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Background: Brucellosis, a zoonotic disease with worldwide spread, is a common disease in Iran and is endemic in Markazi Province. Brucella osteomyelitis, on the other hand, is a rare disease. Here we reported a case of brucella osteomyelitis of the tibia following trauma. Case: The patient was a 22 year old man referring with chronic draining tibia ulcer. He had a history of trauma of the tibia, dating back to 3 years ago, for which local prosthesis had been prescribed. Later on, the prosthesis had been removed due to infection. Staining of the tissue samples indicated the presence of gram-negative coccobacill and brucella growth in the culture of excretions. Conclusion: This case was reported because of rare presentation of brucella and the educational implications of the patient with respect to the possibility of brucella development in chronic ulcers or prosthesis. Although uncommon, brucellosis should be regarded as a potential cause of osteomyelitis in patients with a record of physical contact with animals.

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Background: Brucellosis is an endemic disease in Iran and its treatment is a medical problem. This study was performed to observe the influence of the administration of corticosteroid on symptomatology of subjects with acute, subacute, and chronic brucellosis. Materials and Methods: In this randomized controlled trial, 48 patients with brucellosis were randomly assigned to two groups. The first group (N=30) received the standard regimen plus dexamethasone (4 mg t.d.s for 5 days) and the second group (N=17) received only the standard regimen. The results of corticosteroid administration were evaluated according to such factors as clinical status of the patient, duration of hospital stay, duration of illness, pain score, and use of analgesics. The results were analyzed by Chi-square test, Fisher’s exact test, independent sample t-test, and Mann-Whitney test. Results: No significant differences were seen in the mean of hospital stay, duration of illness, and use of oral and injectable analgesics between the two groups (P<0.05). Also, there was not a significant difference in mean pain score reduction between groups 1 and 2 (P<0.05). Conclusion: Noticing the findings of this study, corticosteroid does not seem to alter the clinical course of brucellosis significantly. Nevertheless, further controlled clinical trials with larger sample sizes are recommended

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Background: Brucellosis is one of the most common bacterial zoonotic infections in the world. The incidence of this infection is quite high and is endemic in several countries. According to WHO report, the prevalence of zoonotic and human brucellosis is on the rise in the Mediterranean region, the Middle East, and west Asian countries. The aim of this study was to investigate the usage of silver nanoparticles in treatment of brucellosis. Materials and Methods: In this experimental study, the activity of silver nanoparticles against Brucella meltensis 16M was determined by agar well diffusion method. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of silver nanoparticles were determined by macrodilution method. Also, the antibacterial effect of silver nanoparticles was studied in mouse model. Results: The results showed that silver nanoparticles in low concentrations can kill Brucella melitensis 16M in laboratory conditions. MIC and MBC of silver nanoparticles were 4 ppm and 6 ppm in macrodilution method, respectively. The anti-brucella effect of silver nanoparticles was also observed in mouse model. Conclusion: This study demonstrated that silver nanoparticles can be used against brucellosis.

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Human Brucellosis is an infectious disease caused by Brucella bacteria. An average of 150 cases of brucellosis among 330 million people is reported in the USA each year. This bacterium is small, gram-negative rods that grow in phagocytes. They primarily cause diseases among different animals and humans become infected when is in contact with animals or their products. Brucella can cause various symptoms in humans which is similar to human influenza. Brucellosis is diagnosed in a laboratory by finding Brucella organisms in samples of blood or bone marrow or to detect antibodies against the bacteria in two blood samples, collected 2 weeks apart. Depending on severity of illness, recovery may take as long as several months. There is no vaccine available for human except live vaccines and that should be consulted to a health care provider. DNA findings for Brucella species in the index patients focused our attention on revealed human cancers. Also, granalomatous inflammation of testes and medulloblastomas has been linked to chronic Brucellosis infection which could be similar to Helicobacter pylori that is associated with gastric tumor formation. More scientific investigation is needed to properly address the connection of Brucella with other human malignancies.

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Background: Prevention, control, or eradication of brucellosis in a country or region needs policy-making, decision-making, and possessing accurate epidemiological data and information. Therefore, this study was done to review the epidemiology and some factors affecting the interval between the onset and diagnosis of brucellosis in Markazi Province, Iran. Materials and Methods: In this cross-sectional study, data on patients diagnosed with brucellosis during 2010-2011 in Markazi Province were studied. Data were analyzed by descriptive statistics as well as chi-square test, Fisher's exact test, t-test, and Kolmogorov-Smirnov test using SPSS software. Results: Out of all cases (907), the interval between the onset of symptoms and diagnosis was more than a month in 363 cases (41.7%). The interval between the onset and diagnosis was significantly associated with location (urban or rural) (P=0.001), city of residence (P=0.001), career (P=0.002), and type of disease (new or failure case) (P=0.008). Conclusion: Since the interval time between the onset and diagnosis of brucellosis among rural residents, ranchers, housewives, and farmers is more, greater attention should be paid to this new class.

