Cognitive impairment and neuropsychiatric manifestations of neurobrucellosis.

AIM: This study aimed to reveal insight into the unclear areas of the diagnosis in neurobrucellosis and to decide the neuropsychiatric manifestations and cognitive impairment among patients with brucellosis. METHODS: 82 patients with serologically confirmed brucellosis were included and divided into two groups according to the neuropsychiatric manifestations, the first group included 18 patients with neurobrucellosis and the second group included 64 patients with non-neurobrucellosis. Both groups were compared regarding the general symptoms and neurological symptoms and signs. Cognitive impairment in both groups was assessed by Montreal-Cognitive Assessment (MoCA), Wechsler Memory Scale-Revised (WMS-R), and forward and backward digital test. Also, depression and anxiety were assessed by Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). RESULTS: 18 (21.9%) patients were diagnosed as neurobrucellosis and 64 (78.1%) patients were diagnosed as non-neurobrucellosis. The mean age of the total patients was 34.91 ± 14.74, consisted of 45 males and 37. Most of the patients were living in rural areas 60 patients (74.4%). The most significantly higher neurological symptoms in neurobrucellosis patients were confusion and headache (P = 0.008 and P = 0.01, respectively). While the most significant higher neurological signs were loss of orientation (P = 0.009), muscle weakness (P = 0.04), neck rigidity (P < 0.05), pyramidal signs, and lost deep reflexes (P < 0.05). The neurobrucellosis patients had significantly impaired cognition in comparison with nonneurobrucellosis patients and more psychiatric signs like behavioral changes, anxiety, and depression (P < 0.001, P < 0.001, and P = 0.01, respectively). CONCLUSIONS: Patients with neuropsychiatric manifestations and cognitive impairment should be considered for neurobrucellosis and should receive proper therapy.

Comparative knowledge, attitudes, and practices regarding anthrax, brucellosis, and rabies in three districts of northern Tanzania.

BACKGROUND: Knowledge, attitudes, and practices (KAP) surveys regarding zoonotic diseases are crucial to understanding the extent of knowledge among citizens and for guiding health-related education programs. METHOD: Employing a structured questionnaire, we interviewed residents (n = 388) in three districts of northern Tanzania (Karatu n = 128, Monduli n = 114, Babati n = 146) to assess knowledge, attitudes and reported practices regarding three zoonotic diseases that occur in the region (anthrax, brucellosis, and rabies). We used generalized linear mixed effects models and multi-model inference to identify demographic correlates of knowledge. RESULTS: Proportional average district- and disease- specific knowledge scores ranged from 0.14-0.61. We found positive correlations between age and knowledge of symptoms, causes and treatments of anthrax (three districts), brucellosis (three districts), and rabies (one district). Gender, ethnic identity, formal education and ownership of livestock or dogs had variable effects on knowledge among the interviewed population. Risk perceptions regarding different diseases varied across districts and were positively correlated with knowledge of the specific diseases. Direct interactions with livestock and domestic dogs were reported to occur across all demographic groups, suggesting that most people living in rural settings of our study area are potentially exposed to zoonotic diseases. Behaviors which may favor transmission of specific pathogens (such as consumption of raw milk or meat) were occasionally reported and varied by district. Wildlife was generally regarded as negative or neutral with regard to overall veterinary and human health. CONCLUSION: The combination of variable knowledge about zoonotic diseases in the three districts, reported occurrence of practices that are conducive to pathogen transmission, and previously documented circulation of pathogens causing anthrax, brucellosis and rabies in our study system, call for health education programs embedded in a holistic One Health approach.

Brucellosis awareness and knowledge in communities worldwide: A systematic review and meta-analysis of 79 observational studies.

