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==Laboratory Findings==
==Laboratory Findings==
====Complete Blood Count====
**
*Mild [[leukopenia]]
*Mild [[anemia]]
*[[Lymphocytosis|Relative lymphocytosis]]
*[[Thrombocytopenia]]
 
====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="b">Brucellosis. CDC. http://www.cdc.gov/brucellosis/transmission/index.html. Accessed on February 1, 2016</ref>
 
====Bacterial Isolation====
*The isolation and identification of [[Brucella|''Brucella'']] can confirm a diagnosis of brucellosis.
*[[Brucella|''Brucella'']] is most commonly isolated from blood cultures.
*It can also, however, be isolated from:
**[[Bone marrow]] ([[gold standard (test)|Gold standard test]])
**[[Cerebrospinal fluid]]
**Wounds
**[[Purulent]] [[discharge]]
**[[Synovial fluid|Joint fluid]]<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="g">Brucellosis. CDC. http://www.cdc.gov/brucellosis/clinicians/bacterial-isolation.html. Accessed on February 4, 2016</ref>
 
====Serological Tests====
*'''There are two types of serological tests, based on:'''
**Antibody production against lipopolysaccharide
**Antibody production against other bacterial antigens
*'''For a diagnosis to be made using serology, two serum samples are required:'''
**The first serum sample should be taken when a person is acutely ill (≤7 days after symptom onset)
**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).
**If submission of paired sera is not possible, a probable diagnosis can be made with a single serum sample.
*'''Brucella microagglutination test (BMAT)'''
**A modified version of the serum (tube) agglutination test (SAT), that can detect antibodies to [[Brucella|''Brucella'']] species: [[Brucella abortus|abortus]], [[Brucella melitensis|melitensis]] or suis.
**There is no serological test available to detect antibodies to [[Brucella canis|''B. canis'']].
**An '''''agglutination''''' '''''titre greater than 1:160''''' is considered '''significant in nonendemic areas'''.
**An '''''agglutination''''' '''''titre greater than 1:320''''' is considered '''significant in endemic areas'''.
**Due to the similarity of the O polysaccharide of [[Brucella|''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.
**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|''Brucella canis'']] exposure.
*'''Rose Bengal'''
**Rose bengal has a positive predictive value is approximately 99% for patients with acute and chronic brucellosis.
**Rose bengal measures [[IgM]] and [[IgG]] antibodies.
*'''2-mercaptoethanol (2-ME)'''
**2-ME measures [[IgG]] antibodies
*'''Antihuman globulin (Coombs)'''
**Used in chronic brucellosis patients with negative seroagglutination because they have [[IgG]] non-agglutinating antibodies.
*'''Indirect enzyme linked immunosorbent assay (ELISA)'''
**[[ELISA test|ELISA]] typically uses cytoplasmic proteins as antigens.
**[[ELISA test|ELISA]] measures [[IgM]], [[IgG]], and [[IgA]] with better [[Sensitivity (tests)|sensitivity]] and [[Specificity (tests)|specificity]] than the SAT in most recent comparative studies.
*'''Dipstick assays'''
**New and promising, based on the binding of [[Brucella|''Brucella'']] [[IgM]] antibodies, and found to be simple, accurate, and rapid.
*'''Brucellacapt test'''
**A single-step immunocapture assay for the detection of total anti-[[Brucella|''Brucella'']] antibodies, is an increasingly used adjunctive test when resources permit.
*'''PCR'''
**PCR is a fast and specific diagnostic tool to confirm the diagnosis of brucellosis
**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 (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="b">Brucellosis. CDC. http://www.cdc.gov/brucellosis/transmission/index.html. Accessed on February 1, 2016</ref><ref name="a">Brucellosis. Wikipedia. https://en.wikipedia.org/wiki/Brucellosis. Accessed on January 29, 2016</ref><ref name="aa">Brucelosis. Wikipedia. https://es.wikipedia.org/wiki/Brucelosis. Accessed on February 2, 2016</ref>


==Gallery==
==Gallery==

Revision as of 18:16, 4 January 2017

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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

The diagnosis of brucellosis can be confirmed by either a positive bacterial culture or a positive titer of anti-Brucella antibodies on serological testing.[1]

Laboratory Findings

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References

  1. ↑ Brucellosis 2010 Case Definition. CDC. http://wwwn.cdc.gov/nndss/conditions/brucellosis/case-definition/2010/. Accessed on February 2, 2016
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 "Public Health Image Library (PHIL)".

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