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.

Immune cell and biochemical marker levels in the cerebrospinal fluid and blood of patients with brucella meningitis and their clinical significance.

OBJECTIVE: To investigate the diagnostic significance of immune cells and biochemical markers in the cerebrospinal fluid and blood of patients with brucella meningitis. METHODS: A retrospective study was conducted to analyze the clinical data from 30 patients with Brucella meningitis (Group A), 30 patients with Brucella infection without neurological impairment (Group B), and 30 cases of non-brucella infection (Group C) that were collected from the People's Hospital of Xinjiang Uygur Autonomous Region between January 2020 and December 2022. The levels of immune cells and biochemical markers in the cerebrospinal fluid and blood were compared between the three groups. Spearman correlation coefficient, logistic regression analysis, and receiver operating characteristic (ROC) curve analysis were used to assess the association between these factors and Brucella meningitis and to determine their diagnostic value. RESULTS: A negative correlation was found between Brucella meningitis and CD3+, CD4+, CD4+/CD8+ T lymphocytes, glucose (C-Glu), and chloride ions (C-Cl) in the cerebrospinal fluid. Conversely, a positive correlation was observed between Brucella meningitis and blood CD4+, CD4+/CD8+ cells, cerebrospinal fluid protein (C-Pro), and lactate dehydrogenase (C-LDH). High levels of C-Glu and C-Cl were identified as protective factors, while elevated C-LDH was considered as a risk factor for Brucella meningitis. The area under the curve (AUC) for C-Glu, C-Cl, C-LDH, and their combination in predicting Brucella meningitis were 0.828, 0.860, 0.869, and 0.971, respectively. CONCLUSION: The levels of CD3+, CD4+, CD4+/CD8+ cells in the cerebrospinal fluid, as well as the levels of CD4+ and CD4+/CD8+ cells in the blood, are correlated with the occurrence of Brucella meningitis. C-Glu, C-Cl, C-LDH and their combination demonstrate significant potential in aiding the auxiliary diagnosis of Brucellosis meningitis.

Spatiotemporal risk of human brucellosis under intensification of livestock keeping based on machine learning techniques in Shaanxi, China.

As one of the most neglected zoonotic diseases, brucellosis has posed a serious threat to public health worldwide. This study is purposed to apply different machine learning models to improve the prediction accuracy of human brucellosis (HB) in Shaanxi, China from 2008 to 2020, under livestock husbandry intensification from a spatiotemporal perspective. We quantitatively evaluated the performance and suitability of ConvLSTM, RF, and LSTM models in epidemic forecasting, and investigated the spatial heterogeneity of how different factors drive the occurrence and transmission of HB in distinct sub-regions by using Kernel Density Analysis and Shapley Additional Explanations. Our findings demonstrated that ConvLSTM network yielded the best predictive performance with the lowest average RMSE of 13.875 and MAE values of 18.393. RF model generated an underestimated outcome while LSTM model had an overestimated one. In addition, climatic conditions, intensification of livestock keeping and socioeconomic status were identified as the dominant factors that drive the occurrence of HB in Shaanbei Plateau, Guanzhong Plain, and Shaannan Region, respectively. This work provided a comprehensive understanding of the potential risk of HB epidemics in Northwest China driven by both anthropogenic activities and natural environment, which can support further practice in disease control and prevention.

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.

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.

Predictive Significance of Laboratory Tests in Bacteremic Brucellosis.

