057实验室获得性布鲁菌病:西班牙全国性调查

布鲁菌病是一种地区性人畜共患病,也是兽医及肉类加工厂工人中最常见的职业性疾病。在一些发达国家,也是微生物实验室最重要的职业获得性感染,因此又称为实验室获得性布鲁菌病（labmatoryacquired Brucellosis,LAB）。     

61例布鲁杆菌病患者流行病学特征、临床表现及疗效分析

<正>布鲁杆菌病(又称布鲁菌病,简称布病)是由布鲁菌感染引起的一种人畜共患疾病,是我国《传染病防治法》规定的乙类传染病。患病的羊、牛等疫畜是布病的主要传染源,布鲁菌可以通过破损的皮肤黏膜、消化道和呼吸道等途径传播。急性期病例以发热、乏力、多汗、肌肉、关节疼痛和肝、脾、淋巴结肿大为主要表现,慢性期病例多表现为关节损害等[1-2],由于该病病情复杂,临床表现多样化,症状不典型[3],因此很难诊断,容易被临床医生忽视     

替加环素与米诺环素治疗布鲁菌病的进展

布鲁菌病是由布鲁菌引起的人畜共患传染性疾病，由带菌动物通过多种途径传染给易感人群，可侵犯人体各器官系统。目前推荐的抗布鲁菌治疗方案为多西环素、利福平、喹诺酮类、氨基糖类等抗菌药物组合的二联或者三联抗菌方案，但治疗无效率和疾病复发率仍较高。替加环素和米诺环素作为四环素类药物，经体外实验证明均可有效抑制布鲁菌，且50%最小抑菌浓度（50% minimal inhibitory concentration，MIC50） 和 90%最小抑菌浓度（90% minimal inhibitory concentration，MIC90）均较低。临床研究亦证实，包含替加环素和米诺环素的联合抗菌方案具有较低的治疗无效率和疾病复发率。因此，替加环素和米诺环素可作为治疗布鲁菌病的候选用药。本文就布鲁菌病传统治疗方案以及替加环素和米诺环素的抗菌效果进行综述。     

032 布鲁菌病和伤寒血清学试验试剂条的评价

伤寒和布鲁菌病常引起血液感染。血及骨髓培养是最准确的诊断方法,在许多发展中国家,这两种疾病的诊断常凭临床表现和经验。血清学试验常被作为一种诊断工具,但肥达反应和布鲁菌试管凝集……     

布鲁菌病临床问答

2010年12月,4只未经检疫的山羊进入了我国某大学实验室。28名师生在实验后患上了布鲁菌病(brucellosis),此事在国内引起较大反响。有较多读者纷纷来信,希望了解该病当前临床进展。布鲁菌病和流行性脑膜炎、肺结核、登革热等传     

布鲁氏菌感染实验室诊断研究进展

布鲁氏菌(Brucella,简称布氏菌)是一种重要的人兽共患病原菌,布鲁氏菌病常发生在牛、羊、猪等家畜中,主要通过接触传播给人类。人类在感染该菌的早期并无特异性症状,其临床表现多样,若不能及时诊断并予以干预,可导致严重关节疼痛和菌血症,甚至引起死亡。布鲁氏菌病一旦广泛发病,不但对畜牧业造成巨大经济损失,还会严重威胁公共安全,因此,布鲁氏菌的快速准确诊断对防治疾病的发展具有重要意义。目前,针对该病原体常见的实验室检测方法包括微生物检测法、免疫学检测法、分子生物学检测法等。本文将就人感染布鲁氏菌的实验室诊断研究进展作以简要综述。     

载体介导的布鲁菌外膜蛋白疫苗研制现状

布鲁菌引起的布鲁菌病是严重危害人畜健康的传染性疾病,采用疫苗防治是当前研究的热点领域之一。外膜蛋白(OMP)是一种有效的疫苗候选分子,本文综述了鼠伤寒沙门菌、卡介苗、根癌农杆菌、大肠杆菌、毕赤酵母、禽流感病毒、山羊痘病毒和牛痘病毒等载体介导的布鲁菌OMP疫苗的研制现状。     

