Negative serology: could exclude the diagnosis of brucellosis?

Çelik, Aygül Doğan; Yuluğkural, Zerrin; Kılınçer, Cumhur; Hamamcıoğlu, Mustafa Kemal; Kuloğlu, Figen; Akata, Filiz

doi:10.1007/s00296-010-1453-y

Cited by 18 publications

(14 citation statements)

References 8 publications

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“…However, the anti-LPS antibodies were nearly undetectable in the B. abortus 2308-infected sheep and B. melitensis M28-and B. suis S1330-infected goats 16 weeks postinfection, indicating that some clinical cases could have been neglected in epidemiological surveys of sheep or goat brucellosis, and the prevalence of Brucella could have been underestimated. This result is consistent with previous reports: Celik reported two brucellosis cases that were diagnosed as positive through bacterial culture or needle biopsy but tested negative in serological tests (24).…”

Section: Discussionsupporting

confidence: 83%

Limitations of the BP26 Protein-Based Indirect Enzyme-Linked Immunosorbent Assay for Diagnosis of Brucellosis

Xin

Yang

Wang

et al. 2013

Clin Vaccine Immunol

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dBrucellosis is a serious zoonosis that occurs worldwide, and its diagnosis is typically based on the detection of antibodies against Brucella lipopolysaccharide (LPS). However, the specificity of the LPS-based test is compromised by cross-reactivity with Escherichia coli O157:H7 and Yersinia enterocolitica O:9. Also, diagnosis based on the LPS test cannot differentiate between vaccinated and infected individuals. The detection of the 26-kDa cytosoluble protein (BP26) antibody is considered an alternative that circumvents these drawbacks because it is exclusively expressed by infectious Brucella. A BP26-based enzyme-linked immunosorbent assay (ELISA) has been tried for the diagnosis of Brucella-infected animals and humans, but a few results showed that BP26 couldn't react with all Brucella-positive sera. In order to explore whether different animals could produce antibodies against BP26 after being infected with various Brucella species, we infected sheep, goats, and beef cattle with common virulent reference Brucella species. All sera were collected from the experimental animals and tested using both LPS-based ELISAs and BP26-based ELISAs. The results showed that all Brucella-infected individuals could produce high levels of antibodies against LPS, but only B. melitensis 16M-and B. melitensis M28-infected sheep and B. melitensis 16M-and B. abortus 2308-infected goats could produce antibodies against BP26. Therefore, we concluded that the BP26-based indirect ELISA (i-ELISA) showed both Brucella species and host specificity, which obviously limits its reliability as a substitute for the traditional LPS-based ELISA for the detection of brucellosis. Brucella is a Gram-negative, facultative intracellular bacterial pathogen that causes one of the world's most widely spread zoonotic infections, including infectious abortion in animals and Malta fever in humans (1, 2). Brucella species include Brucella melitensis (natural host: goat), Brucella abortus (cattle), Brucella ovis (sheep), Brucella suis (swine), Brucella canis (dogs), and Brucella neotomae (desert rats) as well as some strains that infect marine mammals (3). Besides their natural hosts, most Brucella species also infect other animals. B. melitensis and B. abortus are considered to be major health threats because of their highly infectious nature and worldwide occurrence (3-5). Control of brucellosis depends on reliable diagnostic methods.The lipopolysaccharide (LPS) of smooth Brucella species is an antigen of strong reactivity and can elicit a long-lasting serological response in both vaccinated and infected animals (6, 7). Serological tests based on the detection of antibodies against lipopolysaccharide (LPS), like the Rose Bengal plate agglutination test, the complement fixation test, the fluorescence polarization assay, and enzyme-linked immunosorbent assays (ELISAs) display satisfying specificity and sensitivity and therefore are widely used for the diagnosis of brucellosis. Among these serological tests, ELISAs showed the highest sensitivity and specifi...