BACKGROUND: Brucellosis is regarded as a major zoonotic infection worldwide. Awareness and knowledge of brucellosis among occupational workers is considered an important aspect of brucellosis control in both humans and animals. The aim of this study was to explore the distributions of the pooled awareness level and the knowledge level of the disease worldwide. METHODS: A meta-analysis was carried out to obtain pooled brucellosis awareness levels and knowledge levels of respondents regarding the zoonotic nature of brucellosis, mode of brucellosis transmission, and brucellosis symptoms in animals and humans. The analysis was conducted and reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines. RESULTS: A total of seventy-nine original articles reporting the brucellosis awareness levels of in populations from 22 countries were assessed. The total pooled awareness level of brucellosis was 55.5%, and the pooled awareness levels regarding the zoonotic nature of brucellosis, mode of brucellosis transmission, signs of human brucellosis and signs of animal brucellosis were 37.6%, 35.9%, 41.6%, and 28.4% respectively. The pooled awareness level was higher than the brucellosis-related knowledge level. Subgroup analyses showed that no obvious differences in brucellosis awareness levels between high-risk populations in Asia and Africa. Health workers (including human health workers and veterinarians) had the greatest overall awareness and knowledge of human brucellosis. The overall awareness levels and knowledge levels of livestock owners (farmers) and herders were higher than those of dairy farmers and abattoir workers. In addition, awareness and knowledge levels were higher among people who were involved in bovine, caprine and ovine animal production or in caprine and ovine animal production than among people who were involved in only bovine animal production. CONCLUSIONS: Insufficient awareness and knowledge of brucellosis were observed in the original studies conducted mainly in Asia and Africa. Interventions to improve public knowledge about brucellosis are urgently needed.

Brucellosis knowledge, attitudes and practices of a South African communal cattle keeper group.

Brucellosis remains an animal and public health concern in South Africa, given the intensity and widespread distribution of outbreaks in cattle. We conducted a cross-sectional survey among cattle keepers in the Whittlesea community of the Eastern Cape Province of South Africa, which utilises communal grazing. Individual cattle keepers (N = 227) who attended prearranged meetings in selected villages were interviewed using a structured questionnaire to assess their knowledge, attitude and practices (KAP) regarding bovine brucellosis. We compared KAP scores between previous brucellosis-affected villages and unaffected villages. We compared attitude and practices scores between those who had heard of brucellosis and those who had not and between those above the 75th percentile knowledge score and those below. The KAP for the study population were described using frequency tables. Scores of different groups were compared using the Welch t-test or the Wilcoxon rank-sum test. Knowledge scores of those who had heard of brucellosis (60%) showed a bimodal distribution with a 0/18 primary peak and 5-6/18 secondary peak. Attitude scores showed a median of 7/14 (interquartile range [IQR] 6-9), with 98% requesting more information on brucellosis. Practices scores showed a median of 6/18 (IQR 3-8), with high-risk practices identified that could facilitate brucellosis transmission. There were significant differences in attitude and practices scores between the groups above and below the 75th percentile knowledge score. The community showed poor knowledge, poor to average practices and average to good attitude. Identified high-risk practices highlight the risk of potential introduction and transmission of brucellosis between cattle and zoonotic transmission to humans.

Assessment of community awareness and risk perceptions of zoonotic causes of abortion in cattle at three selected livestock-wildlife interface areas of Zimbabwe.

A study was conducted to assess the awareness of cattle abortions due to brucellosis, Rift Valley fever (RVF) and leptospirosis, and to compare frequencies of reported abortions in communities living at the periphery of the Great Limpopo Transfrontier Conservation Area in southeastern Zimbabwe. Three study sites were selected based on the type of livestock-wildlife interface: porous livestock-wildlife interface (unrestricted); non-porous livestock-wildlife interface (restricted by fencing); and livestock-wildlife non-interface (totally absent or control). Respondents randomly selected from a list of potential cattle farmers (N = 379) distributed at porous (40·1%), non-interface (35·5%) and non-porous (26·4%), were interviewed using a combined close- and open-ended questionnaire. Focus group discussions were conducted with 10-12 members of each community. More abortions in the last 5 years were reported from the porous interface (52%) and a significantly higher per cent of respondents from the porous interface (P < 0·05) perceived wildlife as playing a role in livestock abortions compared with the other interface types. The odds of reporting abortions in cattle were higher in large herd sizes (odds ratio (OR) = 2·6; 95% confidence interval (CI) 1·5-4·3), porous (OR = 1·9; 95% CI 1·0-3·5) and non-porous interface (OR = 2·2; 95% CI 1·1-4·3) compared with livestock-wildlife non-interface areas. About 21·6% of the respondents knew brucellosis as a cause of abortion, compared with RVF (9·8%) and leptospirosis (3·7%). These results explain to some extent, the existence of human/wildlife conflict in the studied livestock-wildlife interface areas of Zimbabwe, which militates against biodiversity conservation efforts. The low awareness of zoonoses means the public is at risk of contracting some of these infections. Thus, further studies should focus on livestock-wildlife interface areas to assess if the increased rates of abortions reported in cattle may be due to exposure to wildlife or other factors. The government of Zimbabwe needs to launch educational programmes on public health awareness in these remote areas at the periphery of transfrontier conservation areas where livestock-wildlife interface exists to help mitigate the morbidity and mortality of people from some of the known zoonotic diseases.

