Brucellosis as a rare cause of olecranon bursitis: case-based review.

A 51-year-old man shepherd presented with mild pain and swelling of the right posterior aspect of his right elbow. In ultrasonography, the affected bursal space had swelling and effusion. Moreover, the aspiration of the affected bursa revealed an inflammatory profile. Brucella melitensis was detected in aspirated fluid and blood cultures. The serum agglutination test (SAT) and 2-mercaptoethanol test for brucellosis were also positive. Therefore, the diagnosis of brucellar olecranon was confirmed. Treatment was initiated using gentamicin for the first 7 days and doxycycline plus rifampicin for 2 months. After treatment, all clinical signs and symptoms were resolved. No relapse was seen after 1 year of the completion of treatment. Clinicians should pay attention to the symptoms of olecranon brucellar bursitis that is similar to that of pyogenic bursitis.

Cervical Spine Spondylitis with an Epidural Abscess in a Patient with Brucellosis: A Case Report.

INTRODUCTION: Human brucellosis, the most prevalent zoonotic disease worldwide, is a systemic infection which can involve several organs. Among musculoskeletal complaints, spondylitis is the most frequent complication of brucellosis and primarily affects the lumbar and thoracic vertebrae. The involvement of the cervical spine is infrequent. CASE REPORT: This case report concerns an unusual case of cervical spine spondylitis with an epidural abscess due to Brucella in a 43-year-old man. The diagnosis was based on the patient being domiciled in an endemic region, his symptoms and his occupation. Clinical outcomes improved following antimicrobial therapy of rifampin, doxycycline, and gentamycin, and were confirmed radiologically. CONCLUSION: Early diagnosis and treatment are crucial for these patients. The timely commencement of medical treatment can help prevent surgery.

Changes in the anti-HBc profile of infants born to HBV infected mothers from Iran.

From 2007 to 2014, 328 infants born to hepatitis B surface antigen (HBsAg) positive mothers, who received passive-active immunization against hepatitis B at birth were tested for HBsAg, antibody to hepatitis B core antigen (anti-HBc) and antibody to hepatitis B surface antigen (anti-HBs) at 12-15months of age. Thirteen (4%) cases were HBsAg positive. Forty-four infants who were anti-HBs, anti-HBc positive (group 1) and twenty-one infants who were anti-HBc positive alone (group 2) were identified. Both groups were followed-up annually for testing anti-HBs and anti-HBc to verify if anti-HBc was of maternal origin. In group 1, anti-HBc disappeared in 41 cases at month 24, and it disappeared from the remaining 3 cases at month 36. In group 2, anti-HBc disappeared in 18 cases at month 24 and in the remaining 3 cases at month 36. The results show that maternal anti-HBc may persist up to 3years in some children.

Evaluation of Different Primers for Detection of Brucella by Using PCR Method.

INTRODUCTION: Brucellosis is a worldwide zoonosis and a significant cause of loss of health in humans and animals. Traditionally, classic diagnosis is carried out by isolation of Brucella, which is time-consuming, technically challenging and potentially dangerous. The aim of this study was to expand a molecular test that would be used for the develop detection of Brucella in a single reaction with high sensitivity and specificity, by targeting IS711element. METHODS: This study was carried out from 2015 to 2016 at the Ayatolla Rohani hospital in Babol, Iran. The present study was designed to develop PCR assay, based on IS711 gene for rapid diagnosis of Brucella spp. and immediate detection of Brucella, with high sensitivity and specificity. Four pairs of oligo-nucleotide primers with sizes of 547, 403, 291 and 127bp respectively, were planned to exclusively amplify the targeted genes of Brucella species. RESULTS: Our results show that, five PCR primers set up, would be helpful in amplifying the DNAs from the genus Brucella with high specificity and sensitivity so it can be 12 fg, for Brucella species to provide a valuable tool for diagnosis. CONCLUSION: This method can be more useful than serological and biochemical tests and in addition, this reduces the number of required tests more rapidly and economically.

