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==Laboratory Findings==
==Laboratory Findings==
* [[Complete blood count]]:
* [[Complete blood count]]:
**Mild leukopenia
**Mild [[leukopenia]]
**Mild anemia  
**Mild [[anemia]]
**Relative lymphocytosis
**[[Lymphocytosis|Relative lymphocytosis]]
**Thrombocytopenia
**[[Thrombocytopenia]]
* [[Liver function tests]]:
* [[Liver function tests]]:
**Mild transaminasemia<ref name="pmid15930423">{{cite journal| author=Pappas G, Akritidis N, Bosilkovski M, Tsianos E| title=Brucellosis. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 22 | pages= 2325-36 | pmid=15930423 | doi=10.1056/NEJMra050570 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15930423  }} </ref><ref name="a">Brucellosis. CDC. http://www.cdc.gov/brucellosis/transmission/index.html. Accessed on February 1, 2016</ref>  
**Mild transaminasemia<ref name="pmid15930423">{{cite journal| author=Pappas G, Akritidis N, Bosilkovski M, Tsianos E| title=Brucellosis. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 22 | pages= 2325-36 | pmid=15930423 | doi=10.1056/NEJMra050570 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15930423  }} </ref><ref name="a">Brucellosis. CDC. http://www.cdc.gov/brucellosis/transmission/index.html. Accessed on February 1, 2016</ref>  


Bacterial Isolation:
'''Bacterial Isolation:'''
*The isolation and identification of Brucella can confirm a diagnosis of brucellosis. Brucella is most commonly isolated from blood cultures.
*The isolation and identification of [[Brucella]] can confirm a [[diagnosis]] of brucellosis. [[Brucella]] is most commonly isolated from [[blood cultures]].
*It can also, however, be isolated from:
*It can also, however, be isolated from:
**Bone marrow
**[[Bone marrow]]
***Gold standard
***[[Gold standard (test)|Gold standard]]
**Cerebrospinal fluid
**[[Cerebrospinal fluid]]
**Wounds
**Wounds
**Purulent discharge
**[[Purulent]] [[discharge]]
**Joint fluid<ref name="bb">Brucellosis. CDC. http://www.cdc.gov/brucellosis/clinicians/bacterial-isolation.html. Accessed on February 4, 2016</ref><ref name="pmid15930423">{{cite journal| author=Pappas G, Akritidis N, Bosilkovski M, Tsianos E| title=Brucellosis. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 22 | pages= 2325-36 | pmid=15930423 | doi=10.1056/NEJMra050570 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15930423  }} </ref>  
**[[Synovial fluid|Joint fluid]]<ref name="bb">Brucellosis. CDC. http://www.cdc.gov/brucellosis/clinicians/bacterial-isolation.html. Accessed on February 4, 2016</ref><ref name="pmid15930423">{{cite journal| author=Pappas G, Akritidis N, Bosilkovski M, Tsianos E| title=Brucellosis. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 22 | pages= 2325-36 | pmid=15930423 | doi=10.1056/NEJMra050570 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15930423  }} </ref>  