自身免疫性肝炎合并慢性布鲁菌病1例并文献复习

目的探讨自身免疫性肝炎合并布鲁菌感染时的临床特征、诊断及其治疗等特点。方法回顾性分析我院确诊的1例自身免疫性肝炎合并慢性布鲁菌感染患者的临床特点、相关指标的检测结果并结合文献报道进行总结。结果患者临床表现缺乏特异性。血培养和血清抗体检测呈阳性,C-反应蛋白(CRP)可见升高而降钙素原(PCT)变化不明显。结论布鲁菌病不能仅从临床表现来鉴别和诊断,更不能因为缺少流行病学资料而否定。自身免疫性肝炎患者的CRP水平对急性炎症的敏感性会降低,但仍可以作为疗效判断的参考指标。应适度增加疗程,定期复查,以更好的控制慢性布鲁菌感染。     

布鲁菌致病特点和疫苗的研究新进展

布鲁菌能够干扰宿主细胞发挥固有和适应性免疫应答,这是布鲁菌突出的致病特点。布鲁菌通过减少、修饰或隐藏病原相关分子模式,经由脂筏进入巨噬细胞后形成布氏小体,实现胞内生存复制,从而导致机体的持续性感染。深入了解布鲁菌逃避机体免疫应答的机制有助于研制新型有效的疫苗,如DNA疫苗、重组蛋白疫苗等。     

布鲁菌毒力因子研究进展

布鲁菌是一种兼性细胞内寄生菌,能够严重地导致人畜共患布鲁菌病。本文就影响布鲁菌致病能力的毒力因子进行综述。     

Genotyping of Human Brucella melitensis Biovar 3 Isolated from Shanxi Province in China by MLVA16 and HOOF

Background

Brucellosis presents a significant economic burden for China because it causes reproductive failure in host species and chronic health problems in humans. These problems can involve multiple organs. Brucellosis is highly endemic in Shanxi Province China. Molecular typing would be very useful to epidemiological surveillance. The purpose of this study was to assess the diversity of Brucella melitensis strains for epidemiological surveillance. Historical monitoring data suggest that Brucella melitensis biovar 3 is the predominant strain associated with the epidemic of brucellosis in Shanxi Province.

Methods/Principal Findings

Multiple-locus variable-number repeat analysis (MLVA-16) and hypervariable octameric oligonucleotide fingerprinting (HOOF-print) were used to type a human-hosted Brucella melitensis population (81 strains). Sixty-two MLVA genotypes (discriminatory index: 0.99) were detected, and they had a genetic similarity coefficient ranging from 84.9% to 100%. Eighty strains of the population belonged to the eastern Mediterranean group with panel 1 genotypes 42 (79 strains) and 43 (1 strain). A new panel 1 genotype was found in this study. It was named 114 MLVAorsay genotype and it showed similarity to the two isolates from Guangdong in a previous study. Brucella melitensis is distributed throughout Shanxi Province, and like samples from Inner Mongolia, the eastern Mediterranean genotype 42 was the main epidemic strain (97%). The HOOF-printing showed a higher diversity than MLVA-16 with a genetic similarity coefficient ranging from 56.8% to 100%.

Conclusions

According to the MLVA-16 and HOOF-printing results, both methods could be used for the epidemiological surveillance of brucellosis. A new genotype was found in both Shanxi and Guangdong Provinces. In areas with brucellosis, the MLVA-16 scheme is very important for tracing cases back to their origins during outbreak investigations. It may facilitate the expansion and eradication of the disease.     

