Brucellosis laboratory findings: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
Line 7: Line 7:


==Laboratory Findings==
==Laboratory Findings==
{| class="wikitable"
!
! colspan="2" |
|-
| rowspan="5" |Blood
|Complete blood count
|Complete Blood Count
*Mild [[leukopenia]]
*Mild [[anemia]]
*[[Lymphocytosis|Relative lymphocytosis]]
*[[Thrombocytopenia]]
|-
|Liver function test
|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>
|-
|Culture
|
*The isolation and identification of [[Brucella|''Brucella'']] can confirm a diagnosis of brucellosis.
*[[Brucella|''Brucella'']] is most commonly isolated from blood cultures(blood cultures are positive between the 7th and 21st day)
*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" /><ref name="g">Brucellosis. CDC. http://www.cdc.gov/brucellosis/clinicians/bacterial-isolation.html. Accessed on February 4, 2016</ref>
|-
|Serological tests
|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.
|-
|Molecular tests
|'''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" /><ref name="b" /><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>
|-
|Synovial fluid
| colspan="2" |In patients presenting with brucella arthritis, lymphocytic predominate, WBC count does not generally exceed 15,000 cells/microL, which is similar to findings with reactive arthritis
|}
**
**


Revision as of 18:24, 4 January 2017

Brucellosis Microchapters

Home

Patient Information

Overview

Historical Perspective

Pathophysiology

Causes

Differentiating Brucellosis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Principles of diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X-Ray

CT Scan

MRI

Other Diagnostic Studies

Treatment

Medical Therapy

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Brucellosis laboratory findings On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Brucellosis laboratory findings

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Brucellosis laboratory findings

CDC on Brucellosis laboratory findings

Brucellosis laboratory findings in the news

Blogs on Brucellosis laboratory findings

Directions to Hospitals Treating Brucellosis

Risk calculators and risk factors for Brucellosis laboratory findings

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

Blood Complete blood count Complete Blood Count
Liver function test Liver Function Tests
Culture
Serological tests 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 species: abortus, melitensis or suis.
    • There is no serological test available to detect antibodies to 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 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.
    • 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.
  • 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)
  • Dipstick assays
    • New and promising, based on the binding of 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 antibodies, is an increasingly used adjunctive test when resources permit.
Molecular tests 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) and found to have superior specificity and 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.[2][3][5][6]
Synovial fluid In patients presenting with brucella arthritis, lymphocytic predominate, WBC count does not generally exceed 15,000 cells/microL, which is similar to findings with reactive arthritis

Gallery

References

  1. ↑ Brucellosis 2010 Case Definition. CDC. http://wwwn.cdc.gov/nndss/conditions/brucellosis/case-definition/2010/. Accessed on February 2, 2016
  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)".

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Brucellosis_laboratory_findings&oldid=1279292"