Risk Factors and Diagnostic Criteria of Brucellosis in an Endemic Area in Egypt

Abstract

A case-control study was conducted during the year 2003 in Tanta Fever Hospital within an endemic area for brucellosis (Br) in Egypt. One hundred forty-nine cases of Br and 298 patients with other infectious diseases were consecutively enrolled. Risk factors of Br (adjusted odds ratio) were having sheep (6.2 folds), high-risk occupation such as farmers and butchers (4.5 folds), having an aborted animal (3.5 folds), and increasing age (1.04 fold per year). Previous admission into a fever hospital within a year (6.5 folds), arthritis (2.9 folds), and positive C-reactive protein (1.1 fold) were significant predictors for Br. Rose bengal panel test showed 100% performance agreement with tube agglutination test for diagnosis of Br. Adding 2-mercaptoethanol to tube agglutination test did not increase its sensitivity or specificity for acute Br; neither did Coombs test. In conclusion, laboratory confirmation by tube agglutination test that should be preceded by rose bengal panel test as a screening test is absolute requirement for diagnosis of Br. Considering the previously mentioned risk factors could be useful in developing an algorithm for diagnosis of Br, particularly among those with atypical clinical presentation. (Infect Dis Clin Pract 2005;13:295-299)B rucellosis (Br) is the leading zoonotic disease in the Eastern Mediterranean Region and is of major concern in view of its impact on both public health and animal production scheme. 1 In Egypt, the estimated annual economic losses attributed to Br accounted for US$10 million during the early 1990s. 2 Infection in man is often both a food-borne as well as an occupational-related disease in addition to environmental factors. 3 A definitive diagnosis of Br is based on culture of Brucella strains from different samples, mainly blood. 4 Due to many obstacles with culture, diagnosis relies mainly on serology, particularly the standard tube agglutination test (TAT). 5 Tanta Fever Hospital is a major hospital for infectious diseases in the capital of Gharbia Governorate. An increasing rate of admission of Br was noticed among patients with specific fevers from 3% in 1993 to 13% in 2002. 6 Moreover, Gharbia Governorate was one of the most active governorates in Egypt that report laboratory-confirmed Br in relation to total population. 7 The aim of this study was to identify risk factors which contributed to Br in our community and, eventually, establish an integrated system for its control. The study also aimed at evaluating the diagnostic performance of rose bengal panel test (RBPT) in comparison to the standard TAT and some tests routinely used in Eastern Mediterranean Region countries to promote a reliable protocol for diagnosis of Br. SUBJECTS AND METHODS Technical DesignA case-control study was conducted in Tanta Fever Hospital. Cases were patients admitted with Br during a calendar year to cover seasonal variations. Patients diagnosed by clinical features such as fever of more than 7 days' duration, bone ache ± arthralgia, positive serological tests for Br (RBPT an...

Seroprevalences and local variation of human and livestock brucellosis in two villages in Gharbia Governorate, Egypt

“…Yet such results are in agreement with of our previous study (El Sherbini et al, 2005), although they disagree with those of Almuneef et al (2004), Al-Shamahy et al (2000) and Al-Talafhah et al (2003), indicating that risk factors for brucellosis must be assessed in each community to identify the most appropriate control and prevention measures.…”

“…The association between keeping sheep and human brucellosis has also been found as the major risk factor for this zoonosis in our case-control study (El Sherbini et al, 2005). Several reports claim sheep to have the highest proportion of brucellosis infection among livestock (Almuneef et al, 2004;Al-Shamahy et al, 2000).…”

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