Brucellosis in India — a review

Brucellosis is an important re-emerging zoonosis with a worldwide distribution. It is still an uncontrolled serious public health problem in many developing countries including India. Brucellosis in India is yet a very common but often neglected disease. Currently, Brucella melitensis accounts for most recorded cases globally with cattle emerging as a important reservoir with the few cases of B. suis. Isolated cases of non-terrestrial brucellosis and continuing transmission from wild animals have raised important epidemiological issues. Routine serological surveillance along with high clinical suspicion and screening of family members of index cases would be essential in delineating the real magnitude of human brucellosis in endemic countries. Increased business and leisure travel to endemic countries have led to diagnostic challenge in non-endemic areas. Laboratory testing is indispensable for diagnosis. Advances in newer rapid, sensitive, and specific testing methodologies and alternate treatment strategies are urgently needed. A safe and effective vaccine in human is not yet available. Prevention is dependent upon increasing public awareness through health education programmes and safe livestock practices. Active co-operation between health and veterinary services should be promoted. This review collates world literature and its impact to the discovery, isolation and diagnosis and epidemiology along with the control measures adapted in the Indian scenario.     

Quantifying Risk Factors for Human Brucellosis in Rural Northern Tanzania

Background

Brucellosis is a zoonosis of veterinary, public health and economic significance in most developing countries. Human brucellosis is a severely debilitating disease that requires prolonged treatment with a combination of antibiotics. The disease can result in permanent and disabling sequel, and results in considerable medical expenses in addition to loss of income due to loss of working hours. A study was conducted in Northern Tanzania to determine the risk factors for transmission of brucellosis to humans in Tanzania.

Methods

This was a matched case-control study. Any patient with a positive result by a competitive ELISA (c-ELISA) test for brucellosis, and presenting to selected hospitals with at least two clinical features suggestive of brucellosis such as headache, recurrent or continuous fever, sweating, joint pain, joint swelling, general body malaise or backache, was defined as a case. For every case in a district, a corresponding control was traced and matched by sex using multistage cluster sampling. Other criteria for inclusion as a control included a negative c-ELISA test result and that the matched individual would present to hospital if falls sick.

Results

Multivariable analysis showed that brucellosis was associated with assisted parturition during abortion in cattle, sheep or goat. It was shown that individuals living in close proximity to other households had a higher risk of brucellosis. People who were of Christian religion were found to have a higher risk of brucellosis compared to other religions. The study concludes that assisting an aborting animal, proximity to neighborhoods, and Christianity were associated with brucellosis infection. There was no association between human brucellosis and Human Immunodeficiency Virus (HIV) serostatus. Protecting humans against contact with fluids and tissues during assisted parturition of livestock may be an important means of reducing the risk of transferring brucellosis from livestock to humans. These can be achieved through health education to the communities where brucellosis is common.     

Active evasion of CTL mediated killing and low quality responding CD8+ T cells contribute to persistence of brucellosis

Brucellosis is a common zoonotic disease that remains endemic in many parts of the world. Dissecting the host immune response during this disease provides insight as to why brucellosis is often difficult to resolve. We used a Brucella epitope specific in vivo killing assay to investigate the ability of CD8+ T cells to kill targets treated with purified pathogenic protein. Importantly, we found the pathogenic protein TcpB to be a novel effector of adaptive immune evasion by inhibiting CD8+ T cell killing of Brucella epitope specific target cells in mice. Further, BALB/c mice show active Brucella melitensis infection beyond one year, many with previously unreported focal infection of the urogenital area. A fraction of CD8+ T cells show a CD8+ Tmem phenotype of LFA-1hi, CD127hi, KLRG-1lo during the course of chronic brucellosis, while the CD8+ T cell pool as a whole had a very weak polyfunctional cytokine response with diminished co-expression of IFN-γ with TNFα and/or IL-2, a hallmark of exhaustion. When investigating the expression of these 3 cytokines individually, we observed significant IFN-γ expression at 90 and 180 days post-infection. TNFα expression did not significantly exceed or fall below background levels at any time. IL-2 expression did not significantly exceeded background, but, interestingly, did fall significantly below that of uninfected mice at 180 days post-infection. Brucella melitensis evades and blunts adaptive immunity during acute infection and our findings provide potential mechanisms for the deficit observed in responding CD8+ T cells during chronic brucellosis.     