HBeAg seroconversion in children infected during early childhood with hepatitis B virus.

BACKGROUND: Seroconversion of hepatitis B e-antigen (HBeAg) to anti-HBe is associated with lower viral load and liver diseases. OBJECTIVES: The purpose of this study was to assess the seroconversion rate of HBeAg to anti-HBe in children who acquired hepatitis B virus (HBV) infection during early childhood. STUDY DESIGN: From September 1990 to December 2010, 139 HBeAg-positive children were followed up. Eighty-one subjects were of failure of hepatitis B immune globulin (HBIG) and hepatitis B vaccine at birth and 58 children <10 years of age who were born before 1990 did not receive HBIG and hepatitis B vaccine. HBsAg, HBeAg, anti-HBs and anti-HBe were assessed every 6 months. RESULTS: Sixty-two (44.6%) cases were males and 77 (55.4%) were females. The mean duration of follow-up was 18 ± 6.6 years. Twenty-four (17.3%) mothers were HBeAg positive and 115 (82.7%) were anti-HBe positive. Eighty-two (59%) children became anti-HBe positive. The seroconversion rates in the first, second and third decades were 25%, 63.4% and 70.5%, respectively (p<0.001). The children of anti-HBe-positive mothers had a higher seroconversion rate than the HBeAg-positive mothers (75% vs. 33.9%, p<0.0001). Time to seroconversion in children born to HBeAg-positive mothers was similar to those born to anti-HBe positive mothers (hazard ratio (HR)=1.03, p=0.973). Time to seroconversion in children who received hepatitis B vaccine and HBIG was shorter than those who did not (HR=6.35, p<0001). CONCLUSIONS: HBeAg seroconversion in the second and the third decades was higher than that in the first decade. Children born to anti-HBeAg-positive mothers and those who received HBIG and hepatitis B vaccine had higher seroconversion rates.

Outcomes of 19 pregnant women with brucellosis in Babol, northern Iran.

From April 2000 to March 2010, 19 pregnant women with brucellosis were evaluated, treated and followed up. Ten (53%) pregnant women had spontaneous abortions. Six of eleven (55%) women infected in the first trimester had a spontaneous abortion. After treatment, all subsequently became pregnant and gave birth to normal babies. Among 13 patients who received cotrimoxazole plus rifampin, only four (31%) aborted and nine mothers had normal term deliveries. Two patients with recurrent abortions had brucellosis and became pregnant and gave birth after treatment. The brucellosis screening program for pregnant women and those with spontaneous abortion is necessary in brucellosis endemic regions.

Follow-up standard agglutination and 2-mercaptoethanol tests in 175 clinically cured cases of human brucellosis.

BACKGROUND: The standard agglutination (SAT) and 2-mercaptoethanol (2-ME) tests are usually used in the follow-up of treated cases of human brucellosis. The purpose of this study was to monitor the levels of these tests, two years after clinical cure in cases of brucellosis. METHODS: From April 2003 to September 2008, 175 clinically cured cases of brucellosis (103 males, 72 females) were evaluated. Diagnosis of brucellosis was established with a SAT of > or =1:320 and a 2-ME of > or =1:80, with clinical symptoms and signs compatible with brucellosis. SAT and 2-ME were retested at the end of therapy and at 3-monthly intervals for two years. Serologic cure was considered in the event of a SAT titer decrease to < or =1:160 or a 2-ME decrease to<1:80. RESULTS: The mean age of study patients was 31 +/- 13.5 years. At 6, 12, 18, and 24 months after treatment, SAT titers > or =1:320 were seen in 41 (23.4%), 22 (12.6%), 7 (4%), and 6 (3.4%) cases, respectively, whereas 2-ME titers > or =1:80 were seen in 51 (29.1%), 24 (13.7%), 12 (6.9%), and 8 (4.6%) cases, respectively. The probability of serologic cure for patients with SAT titers < or =1:640 was higher than for those >1:640 (95% confidence interval (CI) 2.5-3.47, p=0.023). The probability of serologic cure for patients with 2-ME titers < or =1:320 was higher than for those >1:320 (95% CI 2.48-3.5, p=0.04). CONCLUSIONS: SAT and 2-ME may be found in significant titers in less than 5% of clinically treated cases after two years. Serologic cure for both tests with lower titers were higher than with higher titers.