Background: Brucellosis is one of the most common zoonotic infections. Although culture is the gold standard diagnostic method, bacterial growth in blood cultures may not always occur due to various factors. We aimed to investigate demographic, clinical, and laboratory findings that may have predictive significance for bacteremia in brucellosis. Methods: Patients older than 18 years of age followed up with a diagnosis of brucellosis between 2012 and 2022 were included in this retrospective multicenter study. They were divided into two main subgroups according to their Brucella species reproductive status as bacteremic and non-bacteremic. Results: A total of 743 patients, 370 (49.80%) bacteremic and 373 (50.20%) non-bacteremic brucellosis patients, were enrolled. The mean age of the bacteremic group (36.74 years) was lower than the non-bacteremic group (43.18 yr). High fever, chills/cold, sweating, nausea, vomiting, and weight loss were more common in the bacteremic group. In the bacteremic group, white blood cell count, platelet count, hemoglobin level, mean platelet volume, eosinophil, and neutrophil counts were lower, and lymphocyte, erythrocyte sedimentation rate, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and ferritin levels were higher. According to the receiver operating characteristic (ROC) analysis, when the cut-off value of ferritin was considered 67, it was the parameter with the strongest predictive significance in Brucella bacteremia. Conclusion: High ferritin level, low eosinophil count, and increased erythrocyte sedimentation rate were determined as the most critical laboratory findings in predicting bacteremia in brucellosis.

Fluorescence Polarization Assay for Infection Diagnostics: A Review.

Rapid and specific diagnosis is necessary for both the treatment and prevention of infectious diseases. Bacteria and viruses that enter the bloodstream can trigger a strong immune response in infected animals and humans. The fluorescence polarization assay (FPA) is a rapid and accurate method for detecting specific antibodies in the blood that are produced in response to infection. One of the first examples of FPA is the non-competitive test for detecting brucellosis in animals, which was followed by the development of other protocols for detecting various infections. Fluorescently labeled polysaccharides (in the case of brucellosis and salmonellosis) or specific peptides (in the case of tuberculosis and salmonellosis, etc.) can be used as biorecognition elements for detecting infections. The availability of new laboratory equipment and mobile devices for fluorescence polarization measurements outside the laboratory has stimulated the development of new fluorescence polarization assays (FPAs) and the emergence of commercial kits on the market for the detection of brucellosis, tuberculosis, and equine infectious anemia viruses. It has been shown that, in addition to antibodies, the FPA method can detect both viruses and nucleic acids. The development of more specific and sensitive biomarkers is essential for the diagnosis of infections and therapy monitoring. This review summarizes studies published between 2003 and 2023 that focus on the detection of infections using FPA. Furthermore, it demonstrates the potential for using new biorecognition elements (e.g., aptamers, proteins, peptides) and the combined use of FPA with new technologies, such as PCR and CRISPR/Cas12a systems, for detecting various infectious agents.

A Thermosensitive and Degradable Chitin-Based Hydrogel as a Brucellosis Vaccine Adjuvant.

Brucellosis is a zoonotic infectious disease that has long endangered the development of animal husbandry and human health. Currently, vaccination stands as the most efficacious method for preventing and managing brucellosis. Alum, as the most commonly used adjuvant for the brucellosis vaccine, has obvious disadvantages, such as the formation of granulomas and its non-degradability. Therefore, the aims of this study were to prepare an absorbable, injectable, and biocompatible hydroxypropyl chitin (HPCT) thermosensitive hydrogel and to evaluate its immunization efficacy as an adjuvant for Brucella antigens. Specifically, etherification modification of marine natural polysaccharide chitin was carried out to obtain a hydroxypropyl chitin. Rheological studies demonstrated the reversible temperature sensitivity of HPCT hydrogel. Notably, 5 mg/mL of bovine serum albumin can be loaded in HPCT hydrogels and released continuously for more than one week. Furthermore, the L929 cytotoxicity test and in vivo degradation test in rats proved that an HPCT hydrogel had good cytocompatibility and histocompatibility and can be degraded and absorbed in vivo. In mouse functional experiments, as adjuvants for Brucella antigens, an HPCT hydrogel showed better specific antibody expression levels and cytokine (Interleukin-4, Interferon-γ) expression levels than alum. Thus, we believe that HPCT hydrogels hold much promise in the development of adjuvants.

Epidemiology characterization and risk factors of brucellosis among older rural populations in northwest China.

