RESUMO
Epidemiological and clinical aspects of Brucella suis infection in 17 workers from a pork processing plant in Argentina occurring between January 2014 and July 2015 are presented. All patients reported working 9 h daily without adequate personal protection garment. Blood cultures were positive for Brucella spp. in 14 of the 17 patients (82.3%). All isolates were identified as B. suis biovar 1. Although fever, sweats, asthenia, myalgia and hepatic involvement were the most frequent clinical manifestations, an unusually high incidence of respiratory involvement was found. From 13 patients in which chest radiography was performed, four (30%) had radiological abnormalities, including lobar pneumonia in two cases (one with pleural effusion) and interstitial involvement in other two. The high frequency of respiratory involvement in our series makes necessary to consider brucellosis in the differential diagnosis of respiratory diseases in pork processing plant employees.
Assuntos
Brucella suis , Brucelose/etiologia , Brucelose/patologia , Surtos de Doenças , Carne/microbiologia , Exposição Ocupacional , Infecções Respiratórias/microbiologia , Adulto , Animais , Argentina/epidemiologia , Manipulação de Alimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , SuínosRESUMO
The pathological consequences of exposure to the vaccine strain Brucella abortus S19 were evaluated in 30 employees from vaccine-manufacturing plants. Active brucellosis was diagnosed in 21 subjects, of whom only five recalled an accidental exposure. Clinical manifestations were mild, and only one patient presented a complication. After antimicrobial therapy, initially symptomatic patients either experienced clinical remission or had mild persistent symptoms. This is the first study reporting infection by B. abortus S19 among workers from vaccine-manufacturing plants, which in many cases was acquired from unnoticed exposures. Measures to improve the safety of B. abortus S19 handling should be implemented.
Assuntos
Vacina contra Brucelose , Brucella abortus/imunologia , Brucelose/diagnóstico , Indústria Farmacêutica/métodos , Pessoal de Laboratório Médico , Exposição Ocupacional , Adulto , Anticorpos Antibacterianos/sangue , Argentina/epidemiologia , Brucella abortus/isolamento & purificação , Brucelose/epidemiologia , Brucelose/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Bacteriemia/microbiologia , Brucella suis/isolamento & purificação , Brucelose/diagnóstico , Meningoencefalite/microbiologia , Adulto , Antibacterianos , Anticorpos Antibacterianos/análise , Argentina , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Brucella suis/imunologia , Brucelose/tratamento farmacológico , Quimioterapia Combinada/administração & dosagem , Seguimentos , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Meningoencefalite/diagnóstico , Meningoencefalite/tratamento farmacológico , Resultado do TratamentoRESUMO
Antibodies to cytoplasmic proteins (CP) of Brucella have been shown to be useful for the diagnosis of human brucellosis; however, some early-diagnosed patients lack such an antibody response while having high titers of antibodies to lipopolysaccharide (LPS). To address which factors determine this serological discrepancy in the early stages of brucellosis we examined the antibody response to CP and LPS of 21 patients involved in an outbreak of B. melitensis infection who had a short duration of clinical illness at diagnosis (3-40 d). At diagnosis, antibodies to LPS (IgM and/or IgG) were found in all patients, while anti-CP antibodies were detected in 16 subjects (76%). At 6 weeks post-diagnosis IgG to CP (with or without IgM) had been detected in 13 patients and IgM alone had been found in 4; however, 4 other patients (19%) had no response to CP. No significant differences were found between these 3 groups in terms of age, gender, antimicrobial agents or factors that could hamper the immune response. Notably, however, the 4 non-responders and 3 of the 4 patients having only IgM to CP had started antibiotic therapy within 14 d post-symptoms, while treatment was started later in 9 of 13 patients who developed anti-CP IgG. In addition, maximum titers of IgG to CP tended to be lower in early-treated patients. These results suggest that very early antibiotic therapy hampers the antibody response to Brucella CP but has little impact on the anti-LPS response. Given the higher specificity of the former and the higher sensitivity of the latter, both reactivities should be measured in order to diagnose human brucellosis.
Assuntos
Anticorpos Antibacterianos/sangue , Proteínas de Bactérias/imunologia , Brucella melitensis/imunologia , Brucelose/diagnóstico , Lipopolissacarídeos/imunologia , Argentina/epidemiologia , Brucella melitensis/química , Brucelose/epidemiologia , Brucelose/imunologia , Estudos de Coortes , Citoplasma/química , Surtos de Doenças , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Sensibilidade e EspecificidadeRESUMO
The diagnosis of human neurobrucellosis usually relies on the detection of antibodies to Brucella lipopolysaccharide (LPS) in cerebrospinal fluid (CSF) by agglutination tests or enzyme-linked immunosorbent assay (ELISA). Here we describe the detection of immunoglobulin G (IgG) to cytoplasmic proteins (CP) of Brucella spp. by ELISA and Western blotting in seven CSF samples from five patients with neurobrucellosis. While IgG to CP (titers of 200 to 12, 800) and IgG to LPS (800 to 6,400) were found in the CSF of these patients, these antibodies were not detected in CSF samples from two patients who had systemic brucellosis without neurological involvement. The latter, however, had serum IgG and IgM to both LPS and CP. No reactivity to these antigens was found in CSF samples from 14 and 20 patients suffering from nonbrucellar meningitis and noninfectious diseases, respectively. These findings suggest that, in addition to its usefulness in the serological diagnosis of human systemic brucellosis, the ELISA with CP antigen can be used for the specific diagnosis of human neurobrucellosis.