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Background: Brucellosis is an endemic infectious disease in Iran. The neurological involvement of the central nervous system in brucellosis patients is about 3 to 5 %. Case: The case was a 25-year old Afghan man with weakness and arthralgia for one year as well as terrible headache, vertigo, vomiting, cough, sputum, and disequilibrium. Brain CT-Scan indicated communicating hydrocephalus in four ventricles. Since hydrocephalus was idiopathic and noticing the prevalence of tuberculosis among Afghan immigrants that can also cause hydrocephalus, ventriculo-peritoneal shunt was inserted for the patient. Pressure in CSF increased and had a turbid appearance. Glucose value of CSF decreased (35 mg/dl), whereas protein value increased (724 mg/dl). Leukocyte count was 10 mm3 with 80% neutrophils and 20% lymphocytes. The presence of brucella species in CSF culture confirmed that subacute meningitis had caused hydrocephalus due to delay in diagnosis and treatment. The patient was treated for brucellosis and discharged after 10 days with oral medications. Conclusion: Noticing this case and other studies, it is recommended that patients with neurological symptoms, such as hydrocephalus, be evaluated for neuro-brucellosis in endemic areas for brucellosis.

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Background: Brucellosis is one of the zoonotic diseases that has always been considered a health problem in Iran. Since this disease is endemic in Arak and Markazi Province, this study was done to investigate its epidemiology during 2001-2010. Materials and Methods: In this epidemiological study, data on patients with brucellosis were obtained from the medical records in Arak Health Center during 2001-2010. The collected data were analyzed by SPSS software version 16. Results: During this period, 3880 new cases were reported. The mean incidence rate of brucellosis was 60 per 100000 people during 2001-2010. The greatest incidence was in 2004 (111.5 per 100000 people), whereas the lowest incidence was in 2006 (40.5 per 100000 people). Overall, 72% of the patients lived in villages, and 60% of them were male. The majority of the patients were in the second decade of their lives (10-19 years old). The majority of the patients had Wright test titer=1:320 and 2ME titer=1:80 in serology titration. Conclusion: Arak is one of the regions with high incidence of brucellosis. In this region, the patients are mostly male, live in villages, and age 10-19.

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Background: Brucellosis is a major zoonotic disease with worldwide distribution. The prevalence of this disease has decreased in developed countries however, in developing countries, it is still prevalent. The aim of study was to determine the effect of a health belief model (HBM) based educational program on the empowerment of rural women in Zarandieh in prevention of brucellosis. Materials and Methods: In a quasi-experimental study with a pre-test/post-test design, 141 rural women were randomly selected and assigned to experimental and control groups. The educational program was implemented for the experimental group. Data were gathered by a researcher-made questionnaire and analyzed by SPSS software version 16. Results: Demographic variables of the two groups were similar before education. In addition, there were no significant differences between the experimental and control groups with regard to mean knowledge, HBM constructs, and performance however, the post-test revealed significant differences in terms of the mean of variables between the two groups (P<0.001). Conclusion: The HBM based educational program is effective in women’s empowerment and also promoting women’s beliefs and performance regarding brucellosis therefore, the findings of this study may be used as a framework in designing zoonotic diseases prevention programs

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Background: Brucellosis, especially if caused by Brucella melitensis, remains one of the most common zoonotic diseases worldwide with more than 500,000 human cases reported annually. In Iran, brucellosis was first recognized in 1932 and control of small ruminant brucellosis began in 1963. The aim of this study is to give an overview of the National Sheep and Goat Brucellosis Control Program in Iran. Materials and Methods: In this cross-sectional study, data were collected from Iran Veterinary Organization over a period of 45 years. The national control program was based on kid and lamb vaccination and testing and slaughtering infected animals. Results: B.melitensis biotype I in sheep, goat, and man was the predominant local infective biotype. This disease was reported in sheep, goat, cattle, horse, camel, and human. In addition, the prevalence of small ruminant brucellosis was estimated around 2.1%. Conclusion: Prevention of brucellosis is dependent upon increasing public awareness of ranchers through health education programs and more active co-operation between health and veterinary medicine organizations as well as animal movement control in the borders.