Brucellosis causes significant economic damage and public health problems in northwest China. The older rural population is considered a high-risk group. However, the epidemiological characteristics and risk factors for brucellosis in this population remain unclear. This study investigated these factors within this high-risk group by performing a cross-sectional study in five townships of Wuwei City, Gansu Province. Cases were screened via rose Bengal and serum plate agglutination tests. Risk factors were evaluated using a standard questionnaire form. This study included 1074 participants aged >50 years. Among them, 15 (1.4%) tested positive for Brucella. The most common symptoms were arthralgia/myalgia (n=5, 33.3%), and 10 (66.7%) cases were asymptomatic. Raising lambs artificially (odds ratio, 4.7; 95% CI, 1.3-17.0; P=0.02) increased the risk of brucellosis. The results indicated a high proportion of asymptomatic brucellosis in this group. Raising lambs artificially is a risk factor for brucellosis. The surveillance and health education of brucellosis for older rural populations in endemic areas of northwest China should been attention.

Risk factors and control strategies for Brucella spp. and RB51 vaccine shedding in buffalo milk: A cross-sectional study.

Brucellosis is prevalent in water buffaloes, which serve as significant reservoirs. The disease adversely affects meat and dairy products and can be transmitted to humans through contaminated products. This study aimed to determine the risk factors and control strategies for Brucella spp. and RB51 vaccine shedding in raw buffalo milk. A cross-sectional study was conducted across 261 farms where only 182 out of 261 farms received regular vaccinations through PCR tests and a questionnaire survey. The survey addressed potential risk factors and farm management. Univariable and multivariable logistic regression analyses were used to analyze the associated risk factors, represented as odds ratios (OR) with 95 % confidence intervals. The PCR survey revealed a 35.2 % prevalence of Brucella spp at the household level and 30.8 % at the buffalo level. Significant risk factors for Brucella PCR-positivity included the number of buffaloes in a household (OR = 1.512, 95 %CI: 1.107-2.065, p = 0.009) and the presence of resident dogs (OR = 2.157, 95 %CI: 1.053-4.417, p = 0.036). Regular vaccination practices were identified as a preventive factor (OR = 0.304, 95 %CI: 0.172-0.537, p <0.001). No animal-level risk factors were identified, and reduced-dose brucellosis vaccination showed a protective effect. Higher buffalo numbers in a household correlated with increased vaccine shedding in milk (OR= 2.489, p-value <0.001). Shedding was lower in households with primary education farmers than those without education (OR=14.163, p-value <0.001). Borrowing bulls for insemination also increased shedding (OR=13.266, p-value= 0.015). The study highlights the need for targeted control strategies, emphasizing education, vaccination, and hygiene practices to mitigate brucellosis's impact on buffalo and human populations.

TLR4 and TNF-α single nucleotide polymorphisms in patients with brucellosis: Association with infection complications.

OBJECTIVES: To investigate associations of the carriage of single nucleotide polymorphisms (SNPs) of proteins involved in the immune response of patients with brucellosis. METHODS: A case control study of patients with brucellosis upon WHO criteria. Blood genomic analysis was performed by RFLP- PCR for the detection of SNPs: i) at promoters -376 G > A (rs1800750); -308 G > A (rs 1,800,629); -238 G > A (rs361525) of the TNF gene, ii) at -896 A > G Asp299Gly (rs4986790) and -1196 C > T Thr399Ile (rs4986791) positions of the TLR-4 gene. Logistic regression analysis of factors related to brucellar spondylodiscitis was performed. RESULTS: Patients with brucellosis (n = 105) were male (n = 67, 63.8 %); mean age (SD): 49.51(18.31); spondylodiscitis (n = 30), sacral osteomyelitis (n = 21). Carriage of the minor frequency A alleles at -238 of the promoter region of TNF was greater in patients than in controls (11.4% vs 2.6 %, p < 0.001). In a stepwise regression model including host variables and TNF-238 G A-1 genotype, only the last one was associated with brucellar spondylodiscitis [OR 2.91 (CI95 % 1.02-8.31), p = 0.047]. CONCLUSIONS: In our cohort, the association of one TNF SNP of patients with brucellosis, in particular spondylodiscitis, might be prognostic whereas further investigation of the exact role in the host immune response is required.