Brucellar epididymo-orchitis: review of 53 cases in Babol, northern Iran.

From September 1998 to December 2008, 53 cases of brucellar epididymo-orchitis were treated and followed. The mean age of the patients was 35.5+/-15.9 y. 26 (49.1%) subjects had orchitis. Scrotal pain and swelling, fever, sweating, and arthralgia or arthritis occurred in 53 (100%), 43 (84.3%), 40 (78.4%) and 25 (47.1%) cases, respectively. 16, 20, 9 and 8 cases were treated with gentamicin for 7 d plus doxycycline for 45 d (GD), cotrimoxazole plus doxycycline (CD) for 45 d, streptomycin for 2 weeks and doxycycline (SD) for 45 d, and cotrimaxazole plus rifampin (CR) for 45 d, respectively. We continued the oral agents in all regimens for 2 months in those not clinically cured. At 45 d, cure rates were 48.3%, 65%, 77.8% and 50%, respectively, and at 2 months they were 87.5%, 90%, 100% and 75%, for GD, CD, SD and CR, respectively. In conclusion, scrotal pain and swelling, fever, sweating and arthralgia or arthritis were the main clinical findings in brucellar epididymo-orchitis patients. An aminoglycoside containing combination therapy was usually efficacious. Cotrimoxazole plus doxycycline may be an alternative regimen for those who cannot take an aminoglycoside.

False negative serological tests may lead to misdiagnosis and mismanagement in osteoarticular brucellosis.

Non-specific clinical presentations and paraclinical findings in osteoarticular brucellosis may mimic many other diseases and other causes of arthritis which could lead to misdiagnosis and mismanagement. We studied retrospectively the records of 232 patients with osteoarticular brucellosis who were admitted to the three teaching hospitals of Babol Medical Sciences University from April 2001 to September 2006. The distribution of osteoarticular involvement and their management were evaluated to determine if any cases had been misdiagnosed because of false negative serologic tests and who had, as a result, undergone inappropriate surgical interventions. Of 232 patients, 138 (59%) were male and 94 (41%) were female. Polyarthritis, monoarthritis, spondylitis and sacroilitis were seen in 91 (39%), 60 (26%), 43 (18.5%) and 38 (16.5%) patients, respectively. Two hundred and twenty-nine (98.7%) patients were diagnosed correctly and treated successfully; three (1.3%) were misdiagnosed and had been given inappropriate surgical interventions. Of these three patients, two (3.3%) were suffering from monoarthritis (hip joint) and one (2.3%) had spondylitis.

Possible transmission of hepatitis B virus between spouses and their children in Babol, Northern Iran.

To determine the possible routes of transmission of hepatitis B virus (HBV) infection between spouses and their children in Babol, Northern Iran, the spouses of 54 infected husbands and 49 wives without any evidence of HBV infection in their family members were evaluated from March 1998 to April 2005. All of these cases were hepatitis B surface antigen and anti-hepatitis B 'e' antigen positive. Mean duration of marriage for husbands was 14.4+/-6.49 and for wives 12.46+/-6.24 years. Past HBV infection was found in 46.3% wives of infected husbands and in 65.3% husbands of infected wives (P = 0.074). HBV markers were seen in 32.5% children of infected fathers and 64.5% children of infected mothers (P = 0.0001). HBV carrier rates in boys and girls of infected mothers were significantly higher than in those of infected fathers (P = 0.002 and P = 0.0001, respectively). The results show that transmission of HBV between spouses and their children were the main routes of transmission of HBV in our region.

