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==Laboratory Findings==
==Laboratory Findings==
Laboratory findings of brucellosis include the following:
{| class="wikitable"
{| class="wikitable"
!
! colspan="3" |
! colspan="2" |
|-
|-
| rowspan="5" |Blood  
| rowspan="7" |Blood  
|Complete blood count
|Complete blood count  
|Complete Blood Count
|Complete Blood Count may reveal:
*Mild [[leukopenia]]
*Mild [[leukopenia]]
*Mild [[anemia]]  
*Mild [[anemia]]  
*[[Lymphocytosis|Relative lymphocytosis]]
*[[Lymphocytosis|Relative lymphocytosis]]
*[[Thrombocytopenia]]
*[[Thrombocytopenia]]
|-
|ESR
|Normal or raised
|-
|CRP
|Normal or raised
|-
|-
|Liver function test  
|Liver function test  
|Liver Function Tests
|Liver function test may reveal:
*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>
*Mild increase in hepatic enzymes  
*Mild increase in bilirubin
|-
|-
|Culture  
|Culture  
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**Wounds
**Wounds
**[[Purulent]] [[discharge]]
**[[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>
**[[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
|Serological tests
Line 70: Line 77:
*PCR is a fast and specific diagnostic tool to confirm the diagnosis of brucellosis  
*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.  
*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>
*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">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>
|-
| colspan="2" |Tissue Biopsy
|liver and lymph node biopsy may reveal non-caseating granulomas
|-
| colspan="2" |CSF analysis
|CSF analysis may reveal:
* Lymphcytosis
* Low glucose levels
|-
|-
|Synovial fluid  
|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
| colspan="2" |Synovial fluid analysis may reveal:
* Lymphocytic predominate with granulocyte count which  does not generally exceed 15,000 cells/microL
* Low glucose levels


|}
|}
**


==Gallery==
==Gallery==

Revision as of 19:12, 6 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

Laboratory findings of brucellosis include the following:

Blood Complete blood count Complete Blood Count may reveal:
ESR Normal or raised
CRP Normal or raised
Liver function test Liver function test may reveal:
  • Mild increase in hepatic enzymes
  • Mild increase in bilirubin
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][4][5][6]
Tissue Biopsy liver and lymph node biopsy may reveal non-caseating granulomas
CSF analysis CSF analysis may reveal:
  • Lymphcytosis
  • Low glucose levels
Synovial fluid Synovial fluid analysis may reveal:
  • Lymphocytic predominate with granulocyte count which does not generally exceed 15,000 cells/microL
  • Low glucose levels

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 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. ↑ Brucellosis. CDC. http://www.cdc.gov/brucellosis/clinicians/bacterial-isolation.html. Accessed on February 4, 2016
  4. ↑ Brucellosis. CDC. http://www.cdc.gov/brucellosis/transmission/index.html. Accessed on February 1, 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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