Brucellosis outbreak in a remote village in northwestern Tajikistan in 2023: a matched case-control study.

Background: A sharp increase in reported brucellosis incidence was observed in northwestern Tajikistan (from 1.0/100,000 people in January-May 2022 to 32.7/100,000 in January-May 2023). Most (82%) cases were from the same remote mountainous village (population = 10,712). The aim of this study was to identify risk factors for brucellosis infection and mitigate disease risk. Methods: Using a case-control design, we conducted face-to-face interviews and collected blood samples during May-June 2023. Fifty-seven cases and 114 controls were recruited. Cases were the first person in a household diagnosed with brucellosis during February-June 2023 with positive serum agglutination test and antibody titers ≥1/160 from blood samples. Two controls were selected for each case (neighbors from different households matched by age and sex). Controls testing positive were excluded and replaced. We conducted conditional multivariable logistic regression to calculate adjusted odds ratio (AOR) and 95% confidence intervals (CI). Results: Among the 87 brucellosis patients reported, 57 (66%) agreed to participate and didn't have secondary cases in the household. Of the 57 cases, 68% were 15-44 years old, and 44% were male. Cases peaked in May 2023. Common symptoms were joint pain (95%), fever (84%), weakness (72%), and night sweats (65%). Of selected controls, 13% tested positive and were excluded. All cases and 94% of controls owned livestock (mostly cattle, sheep, or goats); no animals had not been vaccinated in the past 5 years. Brucellosis was associated with consumption of both homemade kaymak (clotted cream) and home-raised meat compared with neither (AOR: 59 [95%CI: 4.3-798], p < 0.01), home-raised meat but not kaymak compared with neither (AOR: 54 [4.0-731], p < 0.01), and involvement in animal slaughter compared with no involvement (AOR: 36 [2.8-461], p < 0.01). Conclusion: Contact with unvaccinated livestock or consumption of their products was a key contributor to this outbreak in a remote village of Tajikistan. With 13% of controls testing positive, true incidence was likely greater than reported. Following our investigation, a brucellosis awareness education campaign and animal vaccination campaigns were carried out in the region and only one case was reported in September 2023.

Subacute Meningitis: A Rare Presentation of Brucellosis.

A young male adult presented with a two-week-long history of myoarthralgia, vomiting, febrile sensation, holocranial headache with photophobia, neck stiffness, anorexia, and weight loss. He worked as a butcher in a local slaughterhouse, and two of his coworkers had recently been diagnosed with brucellosis. On his fourth visit to the Emergency Department (ED), fever was observed for the first time. He was admitted for subacute meningitis. A lumbar puncture revealed high protein concentration, low glucose concentration, and pleocytosis without predominance. He was started on empirical treatment for acute meningitis and neurobrucellosis with ceftriaxone, doxycycline, and rifampin. There was a complete symptom remission over one week. The etiological investigation yielded a positive cerebrospinal fluid (CSF) and serum Rose Bengal Tests (RBTs), as well as a positive anti-Brucella IgG titer, leading to a final diagnosis of neurobrucellosis. After nine months of antimicrobial therapy and two years of follow-up, the patient remained asymptomatic.

Sero-prevalence, associated risk factors and economic impact of camel brucellosis in Elwayye district, southern Ethiopia.

BACKGROUND: Camel brucellosis is a zoonotic and economically important disease that causes low productivity and mortality in animals through abortion and low herd fertility. METHODS: A cross-sectional study was conducted from March to December 2023 to estimate the seroprevalence of camel brucellosis, associated risk factors, and economic impact in Elwayye district, southern Ethiopia. A total of 240 blood samples were collected from extensively and traditionally managed dromedary camels. The collected samples were subjected to testing for Brucella antibodies using the Rose Bengal Plate Test (RBPT) and indirect ELISA for confirmation. RESULTS: The overall seroprevalence of camel brucellosis in the current study by RBPT was 6.2 %, and by combined RBPT and ELISA, it was 3.7 % (95 % CI: 1.94-7.05). Risk factors like herd size, age, management practice, history of abortion, and sex were assessed. Among these, age, herd size, and management practice were identified as potential risk factors significantly associated with Brucella seropositivity in camels. But the other risk factors were not associated with the disease (P > 0.05). In this study, the total estimated economic loss due to camel brucellosis in the study area was 505,727.2 Ethiopian birr (ETB) for all parameters used. The highest economic loss was due to abortion or perinatal mortality of calves (341,325 ETB). CONCLUSIONS: These indicate the need to study camel brucellosis in the study area, and the disease is endemic and prevalent in pastoralist areas, which need well-organized surveillance, disease control, and prevention programs.