Serological tests:
'''Serological tests:'''
*There are two types of serological tests, based on:
*There are two types of [[Serological testing|serological tests]], based on:
**"Antibody production against lipopolysaccharide"  
**"Antibody production against lipopolysaccharide"  
**"Antibody production against other bacterial antigens"
**"Antibody production against other bacterial antigens"
*Brucella microagglutination test (BMAT):  
*For a [[diagnosis]] to be made using [[serology]], two [[serum]] samples are required.
**A modified version of the serum (tube) agglutination test (SAT), that can detect antibodies to Brucella species - abortus, melitensis or suis.  
**The first [[serum]] sample should be taken when a person is acutely ill (≤7 days after [[symptom]] onset)
**There is no serological test available to detect antibodies to B. canis.
**The second [[serum]] sample should be drawn 2-4 weeks later to check for a rise in [[antibodies]] (a fourfold or greater rise in [[antibodies]] would bean an individual is positive for brucellosis).
**An agglutination titre greater than 1:160 is considered significant in nonendemic areas.
**If submission of paired sera is not possible, a probable [[diagnosis]] can be made with a single [[serum]] sample.
**An agglutination titre greater than 1:320 is considered significant in endemic areas.
*''Brucella microagglutination test (BMAT):''
**Due to the similarity of the O polysaccharide of Brucella to that of various other Gram-negative bacteria (e.g. Francisella tularensis, Escherichia coli, Salmonella urbana, Yersinia enterocolitica, Vibrio cholerae, and Stenotrophomonas maltophilia) the appearance of cross-reactions of class M immunoglobulins may occur.
**A modified version of the serum (tube) agglutination test (SAT), that can detect [[antibodies]] to [[Brucella]] species: [[Brucella abortus|abortus]], [[Brucella melitensis|melitensis]] or suis.  
**False-negative SAT may be caused by the presence of blocking antibodies (the prozone phenomenon) in the α2-globulin (IgA) and in the α-globulin (IgG) fractions.
**There is no [[Serological testing|serological test]] available to detect [[antibodies]] to [[Brucella canis|B. canis]].
**For a diagnosis to be made using serology, two serum samples are required.
**An [[Agglutination (biology)|agglutination]] titre greater than 1:160 is considered significant in nonendemic areas.
***The first serum sample should be taken when a person is acutely ill (≤7 days after symptom onset)
**An [[Agglutination (biology)|agglutination]] titre greater than 1:320 is considered significant in [[Endemic (epidemiology)|endemic]] areas.
***The second serum sample should be drawn 2-4 weeks later to check for a rise in antibodies (a fourfold or greater rise in antibodies would bean an individual is positive for brucellosis).
**Due to the similarity of the O polysaccharide of [[Brucella]] to that of various other [[Gram-negative bacteria]] (e.g. [[Francisella tularensis]], [[Escherichia coli]], Salmonella urbana, [[Yersinia enterocolitica]], [[Vibrio cholerae]], and [[Stenotrophomonas maltophilia]]) the appearance of cross-reactions of class [[Immunoglobulin M|M immunoglobulins]] may occur.
***If submission of paired sera is not possible, a probable diagnosis can be made with a single serum sample.
**[[False-negative test result|False-negative]] SAT may be caused by the presence of blocking [[antibodies]] (the [[prozone]] phenomenon) in the α2-globulin ([[IgA]]) and in the α-globulin ([[IgG]]) fractions.
**Serology is not currently available to monitor persons for RB51 vaccine exposure or for Brucella canis exposure.
**[[Serology]] is not currently available to monitor persons for RB51 [[vaccine]] exposure or for [[Brucella canis]] exposure.
*Rose Bengal:
*''Rose Bengal'':
**It's positive predictive value is approximately 99% for patients with achute and chronic brucellosis.
**Rose bengal has a [[positive predictive value]] is approximately 99% for [[patients]] with [[Acute (medical)|acute]] and [[Chronic (medical)|chronic]] brucellosis.
**It measures IgM and IgG antibodies.
**It measures [[IgM]] and [[IgG]] [[antibodies]].
*2-mercaptoethanol (2-ME):
*''2-mercaptoethanol (2-ME)'':
**It measures IgG antibodies.
**It measures [[IgG]] [[antibodies]].
*Antihuman globulin (Coombs):
*''Antihuman globulin ([[Coombs' Test|Coombs]]):''
**Used in chronic brucellosis patients with negative seroagglutination because they have IgG non-agglutinating antibodies
**Used in [[Chronic (medical)|chronic]] brucellosis patients with negative seroagglutination because they have [[IgG]] non-agglutinating [[Antibodies|antibodies.]]
*Indirect enzymelinked immunosorbent assay (ELISA):
*''[[Enzyme linked immunosorbent assay (ELISA)|Indirect enzyme linked immunosorbent assay (ELISA)]]:''
**ELISA typically uses cytoplasmic proteins as antigens.  
**[[ELISA test|ELISA]] typically uses [[cytoplasmic]] [[proteins]] as [[antigens]].  
**It measures IgM, IgG, and IgA with better sensitivity and specificity than the SAT in most recent comparative studies
**It measures [[IgM]], [[IgG]], and [[IgA]] with better [[Sensitivity (tests)|sensitivity]] and [[Specificity (tests)|specificity]] than the SAT in most recent comparative studies.
*Dipstick assays:  
*''Dipstick assays:''
**New and promising, based on the binding of Brucella IgM antibodies, and found to be simple, accurate, and rapid
**New and promising, based on the binding of [[Brucella]] [[IgM]] [[antibodies]], and found to be simple, accurate, and rapid.
*Brucellacapt test:  
*''Brucellacapt test:''
**A single-step immunocapture assay for the detection of total anti-Brucella antibodies, is an increasingly used adjunctive test when resources permit
**A single-step immunocapture assay for the detection of total anti-[[Brucella]] [[antibodies]], is an increasingly used adjunctive test when resources permit.
*PCR:
*''[[PCR]]:''
**Is fast and should be specific.  
**Is fast and specific.  
**Many varieties of PCR have been developed (e.g. nested PCR, realtime PCR and PCR-ELISA) and found to have superior specificity and sensitivity in detecting both primary infection and relapse after treatment.  
**Many varieties of [[PCR]] have been developed (e.g. nested [[PCR]], realtime [[PCR]] and [[PCR]]-[[ELISA test|ELISA]]) and found to have superior [[Specificity (tests)|specificity]] and [[Sensitivity (tests)|sensitivity]] in detecting both primary [[infection]] and [[relapse]] after treatment.  
**Unfortunately, these have yet to be standardized for routine use, and some centres have reported persistent PCR positivity after clinically successful treatment, fuelling the controversy about the existence of prolonged chronic brucellosis.<ref name="pmid15930423">{{cite journal| author=Pappas G, Akritidis N, Bosilkovski M, Tsianos E| title=Brucellosis. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 22 | pages= 2325-36 | pmid=15930423 | doi=10.1056/NEJMra050570 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15930423  }} </ref><ref name="a">Brucellosis. CDC. http://www.cdc.gov/brucellosis/transmission/index.html. Accessed on February 1, 2016</ref><ref name="b">Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on January 29, 2016</ref></ref><ref name="c">Brucelosis. Wikipedia. https://es.wikipedia.org/wiki/Brucelosis. Accessed on February 2, 2016</ref>
**Unfortunately, these have yet to be standardized for routine use, and some centres have reported persistent [[PCR]] positivity after clinically successful treatment, fuelling the controversy about the existence of prolonged [[Chronic (medicine)|chronic]] brucellosis.<ref name="pmid15930423">{{cite journal| author=Pappas G, Akritidis N, Bosilkovski M, Tsianos E| title=Brucellosis. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 22 | pages= 2325-36 | pmid=15930423 | doi=10.1056/NEJMra050570 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15930423  }} </ref><ref name="a">Brucellosis. CDC. http://www.cdc.gov/brucellosis/transmission/index.html. Accessed on February 1, 2016</ref><ref name="b">Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on January 29, 2016</ref><ref name="c">Brucelosis. Wikipedia. https://es.wikipedia.org/wiki/Brucelosis. Accessed on February 2, 2016</ref>
 
