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  Table of Contents    
LETTER TO EDITOR  
Year : 2012  |  Volume : 55  |  Issue : 2  |  Page : 271-272
Seroprevalence of Brucellosis: A 10-year experience at a tertiary care center in north India


1 Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India

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Date of Web Publication3-Jul-2012
 

How to cite this article:
Appannanavar SB, Sharma K, Verma S, Sharma M. Seroprevalence of Brucellosis: A 10-year experience at a tertiary care center in north India. Indian J Pathol Microbiol 2012;55:271-2

How to cite this URL:
Appannanavar SB, Sharma K, Verma S, Sharma M. Seroprevalence of Brucellosis: A 10-year experience at a tertiary care center in north India. Indian J Pathol Microbiol [serial online] 2012 [cited 2020 Jan 27];55:271-2. Available from: http://www.ijpmonline.org/text.asp?2012/55/2/271/97913


Sir,

 Brucellosis More Details is an important but neglected zoonotic disease having a worldwide distribution. The disease contributes significantly to economic losses for animal handlers. Transmission to humans occurs through contact with animals, animal tissue contaminated with the organisms or through ingestion of contaminated products. Worldwide, around five lakh human cases occur every year. [1] The disease is more prevalent in the Mediterranean region, western Asia, parts of Africa and Latin America. A higher incidence of the disease can be expected in India, which has a major agrarian population who come in close contact with domestic animals. It has been estimated that the true incidence may be 25-times higher than the reported incidence due to misdiagnosis and underreporting, largely due to lack of proper laboratory facilities in remote areas as well as poor exchange of information between veterinary and public health services. Very few reports are available on the prevalence of human brucellosis in our region. [2],[3] Here, we report a high seroprevalence of brucellosis (9.94%) in patients presenting with pyrexia of unknown origin (PUO) from a tertiary care center in North India.

A total of 1448 serum samples from cases of pyrexia of unknown origin submitted to our center over a period of 10 years from January 2000 to June 2011 were screened for evidence of brucellosis. All the samples were subjected for standard agglutination test (SAT) to detect  Brucella More Details agglutinins. For SAT, B. abortus strain 99 antigen was obtained from the Indian Veterinary Research Institute, Izzatnagar, Uttar Pradesh, India. All the samples with a titer of ≥80 IU were considered as positive. Majority of the positive samples were further subjected for SAT using reducing substance like 2 mercaptoethanol (2ME). The reducing agent destroys the agglutinating activity of immunoglobulin M (IgM), leaving IgG intact. In the presence of 2ME, the fall in titer suggests an acute infection while no change in titer means a persistent or chronic infection.

Of the 1448 patients of PUO, 144 (9.94%) were found to be positive by SAT with a titer of ≥80. The 2ME agglutination assay showed acute infection in 45% of the cases with significant titer, and the remaining 55% were having chronic infection. Majority of the patients were in the age group of 20-40 years. The male to female ratio was high in the 40-60 years age group and equal in the age group of >60 years. When we assessed the trend of seroprevalence over a decade we noted a fluctuating trend ranging from 4 to 18% [Figure 1].
Figure 1: Seroprevalence of brucellosis in pyrexia of unknown origin patients from a tertiary care center in North India

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In India, the prevalence of human brucellosis was first described almost a century back, but the actual disease burden is not established and the published literature shows variability. The difference can be attributed to the difference in the study population. In our country, the seroprevalence of brucellosis ranges from 0.8 to 26%. [2],[3] A lower seroprevalence range is noted in the general population presenting as pyrexia of unknown origin, while higher prevalence is noted in groups with occupational exposure. In our center, the seroprevalence of brucellosis among patients with PUO studied over 10 years was 9.94%. Previous reports from other centers from India have reported seroprevalence ranging from 0.8 to 6.8% in patients with PUO. [2] The seroprevalence rates are as high as 17-34% in high-risk groups like abattoir workers, veterinarians and animal attendants. In our study, the higher seroprevalence of brucellosis in PUO patients may be due to the high prevalence of animal brucellosis in this region. In India, the prevalence of animal brucellosis is well established and is shown to be high in certain states. A random survey conducted in Punjab (India) using the "Survey Toolbox" sampling software in 2005 showed that the apparent overall prevalence of animal brucellosis was 12%. [4] The close association between human and animals, consumption of unpasteurized milk and dairy products and inappropriate waste disposal and contact with parturient animals may contribute to perpetuating infection in humans.

Recently, brucellosis has been included among the 11 prioritized zoonotic infections in India by the Roadmap to Combat Zoonoses in India (RCZI) initiative. [5] Despite prioritizing, the disease has remained largely undiagnosed due to diverse clinical manifestations, latent infections, low physician awareness and paucity of diagnostic facility. Thus, we emphasize the need for a routine screening of brucellosis in all patients presenting with PUO in our region. The high prevalence noted in our study prompts the need for future control programmes.


   Acknowledgment Top


Authors are thankful to Aman Sharma, Navneet Sharma, Ashish Bhalla, Devinder K. Seedhar of Post Graduate Institute of Medical Education and Research, Chandigarh for their contribution

 
   References Top

1.Pappas G, Papadimitriou P, Akritidis N, Christou L, Tsianos EV. The new global map of human brucellosis. Lancet Infect Dis 2006;6:91-9.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Mantur BG, Biradar MS, Bidri RC, Mulimani MS, Veerappa K, Kariholu P, et al. Protean clinical manifestations and diagnostic challenges of human brucellosis in adults: 16 years' experience in an endemic are. J Med Microbiol 2006;55:897-903.  Back to cited text no. 2
    
3.Nagarathna S, Sharmada S, Veena Kumari HB, Arvind N, Sundar P, Sangeetha S. Seroprevalence of Brucella agglutinins: A pilot study. Indian J Pathol Microbiol 2009;52:457-8.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.Dhand NK, Gumber S, Singh BB, Aradhana, Bal MS, Kumar H, et al. A study on the epidemiology of brucellosis in Punjab (India) using Survey Toolbox. Rev sci tech Off int Epiz 2005;24:879-85.  Back to cited text no. 4
[PUBMED]    
5.Sekar N, Shah NK, Abbas SS, Kakkar M. Roadmap to Combat Zoonoses in India (RCZI) Initiative. Research Options for Controlling Zoonotic Disease in India, 2010-2015. PLoS One 2011;6:e17120.  Back to cited text no. 5
    

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Correspondence Address:
Kusum Sharma
Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.97913

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