Serological prevalence of Brucella spp. at the livestock-human interface in Jordan.

Despite its endemic status in the Middle East, key knowledge gaps persist regarding the prevalence, transmission rate, and geographical distribution of both human and livestock brucellosis in Jordan. This study aimed to investigate the seroprevalence of human and livestock brucellosis as well as the incidence of brucellosis in humans in Jordan. A total of 500 human participants (202 exposed and 296 unexposed to livestock) were enrolled in the study. Sampling was conducted at baseline and 1.5 years later. Additionally, a total of 700 livestock were sampled, comprising 20 animals per taxa (camels, cattle, sheep, goats) per site, at both baseline (N = 350) and the 1.5-year follow-up (N = 350). Human participants were longitudinally followed, whereas livestock sampling was conducted opportunistically. Blood samples obtained from both humans and livestock at baseline and follow-up were tested for Brucella spp. serum antibodies using the Rose Bengal test (RBT) and complement fixation test (CFT). The overall seroprevalence of brucellosis in humans at baseline was 3.4 % (95 % CI: 2.0-5.4). Positive test results in humans were detected from all five sites with no significant regional variation observed. Seroprevalence was higher in individuals regularly exposed to livestock (6.1 %; 95 % CI: 3.5-9.9) compared to those not regularly exposed (0.80 %; 95 % CI: 0.10-2.9). Incidence of human brucellosis was 924 seropositives per 100,000 person-years, with all incident seropositives occurring in the livestock-exposed cohort. In livestock, the overall seroprevalence of brucellosis was 5.4 % (95 % CI: 3.5-8.3) at baseline compared to 2.6 % (95 % CI: 1.4-4.8) at follow-up. Seropositive livestock were detected at all sites apart from Al-Zarqa, and in all species apart from camels. In conclusion: Brucellosis burden was higher among humans regularly exposed to livestock, re-emphasizing the need for disease control in livestock populations to prevent primary infection in humans.

Differences in Haematological and Imaging Features of Lumbar Spine Fungal and Brucella Infections.

Objective: To observe the clinical characteristics of fungal and Brucella infections of the lumbar spine and explore the key points for their differential diagnosis. Methods: The clinical data of 12 patients with fungal infection (the fungal group) and 31 patients with Brucella infection (the Brucella group) of the lumbar spine confirmed by microbiological culture and antigen test were retrospectively analysed. The differences in the clinical characteristics and imaging manifestations were observed between the two groups. Results: The peripheral blood neutrophil ratio, erythrocyte sedimentation rate, serum total protein and serum globulin levels in the fungal group were higher compared with the Brucella group, while the peripheral blood lymphocyte count, lymphocyte ratio and albumin-globulin ratio were lower in the fungal group compared with the Brucella group (P < 0.05). As for imaging examinations, the proportion of bone destruction centred on the intervertebral disc with surrounding osteosclerosis on computed tomography (CT) imaging showed a statistical difference between the Brucella group and the fungal group (P < 0.05). Fungal infection patients showed more osteosclerosis-free areas around the bone destruction on magnetic resonance imaging (MRI) than Brucella infection patients. Conclusion: There are certain similarities in clinical manifestations between fungal and Brucella infections of the lumbar spine, but the haematological indices and image features of CT and MRI can effectively differentiate between them, providing guidance for the clinical differential diagnosis.

Brucellosis Coinfecting with Liver Hydatid Cyst: Case Report and Literature Review of Zoonoses Coinfection of Human Brucellosis.

