head JofIMAB
Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2020, vol. 26, issue2
Subject Area: Medicine
DOI: 10.5272/jimab.2020262.3122
Published online: 11 May 2020

Original article

J of IMAB. 2020 Apr-Jun;26(2):3122-3126
Maida ŠiširakORCID logo Corresponding Autoremail,
Department of Clinical Microbiology, Clinical Centre Sarajevo, Medical University, Sarajevo, Bosnia and Herzegovina.

Purpose: Brucellosis is a worldwide zoonosis. In Bosnia and Herzegovina first cases of brucellosis were registered in 2000, since than disease is in an expansion. After the implementation of the program for mass vaccination of animals in 2009, the incidence of human brucellosis rapidly decreased, but only a few years. After some period of decreasing brucellosis, in 2017 and 2018 a new outbreak of brucellosis was registered. The aim of this study was to analyze epidemiological characteristics of patients in the last outbreak of brucellosis and diagnostic value of blood culture, Rose Bengal test and immunoenzymatic test (ELISA IgM and IgG). 
Patients and methods: This study included 181 brucellosis patients from January 2017 to September 2018. The disease was diagnosed by positive blood culture results, or by positive and relevant serologic test results.
Results:  The average age of patients was 45.72 years of life-range from 1 to 78.  The gender distribution of patients was: 123/181 (67.96%) males and 58/181 (32.04%) females.  Of the total of 181 studied patients, blood culture was requested for 112 (61.8%) of patients and in 37/112 (33%) were positive. The Rose Bengal test was positive in all patients 181/181(100.0%). Brucella IgM antibodies with ELISA were positive in 64/181(35.35%), while IgG antibodies were positive in 161/181(88.95%) of patients.
Our results showed that sensitivity of test methods was different in the different stages of illness and so only combination of blood culture, the Rose Bengal test and ELISA ensured early and precise diagnosis of human brucellosis.

Keywords: brucellosis, infection, laboratory diagnosis,

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Please cite this article as: Šiširak M. Outbreak of human brucellosis in Bosnia and Herzegovina: Evaluation and importance of microbiological methods for the diagnosis of brucellosis. J of IMAB. 2020 Apr-Jun;26(2):3122-3126. DOI: 10.5272/jimab.2020262.3122

Corresponding AutorCorrespondence to: Maida Šiširak, Department of Microbiology, Clinical Centre University of Sarajevo, Medical University of Sarajevo; Bolnička 25, Sarajevo, Bosnia and Herzegovina; E-mail: maidasisirak@yahoo.com

