosis in children. METHODS: In this retrospective study, the clinical data of five children diagnosed with brucellosis in Anhui Provincial Children's Hospital between January 1, 2021 and December 30, 2022 were analyzed. RESULTS: All five cases were from non-pastoral areas, among which three have a history of livestock exposure and originated from the countryside. All patients had medium-high grade fever, mostly accompanied by night sweats and malaise, and three had joint pains. Laboratory tests showed that their white blood cell count was normal or mildly raised, with lymphocytes as the predominant cell population. Four patients had anemia, four had aspartate aminotransferase and alanine aminotransferase abnormality, and two had elevated ferritin levels. All blood samples were positive for Brucella culture, one of which had positive bone marrow culture, and all had positive serology test results. All patients were treated with rifampicin, in combination with sulfamethoxazole or doxycycline for 6 weeks following diagnosis. Four children had a good prognosis, but one child had recurrent joint pain. CONCLUSIONS: The epidemiologic history of children from non-pastoral areas with brucellosis is often unclear; clinical manifestations and laboratory tests lack specificity; and they are easily delayed diagnosis. Clinicians should remain vigilant regarding the possibility of this disease in children with fever of unknown origin. The epidemiological history should be investigated in detail to improve the diagnostic ability of brucellosis. We recommend emphasizing serological testing. Children with brucellosis who receive timely diagnosis and standardized treatment can expect a favorable prognosis.

Stability of a stochastic brucellosis model with semi-Markovian switching and diffusion.

To explore the influence of state changes on brucellosis, a stochastic brucellosis model with semi-Markovian switchings and diffusion is proposed in this paper. When there is no switching, we introduce a critical value R s and obtain the exponential stability in mean square when R s < 1 by using the stochastic Lyapunov function method. Sudden climate changes can drive changes in transmission rate of brucellosis, which can be modelled by a semi-Markov process. We study the influence of stationary distribution of semi-Markov process on extinction of brucellosis in switching environment including both stable states, during which brucellosis dies out, and unstable states, during which brucellosis persists. The results show that increasing the frequencies and average dwell times in stable states to certain extent can ensure the extinction of brucellosis. Finally, numerical simulations are given to illustrate the analytical results. We also suggest that herdsmen should reduce the densities of animal habitation to decrease the contact rate, increase slaughter rate of animals and apply disinfection measures to kill brucella.

Seroprevalence of brucellosis among high-risk individuals in Madinah, Saudi Arabia.

Background and Aim: Brucellosis is a highly contagious, neglected zoonotic disease of major importance worldwide. The disease is endemic in many countries, burdening healthcare systems and the livestock industry and representing a persistent public health concern in these countries. Brucellosis is considered an important occupational hazard for livestock workers. Limited studies have investigated human brucellosis in Saudi Arabia. Therefore, this study aimed to estimate the prevalence of brucellosis among employees of high-risk brucellosis professions, including veterinarians, animal herders, and abattoir workers in Madinah, Saudi Arabia, and to determine the associated risk factors. Materials and Methods: A cross-sectional study was conducted in Madinah, Saudi Arabia, during the period of January-March 2023. Ninety blood samples were collected from individuals occupationally at risk of exposure to Brucella infections. Serum samples were examined for immunoglobulins (Ig)M and IgG antibodies against Brucella using an indirect enzyme-linked immunosorbent assay. Before sample collection, a predesigned online questionnaire was used to collect the participants' sociodemographic characteristics and the probable risk factors for human brucellosis. A Chi-square test was used to compare the differences among groups; p < 0.05 were considered statistically significant. Results: Among the 90 participants among the high-risk individuals, Brucella IgM and IgG seropositivity were found in 8 (8.8%) and 11 (12.12%) cases, respectively. IgM mono antibody positivity was observed in 4 (4.44%) and 7 (7.77%) of the study population who tested positive for IgG only. Dual positivity for IgM and IgG antibodies was observed in 4 (4.44%) participants. No significant association was determined between seropositivity and age, urbanicity, education, occupation, and duration of exposure (p > 0.05). Conclusion: Brucellosis is a high-risk occupational disease among workers with close contact with livestock. This study demonstrates that the seroprevalence of brucellosis among occupationally high-risk individuals in Madinah, Saudi Arabia, is relatively low compared to other countries in the region. Nevertheless, educational programs should be implemented to improve knowledge regarding brucellosis, particularly among high-risk individuals.

Hematologic Inflammation Indices for Differentiating between Brucella, Pyogenic, and Tuberculous Spondylodiscitis.