Background: Brucellosis is a major global public health problem. Brucellosis usually coinfects with zoonoses because of their similar reservoir and infection routes. Materials and Methods: Here, we present a patient who was diagnosed with coinfecting with liver cyst and brucellosis. Results: A 57-year-old female farmer was hospitalized with right hip joint pain approximately 4 weeks earlier. The patient reported a history of hydatid cysts and a family history of brucellosis. Abdominal computerized tomography and ultrasonography revealed a liver hydatid cyst. The standard agglutination test titer of Wright's test was 1:100. Computerized tomography and magnetic resonance imaging revealed brucellosis hip arthritis. The patient was treated with a combination of doxycycline, rifampicin, and cefotaxime. The symptoms immediately improved. The patient was well and asymptomatic during the 6-month follow-up. We reviewed the literature on other zoonoses superinfection with brucellosis. Conclusion: Brucellosis coinfects with multiple zoonosis organisms and poses a serious health threat to humans. Awareness of possible brucellosis coinfection with other zoonoses, especially professionally exposed persons in endemic regions, is warranted.

Exploring genetic determinants of antimicrobial resistance in Brucella melitensis strains of human and animal origin from India.

Introduction: Antimicrobial resistance (AMR) in Brucella melitensis, the causative agent of brucellosis, is of growing concern, particularly in low and middle-income countries. This study aimed to explore the genetic basis of AMR in B. melitensis strains from India. Methods: Twenty-four isolates from humans and animals were subjected to antimicrobial susceptibility testing and whole-genome sequencing. Results: Resistance to doxycycline (20.80%), ciprofloxacin (16.67%), cotrimoxazole (4.17%), and rifampicin (16.67%) was observed. Genome analysis revealed efflux-related genes like mprF, bepG, bepF, bepC, bepE, and bepD across all isolates, however, classical AMR genes were not detected. Mutations in key AMR-associated genes such as rpoB, gyrA, and folP were identified, intriguingly present in both resistant and susceptible isolates, suggesting a complex genotype-phenotype relationship in AMR among Brucella spp. Additionally, mutations in efflux genes were noted in resistant and some susceptible isolates, indicating their potential role in resistance mechanisms. However, mutations in AMR-associated genes did not consistently align with phenotypic resistance, suggesting a multifactorial basis for resistance. Discussion: The study underscores the complexity of AMR in B. melitensis and advocates for a holistic multi-omics approach to fully understand resistance mechanisms. These findings offer valuable insights into genetic markers associated with AMR, guiding future research and treatment strategies.

Spatial Epidemiology and Temporal Trend of Brucellosis in Iran Using Geographic Information System (GIS) and Join Point Regression Analysis: An Ecological 10-Year Study.

Background: Brucellosis is one of the common diseases between humans and animals. We aimed to assess the annual incidence rate, the geographical distribution of Malta fever using GIS and its time trend. Methods: This was an ecology study carried out in exploratory mixed design. The study population was the individuals with brucellosis in Iran during the years 2009-2018. Data analysis has been done using Joinpoint regression analysis and GIS at a significant level of α = 0.05. Results: The average annual incidence rate of the disease rate was 19.91 per one hundred thousand people. The trend of the changes in the incidence between 2009 and 2018 has increased and the Annual Average Percent Change increased by 4.6%. However, a joinpoint was observed in 2014 and the incidence has changed significantly at this point in time, so that the annual incidence of the disease has increased more strongly between 2009 and 2014 (APC=17.1%) and then from 2014 to 2018, the incidence of the disease has decrease (APC=-9.2%). The spatial distribution showed that the western and northwestern provinces have high incidence rate, but the northern and southern provinces have low incidence rate. Conclusion: The incidence of brucellosis in Iran is higher than in developed countries and similar to developing countries. Ten-year trend of disease incidence increased slightly, but it has decreased in recent years. It is necessary to improve the surveillance system and increase facilities for prevention and treatment in the high-risk areas including the west and northwest of Iran.