'La fiebre de Malta': An Interface of Farmers and Caprine Brucellosis Control Policies in the Bajío Region, Mexico.

This article shows that socio-economic factors, defined here as practices, knowledge, interests, beliefs and experiences have a role in the adoption of brucellosis control strategies in the Bajío region, Mexico. We combined qualitative and quantitative methods to show that socio-economic factors with regard to goat husbandry and brucellosis control are not taken into account in the current policy to combat the disease in Mexico. Farmers ranked constraints like the price of goat milk more important than the control of the disease. The impact of brucellosis in goats is hidden to farmers, and the term brucellosis is still a strange name to them; it is better known as 'la fiebre de Malta' (Malta fever), which farmers are aware of and which they avoid by not drinking goat milk. Brucellosis control measures cause losses such as abortion due to vaccination and ear infections due to ear tagging. In the villages of the state of Michoacán, the uptake of a vaccination and testing programme was almost complete because it was offered for free, whereas in villages of Jalisco, vaccination was not adopted thoroughly because the cost of vaccination was high for farmers and because of a lack of veterinarians offering the service. Neither compensation for culling suspected infected goats does exist nor the infrastructure, like slaughterhouses, to ensure that goats that are brucellosis seropositive are not resold to neighbouring farmers. This article disputes the idea that brucellosis is confined to the lack of awareness and participation of farmers in control measures, but rather that policies are promulgated without a good knowledge of goat husbandry and farmers' perceptions. We claim that governmental authorities should reformulate the policy to take into account socio-economic factors shaping farmers' behaviour so that effective control measures will be adopted by goat farmers.

Celecoxib for the treatment of mild-to-moderate depression due to acute brucellosis: a double-blind, placebo-controlled, randomized trial.

WHAT IS KNOWN AND OBJECTIVE: Depression is a debilitating complication of brucellosis and how best to treat this is a matter of debate. Inflammatory processes are involved in the pathogenesis of both brucellosis and depression. Therefore, we hypothesized that celecoxib could be beneficial for the treatment of depression due to brucellosis. METHODS: Forty outpatients with depression due to brucellosis with a Hamilton Depression Rating Scale score (HDRS) <19 participated in a randomized, double-blind, placebo-controlled trial and underwent 8 weeks of treatment with either celecoxib (200 mg bid) or placebo as an adjunctive to antibiotic therapy. Patients were evaluated using HDRS at baseline and weeks 4 and 8. RESULT AND DISCUSSION: Repeated-measures analysis demonstrated significant effect for time × treatment interaction on the HDRS score [F (1·43, 57·41) = 37·22, P < 0·001]. Significantly greater response to treatment occurred in the celecoxib group than in the placebo group at the study end [10 patients (50%) vs. no patient (0%), respectively, P < 0·001]. No serious adverse event was observed. WHAT IS NEW AND CONCLUSION: Celecoxib is a safe and effective treatment for depression due to brucellosis when compared with placebo.

Awareness and attitude toward zoonoses with particular reference to anthrax among cattle owners in selected rural communities of Zimbabwe.