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Background: Brucellosis is one of the most common zoonotic diseases in the world which imposes a great financial burden on the endemic regions. Diagnosis of the human brucellosis is mainly based on blood culture and serological tests. PCR, however, is recommended for diagnosis at greater specificities and sensitivities. This study aims to compare the diagnosis of human brucellosis by PCR method using l7/l12 and 16srRNA genes and serological tests. Materials and Methods: In a cross-sectional study, a total of 700 blood samples were collected from patients suspected to brucellosis who had referred to the hospitals and laboratories of Ilam, Iran. The samples were selected through Rose Bengal test. Then 50 positive samples diagnosed by Rose Bengal test were assayed by Wright, Coombs Wright, and PCR using l7/l12 and 16srRNA genes and 50 negative samples diagnosed by PCR using these two genes were tested. Results: Of the total 700 samples assayed by Rose Bengal test, 125 were positive and the rest 575 were negative. The 50 positive Rose Bengal samples in PCR were shown to be positive by both genes and 50 negative Rose Bengal samples were shown negative by both samples. 47 samples in Wright test and 49 samples in Coombs test had titration levels above 1:60. Conclusion: PCR method has a higher sensitivity and specificity in diagnosis of human brucellosis in comparison with serological tests. Sensitivity of PCR by l7/l12 gene is similar to16srRNA and can be used for diagnosis of human brucellosis.

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Background: Guillain-Barré syndrome (GBS) has several variant signs and it often presents as an acute monophasic paralyzing illness provoked by a preceding infection. Campylobacter jejuni infection is the most commonly identified cause of GBS while cytomegalovirus, Epstein-Barr virus, and human immunodeficiency virus (HIV) infections have also been associated with GBS. Case: A 55-year-old villager man who was an animal keeper was admitted to Vali-Asr Hospital with symptoms of general weakness, fever, and night sweats. With positive serology of brucellosis (Wright=1:1280, 2ME =1:640), the patient was treated with rifampin, doxycyclin, and tereptomycin (1g/daily). Having received 9 injections of streptomycin, with weakness in the right extremity, the patient was hospitalized. Brain MRI and CT-Scan were reported normal. Within two days, however, the extremity weakness progressed and spread to 4 extremities (2.5 at the proximal and 3.5 in the distal). Generalized areflexia occurred and, three days later, impaired swallowing and facial weakness ensued. Streptomycin was discontinued upon admission. EMG indicated acute and severe demyelinating polyradiculoneuropathy. CSF analysis confirmed Guillain Barre Syndrome while Wright test for CSF was negative. The patient was admitted to the ICU and underwent intubation with progressed paralysis of four limbs, the patient died in 8 days after hospitalization. Conclusion: In endemic areas, brucellosis should be considered in patients with Guillain Barre syndrome.

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Background: Human brucellosis is a significant public health concern in many countries, including Iran. Therefore, the development of new diagnostic techniques, with high sensitivity and minimum risk of laboratory infection are of great importance. PCR is one of the procedures which has these advantages. However, PCR efficiency is largely dependent on DNA extraction methods. In this study, we studied the efficiency of three different extraction methods of brucella DNA in serum samples. Materials and Methods: In this experimental study, microbial suspensions were initially prepared in saline that its turbidity was equivalent to 0.5 McFarland. Human serum samples were spiked with certain concentrations of Brucella melitensis in vitro. DNA was extracted by three methods and tested by a genus-specific PCR method. Results: Our results showed that the cinneagen kit protocol detected brucella DNA in lower serum concentrations compared with the other protocols. Cinnagen kit could detect brucella DNA in ten-fold dilution in comparison with the other two methods. Conclusion: According to the findings of this study, cinnagen kit was the preferred assay method that yields a better sensitivity for isolation of brucella DNA in serum samples.

