Department of Infectious and Tropical Diseases, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Biological Science, California State University, Stanislaus, Turlock, CA, USA.
Microb Pathog. 2019 Apr;129:125-130. doi: 10.1016/j.micpath.2019.02.011. Epub 2019 Feb 10.
According to the WHO factsheet, although approximately half a million brucellosis cases are reported annually, the true incidence is always 10-25 times higher than the reported number of cases. Therefore, we face a common yet uncommonly recognized entity of brucellosis, which highlights the importance of providing precise and understandable guidelines for physician to recognize and manage the disease. Up to now, there is no distinct and clear guideline for brucellosis diagnosis. Hence, this article presents for the first time an algorithm based on our 30 years clinical experiences for brucellosis diagnosis. There are several serological patterns of brucellosis due to the insidious nature and serologic response of this disease. In contrast to most infectious diseases, the IgM response to brucellosis remains after the acute phase, IgG responses often fade after improvement and there is no lifelong positivity for IgG antibody. This diversity of serological pattern leads to seven clinical subtypes of the disease; three of those do not need any medical intervention. In endemic regions, this issue makes a challenging diagnostic puzzle for clinicians, which may consequently lead to national and international over- or underestimation of brucellosis incidence. On one hand, this may change the epidemiological landscape of brucellosis. On the other hand, drugs used in therapy are often accompanied by serious or sometimes irreversible side effects. Accordingly, we attempt to create a unique template to better identify these seven serological patterns and give a comprehensive insight into the diagnostic approach to brucellosis. Moreover, we describe in detail the appropriate use of wright, 2 ME, Coomb's WRIGHT, and ELISA tests.
根据世界卫生组织的情况说明书，尽管每年报告约有 50 万例布鲁氏菌病病例，但实际发病率总是报告病例数的 10-25 倍。因此，我们面临着一种常见但尚未被普遍认识的布鲁氏菌病实体，这凸显了为医生提供准确和易于理解的指南来识别和管理这种疾病的重要性。到目前为止，还没有明确和清晰的布鲁氏菌病诊断指南。因此，本文首次提出了一种基于我们 30 年临床经验的布鲁氏菌病诊断算法。由于这种疾病的隐匿性质和血清学反应，布鲁氏菌病存在几种血清学模式。与大多数传染病不同，布鲁氏菌病的 IgM 反应在急性期后仍然存在，IgG 反应在改善后往往会消退，而且 IgG 抗体不会终生呈阳性。这种血清学模式的多样性导致了该疾病的七种临床亚型；其中三种亚型不需要任何医疗干预。在流行地区，这个问题给临床医生带来了具有挑战性的诊断难题，这可能导致国家和国际上对布鲁氏菌病发病率的过高或过低估计。一方面，这可能改变布鲁氏菌病的流行病学格局。另一方面，治疗中使用的药物通常伴随着严重的、有时是不可逆转的副作用。因此，我们试图创建一个独特的模板，以更好地识别这七种血清学模式，并全面了解布鲁氏菌病的诊断方法。此外，我们详细描述了wright、2 ME、Coomb's WRIGHT 和 ELISA 检测的适当用途。