Infectious spondylodiscitis is a life-threatening disease and has some challenges in terms of diagnostic, differentiative, and therapeutic processes. Therefore, rapid and effective management of infectious spondylodiscitis is necessary. Hematological inflammation indices (HIIs) such as the neutrophil/lymphocyte ratio and aggregate index of systemic inflammation are derived from blood cells and used as diagnostic, prognostic, predictive, and treatment monitoring indicators. This study aimed to evaluate HIIs for discriminating between infectious spondylodiscitis pathogens. This retrospective comparative study included 116 patients with infectious spondylodiscitis. According to the responsible infectious pathogens, three types of infectious spondylodiscitis were defined: Brucella (n = 51), pyogenic (n = 43), and tuberculous (n = 22). The HIIs were derived from baseline complete blood counts. The three types of infectious spondylodiscitis were statistically compared for the HII scores. We found that the Brucella group had significantly lower HII scores than the pyogenic group (p < 0.05). Also, the Brucella group had significantly lower HII scores than the tuberculous group (p < 0.05). However, no significant differences were found between the pyogenic and tuberculous groups regarding HIIs (p > 0.05). In conclusion, the HIIs may be considered in the differentiation between Brucella spondylodiscitis and other types of infectious spondylodiscitis.

Epidemiological Investigation of Animal Brucellosis in Domestic Ruminants in Greece from 2015 to 2022 and Genetic Characterization of Prevalent Strains.

Brucellosis is one of the most important zoonotic diseases in Greece, causing a significant burden on both human and animal vitality as well as economic loss. The present study was conducted from 2015 to 2022 on 711,415 serum samples by determining the seroepidemiology of Brucellosis among livestock in 24 geographical areas in Greece using the Rose Bengal Test (RBT) and the complement fixation test (CFT) and further performing genetic analysis of Brucella spp. by species-specific real-time PCR and MLVA Brucella analysis. A total of 3086 serum samples from goats, sheep, and cattle showed positive results using the RBT and CFT, and only strongly positive samples (n = 800) were preserved in the Βlood Bank of the Veterinary Laboratory of Brucellosis. From these, 212 sera samples were randomly selected for molecular and genetic analysis. The results indicated that the incidence rate of Brucellosis is higher in cattle herds in comparison with other animal species. Overall, 48 samples tested positive by real-time PCR, of which forty-seven of them were B. abortus and one was B. melitensis. Genetic analysis of two B. abortus samples revealed a common pattern, indicating two Bruce04, two Bruce18, four Bruce07, two Bruce09, three Bruce16, and four Bruce30 for both samples, which, interestingly, were not identical with the known genotypes in the public MLVA Brucella database. Our findings substantiate that animal Brucellosis remains a health issue in Greece, with a stable but apparent incidence rate, and further investigation is needed to fully characterize the newly identified Brucella strains in Greece.

Brucella Species Circulating in Smallholder Dairy Cattle in Tanzania.

Brucellosis is a zoonosis caused by bacteria of the genus Brucella, which results in economic losses relating to livestock and threatens public health. A cross-sectional study was conducted to determine the molecular prevalence of Brucella species in smallholder dairy cattle in six regions of Tanzania from July 2019 to October 2020. Dairy cattle (n = 2048) were sampled from 1371 farms. DNA extracted from blood and vaginal swabs was tested for Brucella using qPCR targeting the IS711 gene and positives were tested for the alkB marker for B. abortus and BMEI1172 marker for B. melitensis. The molecular prevalence was 3.5% (95% CI: 2.8-4.4) with the highest prevalence 8.1% (95% CI: 4.6-13.0) in Njombe region. B. melitensis was the predominant species detected (66.2%). Further studies are recommended to understand the source of B. melitensis and its implications for veterinary public health. Livestock keepers should be informed of the risks and biosecurity practices to reduce the introduction and control of Brucella. Cattle and small ruminant vaccination programs could be implemented to control brucellosis in high-risk populations in the country.

Seroprevalence of small ruminant brucellosis and owners knowledge, attitude and practices in Chiro and Burka Dhintu Districts, West Hararghe, Ethiopia.