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Background: Brucellosis is a zoonotic disease in humans and animals that its control is dependent on the prevalence of diseases in animal populations. The purpose of this study was to compare the sensitivity and specificity of common diagnostic tests for brucellosis. Materials and Methods: In an analytical cross-sectional study, 297 serum samples from an infected herd that had a history of abortion were prepared and evaluated through standard tube agglutination, Rose Bengal, 2-Mercaptoethanol, complement fixation, and ELISA tests. In addition, microbial culture was done for positive serum samples, lymph nodes, and infected organs. Results: Based on the total 297 serum samples tested, the sensitivities for standard tube agglutination, Rose Bengal, 2-Mercaptoethanol, complement fixation, and ELISA tests were 89, 81.5, 75.3, 89.7, and 93.2% , whereas specificities were determined to be 97.4, 94, 96, 98, and 99.3%, respectively. Conclusion: The findings of this study show that the standard tube agglutination test, complement fixation test, and ELISA are more sensitive than other tests. Moreover, ELISA test was the most sensitive and specific serological test for diagnosis of brucellosis in the present study

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Background: Brucellosis is a zoonotic disease which is endemic in Iran. Infection with brucella species during pregnancy can have negative impacts on the outcome of pregnancy however, there is no consensus on its leading to abortion or other severe complications. The aim of the present study is to determine the role of brucellosis in pregnancy and to characterize the risk factors, clinical presentations, and immunology of brucellosis based on the existing reports. Materials and Methods: In this review article, we studied papers on Pubmed, Elsevier, Cohrane, SID, Ovid, ISC, and IranMedex through such keywords as brucellosis, abortion, intra-uterine fatal diseases, and preterm labor. Results: Among the original research papers, 51 were found to be related to the title of this study and dealt with the outcome of brucellosis on pregnant women and had discussed the complications of pregnant patients suffering from brucellosis. Conclusion: According to the investigations made in this study, brucellosis in pregnancy can manifest as normal delivery, increased incidence of spontaneous abortion, intra-uterine fatal diseases, and premature delivery. Therefore, in endemic areas, especially those with inhabitants of low socioeconomic class, educating girls and women of childbearing age about brucellosis and its dangers and risk factors and isolating pregnant women may help prevent the disease and its complications in pregnancy. Moreover, further immunological investigation on the role of immunological reactions following brucellosis infection in pregnant women is required.

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Background: Brucellosis is one of the most common zoonotic diseases in Iran. In most cases, the diagnosis of brucellosis is difficult not only because of its clinical similarity to many infectious and noninfectious diseases, but also because diagnostic methods often fail to detect organisms. PCR is a rapid and safe diagnostic method applied to the diagnosis of brucellosis. The purpose of this study was to determine the sensitivity and specificity of PCR for diagnosis of human brucellosis by using serum samples. Materials and Methods: This study which was done to evaluate diagnostic tests included30 serum samples from patients with clinical presentation of brucellosis with positive Wright test and serum samples of30 healthy people with negative Wright test. These samples were examined by PCR. Results: PCR results were positive for 15 samples of the patients group in comparison with 4 samples from the 30 healthy subjects. The sensitivity and specificity of PCR were 50% and 86.6%, respectively. Conclusion: Although in some studies, the preferred sample for diagnosis of brucellosis was serum, in this study, PCR on serum samples did not indicate high sensitivity and specificity in diagnosis of brucellosis. Hence, using a combination of methods for diagnosis of human brucellosisis suggested.

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Background: Cerebral venous sinus thrombosis is a rare form of brain stroke caused by thrombosis in venous sinuses of Dura. This study reports on a patient with venous sinus thrombosis and brucellosis who presented with uncontrolled seizure. Case: A 33-year-old woman with past history of controlled complex partial seizure who presented with headache, asthenia, and uncontrolled seizure for one month is described in this study. She was febrile and in brain CT scan hemorrhagic focus in left posterioparietal and temporal lobe was reported. MRI and MRV proved venous sinus thrombosis in left transverse sinus. In laboratory assessment, brucellosis was confirmed as well. The patient treated with anticoagulant, anti-brucellosis, and antiepileptic agents and discharged in good condition with medication orders. Conclusion: Clinical suspicion and accurate evaluation is the most important clue in the diagnosis and treatment of brucellosis and venous sinus thrombosis, especially in uncontrolled seizure in patients who had previously been under control.

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Background: Brucellosis is a debilitative disease that imposes heavy costs on the economy and society. Therefore, using the most accurate and efficient method to diagnose this disease is essential. In Iran, Brucella melitensis is the common causative agent for brucellosis and BP26 protein of this bacterium has a good level of antigenicity. Thus, the aim of this study is to produce Brucella melitensis recombinant BP26 protein with a PET28a expression vector.

Materials and Methods: In this applied-fundamental study, genomic DNA was isolated from bacterial culture through proteinase K (pK) and phenol/chlorophorm protocol. Then, two pairs of primers were designed based on the known sequence in the gene bank for amplification of Brucella melitensis bp26 gene and PCR reaction was set up and optimized. The PCR product was cloned first into PTZ57R/T vector and accessed on the PET28a vector and sequenced. The recombinant vector was transformed and expressed into E. coli BL21 (DE3). Then, the recombinant protein was purified with Ni-NTA column of chromatography against His tag.