Suction clearance and 2% topical miconazole versus the same combination with acidic drops in the treatment of otomycosis.

From April 2003 to September 2004, 59 ears from 55 patients received suction clearance and topical miconazole 2% (regimen 1) and in September 2004 to December 2005, 64 ears from 58 patients received the same combinations plus acidic drops [acetic acid 3% (v/ v) in 97% ethanol]. The mean age of patients treated with regimen 1 was 35.76+/-16 years and in regimen 2 was 37.98+/-15 years. Aspergilus sp and Candida sp were seen in 35 (59.3%) and 24 (40.7%) cases treated with regimen 1 and in 43 (67.2%) and 21 (32.8%) cases treated in regimen 2, respectively. Relapse occurred in 2 (3.4%) ears treated with regimen 1, but none in cases treated with regimen 2 (p=0.228). The findings reveal that there were no statistically significant differences between the two regimens and both may be used for the treatment of otomycosis.

Efficacy of cotrimoxazole and rifampin for 6 or 8 weeks of therapy in childhood brucellosis.

From March 1998 to September 2001, 64 children and from October 2001 to December 2004, 66 children < or = 15 years with brucellosis in Babol, Iran, were treated with cotrimoxazole and rifampin for 6 or 8 weeks, respectively. Cure rate for 6 weeks was 89.1% and for 8 weeks it was 95.5%. Six weeks of therapy with cotrimoxazole plus rifampin is sufficient for treatment of childhood brucellosis.

Childhood brucellosis in Babol, Iran.

This prospective study was conducted on 111 children with brucellosis, who attended the Department of Infectious Diseases, Babol, Iran, from September 1999 to March 2003. Fever (73.9%), sweating (67.6%), artheralgia (49.5%) and splenomegaly (18%) were common findings. The disease was acute and sub-acute in 97.3% and chronic in 2.7% of cases. Peripheral arthritis was seen in 35 (31.5%) of cases, which was monoarticular in 29 patients, most involving the knees and hips. Sacroilitis was seen in six (5.4%) cases.

Comparison of the efficacy of two months of treatment with co-trimoxazole plus doxycycline vs. co-trimoxazole plus rifampin in brucellosis.

BACKGROUND: To compare the efficacy of two different regimens in treatment of brucellosis. METHODS: This randomised clinical trial study was conducted on 280 patients with brucellosis in Babol, Iran, from April 1999 to January 2002. One of the following two regimens was randomly prescribed for two months: co-trimoxazole plus doxycycline (CD group) and co-trimoxazole plus rifampin (CR group). RESULTS: 140 patients with the mean age of 35.56 (16.2) years, and 140 patients with the mean age of 31.39 (18) years, were treated with co-trimoxazole plus doxycycline and co-trimoxazole plus rifampin, respectively. Clinical manifestations and laboratory test results were similar in both groups (p >0.05), except in sex and clinical types (p <0.05). Failure of treatment was seen in 10 (7.1%) and 23 (16.4%) cases treated in the CD group and CR group, respectively (95% CI, 0.174 to 0.862; OR = 0.387; p = 0.020). Relapse was seen in 12 cases (8.6%) treated in the CD group and in 14 cases (10%) treated in the CR group (95% CI, 0.365 to 1.87; OR = 0.826; p = 0.646). Failure of treatment plus relapse was seen in 22 (15.7%) and 37 (26.4%) cases treated in the CD group and CR group, respectively (95%CI, 0.278 to 0.929, OR = 0.508; p = 0.028). Risk for developing of failure of treatment and relapse in patients treated with co-trimoxazole plus rifampin was 1.96 times higher than those treated with co-trimoxazole plus doxycycline. Among the relapsed patients, 18 (69.2%) cases occurred within 6 months after completion of therapy, and most of them in uncomplicated patients. CONCLUSION: Using two months of treatment, the efficacy of co-trimoxazole plus doxycycline is better than co-trimoxazole plus rifampin.