Infection by Brucella melitensis or Brucella papionis modifies essential physiological functions of human trophoblasts

Brucellosis is a zoonosis caused by bacteria of the Brucella genus. In ruminants, brucellosis causes abortion, followed by chronic infection and secretion of bacteria in milk. In humans, it usually presents as flu‐like symptoms, with serious complications if untreated. Epidemiological studies have only recently established that brucellosis can also cause pregnancy complications in women, but the pathogenic mechanisms are unknown. Pioneering studies in ruminants showed that Brucella infect trophoblasts and then colonise the placenta where they grow to high density. A recent study showed that the main zoonotic Brucella species can infect human cytotrophoblasts (CTB) and extravillous trophoblasts (EVT). In this work, we show that Brucella papionis (associated with stillbirth in primates) also infects human trophoblasts. However, it replicates actively in CTB, whereas its replication is very restricted within EVT. We also observed alteration of several trophoblastic functions upon infection by B. papionis or Brucella melitensis (the most prevalent species in human brucellosis). Infection altered the production of hormones, the ability of CTB to form syncytiotrophoblasts, and the invasion capacity of EVT. We also found that infection can spread between different types of trophoblasts. These findings constitute a new step in understanding how Brucella infection causes adverse pregnancy outcomes.     

Laboratory diagnosis of animal brucellosis]

Brucellosis is still a topical disease both in humans and in animals. The need for a laboratory diagnosis is very important to confirm the disease. The present article reviews the principal techniques used in the laboratory for the diagnosis of brucellosis.     

Complete Genome Sequence of Brucella melitensis 133, an Isolate of Biovar 1 of Sequence Type 32

Brucellosis is highly epidemic in China. Of the six classical species, Brucella melitensis and biovar 1 are the most represented species and biovar that cause human brucellosis in China. Here, we report the genome sequence of Brucella melitensis strain 133, a strain of biovar 1 of sequence type 32.     

Virulence factors in brucellosis: implications for aetiopathogenesis and treatment

Brucella species are responsible for the global zoonotic disease brucellosis. These intracellular pathogens express a set of factors - including lipopolysaccharides, virulence regulator proteins and phosphatidylcholine - to ensure their full virulence. Some virulence factors are essential for invasion of the host cell, whereas others are crucial to avoid elimination by the host. They allow Brucella spp. to survive and proliferate within its replicative vacuole and enable the bacteria to escape detection by the host immune system. Several strategies have been used to develop animal vaccines against brucellosis, but no adequate vaccine yet exists to cure the disease in humans. This is probably due to the complicated pathophysiology of human Brucella spp. infection, which is different than in animal models. Here we review Brucella spp. virulence factors and how they control bacterial trafficking within the host cell.     

The NtrY/X two-component system of Brucella spp. acts as a redox sensor and regulates the expression of nitrogen respiration enzymes

Brucella spp. are facultative intracellular bacteria pathogenic for many mammalian species including humans, causing a disease called brucellosis. Learning how Brucella adapts to its intracellular niche is crucial for understanding its pathogenesis mechanism, allowing for the development of new and more effective vaccines and treatments against brucellosis. Brucella pathogenesis resides mostly in its ability to adapt to the harsh environmental conditions encountered during host infection such as the oxygen depletion. The mechanism by which Brucella senses the oxygen tension and triggers its environmental adaptation is unknown. In this work we show that the Brucella abortus NtrY/NtrX two-component system is involved in oxygen sensing through a haem group contained in a Per-ARNT-SIM (PAS) domain of the NtrY histidine kinase. The NtrY haem iron can be reduced to the ferrous form and is rapidly oxidized to the ferric form in presence of oxygen. Importantly, we show that the oxidation state of the haem iron modulates the autokinase activity, being the anoxygenic reduced ferrous form the signalling state of NtrY. Also, we show that ntrY gene expression increases under low oxygen tension and that NtrY transfers its signal to its cognate response regulator NtrX, regulating in this way the expression of nitrogen respiration enzymes. Based on these findings, we postulate that NtrY acts as a redox sensor in Brucella spp.