Results: The size of PCR product was in accordance with the part of bp26 gene size in the gene bank. The bp26 gene without adding IPTG had little expression and 3 hours after adding IPTG with a 1 Mm concentration to culture media, extreme expression was observed.

Conclusion: The production of recombinant BP26 protein from isolated Brucella melitensis native to Markazi province was done. Noticing the importance of BP26 protein and its significance for future studies on providing brucellosis diagnosis kits, its production was made possible.

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Background: Treatment failure and relapse is a major problem in the treatment and control of brucellosis. The present study directed to determine risk factors for failure of treatment and relapse in patients treated for brucellosis.

Materials and Methods: This study was a descriptive - analytic and prospective study and were conducted in 72 patients with acute brucellosis.Patients were followed up during treatment and for six months after completion of therapy, and patients with treatment failure or relapse were analyzed. All data analyzed using SPSS software and P-value of less than 0.05 was considered significant.

Results: The mean value of age in patients was 40.2 ± 16.5 years. Treatment failures was 6.9% and the relapse at the end of the ninth month was 12.5% that recurrence of symptoms were associated with increased titers of serological tests and 80.6 percent had successful treatment. In this study gender of male (P = 0.026), occupational exposure (P = 0.005), delayed treatment in less than two weeks (P = 0.016), hepatosplenomegaly (P = 0.003), thrombocytopenia (P = 0.023), CRP &ge +2 (P = 0.017) and Wright &ge 1/320 and 2-ME &ge 1.160 at the end of the sixth week of treatment (P = 0.004 and P = 0.010) were risk factors of treatment failure and relapse in brucellosis.

Conclusion: The diagnosis and treatment of relapse and treatment failure in acute brucellosis is not clear, therefore, the prediction of relapse may be useful in preventing recurrence and treatment of patients.

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Background: Brucellosis is a major cause of zoonosis disease and is endemic in hamadan Province in Iran. The purpose of this study was to isolate Brucella species from brucellosis patients and identify different species of this bacterium in order to determine the prevalence of the species.

Materials and Methods: This study was descriptive- cross sectional and fifty blood samples were obtained from brucellosis patients with clinical symptoms. The samples were cultured in BACTEC system and incubated for 14 days. Then, the samples were cultured on Brucella agar and biochemical tests were done for identification of bacteria. Finally, Polymerase Chain Reaction (PCR) applied for confirmation and isolated identification with specific primers.

Results: Seven Brucella strains were isolated from 50 blood samples of the patients with brucellosis by blood culture and PCR. The PCR results on blood specimens showed 4 positive in spite of the negative results of blood culture. PCR and biochemical methods revealed that all the 11 isolated bacteria were Brucella Melitensis.

Conclusion: This study was designed to evaluate PCR technique as a diagnostic tool for brucella spp in comparison to conventional techniques. This study showed a high prevalence of brucellosis due to Brucella Melitensis in Hamadan Province and efforts in this region should be aimed at the eradication of this bacterium.

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Background: Brucellosis is a highly contagious zoonotic disease between humans and animals known for high frequency of relapsing and ability to cause chronic infection. The function of immune system plays an important role in induction of chronic diseases. However, the role of immune system response is not completely studied. Therefore, this study designed to investigate the cytokine profile of the patients suffering from chronic and acute brucellosis.

 Materials and Methods: This descriptive- analytical study was performed on 22 patients with acute brucellosis (mean age 38±17), 21 patients with chronic brucellosis (mean age 43±10) and 21 healthy people (mean age 26±4) with the same age and sex as patients. The serum IFN-&gamma, IL-17, IL-5 and TGF- &beta levels were measured using ELISA method.

 Results: The mean IFN-&gamma serum level in acute and chronic brucellosis patients group was significantly higher than control group (p=0.045). The mean IL-17 serum level in acute brucellosis patients was significant decreased once compared with control group and in chronic patients was significantly decreased when compared with control group (p=0.024). In addition, the mean IL-5 and TGF-&beta serum levels of acute brucellosis patients group were significantly decreased as compared to chronic patients (p=0.001).

 Conclusion: The results of current study indicate that cytokine profile of chronic brucellosis patients is more related to Th2 immune response. Hence, Th2 immune response inhibition would be an appropriate way to treat and prevent disease to become chronic.