Brucellosis is one of zoonotic bacterial diseases with significant veterinary and public health consequences in sub-Saharan African countries, including Ethiopia. A cross-sectional study design was conducted with the objective of estimating the seroprevalence of small ruminant brucellosis and assessing owners' knowledge, attitude and practices (KAP) on brucellosis in Chiro and Burka Dhintu Districts in Eastern Ethiopia. A total sample of 444 animals were taken using a cluster based multistage sampling technique. Screening for Brucella antibodies and confirmation of positive test results were conducted using Modified Rose Bengal Plate Test (MRBPT) and indirect enzyme-linked immunosorbent assay (I-ELISA) respectively. For the questionnaire survey, 444 randomly selected sheep and goat owners were interviewed using a pretested structured questionnaire. The overall seroprevalence of small ruminant brucellosis was found to be 6.5 % (95 % CI: 4.6-9.3). The multivariable logistic regression analysis identified sex and age as potential risk factors (P < 0.05). More specifically, females were 3.4 times (AOR = 3.4, 95 % CI: 1.2-9.2) more likely to become seropositive than their counterparts, and the odds of seropositivity in adult sheep and goats was 5.6 times (AOR = 5.6, 95 % CI: 1.3-24.7) higher than that of young animals. The knowledge, attitude and practices of animal owners with regard to brucellosis were low, and the level of education was independently associated with the owners' knowledge and attitude. Moderate seroprevalence, combined with inadequate knowledge, attitudes, and practices of animal owners, makes small ruminant brucellosis a threat to animals and the entire community. Hence, strengthening veterinary services and raising community awareness about the disease is essential to reduce the impact on small ruminant productivity and minimize the risks to public health.

Genomic analysis of Brucella isolates from animals and humans, Türkiye, 2010 to 2020.

BackgroundBrucellosis is a bacterial zoonosis causing severe illness in humans and animals and leading to economic losses in the livestock production in Türkiye and other endemic countries.AimWe aimed at investigating genomic differences of Brucella isolates from animals and humans in Türkiye.MethodsWe used whole genome sequencing (WGS) to assess the genetic diversity of Brucella isolates from 41 provinces in Türkiye and compared with isolates from other countries. We applied allele-based typing and core genome single nucleotide polymorphism (cgSNP) determination.ResultsOf the 106 Turkish Brucella isolates included, 57 were B. abortus and 49 were B. melitensis. One B. melitensis and two B. abortus isolates were identified as vaccine strains. Most (n = 55) B. abortus isolates clustered in three major branches, with no spatial discernible pattern. Of the B. melitensis isolates, 48 were assigned to the Eastern Mediterranean lineage with no discernible patterns between host species, location and sampling date. The Turkish isolates clustered with isolates from neighbouring countries such as Greece and Syria, but some also with isolates from human patients in European countries, like Germany, Norway and Sweden, suggesting that the source may be travel-related.ConclusionSeveral B. melitensis and B. abortus lineages are circulating in Türkiye. To decrease the prevalence and prevent brucellosis in animals and humans, stricter control measures are needed, particularly in areas where humans and animals have close contact. Furthermore, illegal transportation of animals across borders should be more closely controlled and regulated.

Seroprevalence of brucellosis in sheep and goats from Al Jufrah district in Libya.

Introduction: brucellosis is a global neglected zoonotic disease affecting mainly livestock, causing communicable and zoonotic infections. This study aimed to investigate the seroprevalence and determine epidemiological risk factors associated with Brucella infection in sheep and goats in Al Jufrah central district of Libya. Methods: sera samples from 555 animals (goats (n=320) and sheep (n=235)) sheep) were obtained and subjected to the Rose Bengal Plate Test (RBPT) then further confirmed by a validated Enzyme Linked Immunosorbent assay (ELISA). Collected data was analyzed using Statistical Package for the Social Sciences (SPSS). Results: in total, 2.7% were ELISA seropositive for brucellosis with the highest seropositivity rate among the studied animals from Sokna with 5.8% (n=13/225) followed by 0.7% (n=2/285) in Waddan and 0% (n=0/45) in Houn. Only location was identified as a significant risk and no significant differences were identified between seropositivity and the age studied groups, species of animals, gender, and size of farms (p-value>0.05). Conclusion: the present study provides important information on the epidemiological status of Brucella infection in an important region in North Africa. Prevention control systems adopting "One Health" concept, and regional and international collaboration are important to control brucellosis and other zoonotic and transboundary diseases.

Tracking sero-molecular trends of swine brucellosis in Hawai'i and the central Pacific.