1. Franco MP, Mulder M, Gilman RH, Smits HL. Human brucellosis. Lancet Infect Dis. 2007 Dec;7(12): 775-86. [PubMed] [Crossref]
2. Gwida M, Al Dahouk S, Melzer F, Rosler U, Neubauer H, Tomaso H. Brucellosis: regionally emerging zoonotic disease? Croat  Med J. 2010 Aug;51(4): 289-95.[PubMed] [Crossref]
3. Hukic M, Numanovic F, Sisirak M, Moro A, Dervovic E,Jakovec S, et al. Surveillance of wildlife zoonotic diseases in the Balkans Region. Med Glas (Zenica). 2010 Aug; 7(2):96-105.  [PubMed]
4. Lai S, Zhou H, Xiong W, Gilbert M, Huang Z, Yu J, et al. Changing epidemiology of human brucellosis, China, 1955-2014. Emerg Infect Dis. 2017 Feb;23():184-194. [PubMed] [Crossref]
5. Obradović Z, Velić R. Epidemiological Characteristics of Brucellosis in Federation of Bosnia and Herzegovina. Croat Med J. 2010 Aug;51(4):345-50. [PubMed] [Crossref]
6. Moreno E. Retrospective and prospective perspectives on zoonotic brucellosis. Front Microbiol. 2014 May 13; 5:213. [PubMed] [Crossref]
7. Seleem MN, Boyle SM, Sriranganathan N. Brucellosis: a re-emerging zoonosis. Vet Microbiol. 2010 Jan 27; 140:392-8. [PubMed] [Crossref]
8. Herrick JA, Lederman RJ, Sullivan B, Powers JH, Palmore TN. Brucella arteritis: clinical manifestations, treatment, and prognosis. Lancet Infect Dis. 2014 Jun; 14(6): 520-6. [PubMed] [Crossref]
9. Dean AS, Crump L, Greter H, Hattendorf J, Schelling E, Zinsstag J. Clinical manifestations of human brucellosis: a systematic review and meta-analysis. PLoS Negl Trop Dis. 2012; 6(12):e1929. [PubMed] [Crossref]
10. Bosilkovski M, Krteva L, Dimzova M, Kondova I. Brucellosis in 418 patients from the Balkan Peninsula: exposure-related differences in clinical manifestations, laboratory test results, and therapy outcome. Int J Infect Dis. 2007; 11(4):342-7. [PubMed] [Crossref]
11. Buzgan T, Karahocagil MK, Irmak H, Baran AI, Karsen H, Evirgen O, et al. Clinical manifestations and complications in 1028 cases of brucellosis: a retrospective evaluation and review of the literature. Int J Infect Dis. 2010 Jun;14(6):e469-78. [PubMed] [Crossref]
12. Shome R, Kalleshamurthy T, Shankaranarayana PB, Giribattanvar P, Chandrashekar N, Mohandoss N, et al. Prevalence and risk factors of brucellosis among veterinary health care professionals. Pathog Glob Health. 2017 Jul; 111(5): 234-9.  [PubMed] [Crossref]
13. Al-Attas RA, Al-Khalifa M, Al-Qurashi AR, Badawy M, Al-Gualy N. Evaluation of PCR, culture and serology for the diagnosis of acute human brucellosis. Ann Saudi Med. 2000 May-July;20(3-4):224-8. [PubMed] [Crossref]
14. Arapović J, Špičić S, Ostojić M, Duvnjak S, Arapović M, Nikolić J, et al. Epidemiological, clinical and molecular characterization of human brucellosis in Bosnia and Herzegovina-An ongoing brucellosis outbreak. ActaMedica Acad. 2018 May;47(1):50-60. [PubMed] [Crossref]
15. Šiširak M., Hukic M. Evaluation and importance of selected microbiological methods in the diagnosis of human brucellosis. Bosn J Basic Med Sci. Dis. 2009 Aug; 9(3):198-203. [PubMed] [Crossref]
16. Muhammad N, Hossain MA, Musa AK, Mahmud MC, Paul SK, Rahman MA, et al. Seroprevalence of human brucellosis among the population at risk in rural area. Mymensingh Med J. 2010 Jan;19(1): 1-4. [PubMed]
17. Ruiz-Mesa JD, Sanches-Gonzales J, Reguera J, Martin L, Lopez-Palmero S, Colmenero JD. Rose Bengal test: diagnostic yield and use for the rapid diagnosis of human brucellosis in emergency departments in endemic areas. Clin Microbiol Infect. 2005 Mar;11(3):221-5. [PubMed] [Crossref]
18. Osoba  AO, Balkhy H, Memish Z, Khan MY, Al-Thagafi A, Al Shareef B, et al. Diagnostic value of Brucella ELISA IgG and IgM in bacteremic and non-bacteremic patients with brucellosis. J Chemother.2001 April;13(suppl 1):54-9. [PubMed] [Crossref]
19. Ariza J, Pellicer T, Pallares R, Foz A, Gudiol F. Specific antibody profile in human brucellosis. Clin Infect Dis. 1992 Jan;14(1): 131-40. [PubMed] [Crossref]
20. Bosilkovski M, Stojanov A, Stevanovic M, Karadzovski Z, Krstevski K. Impact of measures to control brucellosis on disease characteristics in humans: experience from an endemic region in the Balkans. Infect Dis (Lond). 2018 May;50(5):340-345. [PubMed] [Crossref]
21. Tuon FF, Cerchiari N, Cequinel JC, Droppa EEH, Moreira SDR, Costa TP, et al. Guidelines for the management of human brucellosis in the State Parana, Brazil. Rev Soc Bras Med Trop. 2017 Jul-Aug;50(4):458-464. [PubMed] [Crossref].

Received: 11 July 2019
Published online: 11 May 2020

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