We conducted a cross-sectional study to assess cattle owners' awareness, perceptions, and attitudes toward zoonoses, with particular emphasis regarding anthrax. Data on awareness of zoonoses, clinical signs of anthrax in animals and human, its routes of transmission and methods of prevention, the families' consumption habits of anthrax-infected carcasses, and other family activities that increase exposure to anthrax were collected using an interviewer-administered questionnaire. A total of 41.4% (135/326) of the farmers were from high-anthrax-risk districts, whereas 28.5% and 30.1% were from medium- and low-risk districts, respectively. Overall, the level of awareness amongst the farmers for the named zoonoses were rabies (88.7%), anthrax (71.5%), and brucellosis (20.9%). Except for anthrax, awareness of other zoonoses did not differ significantly (p>0.05) among the district categories. Farmers from anthrax high-risk districts were significantly more aware of anthrax compared to those from moderate- (p=0.000) and low- (p=0.000) risk districts. All of the farmers were aware that anthrax occurs in cattle, and 73% indicated the presence of unclotting blood oozing from natural orifices as a consistent finding in cattle that died of anthrax, whereas 86.7% of them indicated the presence of skin lesions as the most common sign of the disease in humans. The good efficacy of human anthrax treatment (58.3%), slaughter of moribund cattle and selling of meat from cattle found dead to unsuspecting consumers (59.8%), reluctance to lose animals (47.9%), and forgetting about anthrax (41.1%) were cited as the major reasons for consuming anthrax-infected carcasses. Given that 75.2% of cattle owners indicated that they would not consume meat from cattle found dead, because they were discouraged by veterinary authorities, introducing meat inspection services is likely to have a positive impact in preventing human anthrax outbreaks in Zimbabwe.

Brucellar psychosis.

Brucellosis is the most common worldwide zoonotic infection of which psychosis is a rare feature of this disease. Brucellar psychosis should be considered in a patient with unexplained, nonspecific psychological complaints. Its timely diagnosis relies on special attention to the epidemiologic profile of the patient for a possible exposure to the brucella species. This article has presented three cases of brucellar psychosis initially misdiagnosed because the risk factors which made them at risk for the disease were ignored.

[Effect of immunomodulator cycloferon on quality of life and psychoemotional state of patients with chronic active brucellosis subjected to complex pharmacotherapy].

Indices of the quality of life and parameters of the psychofunctional status of patients with chronic active brucellosis are presented and the clinical efficiency of immunomodulator cycloferon in a complex therapy of this disease is estimated for a group of 40 patients. Cycloferon was administered to 20 patients, while the control group of 20 other patients received only a traditional therapy. It is established that the chronic active brucellosis is accompanied by a considerable decrease in parameters of the quality of life. The administration of cycloferon on the background of a base therapy leads to improvement of the quality of life and the parameters of the psychoemotional status in comparison to those achieved with the traditional methods of therapy.

Health literacy in the field of infectious diseases: the paradigm of brucellosis.

OBJECTIVES: Treatment outcome for infectious diseases, including brucellosis, may be influenced by patient awareness of the disease itself, as well as by compounding socioeconomic factors. We attempted to evaluate parameters of patient awareness and disease perception in brucellosis and the ways they influence outcome. METHODS: We used a specifically developed questionnaire assessing various parameters of patient literacy on brucellosis in 70 patients with a new diagnosis of brucellosis. Patients were assessed by interviewing at the time of diagnosis and during follow-up. Awareness and perception of the disease, willingness for epidemiologic surveillance, mode of referral, treatment preferences, and adherence were evaluated. RESULTS: Although basic disease awareness is high, willingness to collaborate in epidemiologic surveillance is limited. Patient education may improve adherence to treatment and willingness to undergo surveillance, but may also result in many false referrals for relapse. Level of academic education does not influence the results. Convenience is the major factor when determining treatment preferences. CONCLUSION: Improving health literacy may result in improved treatment outcome and improved control of disease incidence. There is a need for constant evaluation of the quality and quantity of information distributed in order to reduce transmission of misinformation and occurrences of public anxiety.

Andrologic studies and sexual potency in chronic human brucellosis.

A 100 male patients aged from 20 to 45 years were treated for chronic brucellosis. Sixty-eight complained of impaired sexual potency. The percentage of patients with sexual disorders increased parallel to the duration of the disease. Andrologic investigations comprised a study sexual history, physical examination of the external sexual organs, examination of the seminal fluid and in a few cases biopsy of testes material. Impaired sexual potency was mostly associated with changes in the gonads and in the seminal fluid. In some cases, however, decreased sexual potency appeared without any visible involvment of the genital organs. The pathogenesis of the changes in the genital organs and in semen in relation to age and sexual potency are discussed.