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Section: Discussionsupporting

confidence: 83%

Limitations of the BP26 Protein-Based Indirect Enzyme-Linked Immunosorbent Assay for Diagnosis of Brucellosis

Xin

Yang

Wang

et al. 2013

Clin Vaccine Immunol

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“…20 No entanto em doentes com terapêutica prévia, os títulos serológicos poderão ser baixos 12 e em casos de doença focalizada alguns estudos reportaram baixa sensibilidade 13 -deste modo, tal não deverá, caso a suspeita etiológica permaneça, levar à exclusão do diagnóstico, tal como ocorreu em alguns doentes da presente amostra. 21 No nosso estudo a Figura 2 -Ressonância magnética da coluna, plano sagital ponderação T2 (A) e T1 com supressão de gordura após contraste (B) de doente da amostra. Identificam-se alterações do disco intervertebral L4-L5 e plataformas vertebrais adjacentes, em menor grau do disco L5-S1, com extensão pré-vertebral (*), componente epidural contíguo (+) e envolvimento dos tecidos moles posteriores inter-espinhosos (-).…”

Section: Discussionunclassified

Espondilodiscite Brucélica: Casuística dos Últimos 25 Anos

Lebre

Vélez²,

Seixas³

et al. 2014

Acta Med Port

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Introduction:Brucellosis is an endemic zoonosis in Portugal. Brucellar spondylodiscitis is one of the most frequent focal manifestations which may cause severe sequelae despite appropriate therapy. Material and Methods:Retrospective study of patients with diagnosis of brucellar spondylodiscitis admitted to the Infectious Diseases Department of Centro Hospitalar e Universitário de Coimbra, over a 25-year period . Results: We identified 54 patients, 55.6% male, mean age of 54.8 years. In 81.5% an epidemiological context was identified, mostly contact with sheep and goats. The duration of symptoms prior to diagnosis was 5.5 months. The most common signs and symptoms were pain (98.1%), fever (46.3%) and neurological deficits (25.9%). Spinal magnetic resonance imaging was the most used imaging method (77.8%) showing abscesses in 29.6% of patients. Lumbar location predominated (77.7%). Diagnosis was attained in 47 patients (87.0%): positive blood cultures (3 patients), positive serology (32 patients) or by both methods (12 patients). Combined regimens of doxycycline and rifampicin (64.8%), or streptomycin (24.1%) were most used, for an average duration of 4.4 months. A patient was referred for surgery for abscess drainage. Evolution was mostly favorable (92.6%), no deaths occurring. Discussion: Research of the epidemiologic context turned out to be a major key leading to the diagnosis. Treatment of osteoarticular brucellosis is still controversial. Conclusions: Brucellar spondylodiscitis should be considered in the differential diagnosis of patients with low back pain, even in the absence of fever, particularly in regions where the disease is endemic. Antibiotic regimen, its' duration and the need for surgery should be individualized to achieve a better prognosis. Cases have declined over the years, a fact related to better control of animal endemic.

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“…Literatürde spondilodiskit gibi fokal komplikasyonlara sahip bruselloz vakalarında serum aglütinasyon testlerinin düşük sensitiviteye sahip olabileceği bildirilmiştir. Bu durumda klinik şüphe yüksek ise; aglütinasyon testinin bu şekilde dilüsyonla tekrarı dışında, Brusellacapt testi, kompleman fiksasyon testi, floresan polorizasyon testi, Brusella dipstik testi gibi başka serolojik testlerle kombine edilmesi veya mümkünse tutulan dokudan örnek alınarak patolojik inceleme veya PCR ile inceleme yapılması tanısal açıdan anlamlılığı artıracaktır (9,10).…”