Introduction: Brucellosis is a zoonotic disease of mammals caused by bacterial species of the Brucella genus. The reservoir for disease is typically mammals, with species of Brucella found infecting amphibians, bats, and marine mammals. Brucella spp. can pass directly to humans through contact with infected animals or their products. Brucella spp. can cause chronic debilitating infections in mammals, including humans, and is associated with spontaneous abortions in infected animals, causing reduced fecundity. In Hawai'i, terrestrial species that could harbor Brucella spp. include swine, cattle, horses, and axis deer among others. The numerous feral swine in Hawai'i are known to carry Brucella suis, with evidence supporting infections in cattle. Brucella suis also poses infection risk to humans, dogs, and potentially horses across the state. Methods: In this study, 3,274 feral swine serum samples collected from 5 of the 8 main islands over a 15-year span were analyzed for exposure to B. suis. Of the 558 watersheds in the state, 77 were sampled as part of this effort. Spatial analysis was used to identify watersheds of concern. MLVA and whole genome SNP analysis was used for molecular epidemiological analysis. Results: Statewide seropositivity rates were triple that of feral swine found in the conterminous United States. Smoothed positivity rates were highest on Maui, followed by O'ahu, and the island of Hawai'i. Island-by-island analysis found high brucellosis positivity levels associated with specific watersheds and agricultural areas. Local spatial autocorrelation identified hot spots on O'ahu and Hawai'i. MLVA analysis of available B. suis from Hawai'i found molecular epidemiological connections with B. suis found in French Polynesia and the mainland US while differing from those in Tonga, Western Polynesia. Strains from Hawai'i are phylogenetically closest to strains from the United States. MLVA and SNP analysis found B. suis strains from Hawai'i fell into the genetic group that contains biovar 1 B. suis. Discussion: This work identified islands and watersheds of high brucellosis seropositivity in feral swine of Hawai'i, highlighting the magnitude of the zoonotic risk. Introduction of strains in recent history is unlikely due to modern animal trade and disease control practices. Genomic analysis of strains in Hawai'i and the Pacific area can provide hidden historical and local clues to brucellosis epidemiology in the state.

Diagnosis of an atypical fever in a 55-year-old man. / Diagnostyka nietypowego stanu goraczkowego u 55-letniego mezczyzny.

BACKGROUND: The paper describes a diagnostically challenging case of recurrent fever with an atypical course in a 55-year-old man. The authors highlight the significant difficulty in reaching a correct diagnosis, as well as the doubts and problems associated with the diagnostics. They suggest considering brucellosis as a diagnosis based on the patient's history and the course of the disease characterized by fluctuating, intermittent, and nocturnal fever. OBJECTIVE: The aim of the study was to present an atypical and diagnostically challenging case of recurrent febrile episodes in a 55-year-old man. MATERIAL AND METHODS: A comprehensive diagnostic workup, including laboratory tests, imaging, and specialist consultations, was conducted. The patient's medical history, physical examination, and various diagnostic tests were analyzed. RESULTS: In a patient with recurrent episodes of fever, an infection with Brucella spp. was detected, which was effectively treated with long-term antibiotic therapy. Imaging and laboratory diagnostics, along with specialist consultations, helped rule out other potential causes of the symptoms. The patient achieved lasting improvement following the treatment. CONCLUSIONS: There is a high probability that the patient was infected with Brucella bacteria. Diagnostic challenges and the rarity of the disease, considered non-existent in Poland, hinder prompt confirmation or exclusion of infection. The authors aimed to highlight the possibility of a higher frequency of brucellosis in Poland. They suggest that Brucella bacteria may still be present, causing chronic, unrecognized, recurrent fevers. Based on the case analysis, the authors indicate that the frequent occurrence of this disease in Poland might be higher than reported by statistics.

Clinical Insights into Brucella Peritonitis: A Comprehensive Analysis of Four Cases.

INTRODUCTION: Brucellosis, a globally distributed zoonotic disease, exhibits diverse clinical manifestations, with Brucella peritonitis being a rare but consequential complication. METHODS: Analyzing the medical records of four patients with Brucella peritonitis admitted to the First People's Hospital of Kashi Region from January 2022 to November 2023. A retrospective approach was used to analyze the general data, epidemiological history, clinical features, laboratory tests, and efficacy. All four patients with Brucella peritonitis were farmers. RESULTS: All of them were combined with decompensated stage of liver cirrhosis. The main manifestations were poor appetite, fatigue, bloating. Two patients were accompanied by moderate-high fever. All patients presented with mildly elevated C-reactive protein and procalcitonin < 0.25ng/ml. Brucella was cultured from blood in 2 cases, from pleural fluid in 1 case, and from ascitic fluid in another case. All patients had moderate-to-large amounts of ascites with elevated leukocytes in the ascites, predominantly mononuclear cells. Symptoms of the above patients were reduced or disappeared after effective anti-infection. CONCLUSION: When patients with decompensated cirrhosis present with exudative ascites dominated by elevated mononuclear cells, the possibility of Brucella peritonitis should also be considered in areas where brucellosis is endemic.