 
* Demonstration of the agent: blood cultures in tryptose broth, bone marrow cultures. The growth of brucellae is extremely slow (they can take until 2 months to grow) and the culture poses a risk to laboratory personnel due to high infectivity of brucellae.
* Demonstration of antibodies against the agent either with the classic Huddleson, Wright and/or Bengal Rose reactions, either with ELISA or the 2-mercaptoethanol assay for IgM antibodies associated with chronic disease
 


==Gallery==
==Gallery==

Revision as of 21:37, 4 February 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2] Danitza Lukac

Overview

Brucellosis is diagnosed in a laboratory by finding Brucella organisms in samples of blood or bone marrow. Also, blood tests can be done to detect antibodies against the bacteria. If this method is used, two blood samples should be collected 2 weeks apart [1].

Laboratory Findings

Bacterial Isolation:

Serological tests:

Gallery

References

  1. ↑ http://www.cdc.gov/brucellosis/
  2. ↑ 2.0 2.1 2.2 Pappas G, Akritidis N, Bosilkovski M, Tsianos E (2005). "Brucellosis". N Engl J Med. 352 (22): 2325–36. doi:10.1056/NEJMra050570. PMID 15930423.
  3. ↑ 3.0 3.1 Brucellosis. CDC. http://www.cdc.gov/brucellosis/transmission/index.html. Accessed on February 1, 2016
  4. ↑ Brucellosis. CDC. http://www.cdc.gov/brucellosis/clinicians/bacterial-isolation.html. Accessed on February 4, 2016
  5. ↑ Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on January 29, 2016
  6. ↑ Brucelosis. Wikipedia. https://es.wikipedia.org/wiki/Brucelosis. Accessed on February 2, 2016
  7. ↑ 7.00 7.01 7.02 7.03 7.04 7.05 7.06 7.07 7.08 7.09 7.10 7.11 "Public Health Image Library (PHIL)".

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