Section: Discussionunclassified

Brusellar Spondilodiskit: Olgu Sunumu

Kara¹

2013

gmj

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ÖZETBruselloz tüm dünyada yaygın olarak görülen, birçok organ ve sistem tutulumu gösteren bir hastalıktır. Klinikte karşımıza çıkan en sık komplikasyonu; osteoartiküler tutulumdur. Osteoartiküler tutulumun alt tiplerinden biri olan brusellar spondilodiskit, omurgayı tutan herhangi bir hastalıkla karışabilir. Brusella aglütinasyon testi negatif sonuçlanan bu hastada, sonrasında akla gelen prozon fenomeni ve çekilen manyetik rezonans görüntüleme ile brusellar spondilodiskit tanısı konulmuştur. Tanıda sıklıkla kullanılmakta olan serolojik testlerde negatiflik saptansa bile bruselloz açısından klinik şüphe yüksek olduğunda mutlaka prozon fenomeni akla gelmeli ve tanı için zaman kaybedilmemelidir. GİRİŞBruselloz, tüm dünyada yaygın olarak görülen, zorunlu bir intrasellüler bakteri olan Brucella türü tarafından oluşturulan, birçok organ ve dokuyu tutabilen bir zoonozdur. Hastalığın patognomonik bir semptom veya bulgusu yoktur ve tanı için öncelikle klinik şüphe duyulması ve bunun laboratuvar ve tutulan sisteme göre görüntüleme yöntemleriyle desteklenmesi gerekmektedir. Hastalığın kesin tanı yöntemi etkenin, kan ve özellikle kemik iliğinden izolasyonudur. Ancak etkenin zor ve uzun sürede üretilebilmesi nedeniyle tanıda serolojik testler daha sık kullanılmaktadır. Bazen hastalığın erken dönemlerinde de düşük serum dilüsyonlarında en sık kullanılan serolojik testlerden biri olan serum aglütinasyon testinde yalancı negatiflik görülebilir. 'Prozon fenomeni' olarak adlandırılan bu durum nedeniyle hasta serumunun yüksek titrede sulandırılması önerilmektedir (1).Osteoartikuler bruselloz periferik artrit, sakroileit, spondilit, tenosinovit, bursit ve osteomyelit şeklinde ortaya çıkabilmektedir (2). Burada ateş, bel ağrısı ve skolyoz ile gelen bir hastada klinik şüphe, prozon fenomeninin akla gelmesi ve manyetik rezonans görüntüleme yöntemi ile tanı alan brusellar spondilodiskitli bir olgu sunulmuştur. ABSTRACTBrucellosis is a common, worldwide disease having multiple organ and system involvements. The most frequent complication that we encounter in the clinics is the osteoarticular involvement. Brucellar spondylodiscitis, a type of osteoarticular involvement tends to be confused with any other diseases involving the spine. In this patient with negative results of brucella agglutination test, brucellar spondylodiscitis was diagnosed by the help of magnetic resonance imaging and prozone phenomenon. Despite the negative results of frequently used serologic tests, when a high suspicion for brucellosis is present, the prozone phenomenon must be kept in mind and the diagnosis should not be delayed. OLGU SUNUMUOn iki yaşında erkek hasta yaklaşık 40 gündür olan, bacaklarına doğru yayılan bel ağrısı ve son dönemde başlayan, yürümesini de bozan belinde eğrilik; özellikle geceleri eşlik eden ateş, terleme ve son 1 ayda 5 kg kilo kaybı şikayetleri ile başvurdu. Özgeçmişinde ve soygeçmişinde özellik yoktu. Fizik muayenesinde vücut ısısı: 38,1°C, vücut ağırlığı 50 kg (% 75-90), boy 162 cm (% 50-75), kalça hareketleri her yöne ağrılı idi. ...

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Negative serology: could exclude the diagnosis of brucellosis?

Cited by 18 publications

References 8 publications

Limitations of the BP26 Protein-Based Indirect Enzyme-Linked Immunosorbent Assay for Diagnosis of Brucellosis

Limitations of the BP26 Protein-Based Indirect Enzyme-Linked Immunosorbent Assay for Diagnosis of Brucellosis

Espondilodiscite Brucélica: Casuística dos Últimos 25 Anos

Brusellar Spondilodiskit: Olgu Sunumu

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