Integrated Approaches of Prevention and Medicine for Dealing with Central Nervous System Brucellosis: A Case from a Non-Epidemic Area - China, 2023.

What is already known about this topic?: Brucellosis of the central nervous system (CNS) is rare and frequently fatal, often being overlooked or misdiagnosed. What is added by this report?: In April 2023, the Jinan CDC identified a case of CNS brucellosis in a 54-year-old woman through cerebrospinal fluid (CSF) culture. Upon confirming the diagnosis of brucellosis, the Jinan CDC immediately informed Qilu Hospital of Shandong University, to which the patient had been transferred, and she was subsequently tracked and successfully treated. What are the implications for public health practice?: The successful outcome can be attributed to the effective integration of a system that facilitated coordinated and collaborative actions between public health services and clinical institutions.

Human brucellosis and associated risk factors in the Middle East region: A comprehensive systematic review, meta-analysis, and meta-regression.

Introduction: Human brucellosis, caused by the bacteria Brucella, is a significant infectious disease globally, also known as Mediterranean fever or Malta fever. Methods: This meta-analysis and systematic review focuses on the prevalence rate, risk factors, and diagnostic methods of human brucellosis in Middle Eastern countries, where the disease remains a significant public health issue. The analysis included 92 studies conducted between 1993 and 2024, following specified inclusion and exclusion criteria among symptomatic patients across these countries. The prevalence rate was calculated by dividing positive samples by total samples. The I2 index and Chi-squared test assessed study heterogeneity. Significant heterogeneity occurred when I2 exceeded 50 %. Results: The highest prevalence rate was observed in Oman, Lebanon, and Kuwait countries, emphasizing a notable burden of Brucella infection in these regions. Risk factors associated with human brucellosis were identified, with unpasteurized dairy consumption and close animal contact being predominant. Various professions such as farmers, dairy factory workers, and agriculture workers showed higher prevalence rate. Gender analysis indicated a prevalence rate of 18.02 % (95 % CI: 11.55-25.51 %) in males and 13.61 % (95 % CI: 10.8-16.68 %) in females, with no significant difference in hospitalization rates. The prevalence rate of Brucella spp. was varied across detection methods, with immunocapture agglutination assay (Brucellacapt) showing the highest estimated prevalence rate of (44.04 %, 95 % CI: 27.71-61.04), followed by PCR (39.84 %, 95 % CI: 20.14-61.39) and culture (29.22 %, 95 % CI: 17.89-42.03). Among Brucella species, Brucella melitensis (B. melitensis) and Brucella abortus (B. abortus) were the highest prevalence rate. Although statistically insignificant, the meta-analysis also revealed an upward trend in prevalence rate from 1993 to 2024, (P value = 0.277). Discussion: This comprehensive review emphasizes the need for tailored strategies to control brucellosis in the Middle East, highlighting the importance of timely diagnosis, public awareness, and effective treatment protocols. These findings provide valuable insights for policymakers and healthcare professionals working to mitigate the impact of this disease in the region.

A systematic review and meta-analysis of comparative clinical studies on antibiotic treatment of brucellosis.

Brucellosis is a difficult to treat infection that requires antibiotic combinations administered over several weeks for clearance of infection and relapse prevention. This systematic review summarizes current evidence for antibiotic treatment of human brucellosis. PubMed, EMBASE, Scopus, CINAHL, Web of Science, and China Academic Journal databases were searched for prospective studies that had compared different antibiotic regimens for treating human brucellosis in the last 25 years. Thirty-four studies recruiting 4182 participants were eligible. Standard dual therapy with doxycycline + rifampicin had a higher risk of treatment failure compared to triple therapy which added streptomycin (RR: 1.98, 95% CI 1.17-3.35, p = 0.01) or levofloxacin (RR: 2.98, 95% CI 1.67-5.32, p = 0.0002), but a similar or lower risk compared to alternative dual antibiotic combinations (p > 0.05). The same combination had a higher risk of relapses compared to triple therapy which added streptomycin (RR: 22.12, 95% CI 3.48-140.52, p = 0.001), or levofloxacin (RR: 4.61, 95% CI 2.20-9.66, p < 0.0001), but a similar or lower risk compared to other dual antibiotic combinations (p > 0.05). Triple antibiotic therapy is more effective than standard dual therapy with rifampicin and doxycycline. However, the latter is also efficacious and suitable for uncomplicated disease.